Download tinnitus - alexorl.edu.eg

Survey
yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

Document related concepts

Hearing loss wikipedia, lookup

Auditory processing disorder wikipedia, lookup

Sound wikipedia, lookup

Dysprosody wikipedia, lookup

Earplug wikipedia, lookup

Evolution of mammalian auditory ossicles wikipedia, lookup

Audiology and hearing health professionals in developed and developing countries wikipedia, lookup

Sound localization wikipedia, lookup

Ear wikipedia, lookup

Noise-induced hearing loss wikipedia, lookup

Sensorineural hearing loss wikipedia, lookup

Auditory system wikipedia, lookup

Tinnitus wikipedia, lookup

Transcript
TINNITUS
1
Definition
Auditory perception of unwanted sound or
noise in the ear without an external sound
stimulus.
- Tinnitus is a symptom and is not a
disease.
- Tinnitus may be subjective (only heard by
the patient), or objective (heard by the
patient and others).
Classification
Tinnitus
Vibratory
Subjective
Objective
Non -vibratory
Always subjective
2
(1) Non vibratory tinnitus
It is the most common type .
Always subjective .
Mechanism unknown ( neural excitation
within auditory
auditory system )
May be peripheral or central
Etiology
Tinnitus with CHL
1- Ear wax.
2- TM perforation
3- Otosclerosis.
4- Middle ear effusion.
5- Eustachian tubal dysfunction.
3
Tinnitus with SNHL:
1-Presbyacusis.
2- Meniere’s disease.
3- Noise induced hearing loss.
4- Drug ototoxicity.
5- Acoustic neuroma.
2) Vibratory tinnitus
Real sound
Mechanical in origin
Arise within or near the ear
ear
Vascular or neuromascular
4
a)
Vascular Mechanism
(Pulsatile Tinnitus)
Mechanism
Vascular tinnitus is due to either increase or turbulence in the blood
flow. Usually abolished by jugular/carotid vessel compression.
Etiology
1- A-V malformation, or aneurysm.
2- Vascular tumor: glomus jugulare.
jugulare.
3- Aberrant vessel: persistent stapedial
Artery.
4- Hyperdynamic circulatory states:
Thyrotoxicosis,
Thyrotoxicosis, anemia, atherosclerosis.
(b) Neuromascular Mechanism
(muscle contraction tinnitus)
1- Colonic contraction of tensor tympani and stapedius
muscle
Clicking sound that can be heard by both patient and examiner
Faster rate than pulse ( 40 – 200)
TM movement which is synchronous
synchronous with tinnitus .
Can be altered by conscious effort
effort of the patient
5
2- Palatal myclonus
- Repetitive contraction of tensor and levator palati
muscle
- Usually associated neurological disorder e.g MS ,
BS
( c ) Patulous E.T
Mechanism
Turbulence of nasopharyngeal air of
respiration . Usually dt large weight loss
Clinically
- Autophony
- Respiratory movement of tympanic membrane
6
EVALUATION OF TINNITUS
PATIENT
1-Complete history taking
should emphasize on the following:following:-complete description of the tinnitus
-associated manifestations e.g hearing loss
-past history e.g trauma…
trauma…
- past history of ototoxic drugs
7
2- Clinical examination
- ENT exam may reveal e.g - wax
- effusion
- Auscultation of the head and neck may show bruit
in vascular tinnitus
- Physical exam e.g anemia
3- Investigation
(a) Audiological investigation
- Basic evaluation ( PTA – Tymp)
Tymp)
- ABR
8
( b) Radiological investigation
- CT
- MRI
(c) Laboratory investigation
- CBC
- Thyroid
9
(1) Treatment of the causes of tinnitus
Medical
Surgical
e.g SOM
Meniere
e.g Otosclerosis
Otosclerosis
(2) Drugs therapy
1- Local anesthetics e.g Lidocaine
It suppresses tinnitus due to its central effect (not
affecting the cochlea).
2- AntiAnti-anxiety e.g Diazepam , Lorazepam
It has beneficial effect on tinnitus , improve patient
emotional state and decrease anxiety .
3- AntiAnti-depressant e.g tricyclic
Improve sleep and improve feeling of well being .
4- VasodilatorsVasodilators- Ca channel blockers
10
(3) MASKER THERAPY
- Types of masker
1- simple masker device
2- hearing aid only
11