Dr. Simon H. W. Wong Specialist in Otorhinolaryngology

• Dr. Simon H.W. Wong

• Specialist in Otorhinolaryngology

• 黃漢威耳鼻喉科專科醫生

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

• Outer, Middle or Inner?

• Central: Structural or Functional

• Systemic: Renal, anaemia

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

• Eustachian tube dysfunction

• Antihistamines

• Steroid nasal spray

Chronic Suppurative Otitis Media

• Suction clearance

• Topical antibiotics

• Antihistamines

• Tympanoplasty

Cholesteatoma

• Keratinized epithelium in middle ear

• Topical antibiotics

• CT scan

• Mastoidectomy

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