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Tinnitus definition, causes, investigations and treatment

Definition:Tinnitus is a subjective sensation of noise in the ear and / or the head, without an acoustic stimulation from outside.

Causes  and types of Tinnitus

a. Subjective: experienced by the patient only .It arises from pathological changes along the entire auditory pathway. According to the function and anatomy, the following three divisions can be made:
  1. Conductive tinnitus: Outer and middle ear pathologies.
    Tinnitus-definition-causes-investigations-treatment
  2. Sensorineural tinnitus: include all possible cochlear and neural (auditory nerve) pathology.
  3. Central tinnitus:
  • Primary central tinnitus,
  • Secondary central is based on the fact that conductive and sensorineural tinnitus can only be perceived as such when the peripheral signal is processed in the brain,( phantom tinnitus) .
b. Objective: tinnitus is defined as sounds originating from the body and can be heared by the patient and examiner. It may be: 

  1. Pulsatile tinnitus: is heartbeat synchronous, which is often caused by vascular abnormalities such as arteriovenous malformation, carotid stenosis, or dissections, venous sinus thrombosis, benign intracranial hypertension, and high jugular bulb or by increased blood flow (eg, in anaemia hypertension, thyrotoxicosis).
  2. Non-pulsatile tinnitus: middle-ear myoclonus (tensor tympani) , palatal myoclonus, tempro-mandibular joint (TMJ) dysfunction, patulous Eustachian tube.

Investigations for diagnosis of Tinnitus:

General: personal & occupational history, blood pressure & blood picture, Auscultation of the neck
Special: Full ENT examination, audiometry & tympanometry, and CT & MRI of temporal bone
Doppler & angiography of carotids & vertebrobasilar arteries.

Treatment of Tinnitus:

1. Specific treatment of underlying pathology.
2. Management of comorbidities e.g anxiety, depression, insomnia, decreased sound tolerance (hyperacusis). Pharmacotherapy include: anti-depressants, anti-convulsant carbamazepine, benzodiazepines.
3. IV vasodilators & plasma expanders, steroids either systemic or intratympanic.
4. In addition to other treatments:
  • Counselling and Psycho-education to help achieve habituation to the perception of the phantom sound.
  • Sound therapy, using both environmental and custom sound generators to reduce the perception of the tinnitus sound. Tinnitus Retraining Therapy (TRT) is combination of counselling and sound therapy.
  • Hearing aids for patients with tinnitus with hearing loss.
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Tamer Mobarak

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