tinnitus

see also:

• ED Mx of vertigo and BPV
• endolymphatic hydrops including Meniere's disease

• most tinnitus originating in the auditory system is due to a sensorineural hearing loss with resulting dysfunction within the auditory system
  • mostly this is high pitched
  • Ménière's disease is generally low pitched tinnitus
  • a whooshing sound is generally regarded as whooshing or pulsatile tinnitus and is often due to vascular noises which may be serious

• eustachian tube dysfunction
• presbycusis (sensorineural hearing loss with aging)
• otosclerosis - conductive hearing loss
• patulous Eustachian tube - also have autophony
• endolymphatic hydrops including Meniere's disease - generally low pitched; also have vertigo, deafness
• acoustic neuroma - also have deafness
• superior canal dehiscence syndrome (SCDS) - rare; pulsatile tinnitus
• arterial bruits, AVM's, fistulae - mainly while sleeping; no vertigo/deafness;
• head and neck paragangliomas of the carotids - may interfere with hearing
• venous hums - eg. hypertension; often change with head position
• spasm of the tensor tympani or stapedius muscle - pulsatile tinnitus +/- deafness, aural fullness
• myoclonus of the palatal muscles - clicking noises or irregular or rapid pulsations; MS, etc
• TMJ dysfunction
• cervical spine soft tissue injuries
• leukostasis - as in myeloproliferative disorders
• drugs (may also have deafness if ototoxic)
  • salicylate poisoning
  • non-steroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors
  • aminoglycoside antibiotics such as gentamicin
  • vancomycin
  • azithromycin
  • flouroquinolone antibiotics
  • SSRI/SNRI antidepressants
  • local anaesthetic agents
  • ACE inhibitors
  • antimalarials
  • benzodiazepines
  • calcium channel blockers
  • carbamazepine
  • sodium valproate (Epilim)
  • loop diuretics such as frusemide / furosemide / Lasix
  • proton pump inhibitors (PPIs)
  • quinidine
  • tricyclic antidepressants

• if the tinnitus is whoosing or pulsatile then this needs more urgent Ix - see whooshing or pulsatile tinnitus
• check for and cease any ototoxic medications
• otherwise if it is a constant tinnitus this can generally be managed by the GP:
  • referral for audiometry
  • referral to an ENT specialist
    • further Ix may be an OP MRI, etc.