Tinnitus

TINNITUS= “TINNIRE”-LATIN -TO JINGLE
TINNITUS AURIUM “FROM THE EARS” VS TINNITUS CRANII/CEREBRI “FROM THE HEAD”
MUST ASCERTAIN WHETHER OR NOT IT IS BILATERAL, THE FREQ, DURATION, FLUCTUATION, AND VIBRATION (PULSATILE)
AFFECTS > 37 MILLION PEOPLE IN THE UNITED STATES
95% OF POP HAS SOME DEGREE OF IT SOMETIMES
PNEUMONIC CCLAMP HELPS DESCRIBE IT (CAUSE, COMPOSITION, LOUDNESS, ANNOYANCE, AND PITCH)
20% SEVERELY AFFECTED
50% HAVE BILATERAL DZ
50% HAVE PITCH AND LOUDNESS THAT VARIES
M=F
PEAK FREQUENCY 3000-5000 HZ
USUALLY LESS THAN 20 DB IN INTENSITY
LOW FREQUENCY TINNITUS USUALLY  LOUDER THAN HIGH FREQUENCY TINNITUS
FIRST DIVIDE INTO VIBRATORY AND NONVIBRATORY(CONSTANT)
DIVIDE VIBRATORY INTO PULSATILE AND NON-PULSATILE
ALWAYS CHECK TO SEE IF VIBRATORY TINNITUS IS OBJECTIVE
OBJECTIVE TINNITUS(10-12%)—AUDIBLE TO ANOTHER—A MODIFIED AMPLIFIED ELECTRONIC STETHOSCOPE IS RECOMMENDED
VIBRATORY/PULSATILE
VASCULAR ABNORMALITY
-SYNCHRONIZED WITH  HEARTBEAT
-SOFT RUSHING QUALITY
-AFFECTS 12% OF PEOPLE WITH TINNITUS
-AUDIBLE BRUIT IN ONLY A SMALL PERCENTAGE
HEAR TURBULENT FLOW IF REYNOLD’S NUMBER EXCEEDS 2000
* AVMS -CONGENITAL -USUALLY BETWEEN OCCIPITAL ARTERY AND TRANSVERSE SINUS, INTERNAL CAROTID ARTERY AND VERTEBRAL VEIN, OR MIDDLE MENINGEAL ARTERY AND GREATER SUPERFICIAL PETROSAL SINUS
-IMAGE WITH MRI/MRA OR PREFERABLY ANGIOGRAPHY
-Rx – NONE, LIGATION, OR EMBOLIZATION
-ACQUIRED -GLOMUS TUMORS
-ASSOCIATED WITH A CHL
-TM MAY HAVE REDDISH BLUE MASS BEHIND IT THAT BLUSHES WITH + PRESSURE – BROWN’S SIGN
-MAY HAVE OTHER ASSOCIATED CRANIAL NEUROPATHIES
-MRI/CT SCANNING USEFUL
-Rx – SURGERY/RADIATION/BOTH
*ARTERIAL BRUITS -VASCULAR LOOPS WHICH COULD BE AN ABNORMAL POSITION OF INTERNAL CAROTID OR PERSISTENT STAPEDIAL ARTERY OR ANT AURICULAR ARTERY
OFTEN IS ATHEROSCLEROTIC DZ OF THE CAROTID
-MRI/MRA/CT SCANNING HELPFUL—DOES NOT REPLACE ANGIOGRAPHY
-TX – ENDARTERECTOMY VS EMBOLIZATION VS LIGATION
*VENOUS HUM -ASSOCIATED WITH HIGH JUGULAR BULB AND HTN
-CAN BE ALTERED BY HEAD POSITION, ACTIVITY, OR PRESSURE ON THE IJ
-MRI/CT SCANNING HELPFUL TO R/O OTHER ETIOLOGY
-TX – IJ LIGATION
PSEUDOTUMOR CEREBRI = BIH (BENIGN INTRACRANIAL HTN)
USUALLY YOUNG FEMALES, OBESE WITH RECENT WEIGHT OR HORMONAL CHANGES
PRIMARY Sx IS THE HEADACHE—USUALLY NO FOCAL NEURO SIGNS
PULSATILE TINNITUS–VERY COMMON—ALSO-HYDROPIC HEARING CHANGES
+ PAPILLEDEMA—MUST DO FUNDOSCOPIC EXAM
ASK ABOUT HYPERVITAMINOSIA (A&D), STEROIDS, BCP, LMP (?PREGNANT)
TEST THYROID
CT SCAN—-SLIT LIKE VENTRICLES
Rx: IF PREGNANT —DELIVER
SALT RESTRICTION (ETOH, CAFFEINE, ECT….)
ACETAZOLAMIDE, LASIX
SERIAL LP’S
OTOCLEROSIS—ENHANCES BONE CONDUCTION ARTERIAL SOUNDS
VIBRATORY/NON-PULSATILE
PATULOUS EUSTACHIAN TUBE
-COMPLAIN OF A ROARING TINNITUS THAT IS SYNCHRONOUS WITH RESPIRATIONS AND MAY COMPLAIN OF AUTOPHONIA
-SYMPTOMS RELIEVED IF HEAD PUT INTO A DEPENDENT POSITION AND BRIEFLY RELIEVED BY STANDING UP
-TYMPANOMETRY WILL SHOW A FLUTTERING TM WITH QUICK RESPIRATIONS
-ASSOCIATED WITH WEIGHT LOSS (POST PARTUM) OR RADIATION TO NASOPHARYNX
Rx:  CAUSTICS OR TEFLON INJECTION OF TORUS REGION, ? PE TUBES
PALATAL MYOCLONUS
-COMPLAINS OF A IRREGULAR CLICKING SOUND THAT IS VERY RAPID
-ASSOCIATED WITH EAR FULLNESS AND HEARING LOSS
-ETIOLOGY – ? STRESS
-AFFECTS YOUNGER PATIENTS
-MAY BE SUPPRESSED BY OPENING MOUTH—-THUS THE EXAMINER MAY MISS IT
-DIFF DX – MS, STROKE, NEOPLASM, STAPEDIAL MUSCLE SPASM
Rx – BENZODIAZEPINES, ANTICONVULSANTS—BOTOX
STAPEDIAL MUSCLE SPASM
-COMPLAINS OF A RUMBLING/CRACKLING SOUND MADE WORSE BY EXTERNAL SOUND
-TX – DIVIDE BOTH STAPEDIUS AND TENSOR TYMPANI MUSCLES
DENTAL ABNL—TMJ CLICKING
IDIOPATHIC—BEEN REPORTED THAT HYPOTYMPANIC OBLITERATION WITH LOBULE FAT CAN SOMETIMES HELP
NONVIBRATORY SUBJECTIVE TINNITUS
BY FAR—MOST COMMON TYPE OF TINNITUS
-AFFECTS 8%IN CAUSING DIFFICULTY WITH SLEEP
-0.5% HAVE MAJOR IMPACT ON LIFE
-ETIOLOGY -? ABNORMALITY OF HAIR CELLS AND CENTRAL AUDITORY PATHWAYS
INNER EAR ETIOLOGY -OUTER HAIR CELLS
-BASIS OF OTOACOUSTIC EMISSION TESTING—ACTUAL SOUND PUT OUT BY OUTER HAIR CELLS—BORDERS ON OBJECTIVE TINNITUS—–MAY OBLITERATE WITH ASA
-ASSOCIATED DZ PROCESSES
OTOLOGIC  —NOISE EXPOSURE, PRESBYCUSIS, MENEIRE’S, OTITIS MEDIA, LABYRINTHITIS, ANY PROCESS CAUSING CHL, ACOUSTIC NEUROMAS
CARDIOVASCULAR -HTN
METABOLIC—THYROID DYSFUNCTION, HYPERLIPIDEMIA, VITAMIN DEFICIENCY, DIABETES
NEUROLOGICAL—-TRAUMA, MS, MENINGITIS, STROKE, POST ICTAL TINNITUS
PHARMACOLOGIC    —ASA/NSAID, ABX -AMINOGLYCOSIDES USUALLY GIVEN CONCURRENTLY WITH LASIX, QUININE, ANTIDEPRESSANTS, HEAVY METAL EXPOSURE
PSYCHOLOGICAL

-EVALUATION -AUDIO
-LABS -HCT, CHEMISTRY PROFILE, THYROID PROFILE, LIPID PROFILE, AUTOIMMUNE PROFILE, MHA-TP
-IF UNILATERAL AND ASSOCIATED WITH SIGN HEARING LOSS – MRI
-TX  -SUCCESS – 25% MARKEDLY IMPROVED, 50% MODERATELY IMPROVED, AND 25% NONE
-DIET/HABITS    -AVOID CAFFEINE AND CHOCOLATES
-STOP SMOKING
-CHECK MEDS
GINGKO-BILOBA (A TREE EXTRACT)
-AVOID LOUD NOISES
-PSYCH EVALUATION
MASKER, WHITE NOISE —-WILL GET SOME RESIDUAL INHIBITION
FOROSEMIDE
CYCLANDELATE
MELATONIN
SELECTIVE COCHLEAR NEURECTOMY
-TINNITUS PROGRAM
-PITCH CAN BE MATCHED IN 90%
-LOUDNESS – MOST TINNITUS LESS THAN 7 DB
-USE APPROPRIATE MASKING DEVICE
-HEARING AIDS HELP IF SIGN. HEARING LOSS
COCHLEAR IMPLANT

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