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

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 Eustachian Tube Dysfunction Middle Ear Effusion

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