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Tinnitus. The sensation of sounds in the ears or head in the absence of an external sound source. Pathophysiology. Still poorly understood Almost every ear disease and cause of deafness can be associated with tinnitus Useful web resource if RNID website. Any area’s that want to discuss?
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Tinnitus The sensation of sounds in the ears or head in the absence of an external sound source
Pathophysiology • Still poorly understood • Almost every ear disease and cause of deafness can be associated with tinnitus • Useful web resource if RNID website
Any area’s that want to discuss? • Current pathways: • Manage in primary care – the majority • Referral to ENT – who to refer and when?
History • Description of the sound • Pulse, ringing, whoosh • Unilateral, Bilateral • Intrusive (sleep interrupted?) • Persistent or intermittent • Associated symptoms • Hearing loss • Vertigo
Examination and Investigation • TM’s • EAM’s • Cranial, Carotid, Cardiac bruit – especially if pulsatile • Consider FBC, TFT
Management • Treat any underlying cause if found • Bilateral +/- symmetrical hearing loss, No other symptoms, not intrusive –advice • Unilateral < 3/12. No worrying feature. Manage primary care • Objective tinnitus - refer • Unilateral tinnitus > 3/12 refer - ?CPA lesion • Intrusive tinnitus – refer • Bilateral + asymmetrical hearing loss > 3/12 – refer • Tinnitus therapy • Masking with white noise therapy • Pillow radio • Bilateral, none intrusive tinnitus – Ok to manage in primary care • Advice and reassurance • RNID website useful
Management • Advice • Sound therapy • Tinnitus councelling
