= Perception of sounds in the head, ears or around the head in the absence of external sound stimulus. It can be associated with hearing loss or be idiopathic. It is often characterised by a buzzing, ringing, roaring, whistling or hissing noise. The sounds can be intermittent, continuous, or pulsatile. It is thought to be due to a misinterpretation of the signals in the brain, arising in the central auditory pathways. The misinterpreted signals can occur in any part of the auditory system: ie the cochlear, auditory nerve or within the brain itself.

Tinnitus can arise as a symptom of nearly all ear disorders e.g. infections, meniere’s disease, ototoxicity due to side effects of medications (such as Salicylates, Aspartame (NutraSweet), Aminoglycosides, Quinine, Loop diuretics, alcohol, heavy metals), cardiovascular disease (e.g. hypertension, aneurysms), anaemia, hypothyroidism or noise-induced hearing loss and head trauma.

Patients with tinnitus require evaluation with the minimum comprehensive audiologic assessment, CT of the temporal lobe and MRI of the head. If a sensorineural hearing loss is detected, tests to differentiate between sensory and neural hearing losses are indicated.

Referal to an ENT specialist is needed to eliminate retrocochlear pathology if tinnitus is unilateral.

Treatment :

Evidence of benefit for most treatments is not substantial. The underlying disease should be identified and corrected. Hearing aids may suppress the tinnitus by increasing awareness of surrounding ambient noise. Cognitive therapy, relaxation techniques and sound therapy can also be used. Relief may be obtained by playing background music to mask the tinnitus.

TCA’s – Tricyclic antidepressants may offer some benefit, factors limiting their use is their side effect profile and these are increased for elderly patients.

References: AMH 2010, Oxford handbook of general practice, Merck Manual 17^th Edition, www.australianprescriber.com

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(Vestibular neuronitis) = Inflammation of the inner ear (vestibular nerve).

Labyrinthitis can bring upon hearing loss and tinnitus. Usually caused by a  viral infection, often follows an upper respiratory tract infection. It can also occur from a bacterial infection, allergy, head injury, extreme stress or an adverse effect of a medication.

It is generally a self-limiting condition. Symptoms may include severe onset of vertigo, nausea and vomiting, prostration, nystagmus, normal tympanic membrane. Acute attacks may be treated as for meniere’s disease. Continual vomiting may require IV fluids.

Duration of condition usually resolves within 2-3 weeks. If it persists for > 6 weeks, need to refer.

Treatment  includes:

-        Bed rest, vestibular sedatives such as cyclizine or prochlorperazine anti-emetics in the first 24-72 hours.

-        Vestibular adaptation exercises/rehabilitation in recovery phase.

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