TINNITUS

DR SRAVYA M V
THIRD YEAR
MS SALAKYATANTRA
GAVC TRIPUNITHURA
• Ringing sound / noise in the ear

• Characteristic feature - origin of sound is within the patient

• Usually - unilateral , also affect both ears

• May vary in pitch & loudness

• Roaring, hissing, swishing, rustling / clicking type of noise

• More annoying in quiet surroundings, particularly at night, when the masking

effect of ambient noise from the environment is lost
2 types
1. Subjective - only be heard by the patient

2. Objective - even be heard by the examiner with the use of a stethoscope

CAUSES
Subjective tinnitus

• Origin in the external ear, middle ear, inner ear, VIIIth nerve / CNS

• Systemic disorders - anemia, arteriosclerosis, hypertension & certain drugs

may act through the inner ear / central auditory pathways

• In the presence of conductive hearing loss, the patient may hear abnormal
noises in the head during eating, speaking / even respiration
• Subjective tinnitus

• Otologic • Neurologic
• Impacted wax • Head injury (labyrinthine
• Fluid in middle ear
concussion)
• Acute otitis media
• Temporal bone fractures
• Chronic otitis media
• Whiplash injury
• Ménière’s disease
• Multiple sclerosis
• Presbycusis
• Postmeningitic
• Noise-induced hearing loss
• Brain haemorrhage
• Idiopathic sudden SNHL
• Brain infarct
• Acoustic neuroma
• Metabolic

• Hypothyroidism

• Hyperthyroidism

• Obesity

• Hyperlipidaemia

• Vitamin deficiency

• Pharmacologic • Psychogenic

• Certain drugs used by the patient • Anxiety

• All ototoxic drugs • Depression
• Objective tinnitus

• Less frequent

• Vascular lesions - glomus tumour / carotid artery aneurysm cause

swishing tinnitus synchronous with pulse

• It can be temporarily abolished by pressure on the common carotid artery

• Venous hum can sometimes be stopped by pressure on the neck veins

• Tinnitus synchronous with respiration may occur due to abnormally patent
eustachian tube

• Palatal myoclonus produces clicking sound due to clonic contraction of the

muscles of soft palate – easy to diagnose

• Clonic contraction of muscles of middle ear (stapedius & tensor tympani) -

difficult to diagnose
• Sometimes, tinnitus is psychogenic & no cause can be found in the ear / CNS

• Tinnitus should be differentiated from auditory hallucinations in which a

person hears voices / other organized sounds like that of music

• It is seen in psychiatric disorders

• Vascular
• AV shunts
• Congenital AV malformations

• Glomus tumour of middle ear

• Arterial bruit
• Carotid aneurysm

• Carotid stenosis

• Vascular loop pressing on VIIIth nerve in internal auditory canal

• High-riding carotid artery

• Persistent stapedial artery

• Venous hum
• Dehiscent jugular bulb
• Patulous eustachian tube

• Palatal myoclonus

• Idiopathic stapedial or tensor tympani myoclonus

• Dental

• Clicking of TM joint
TREATMENT

• Tinnitus is a symptom & not a disease

• Cause should be discovered & treated

• Sometimes, even the treatment of cause may not alleviate tinnitus

• When no cause is found, management of tinnitus includes
1. Reassurance & psychotherapy

2. Techniques of relaxation & biofeedback

3. Sedation & tranquillizers

4. Masking of tinnitus - Use of a fan, Use of a hearing aid ,Tinnitus maskers

TINNITUS INSTRUMENT

• Combination of a hearing aid and a masker in one device

TINNITUS RETRAINING THERAPY (TRT)

1. Habituation of reaction

• It is uncoupling of brain & body from negative reactions to tinnitus

2. Habituation of tinnitus

• It is blocking the tinnitus-related neuronal activity to reach level of

consciousness

• With this therapy patients suffering from tinnitus lose awareness of tinnitus
& also do not get annoyed even when they do have tinnitus
• Counselling
• Sleep disturbance

• Inability to concentrate

• Annoyance

• Anxiety

• Depression
• Sound therapy

• Patient is exposed to environmental sounds, music radio, television

• In general, he should avoid silent environment

THANK YOU