Patient will present as→ a 70-year-old female who states that her children and grandchildren have asked her to seek medical attention as she seems to be losing her hearing. She also describes an occasional ringing, buzzing, and hissing sound. She is in generally good health and her only medications are a multivitamin along with calcium and vitamin D. You examine her ears and find the external auditory canals to be free of cerumen and the tympanic membranes to be normal in appearance.
Tinnitus is a noise in the ears. It is experienced by 10 to 15% of the population; often described as a ringing, hissing, buzzing, or whooshing.
- You have to understand the underlying cause:
- 90% is associated with sensorineural hearing loss: caused by loud noise, presbycusis (as in the patient case presentation), medications (Aspirin, Antibiotics, Aminoglycosides, loop diuretics and CCBs), Meniere's disease, and acoustic neuroma.
- 5% vascular: Carotid stenosis.
- 5% mechanical abnormalities: TMJ
Continuous tinnitus: presbycusis or long-term hearing loss
Episodic, low-pitched, rumbling tinnitus: Meniere disease
Pulsatile tinnitus: vascular cause
All patients with significant tinnitus should be referred for comprehensive audiologic evaluation to determine the presence, degree, and type of hearing loss.
- In patients with unilateral tinnitus and hearing loss, acoustic neuroma should be ruled out by gadolinium-enhanced MRI
- In patients with unilateral tinnitus and normal hearing and physical examination, MRI is not necessary unless tinnitus persists > 6 mo
No pharmacologic agent has been shown to cure or consistently alleviate tinnitus
- The goal is to try to identify the cause, i.e remove ototoxic medications, hearing aids.
oral steroids on an as-needed basis
Ménière disease is a disorder associated with an increased endolymph within the cochlea and labyrinth. The precise pathogenesis is unknown, but evidence suggests an inability to regulate the volume, flow, and composition of endolymph. Oral steroids are of no benefit, but intratympanic steroid injections performed by an otolaryngologist may provide relief.
symptomatic care with antihistamines and diuretics
topical antibiotic drops for 7 days
The etiology of Ménière disease is not infectious, and there is no role for antimicrobial therapy orally or topically.
vestibular suppressant medication until symptoms subside
Vestibular suppressant medication is indicated for labyrinthitis or benign positional vertigo, not Ménière disease.
Infection (otitis media)
Chronic use of salicylates
Sensorineural hearing loss
Benign positional vertigo