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