Tinnitus

Differential diagnosis

  • Acoustic neuroma
  • Menieres
  • Medications
  • Trauma
  • Anaemia
  • Loud noise
  • Idiopathic

 

Data gathering

  • Red flags – unilateral tinnitus, head/ear injury
  • Others – hearing loss, balance
  • Examine – Otoscopy, CN exam

 

Clinical management

  • Investigations
    • Bloods – FBC
    • Audiometry
  • Explanation
    • fairly common, ways to make it more manageable
  • Treatment
    • Self help www.tinnitus.org.uk
    • stop medications causing it
    • background noise
    • SSRI
  • Follow-up / Safety-net
    • refer to ENT

 

Cranial nerve examination

  • 1 – change in sense of smell or taste
  • 2/3/4/5 – change in vision, acuity, fields, reflexes, ophthalmoscopy, visual movements
  • 6 – sensation of face
  • 7 – face movements
  • 8 – whisper test
  • 9/10/12 – open mouth, stick tongue out, say ahh
  • 11 – Shrug shoulders, turn neck against resistance