Tinnitus

TinnitusTinnitusPerceptionofnoiseintheabsenceofanacousticstimulus.Puretoneormultipletones.Highpitched,lowpitched,ringing,buzzing,roaring,clicking,hissing,rough,pulsatile,orsteady.40-70y/o.Menwomen.ObjectivetinnitusAudibletothephysicianoranotherperson.Pulsatingcharacter.DD:1.Vascularabnormalities.2.Eustachiantubeabnormalities.3.Tympanicmuscleproblems.VascularAbnormalitiesSoft,rushing,pulsatilesound.Synchronouswiththeheartbeat.Diagnosis:increasingratewithexercise.Fewerthan10%.Audiblebruit.Arteriovenousshunts,arterialbruits,andvenoushums.ArteriovenousShuntsIntracranialorpreauricular.Congenitaloracquired.Mayormaynotbeassociatedwithdecreasedhearing,dependingontheirorigin.CongenitalArteriovenousMalformationsOccipitalartery-transversesinus.Internalcarotid-vertebralvessels.Middlemeningealartery-greatersuperficialpetrosalartery.Diagnosis:byexclusion,MRIorangiography.Rarelyisthesymptomsevereenoughtomerittherapy.Selectiveembolizationorligation.AcquiredArteriovenousShuntsGlomustympanicumorglomusjugularetumor.Softorblowingsound,diminishedhearing.Reddishbluemassbehindthetympanicmembrane.Ninth,tenth,andtwelfthcranialnerves.Diagnosis:CTofthemiddleear1.erosionofthecaroticojugularspine2.lesionlyingwithinthemiddle-earspace.ArterialBruitsAberrantcarotidpositions.Transmittedfromthecarotidorprevertebralvessels.VascularloopswithintheIACpressingontheeighthcranialnerve.Diagnosis:CT,MRI,orMRA.Carotidbruitwithapulsatiletinnitusendarterectomy.Arterialligation,embolization,orvasculardecompression.VenousHumsHypertensionorabnormalhighplacementofthejugularbulb.Dehiscentjugularbulb:1.soft,low-pitchedvenoushum.2.alteredbyheadposition,activity,orpressureoverthejugularvein.Diagnosis:CT.Unilateral.VenousHumsAudiblevenoushum:1.partialocclusionornarrowingofthetransversesinus.2.transversesinus/sigmoidsinusjunction.3.ingrowthofarachnoidgranulation.MRAorMRV.nodefinedspecificmanagement.PatulousEustachianTubeOceanroarintheear.Synchronouswithnasalrespiration.Absentonarisingbutrapidlyoccurthereafter.Diminishedoralleviatedbylyingdown.Placingtheheadinadependentpositionmayrelievethesymptoms.Tympanography(breathesharplyorquicklythroughnose)FlutteringmotionofTMassociatedwithrespiration.Autophony.PatulousEustachianTubeTreatment:1.causticstothenasopharynx.2.mucosalirritants.3.saturatedsolutionofpotassiumiodide,Teflonorgelfoaminjections(torustubarius).Postpartum,cancer-associated,dietaryweightloss,nasopharynxradiationtherapy.PalatomyoclonusIrregularclickingsound.Rapid(40to200beatsperminute)andoccursintermittently.MucousmembranesofE-tubesnappingtogether(movementofthepalatalmusculature).Earfullness,distortionofhearing.Musclespasmpostoccipitalheadache,temporomandibularjointpain.Symptomsincreaseduringperiodsofstress.PalatomyoclonusToynbeetubeclicking.Tympanogram:movementsynchronouswiththecontractions.EMGofpalatalmusculatureconfirmthediagnosis.Idiopathicstapedialmusclespasm,multiplesclerosis,cerebralvasculardisorders,tumor.Treatment:1.Musclerelaxants(clonazepam,diazepam).2.Botulinumtoxininjection.3.Sugery.IdiopathicStapedialMuscleSpasmRoughrumblingorcracklingnoise(accentuatedbyexternalsound).Diagnosis:TMmovementsynchronouswiththenoise.Treatment:1.divisionofstapediusmuscleandtensortympanimuscle.2.musclerelaxants(diazepam)3.avoidstimulantssuchasnicotine,coffee,anddecongestants.SubjectivetinnitusOtologicfactorsPresbycusisNoise-inducedhearinglossMeniere’sdiseaseOtosclerosisMetabolicfunctionHypothyroidismHyperthyroidismHyperlipidemiaZincdeficiencyVitamindeficiencyNeurologicabnormalitiesSkullfractureorclosedheadtraumaWhiplashinjuryMultiplesclerosisMeningiticeffectsPharmacologicfactorsAspirincompoundsNonsteroidalantiinflammatorydrugsAminoglycosidesHeavymetalsDentalfactorsTemporomandibularjointsyndromePsychologicfactorsDepressionAnxietyOtologicFactorsNoiseexposureorpresbycusis.High-frequencyneurosensoryhearingloss.75%patientshavea30+dBhearinglossfrom3to8kHz.3%prolongedotitis.2%recurrentlabyrinthitis.Meniere’sdisease(4%unresolve).Dizziness.CardiovascularFactors30%.60y/o.Hypertension.Anemia(increasedcardiovascularoutput).Extensivearteriosclerosis(objectiveandpulsatile).MetabolicFunctionHyperthyroidism:pulsatileorrushingnoise.Hyperlipidemia:fluctuatingneurosensoryhearinglossanddizziness.VitaminAorBdeficiency.NeurologicDisease9%majorheadtrauma(hearingloss).7%whiplashinjuriesorcervicaltrauma.Tinnitusafterwhiplashinjuryusuallyoccurs7-10daysaftertheaccident.Appearanceoftinnitusimmediatelyafterheadtraumawithoutclearlydefinedearabnormalitiesorvestibulardiseaseisuncommon.PharmacologicFactorsAspirinandaspirin-containingcompoundsPercodanDarvonBufferinEcotrinAminoglycosideantibioticsGentamycinKanamycinNeomycinStreptomycinTobramycinAmikacinNSAIDFenoprofenIbuprofenIndomethacinKetoprofenNaproxenPhenylbutazoneSulindacTolmetinHeterocyclineantidepressantsAmitriptylineAmoxapineDesipramineDoxepinImipramineMaprotilineNortriptylineProtriptylineTrazodoneTrimipramineTreatment25%improvesignificantly.50%impro