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

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Presentation on theme: "Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生."— Presentation transcript:

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

3 Management Objective Find cause Find cause Treat cause Treat cause Treat symptom Treat symptom

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

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

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

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

8 Ear Wax Impaction

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

10 Fungal Otitis Externa

11 Repeated ear toilet Repeated ear toilet Clotrimazole ear drop Clotrimazole ear drop Oral Nystatin Oral Nystatin

12 Foreign Body

13 Otitis Media with Effusion

14 Adhesive OM Eustachian tube dysfunction Eustachian tube dysfunction Antihistamines Antihistamines Steroid nasal spray Steroid nasal spray

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

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

17 Nasal Endoscopy

18 Nasopharyngeal Carcinoma Biopsy Biopsy Tinnitus Tinnitus Hearing loss Hearing loss Epistaxis Epistaxis Cervical LN Cervical LN

19 Impedance Tympanometry Eustachian Tube Dysfunction Middle Ear Effusion

20 Impedance Tympanometry

21 Pure Tone Audiometry

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

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

24 Medical Management Vasodilator: Betahistine, Ca 2+ antagonist Vasodilator: Betahistine, Ca 2+ antagonist Cerebral activator: Nicergoline (Sermion) Cerebral activator: Nicergoline (Sermion) Almitrine : increase PaO 2 Almitrine : increase PaO 2 Gingko Gingko

25 Medical Management ? Vitamin B12 ? Vitamin B12 Sedatives Sedatives Maskers Maskers Hearing aid Hearing aid

26 Medical Management Self-help groups Self-help groups Psychological counseling Psychological counseling

27 Conclusion Tinnitus treatable Tinnitus treatable Underlying cause Underlying cause Treat symptom Treat symptom


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