1. Tinnitus ALI KALAN Consultant ENT Surgeon
Hillingdon, Mount Vernon, Central Middlesex & Northwick Park Hospitals
North West London Hospitals NHS Trusts

2. Tinnitus
Tinnitus is defined as the “perception of a sound” that is generated involuntarily within the head of an individual

3. Tinnitus Prevalence in the adult population of around 10%.
severe in 1 % -- affecting daily life routine
78 % of adult population will experience tinnitus at least once during their lifetime

4. Tinnitus -- Types
Subjective
Objective

5. Tinnitus - causes
The majority of patients with tinnitus do not have any identifiable underlying pathology except for age-related sensorineural hearing loss

6. Conductive hearing loss Clinical examination and audiology
Condition Diagnosis
Conductive hearing loss Clinical examination and audiology
Ossicular erosion
Ossicular fixation
Otosclerosis
Middle ear effusion/patulous ET
Neoplastic
Vestibular schwannoma MRI with DTPA-Gadolinium
Glomus jugulare Clinical examination and imaging
Ototoxic drugs
Salicylates History
Aminoglycasides
Loop diuretics
Meniere’s disease History, audiology, electrocochleography
Vascular
Carotid artery stenosis Clinical examination and duplex ultrasound scan
Venous sinus stenosis Angiography
IAM vascular loop MRI+ ⁄ - angiography
Myoclonus
Stapedius History, clinical examination, tympanometry
Tensor tympani
Palatal
Other : Benign intracranial hypertension History, clinical examination, MRI, lumbar puncture

7. History --- what to cover ?
Character :unilateral/bilateral
persistent/intermittent
type : clicking,pulsatile,whirring etc
Intensity/severity – “Klockhoff & Lindblom Grading “
Hyperacusis – 40% (recruitment)
Impact on quality of life : sleep(35%),depression,suicidal
Associated otological symptoms
Medications :salicylates,loop diuretics etc

8. Examination Otoscopy Auscultation : neck Fundi : pappiloedema (BIH)
oropharyngeal

9. Investigations Pure tone audiogram Impedance audiometry MRI brain
Duplex ultrasound – carotid bruit
Lumber puncture

10. Management Treat the organic pathology, when known, on its own merits
Counselling : mainstay
Hearing aid : when hearing loss accompanied
Tinnitus maskers (adaptation)
Medication : no role
Surgery : rarely considered
Cognitive behavioural therapy : for selected refractory tinnitus
Habituation therapy (tinnitus retraining): for refractory cases
Complementary therapies : no evidence
Self help groups : British Tinnitus association etc.