Seminar - Tinnitus 2021 PDF

SEMINAR - TINNITUS BY Amna Safdar Shah (2021M093) Falaq Naz (2021M047) Nazia Akhtar (2021M012) Samra Sajan (2021M020) Tasnim Mohamed (2021M066) DEFINITION Tinnitus is a common condition in which sound (whistling, hissing, buzzing, ringing, pulsating) is perceived in the absence of an external sourc...

SEMINAR - TINNITUS BY Amna Safdar Shah (2021M093) Falaq Naz (2021M047) Nazia Akhtar (2021M012) Samra Sajan (2021M020) Tasnim Mohamed (2021M066) DEFINITION Tinnitus is a common condition in which sound (whistling, hissing, buzzing, ringing, pulsating) is perceived in the absence of an external source. It can be unilateral or bilateral, acute or chronic, and intermittent or constant. Prevalence ○ Most people will experience tinnitus at some point in their lifetime. ○ ∼ 10–15% overall prevalence in the US adult population ○ Increases with age ○ More common in men and smokers PATHOPHYSIOLOGY Tinnitus is classified into two types: objective and subjective. Objective tinnitus occurs when noise is produced near the ear and, in some cases, can be detected by a doctor using a stethoscope. Subjective tinnitus, however, is the sensation of sound without any external source and is only heard by the person experiencing it. Objective tinnitus is relatively rare and typically presents as a rhythmic hum, often caused by turbulent blood flow in the carotid artery or jugular vein. It may also be linked to highly vascular tumors in the middle ear, such as glomus jugulare tumors, or to dural arteriovenous malformations. In contrast, subjective tinnitus is much more common and can occur alongside almost any ear condition. Common triggers include sensorineural hearing loss, ear canal blockage from earwax, infections like otitis media, Eustachian tube blockage, and certain medications like salicylates. Most individuals with tinnitus experience the "sensorineural" type, which is related to hearing loss in the cochlea or cochlear nerve. PATHOPHYSIOLOGY Tinnitus has been linked to several risk factors, including : a) Long-term exposure to loud noise (22% of cases) b) Head or neck injuries (17% of cases) c) Infections (10% of cases). The most recent understanding of tinnitus suggests that it originates from the central nervous system. Studies using positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) have shown that damage to the cochlea, such as injury to cochlear hair cells or the vestibulocochlear nerve, reduces the input to neurons in the brainʼs auditory system. This reduction leads to abnormal neural activity in the auditory cortex, which is believed to be linked to the perception of tinnitus. In addition to this abnormal neural activity, the brainʼs feedback loops that normally regulate and fine-tune auditory signals become impaired. These loops help reinforce auditory memory, but when disrupted, they fail to suppress the signals properly. As a result, the normal connections between synapses are lost, and alternative, uncontrolled neural pathways are formed. This lack of inhibition and formation of abnormal synapses leads to the unusual auditory perception known as tinnitus. PATHOPHYSIOLOGY https://www.youtube.com/watch?v=kiXPoTyTlt4 CAUSES - Subjective tinnitus Otological/Ear related ; Neurologic ; Ototoxic drugs - Impacted wax - Head injury - fluid in the middle ear - Temporal bone fractures - Acute and chronic otitis media, - Multiple sclerosis - Meniere's disease - Post-meningitis - Presbycusis - Brain hemorrhage - Noise induced hearing loss - Brain infarct - Acoustic neuroma Metabolic causes Cardiovascular; Psychogenic - Hypothyroidism - Hypertension - Anxiety - Hyperthyroidism - Hypotension - Depression - Obesity - Anemia - Vitamin deficiency (B12) - Cardiac arrhythmias - Arteriosclerosis CAUSES - Objective tinnitus Vascular; ○ AV shunts ○ Arterial bruit; carotid stenosis or aneurysm Patulous eustachian tube Palatal myoclonus Clicking of TM joint Idiopathic stapedial/tensor tympani myoclonus DIAGNOSIS 1. Medical History: characterize the tinnitus (e.g., unilateral vs. bilateral, symptoms associated like dizziness or hearing loss, ringing in the ear) and risk factors (sound exposure, chronic illness, and recent use of ototoxic medication) 2. Physical Examination: Otoscope exam: check for impacted cerumen, infections, abnormalities in the ear canal or ear drum Head and neck auscultation: assess for bruits which may contribute to pulsatile tinnitus Neurologic examination: look for focal defects that can be linked to tinnitus such as multiple sclerosis or acoustic neuroma. Audiological examination: to evaluate the hearing ability. Pure tone audiometry, speech audiometry and tympanometry can be done. Other tests: to assess for hearing loss tests can be done such as Rinne’s, Webber’s, absolute bone conduction and other tuning fork tests. DIAGNOSIS 3. Additional tests: Imaging (CT Scan, MRI) is recommended for patients with one or more of the following: unilateral tinnitus, asymmetric tinnitus, pulsatile tinnitus, and/or focal neurological deficits (to rule out stroke, tumors, or multiple sclerosis) Routine blood work if a treatable cause of tinnitus is suspected (e.g., hypothyroidism, anemia can oftentimes cause tinnitus) Infectious workup (FTA-ABS for syphilis) and autoimmune workup (ANA, sedimentation rate, rheumatoid factor) if suspected, since many autoimmune disorders can cause a variety of auditory issues TREATMENT AND MANAGEMENT Tinnitus is a symptom, not a disease. Its underlying cause should be identified and treated if possible, though treatment may not always alleviate the symptom. If no cause is found, tinnitus management focuses on symptom control which includes: 1. Reassurance & Psychotherapy ○ Patients may need to adapt to living with tinnitus over time. 2. Relaxation Techniques & Biofeedback ○ Help reduce stress and manage symptoms. 3. Sedatives & Tranquilizers ○ May be used initially to help patients adjust. 4. Tinnitus Masking ○ More noticeable at bedtime; using a fan, ticking clock, or other devices can help mask the sound and improve sleep. ○ Hearing aids for those with hearing loss can improve hearing and provide masking effects. TREATMENT 1. Laser Therapy Tinnitool (Low-Energy Laser Application) ○ The use of low-energy laser therapy applied directly to the ear has been proposed as a treatment option for tinnitus. This therapy aims to stimulate cellular repair and reduce inflammation within the auditory pathways, potentially alleviating symptoms. 2. Pharmacological Treatment Clonazepam ○ A benzodiazepine that may help reduce the hyperactivity of auditory neurons and provide symptomatic relief for tinnitus sufferers. Carbamazepine ○ An anticonvulsant often used in tinnitus management for its potential to reduce the abnormal firing of auditory nerve pathways. Nimodipine ○ A calcium channel blocker that may enhance cerebral blood flow and has been explored as a treatment to reduce tinnitus symptoms, particularly in cases related to vascular issues. 3. Alternative Therapies Acupuncture ○ A traditional Chinese medicine technique that involves inserting fine needles into specific points on the body, potentially helping to reduce tinnitus symptoms by promoting circulation and relieving stress. Ginkgo Biloba Extract ○ A herbal remedy believed to improve blood circulation to the brain and inner ear, and may have beneficial effects for some tinnitus patients, though evidence is mixed. 4. Intratympanic Medication Steroids ○ The direct injection of corticosteroids into the middle ear has been used in certain cases of tinnitus, especially when related to inner ear inflammation or sudden hearing loss. 5. Tinnitus Retraining Therapy (TRT): TRT typically lasts 18–24 months and leads to significant improvement in over 80% of patients. Components: 1. Counseling 2. Sound Therapy REFERENCES - Atik A. Pathophysiology and treatment of tinnitus: an elusive disease. Indian J Otolaryngol Head Neck Surg. 2014;66(Suppl 1):1-5. doi:10.1007/s12070-011-0374-8 - Dhingra PL, Dhingra S. Diseases of Ear, Nose & Throat and Head & Neck Surgery - E-Book. Elsevier India; 2021. - https://next.amboss.com/us/article/wn0hvg?q=Prevalence%20of%20tinnitus#z5Xr5A - https://next.amboss.com/us/article/wn0hvg?q=TINNITUS - https://next.amboss.com/us/article/wn0hvg?q=how%20do%20we%20diagnose%20tinitus - https://nyulangone.org/conditions/tinnitus/diagnosis