Tinnitus

Question 1

What is it?

Answer 1

Perception of sound typically with the absence of auditory stimulation

Question 2

Characteristics of tinnitus

What are the sounds heard with an inner ear/central cause?

What sounds are heard with an external/middle ear cause?

Answer 2

Uni/bilateral
Pulsatile - usually objective/increased awareness of blood flow in the ear
Non-pulsatile

Ringing
Hissing
Buzzing

Popping
Clicking

Question 3

Tinnitus can be classified into subjective and objective.

Define both and give some causes

Answer 3

Objective - audible to examiner

Vascular disorders - Carotid pathology
High output cardiac states - hyperthyroidism, anaemia

Subjective - only audible to patient

Usually associated with disorders causing sensorineural hearing loss 
Conductive hearing loss 
Ototoxic drugs 
Otitis media +/- effusion
ACOUSTIC NEUROMA

Question 4

Tests - 2

What needs to be excluded and how is it excluded?

Answer 4

Audiometry
Tympanogram

Acoustic neuroma - MRI

Question 5

Management

Answer 5

Treat underlying cause
Usually improves with time

Hearing aids
Psychological support
Cognitive behavioural therapy (CBT)