What is Tinnitus?
Tinnitus is a condition in which a human ear gets perception of sound in the absence of external stimuli. Tinnere – means “ringing” in Latin and it includes Buzzing, roaring, clicking, pulsatile sounds. It can result from myriad causes like neurological damage (commonly known as multiple sclerosis), oxidative stress and ear infections.
Some of its features:
* May be perceived as unilateral or bilateral
* Originating in the ears or around the head
* First or only symptom of a disease process or auditory/psychological annoyance
It can be felt in both or single ear and in the head and the resulting voice has been explained by patients in many various ways. Most say it is a buzzing noise, while others say it takes the form of a whining noise or whistling noise. Then there are other people who explain it as a humming, buzzing, or hissing sound.
Some say it reminds them roaring, and even tree frogs or cricket. At some events tinnitus happen occasionally while for others it can be nonstop which can be very worrying and some conditions has led to informed events of suicide. Some persons can vary the sternness of the anxiety by moving their head, shoulders, jaw, tongue, or even by eyes moving.
Hearing failure is a by item of tinnitus and most persons with the problem suffer different degrees of hearing injury. The power of sound heard may vary, on the mild area, from a silent background sound to the other side of the band as something that can be heard over noisy outside noise.
Types of Tinnitus. There are Four types:
1) Objective tinnitus – sound produced by para-auditory structures which may be heard by an examiner.
2) Subjective tinnitus – sound is only perceived by the patient (which is most common).
3) Pulsatile tinnitus – matches pulse or a rushing sound
* Possible vascular etiology
* Either objective or subjective
* Increased or turbulent blood flow through para-auditory structures
4) Objective -Pulsatile tinnitus
a) Arteriovenous malformations:
Congenital lesions
Occipital artery and transverse sinus, internal carotid and vertebral arteries, middle meningeal and greater superficial petrosal arteries
Mandible
Brain parenchyma
Dura
Pulsatile tinnitus
Headache
Papilledema
Discoloration of skin or mucosa
b) Vascular tumors
i) Glomus tympanicum
Paraganglioma of middle ear
Pulsatile tinnitus which may decrease with ipsilateral carotid artery compression
Reddish mass behind tympanic membrane which blanches with positive pressure
Conductive hearing loss
ii) Glomus jugulare
c) Paraganlioma of jugular fossa
d) Pulsatile tinnitus
e) Conductive hearing loss if into middle ear
f) Cranial neuropathies
g) Venous hum, also known as Benign intracranial hypertension
Young, obese, female patients
Hearing loss
Aural fullness
Dizziness
Headaches
Visual disturbance
Papilledema, pressure >200mm H20 on LP
Sismanis and Smoker 1994
100 patients with pulsatile tinnitus
42 found to have BIH syndrome
16 glomus tumors
15 atherosclerotic carotid artery disease
h) Dehiscent jugular bulb
i) Transverse sinus partial obstruction
j) Increased cardiac output from
** Pregnancy
** Thyrotoxicosis
** Anemia
k) Atherosclerosis
l) Ectopic carotid artery
m) Persistent stapedial artery
n) Dehiscent jugular bulb
o) Vascular loops
p) Benign intracranial hypertension (BIH Syndrome)