Tinnitus

PRECAUTIONS

• Exclude wax, drugs incl. marijuana, NSAIDs incl. aspirin, antidepressants, quinine, vascular disease, venous hum (jugular vein), Ménière syndrome, alcohol, depression, aneurysm, acoustic neuroma and vascular tumours

• Beware of lonely elderly people living alone (suicide risk)

Note: Otosclerosis in young adults causes tinnitus and deafness.

INVESTIGATIONS

• Audiological examination by audiologist

• Tympanometry and speech discrimination

• MRI (if serious cause suspected or head injury)

Management

• Treat any underlying cause and aggravating factors, esp. ear wax

• Educate and reassure the patient/counselling

Holistic approach to minimise symptoms (options)

• Relaxation techniques

• Cognitive behaviour therapy

• Background ‘noise’ (e.g. music playing during night) or

• Tinnitus maskers or

• Hearing aids (based on audiological assessment)

• Tinnitus retraining therapy

• Refer to: www.tinnitus.asn.au

Drug trials to consider (limited efficacy)

• Clonazepam 0.5 mg nocte

• Minerals (e.g. zinc and magnesium)

ACUTE SEVERE TINNITUS

Slow IV injection of 1% lignocaine. Up to about 5 mL can be very effective.

Those for investigation

• Asymmetrical with hearing loss (?acoustic neuroma)

• True pulsatile tinnitus

• Severe hearing loss