Tinnitus

What is Tinnitus?

Tinnitus (means ringing in Latin) is sound sensation in the ear or head. Tinnitus is not a disease rather an annoying symptom of myriad of conditions, caused by minor changes in the sensitive hearing system (Cochlea and auditory nerve).

In most cases tinnitus is not harmful but patient should be investigated properly to find any treatable condition.
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Assessment of Tinnitus

Most important is History and Identification of hearing loss and Clinical Examination of ear by otoscope/operating microscope with detail head and neck examination by specialist.
Investigations:
  • PT Audiometry
  • Brain-stem Evoked Response Audiometry
  • CT scan (especially if tinnitus is asymmetrical, 10% of cases it may be a tumor (Acoustic Neuroma).
  • Blood Investigations to test Anaemia- CBC, Hypothyroidism- TSH, Diabetes-sugar, Syphilis- FTABS and lipid profile.
  • Tinnitus pitch matching and masking.

What causes Tinnitus?

I. Causes of tinnitus Related to ear (otologic):**

Cause may be in the external, middle or inner ear

Subjective causes:

  • Impacted wax

  • Fluid in the middle ear

  • Acute and chronic otitis media

  • Otosclerosis

  • Menieres disease

  • Presbiacusis

  • Noise-trauma

  • Ototoxic drugs (such as ACE inhibitors, Antibiotics-ciprofloxacin, erythromycin, streptomycin, and vancomycin, Anti depressant-alprazolam, Anti-malarials-chloroquine and quinine, B-blockers, Diuretics-acetazolamide and amiloride, NSAIDs and Aspirin)

Objective causes are less frequent:

  • Aneurism of carotid artery (it is synchronous with pulse)

  • Vascular tumor of middle ear

  • Palatal myoclonus

  • Tinnitus synchronous with respiration may occur with abnormally patent Eustachian tube (mostly seen after weight loss).

II. Causes of tinnitus not related to ear:
Tinnitus Retraining Therapy

Treatment

Counseling
Effective counseling is most critical aspect of tinnitus management. Tinnitus sufferers are anxious and frightened by the presence of tinnitus and need a careful and clear explanation of the nature of the disorder
Cognitive Behavioral Therapy (CBT)
Biofeedback
Music and Tinnitus
Yoga for Tinnitus Treatment
Transcranial Magnetic Stimulation for Tinnitus:
Hearing aids for Tinnitus
Ultra-High-Frequency Vibration Therapy
Alternate Therapies for Tiniitus

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