Tinnitus Overview Seminar

Definition of Tinnitus

• Tinnitus involves perceiving sounds like whistling, hissing, buzzing, or ringing without any external source.
• Can occur unilaterally or bilaterally; may be acute or chronic and intermittent or constant.
• Approximately 10–15% prevalence in the US adult population, increasing with age, more common in men and smokers.

Types of Tinnitus

• Objective Tinnitus: Rare condition detected by a doctor; can be caused by turbulent blood flow or vascular tumors.
• Subjective Tinnitus: Common sensation of sound without an external source, often related to ear conditions like hearing loss or infections.

Causes of Subjective Tinnitus

• Otological Causes: Impacted wax, fluid in the middle ear, otitis media, Meniere’s disease, noise-induced hearing loss, and acoustic neuroma.
• Neurological Causes: Head injuries, multiple sclerosis, and post-meningitis complications.
• Metabolic Causes: Hypothyroidism, hyperthyroidism, obesity, and vitamin B12 deficiency.
• Cardiovascular Causes: Hypertension, cardiac arrhythmias.
• Psychogenic Causes: Anxiety and depression.

Causes of Objective Tinnitus

• Vascular Conditions: AV shunts, arterial bruit from carotid stenosis or aneurysm.
• Structural Causes: Patulous eustachian tube, palatal myoclonus, myoclonus of the tensor tympani.

Pathophysiology

• Damage to cochlea or auditory nerve leads to reduced input to auditory neurons; results in abnormal neural activity in the auditory cortex.
• Brain feedback loops that regulate auditory signals become impaired, leading to unusual auditory perceptions.
• Key risk factors for tinnitus include long-term loud noise exposure, head/neck injuries, and infections.

Diagnosis of Tinnitus

• Medical History: Characterize tinnitus type (unilateral/bilateral) and assess risk factors.
• Physical Examination: Use otoscope for ear abnormalities, perform head and neck auscultation for bruits, and conduct a neurologic examination.
• Audiological Tests: Include pure tone audiometry and tympanometry.
• Additional Tests: Imaging (CT/MRI) for specific symptoms; blood tests for treatable causes; autoimmune and infectious workups if needed.

Treatment and Management

• Identify and treat underlying causes if possible; management focuses on symptom control.
• Reassurance & Psychotherapy: Adaptation strategies for living with tinnitus.
• Relaxation Techniques & Biofeedback: Stress-reduction methods.
• Sedatives: May be used initially for adjustment.
• Tinnitus Masking: Using sound devices to mask tinnitus, especially at bedtime; hearing aids can provide additional benefit.

Pharmacological Treatments

• Clonazepam: A benzodiazepine reducing neuronal hyperactivity.
• Carbamazepine: Anticonvulsant for abnormal auditory nerve firing.
• Nimodipine: Calcium channel blocker potentially benefiting vascular-related tinnitus.

Alternative and Innovative Therapies

• Acupuncture: Promotes circulation and stress relief.
• Ginkgo Biloba Extract: Believed to enhance blood circulation to the brain; evidence is mixed.
• Intratympanic Steroids: Injection for inner ear inflammation or sudden hearing loss.
• Tinnitus Retraining Therapy (TRT): Includes counseling and sound therapy, lasting 18–24 months with significant improvement in many patients.

Summary

• Tinnitus is a prevalent auditory condition with various causes and types.
• Diagnosis requires thorough history-taking and clinical evaluation.
• Management focuses on addressing underlying causes where possible and symptom relief through multiple strategies including therapies and sound masking.