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Tinnitus
Evaluation and management
Facts
• ‘Bewitched ear’,
‘ worm in the ear’
‘acoustic hallucination’
• Treatment remedies
for tinnitus date back to the er...
Definition
• Tinnitus is the description of a noise inside
a person’s head in the absence of auditory
stimulation.
• Tinni...
Types of tinnitus
Causes
• Ear problems
• Neurological disorders
• Psychiatric disorders
• Metabolic disorders
• Miscellaneous
Category Conditions Associated
Ear
Problems
Conductive : otitis externa, acoustic shock, noise induced,
cerumen impaction,...
Evaluation
• Diagnosis
• Severity
• Auditory Evoked Responses
• Diagnosis
– Subjective vs Objective ??
• Severity
– Validated self report
questionnaires
• AERs
Management
• Modes
– Psychotherapy and Reassurance
– Relaxation and biofeedback techniques
– Sedation and pharmacotherapy
...
• Psychotherapy and reassurance
First line therapy for patients with subjective form.
Psychological counselling may help.
...
• Pharmacotherapy
– Acute tinnitus
• Systemic Delivery
– Corticosteroids
– Rheological therapy
– Nootropics
– Lidocaine
• ...
• Others
– Misoprostol
– Betahistine
– Nimlodipine
– Furosemide
– Pramipexole
– Zinc
– Vitamin tablets
– Antihistamines
– ...
Other modalities of treatment
• HBO therapy
• Sound therapy devices
• Tinnitus retraining therapy
– Maskers
– Noise Genera...
Recent Advances
• Acoustic Coordinated Reset
Neuromodulation
• Magnetic and Electrical Brain stimulation
Thank You
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Tinnitus is a symptom commonly referred to as ringing sensation in the ears which is associated with a variety of disease conditions.

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Tinnitus

  1. 1. Tinnitus Evaluation and management
  2. 2. Facts • ‘Bewitched ear’, ‘ worm in the ear’ ‘acoustic hallucination’ • Treatment remedies for tinnitus date back to the era of Aristotle who proposed masking tinnitus with an external stimulus as a remedy
  3. 3. Definition • Tinnitus is the description of a noise inside a person’s head in the absence of auditory stimulation. • Tinnitus is not a disease, but a condition that can result from a wide range of underlying causes.
  4. 4. Types of tinnitus
  5. 5. Causes • Ear problems • Neurological disorders • Psychiatric disorders • Metabolic disorders • Miscellaneous
  6. 6. Category Conditions Associated Ear Problems Conductive : otitis externa, acoustic shock, noise induced, cerumen impaction, middle ear effusion, superior canal dehiscence Sensorineural : Noise induced, presbycusis, Ménière's disease, acoustic neuroma, mercury or lead poisoning, Ototoxic medications Neurological Conditions Arnold–Chiari malformation, multiple sclerosis, head injury ( skull fracture, closed head injury, whiplash injury, temporomandibular joint dysfunction, giant cell arteritis ) Metabolic disorders Thyroid disease, Hyperlipidemia, vitamin B12 deficiency, iron deficiency anemia Psychiatric disorders Depression, Anxiety Miscellaneous Fibromyalgia, vasculitis, hypertonia, thoracic outlet syndrome, Lyme disease, migraine, glomus tumor, anthrax vaccines, Some psychedelic drugs, benzodiazepine withdrawal, nasal congestion, intracranial hyper or hypotension
  7. 7. Evaluation • Diagnosis • Severity • Auditory Evoked Responses
  8. 8. • Diagnosis – Subjective vs Objective ?? • Severity – Validated self report questionnaires • AERs
  9. 9. Management • Modes – Psychotherapy and Reassurance – Relaxation and biofeedback techniques – Sedation and pharmacotherapy – Masking manouvers and devices
  10. 10. • Psychotherapy and reassurance First line therapy for patients with subjective form. Psychological counselling may help. • Biofeedback techniques Biofeedback is a relaxation technique that teaches people to control certain autonomic body functions, such as pulse, muscle tension, and skin temperature. The goal of biofeedback is to help people manage stress in their lives not by reducing the stress but by changing the body’s reaction to it.
  11. 11. • Pharmacotherapy – Acute tinnitus • Systemic Delivery – Corticosteroids – Rheological therapy – Nootropics – Lidocaine • Local Therapy – Topical Corticosteroids – Chronic tinnitus • Antidepressants • Anticonvulsants • Glutamate receptor antagonists (Caroverine)
  12. 12. • Others – Misoprostol – Betahistine – Nimlodipine – Furosemide – Pramipexole – Zinc – Vitamin tablets – Antihistamines – Antioxidants ( Ginkgo biloba ) – Botulinum toxin and so on…….
  13. 13. Other modalities of treatment • HBO therapy • Sound therapy devices • Tinnitus retraining therapy – Maskers – Noise Generators – Hearing Aids – Tinnitus instruments • Cognitive Behavior therapy • Music Therapy
  14. 14. Recent Advances • Acoustic Coordinated Reset Neuromodulation • Magnetic and Electrical Brain stimulation
  15. 15. Thank You
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Tinnitus is a symptom commonly referred to as ringing sensation in the ears which is associated with a variety of disease conditions.

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