Tinnitus

Definition: perception of sound in the head or the ears.

Usually ringing, buzzing, might be various noise.

*Cause:*

Presbycusis

SNHL

Noise trauma

Ototoxicity

Auditory nerve anbnormality

Mechanical problem

*Red Flag:*

Sudden onset tinnitus with / without hearing loss. Early referral to prevent hearing loss.

*Type*

Subjective tinnitus vs objective tinnitus

Subjective is common. Only the patient can hear

Objective : if we listen closely, sometimes we also can hear it.

Objective usually cause by:

⁃ Muscle problem e.g: Tensor tympani myoclonus, Palatine myoclonus

⁃ Joint problem (TMJ)

⁃ Vascular: carotid, jugular.

*Cause & Prevention*

⁃ Prevent prolong noise trauma. Rule of earphone/headphone use: 60% volume for only 60 minute (60/60 rule)

⁃ Cautious with Ototoxicity drug: Gentamycin,TB drug, Aminoglycoside

⁃ CMC ear drop, TM ruptured? Don’t prescribed CMC drop. Counsel the side effect. Stop if any after first.

*Complication*

Anxiety

Depression

Sleep problem

Hyoeracusis

Hypochondria

Cognitive impairment

Suicidal

*Management*

Tinnitus have treatment depend on aetiology.

25% resolve, 50% decrease, 25% persist.

Objective of treatment is to treat the tinnitus and address the emotional part.

Refer ENT & audiologist

Treatment involve:

• surgery, depend on aetiology

• Medication: epileptic drug for myoclonus

• Sound theraphy, hearing aids etc

• Oto-psychiatric theraphy

• electrical stimulation

• Biofeedback process

• Acoustic neuromodulation

• Repetitive transcranial magnetic stimulation

• Alternative (efficacy is depent on individual)

• ginko biloba

• Acupuncture

• Aromatheraphy

• Mediterranean diet

• Zinc supplement

• Vit B

*Paediatric*

Abnormal behaviour child might have tinnitus too causing the abnormal behaviour mimicking ADHD or Autism. Thorough assessment is needed to prevent misdiagnosed and left the tinnitus untreated.

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