Dr. Simon H. W. Wong Specialist in Otorhinolaryngology



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tarix25.03.2017
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Tinnitus

  • Subjective sensation of sound in the ear

  • Rarely objective

  • Associated with any form of ear disease

  • Idiopathic in 20%



Management Objective

  • Find cause

  • Treat cause

  • Treat symptom



Causes



History

  • Age

  • Duration

  • Frequency

  • Positional

  • Nasal symptoms

  • Hearing loss

  • Vertigo



Examination

  • Full ENT exam

  • Must see the ear drum

  • Always check nasopharynx

  • Audiometry



Microscopic Exam

  • Ear toilet

  • Wax hook, suction, forceps

  • Culture

  • Grommet insertion



Ear Wax Impaction



Otitis Externa

  • Suction clearance

  • Topical antibiotics

  • Ear wick

  • Pain relief



Fungal Otitis Externa



Fungal Otitis Externa

  • Repeated ear toilet

  • Clotrimazole ear drop

  • Oral Nystatin



Foreign Body



Otitis Media with Effusion



Adhesive OM



Chronic Suppurative Otitis Media

  • Suction clearance

  • Topical antibiotics

  • Antihistamines

  • Tympanoplasty



Cholesteatoma



Nasal Endoscopy



Nasopharyngeal Carcinoma

  • Biopsy

  • Tinnitus

  • Hearing loss

  • Epistaxis

  • Cervical LN



Impedance Tympanometry



Impedance Tympanometry



Pure Tone Audiometry



Pure Tone Audiometry

  • Down sloping SNHL

  • 4 kHz dip

  • Conductive HL

  • Low frequency SNHL: Meniere’s

  • Asymmetrical SHNL



Acoustic Neuroma

  • Schwannoma

  • Facial palsy or numbness

  • Gamma/X-knife

  • Surgery



Medical Management

  • Vasodilator: Betahistine, Ca2+ antagonist

  • Cerebral activator: Nicergoline (Sermion)

  • Almitrine : increase PaO2

  • Gingko



Medical Management

  • ? Vitamin B12

  • Sedatives

  • Maskers

  • Hearing aid



Medical Management

  • Self-help groups

  • Psychological counseling



Conclusion

  • Tinnitus treatable

  • Underlying cause

  • Treat symptom




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