Tinnitus Tinnitus Gerald J. Hansen, III, MD
Associate DirectorFamily Medicine Residency Program
Abington Jefferson Health
Gerald J. Hansen, III, MDAssociate Director
Family Medicine Residency ProgramAbington Jefferson Health
Objectives – Become Familiar With TinnitusObjectives – Become Familiar With Tinnitus
• Definition
• Importance
• Etiologies
• Diagnosis
• Treatment Options
DefinitionDefinition• “An auditory perception in the absence of
an external auditory stimulus”
• Can be buzzing, ringing, hissing, humming or clicking
ImportanceImportance
• 50 million Americans with chronic tinnitus (greater than 6 months)
• 12 million disabled to some degree by tinnitus• 42% U.S. Military veterans receive compensation
for tinnitus• Can be a symptom of a serious condition such as
increased intracranial pressure, dural AV fistula, arterial disease or paragangliomas
• Increased rates of insomnia, anxiety and depression
EtiologiesEtiologies
• “Top Down” or “Bottom Up”
• Non-pulsatile
Bottom UpBottom Up
• Loss of sensory input from the cochlea to the auditory thalamus
• Disruption of normal firing
• Cochlear damage – noise trauma, meniere’s, ototoxility, lesions
Top DownTop Down
• Dysfunctional reorganization of neural networks responsible for audition, attention and emotion
• “Phantom limb” analogy
• “Auditory seizure” comparison
DiagnosisDiagnosis
• History –– “Most important question” “Is it pulsatile or
continuous?”– Pulsatile = referral– Neurology Department Review of 84 patients
referred – 42% significant vascular disorder (AV or
carotid – cavernous sinus fistula)– 14% paraganglioma or intracranial
hypertension
• Description of Tinnitus– Episodic, constant, pitch, rhythmicity,
bilateral or unilateral• Inquiry into risk factors
– Trauma, hearing loss, ENT disease, TMJ, noise exposure
• Co-morbidities – Depression, anxiety, insomnia, HTN, ASCVD,
neurological diseases
• Tinnitus Handicap Inventory
• Tinnitus Reaction Questionnaire
Physical ExamPhysical Exam
• Complete head and neck exam including cranial nerves, TM, palate
• Auscultation for bruits carotids, periauricular, temporal, orbit and mastoid
• Complete neuro exam
Supplemental TestingSupplemental Testing
• Vascular – MRI/MRA, CT Angiography, CT with contrast
• Auditory System – Audiogram, tympanometry, auditory reflex testing, otoacoustic emissions testing
TreatmentTreatment
• Vascular/Tumors– Treat if possible
• Drug toxicity– Discontinue offending medication if possible
Auditory systemAuditory system
• Hearing aids
• Cochlear implants
• Patulous eustacian tube
• Myoclonus
Medication OptionsMedication Options
• Misoprostal
• Benzodiazepines
• Intratympanic dexamethasone
Behavioral TherapiesBehavioral Therapies
• Tinnitus retraining therapy (TRT)
• Biofeedback
• CBT
Tinnitus “Masking”Tinnitus “Masking”
• Noise/sound generators
SummarySummary
• Tinnitus is common
• Tinnitus can be disabling
• Tinnitus may be a harbinger of serious conditions
• Treatments for tinnitus exist
