Page 1001 - TNFlipTest
P. 1001

 Toronto Notes 2019 Tinnitus
• facialnervepalsyandtrigeminal(V1)sensorydeficit(cornealreflex)arelatecomplications
• riskfactors:exposuretoloudnoise,childhoodexposuretolow-doseradiation,historyofparathyroid
adenoma
Diagnosis
• MRIwithgadoliniumcontrast(goldstandard)
• audiogram(toassessSNHL)
• poorspeechdiscriminationrelativetothehearingloss
• stapedialreflexabsentorsignificantreflexdecay
• ABR:increaseinlatencyofthe5thwave
• vestibulartests:normalorasymmetriccaloricweakness(anearlysign)
Treatment
• expectantmanagementiftumourisverysmall,orinelderly • definitivemanagementissurgicalexcision
• otheroptions:gammaknife,radiation
Tinnitus
Definition
• anauditoryperceptionintheabsenceofanacousticstimuli,likelyrelatedtolossofinputtoneuronsin central auditory pathways and resulting in abnormal firing
History
• subjectivevs.objective(seeFigure14,OT7)
• continuousvs.pulsatile(vascularinorigin)
• unilateralvs.bilateral
• associatedsymptoms:hearingloss,vertigo,auralfullness,otalgia,otorrhea
Investigations
• audiology • ifunilateral
■ ABR, gadolinium-enhanced MRI to exclude a retrocochlear lesion ■ CTtodiagnoseglomustympanicum(rare)
■ MRI or angiogram to diagnose arteriovenous malformation
• ifsuspectmetabolicabnormality:lipidprofile,TSH,zinclevels
Treatment
• ifacauseisfound,treatthecause(e.g.drainageofmiddleeareffusion,embolizationorexcisionof AVM)
• withnotreatablecause:50%willimprove,25%worsen,25%remainthesame
• avoidloudnoise,ototoxicmeds,caffeine,smoking
• tinnitusclinics
• identifysituationswheretinnitusismostbothersome(e.g.quiettimes),masktinnituswithsoftmusic
or “white noise”
• hearingaidifcoexistenthearingloss
• tinnitusinstrument:combineshearingaidwithwhitenoisemasker
• trialoftocainamide
Diseases of the External Ear
Cerumen Impaction
Etiology
• earwax:amixtureofsecretionsfromceruminousandpilosebaceousglands,squamesofepithelium, dust, and debris
Risk Factors
• hairyornarrowearcanals,in-the-earhearingaids,cottonswabusage,osteomata
Clinical Features
• hearingloss(conductive)
• ±tinnitus,vertigo,otalgia,auralfullness
Treatment
• waterorceruminolyticdrops(bicarbonatesolution,oliveoil,glycerine,Cerumenol®,Cerumenex®) • manualdebridement(byMD)
Otolaryngology OT15
    Cerumen impaction is the most common cause of CHL for those aged 15-50 yr
Syringing
Indications
• Totally occlusive cerumen with pain, decreased hearing, or tinnitus
Contraindications
• Active infection
• Previous ear surgery • Only hearing ear
• TMperforation
Complications
• Otitis externa • TMperforation • Trauma
• Pain
• Vertigo
• Tinnitus
• Otitis media
Method
• Establish that TM is intact
• Gently pull the pinna superiorly and
posteriorly
• Using lukewarm water, aim the syringe
nozzle upwards and posteriorly to irrigate the ear canal
    





























   999   1000   1001   1002   1003