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Pulsatile Tinnitus, Tonal Tinnitus, and Hyperacusis
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
9 sections · 132 slides
Definitions and epidemiology
- Definition of tinnitus
- Burden of tinnitus
- Definition of hyperacusis
- Epidemiology of tinnitus
- Demographic pattern of tinnitus
- Subjective and objective tinnitus
- Tonal and pulsatile tinnitus defined
Pulsatile tinnitus
- Clinical features of pulsatile tinnitus
- Auscultation with the Toynbee stethoscope
- Subtypes of objective tinnitus
- Muscular tinnitus
- Typewriter tinnitus
- Typewriter tinnitus versus middle ear myoclonus
- Proposed mechanisms of pulsatile tinnitus
- Arterial causes of pulsatile tinnitus
- Further arterial and high-flow causes
- Venous causes of pulsatile tinnitus
- Vascular relations of the temporal bone
- Non-vascular causes of pulsatile tinnitus
- Causes of pulsatile tinnitus
- Causes of pulsatile tinnitus (continued)
Diagnosis of pulsatile tinnitus
- Diagnostic framework for pulsatile tinnitus
- Vessel compression manoeuvres
- Physical exam findings which can differentiate venous from arterial pulsatile tinnitus (PT)
- Carotid duplex ultrasound with spectral waveform
- Computed tomography angiography as first-line imaging
- Computed tomography angiography of the head
- Four-vessel cerebral angiography
- Lateral catheter cerebral angiogram
- Risks of vascular imaging
- Imaging strategy for bilateral pulsatile tinnitus
- Idiopathic intracranial hypertension
- Venous mechanism of tinnitus in intracranial hypertension
- Superior semicircular canal dehiscence
- Treatment principles in pulsatile tinnitus
- Pentoxifylline in pulsatile tinnitus
- Interventional treatment of pulsatile tinnitus
Tonal tinnitus
- Definition of tonal tinnitus
- Etiological categories in tonal tinnitus
- Confounders in tinnitus research
- Neural hyperactivity in the dorsal cochlear nucleus
- Discordant dysfunction theory
- Structure of the cochlea and organ of Corti
- Innervation of the inner and outer hair cells
- Evidence against a single pathway
- Other implicated regions and transmitters
- Role of the limbic system
- Limbic structures implicated in tinnitus distress
Evaluation of the tinnitus patient
- AAO-HNS clinical practice guideline
- Focused history in tinnitus
- Medical, drug and psychosocial history
- Validated tinnitus questionnaires
- Physical examination in tinnitus
- Indications for comprehensive audiological evaluation
- Components of the audiological evaluation
- Pure-tone audiogram showing mixed hearing loss
- Indications for imaging in tonal tinnitus
Treatment of tonal tinnitus
- Treatment escalation in tonal tinnitus
- Counselling and reassurance
- Natural history and dietary modification
- Drug-related tinnitus
- Hearing aids in tinnitus
- Behind-the-ear hearing aid with earmould
- Masking therapy and residual inhibition
- Limitations of masking
- Jastreboff neurophysiological model
- Components of tinnitus retraining therapy
- Sound therapy within retraining therapy
- Evidence for tinnitus retraining therapy
- Tinnitus Retraining Therapy Trial 2019
- Cognitive behavioural therapy
- Principles of pharmacological therapy
- Antidepressants in tinnitus
- Anxiolytics in tinnitus
- Gabapentin in tinnitus
- Transtympanic therapy
- Investigational intratympanic agents
- Complementary and integrative approaches
- Melatonin
- B-complex vitamins and cobalamin
- Zinc
- Ginkgo biloba and EGb 761
- Ginkgo biloba leaves
Procedural interventions
- Rationale for procedural intervention
- Cochlear implantation and tinnitus
- Cochlear implant internal components
- Cochlear nerve section
- House and Brackmann nerve section series
- Direct electrical stimulation of the auditory cortex
- Deep brain stimulation
- Vagal nerve stimulation with paired tones
- Bimodal auditory and non-auditory stimulation
Hyperacusis
- Hyperacusis defined
- Epidemiology of hyperacusis
- Conditions associated with hyperacusis
- Central gain model
- Serotonergic dysfunction and Williams syndrome
- Diagnostic evaluation of hyperacusis
- Uncomfortable loudness levels
- Hyperacusis questionnaires
- Counselling and the earplug paradox
- Tinnitus retraining therapy for hyperacusis
- Randomised evidence in hyperacusis
- Further therapeutic options in hyperacusis
- Summary of key points
- Practice points for the clinic
References
- References
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- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
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