Tinnitus

Samar Mahmood (aka SummerM/Sam/Aston)ST1

Definition

Ringing or buzzing heard in the ears or head

Can be occasional or severe

Can be unilateral or bilateral

May lead to depression

Causes Unknown Associated with hearing loss Noise exposure Head injury Menieres Anaemia Hypertension Drugs (loop diuretics, tricyclics, aspirin, NSAIDS) Acoustic neuroma Vascular malformations TMJ problems

History

Onset Character Localisation Otological history Occupational history

Examination

Examine ears – wax, foreign body, perforation, infection

Cranial nerves (particularly V and VII) Auscultation – neck, periauricular area,

mastoid, orbits Audiometry

Management

REASSURANCE Treat depression, if present (may be cause or result) Treat infection, if present Refer audiology if associated hearing loss Low dose tricyclics Mask with background noise/music Tinnitus masker (‘white noise’ aid)s Psychological support Sectioning of cochlear nerve deafness

When to refer to ENT

If unilateral, particularly if deafness also present (?acoustic neuroma)

If can be heard by the examiner (?vascular tumours)

Associated with non-ENT problems, e.g. MS, endocrine, cardiovascular