1 / 8

Tinnitus CKS | A4 Medicine

From Latin tinnire ( to ring or tinkle )- a sensation of any sound perceived in the head or in the ears without u2028an evident external stimulus.<br>

a4medicineuk
Download Presentation

Tinnitus CKS | A4 Medicine

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. TINNITUS CKS a4medicine.co.uk

  2. FromLatintinnire ( toringortinkle )- asensationofanysoundperceived intheheadorintheearswithoutanevidentexternalstimulus. Atanypointintimearound10 % ofthepopulationexperiencestinnitus ( BTA ) Thereisnostandarddiagnosticcriterionfortinnitusandisnormally determinedbyself -reporttypicallyinreponsetoasinglequestion Tinnitushasareportedprevalenceofabout8-25.3 % intheUSAsystemic review ( AbbyMcCormacketal2016 ) reportedarangefrom5.1to42.7 % NogenderdiscriminationinincidenceHigherincidenceamong- militarypersonnel, stageworkers , drummersandthosewhoperformin frontofloudspeakers Subjectivetinnituscks –Occursinabsenceofanyphysicalsoundreaching theear – audibleonlytothepatient. Causes- waxinexternalear . Middleearcauses – otosclerosis , middleeareffusion

  3. Innerearcauses –Noise-inducedhearinglossPresbyacusisMeniere’sdis Trauma ( surgery , headinjury ) OtotoxicdrugsLabyrinthitisAcoustic neuroma Two-thirdsofpeoplewithtinnitushaveadisordercausinghearing impairmentMostcommonlytinnitusisassociatedwithdisorderscausing sensorineuralhearingloss- includes
○agerelated
○noiserelated ( lesscommon )
○Meniere’sdis ( uncommon ) Lesscommonlytinnitusis associatedwithdisorderscausingconductivehearingloss
○wax
○ otosclerosis ( rare ) Ototoxicdrugs ( uncommonly ) Earinfections – including
○otitismedia
○otitismediawitheffusion
○chronic suppurativeotitismediaNeurologicaldisorders
○acousticneuroma
○ multiplesclerosisMetabolicdisorder – thyroiddiseaseanddiabetes Psychological→anxietyanddepressionTraumaoftheheadorneck


  4. ObjectiveTinnitus –Generatedinthebodyandreachestheearthrough conductioninbodytissuesandisaudibletothepatientaswellasthe clinician ( alsocalledsomatosounds ).Highcardiacoutput
○treatment ofhypertensionwithACEi’sorCCB’sBenignintracranialhypertension DuralorextracranialAVfistulaCarotidorvertebralarterystenosis , tortuosity , dissectionoraneurysmAorticdissectionandmitral regurgitationDuralorcervcalAVM ( arteriovenousmalformation ) High jugularbulbVestibularschwannomaTemporomandibularjointsyndrome HaemangiomaGlomustumourOtosclerosisPaget’sdisease. Hasa vibratory , clickingorpulsatilecharacterAudiblewithastethoscope
○ placethestethoscopeclosetoexternalauditorymeatusoverthecarotid arteries , andontheskullinfrontandbehindthear. Ifpatientc/o pulsatiletinnitus – clinicianshouldconductextensivesearchforaskull basetumourNumerousvascularcausesofpulsatiletinnitus
mostcommon being○arteriovenousmalformations ( AVM ) and○fistulasBenign intracranialhypertensionhasbeenreportedasamajorcauseofpulsatile tinnitusintoungwomen
 


  5. History–Noknownobjectiveteststhatcandeterminetheseverityof subjectivetinnitusunilateralorbilateralconstantorintermittenttriggers aroundonsetwhendiditstartbecomeannoyingassociatedsymptoms
○ deafness
○dizziness
○hyperacusis
○otalgiah/osignoiseexposure drughistory ( ototoxicdruguse ) familyh/ohearinglossfromotosclerosis Otosclersosis→bonearoundthebaseofstapesbecomesthickenedand eventuallyfuseswiththeboneofcochlea→reducesnormalsound transmissionleadingtoconductivehearinglosseffectonlifepsychological Examination –Otoscopy
○wax
○infectionsTuningforktests ( conductive orsensoryhearingloss ) BedsidehearingtestGeneralneurological assessment
○acoustincneuroma
○multiplesclerosisCheckblood pressureBloodtests
○hypoandhyperthyroidism
○FBC
○randomor fastingBMAuscultateears , headandneckifpulsatiletinnitus
○exclude bruitFundoscopy ( benignintracranialhypertension ) Referforformal hearingtest
○puretoneaudiometrywithassessmentofairandbone conductionMRI- forvestibularschwannoma ( acousticneuroma ) RedflagsSuddenonsetpulsatiletinnitusTinnitusinassociationwith significant/severevertigoUnilateraltinnitusTinnitusinassociationwith asymmetrichearinglossortinnituswithunexplainedsuddenhearingloss Tinnitusinassociationwithsignificantneurologicalsymptomandorsigns TinnitusfollowingheadtraumaTinnituscausingpsychologicaldistress 


  6. Hearingtest –Arrangeahearingtestforallpatientswithtinnitus- CKS advice’sanaudiologyreferraliftinnituspersistsfortinnitusthatlasts6 monthsormoreTwentypercentofpersonsvisitingtinnitusclinicshave normalhearing discussimpact , concernsanyrecentassessment , managementplans reassurethattinnitusiscommon & mayresolvebyitselfcommonly associatedwithhearinglossbutnotcommonlyassociatedwithother underlyingphysicalproblemsreassurethatmanagementstrategiesexist whichmayhelppeoplelivewellwithtinnitus. Referral – referimmediately -peoplewithtinnituswhoareathighriskof suicidetothecrisisteamreferimmediatelyiftinnitusisassociatedwith
○ suddenonsetofsignificantneurologicalsymptomsorsigns ( egfacial weakness ) or
○acuteuncontrolledvestibularsymptoms ( e,gvertigo ) or
 ○suspectedstrokerefertobeseenwithin24hrsiftheyhavetinnitusand havehearinglossthathasdevelopedsuddenly -
( ieoveraperiodof3 daysorless ) inthepast30daysrefertobeseenwithin2weeksiftinnitus &
○distressaffectingmentalwellbeing ( eveniftheyhavereceived tinnitussupportatfirstpointofcontact )
○hearinglossthatdeveloped suddenlymorethan30daysagoorrapidlyworseninghearingloss ( overa periodof4 -90days ) referfortinnitusassessmentif○continuestobe bothersome
○persistentobjectivetinnitus
○associatedwithasymmetric orunilateralhearinglossconsiderareferralif
○persistentpulsatile tinnitus
○persistentunilateraltinnitus

  7. NICErecommendsusingquestionnairestoassesstheimpactoftinnitus TinnitusFunctionalIndex – howtinnitusaffectsthemVisualanaloguescale – ifquestionnairecannotbeusedDiscusshowthisaffectstheirQoLInsomnia SeverityIndex – ifitimpactssleepTinnitusquestionnaire ( TQ ) ormini- TQ alongsideTinnitusFunctionalIndextoassesspsychologicalimpactAssess fordepressionandanxietyusingaquestionnaireoranabilityappropriate measureandagreeonamanagementplaninlinewithcurrentguidance Investigations – somerecommendationsmayrelatetospecialists investigationscaninclude
○audiologicalassessment ( followNICE guidance )
○psychoacoustictests
○imagingofferMRIofinternal auditorymeati ( IAM )
○thosewithnon-pulsatiletinnituswithassociated neurological , otologicalorhead & necksignsandsymptoms
○contrast enhancedCT ( IAM ) isanalternativetechnique
○donotofferimaging forpeoplewithsymmetricalnon-pulsatiletinnituswithnoassociated neurological , audiological , otologicalorhead & necksignsandsymptoms synchronouspulsatiletinnitusconsider
○MRAorMRIofhead , neck , temporalboneandIAMifclinicalexamination & audiologicalassessment arenormalOR
○contrastenhancedCTofhead , neck , temporalbone andIAMiftheycannothaveMRAorMRInon- synchronouspulsatiletinnitus ( fore,gifcausedbypalatalmyoclonus ) considerMRIofheadorcontrast enhancedCTofhead.

  8. Amplificationdevice – offerhearingaidiftheyhaveahearinglossthat affectstheirabilitytocommunicateconsiderahearingaidiftheyhavea hearinglossbutdonothavedifficultiescommunicatinghearingaidisnot indicatedinabsenceofhearingloss. Soundtherapy – NICEhasnotmadeanyrecommendationsforpracticein thisareaduetolackofevidenceoftheseinterventionsinisolation. 


More Related