1. Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生
Management of Tinnitus
Dr. Simon H.W. Wong
Specialist in Otorhinolaryngology
黃漢威耳鼻喉科專科醫生

2. Tinnitus Subjective sensation of sound in the ear Rarely objective
Associated with any form of ear disease
Idiopathic in 20%

3. Management Objective
Find cause
Treat cause
Treat symptom

4. Causes Outer, Middle or Inner? Central: Structural or Functional
Systemic: Renal, anaemia

5. History Age Duration Frequency Positional Nasal symptoms Hearing loss
Vertigo

6. Examination Full ENT exam Must see the ear drum
Always check nasopharynx
Audiometry

7. Microscopic Exam Ear toilet Wax hook, suction, forceps Culture
Grommet insertion

8. Ear Wax Impaction

9. Otitis Externa Suction clearance Topical antibiotics Ear wick
Pain relief

10. Fungal Otitis Externa

11. Fungal Otitis Externa Repeated ear toilet Clotrimazole ear drop
Oral Nystatin

12. Foreign Body

13. Otitis Media with Effusion

14. Adhesive OM Eustachian tube dysfunction Antihistamines
Steroid nasal spray

15. Chronic Suppurative Otitis Media
Suction clearance
Topical antibiotics
Antihistamines
Tympanoplasty

16. Cholesteatoma Keratinized epithelium in middle ear Topical antibiotics
CT scan
Mastoidectomy

17. Nasal Endoscopy

18. Nasopharyngeal Carcinoma
Biopsy
Tinnitus
Hearing loss
Epistaxis
Cervical LN

19. Impedance Tympanometry
Eustachian Tube Dysfunction
Middle Ear Effusion

20. Impedance Tympanometry

21. Pure Tone Audiometry

22. Pure Tone Audiometry Down sloping SNHL 4 kHz dip Conductive HL
Low frequency SNHL: Meniere’s
Asymmetrical SHNL

23. Acoustic Neuroma Schwannoma Facial palsy or numbness Gamma/X-knife
Surgery

24. Medical Management Vasodilator: Betahistine, Ca2+ antagonist
Cerebral activator: Nicergoline (Sermion)
Almitrine : increase PaO2
Gingko

25. Medical Management
? Vitamin B12
Sedatives
Maskers
Hearing aid

26. Medical Management
Self-help groups
Psychological counseling

27. Conclusion
Tinnitus treatable
Underlying cause
Treat symptom