tinnitus presentasi
TRANSCRIPT
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MANAGEMENT OFTINNITUS
By : Dina Riana
Supervised : dr. Sally Mahdiani, Mes, Sp.T!T. "# ,
$
#ITERATUR READINGAUDIO#OGI
DE%ARTEMEN I#MU "ESE!ATAN TE#INGA !IDUNG TENGGORO"BEDA! "E%A#A DAN #E!ER RS!S & F" UN%AD BANDUNG
'($)Sa*al+, TR. Sa*al+,-. !asha,
M. Tinni*us. In Sa*al+, TR.Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
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Sa*al+, TR. Sa*al+,-. !asha, M. Tinni*us. In Sa*al+, TR. Sa*al+,-. !earin/ #+ss. 0*h ed. Mar1el Deer In1,Ne 2+r. $330. p400544.
Tinni*us, +r *heper1ep*i+n +6s+und in *he
a7sen1e +6 ane8*ernal audi*+ry
s+ur1e
A 1+99+npa*ien*
1+9plain* in+*+laryn/+l+/i1
pra1*i1es.
up *+ )( 9illi+nadul*s in *he US,i*h $ 9illi+n
e8perien1in/6re;uen* +r
1hr+ni1 *inni*usin *he pri+r $'
9+n*hs
N+n pulsa*ile &pulsa*ile *inni*us
< su7=e1*ive &+7=e1*ive *inni*usare 1ri*i1al in *he
appr+pria*edia/n+sis and9ana/e9en*
INTRODU>TION
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Sa*al+, TR. Sa*al+,-. !asha,
M. Tinni*us. In Sa*al+, TR.Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
0
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>ara1*eris*i1s
*inni*uspulsa*il
n+npulsa*ile
4Sa*al+, TR. Sa*al+,-. !asha, M. Tinni*us. In Sa*al+, TR. Sa*al+,-. !earin/ #+ss. 0*h ed. Mar1el Deer In1,Ne 2+r. $330. p400544.
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)
Tinni*
uspulsa*i6
F+ll+in/hear*7ea*
?en+us i*h
@h++sin/s+und
Rhy*9i1i*h *hepa*ien*s
pulse
M+died 7ye8*ernal
9+ve9en*s,+r1han/e inp+si*i+n
Sa*al+, TR. Sa*al+,-. !asha, M. Tinni*us. In Sa*al+, TR. Sa*al+,-. !earin/ #+ss. 0*h ed. Mar1el Deer In1,Ne 2+r. $330. p400544.
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*inni*us
+7=e*i6
A7le *+ 7e
heard 7ypa*ien* ande8a9iner
?as1uar7rui*s,vas1ular*u9+r,pala*al*ens+r *i9pani
9y+1l+nus
su7=e*i6
!ard +nly
7y *hepa*ien*s
Sa*al+, TR. Sa*al+,-. !asha,
M. Tinni*us. In Sa*al+, TR.Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
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!+ *+ dia/n+sedC
Sa*al+, TR. Sa*al+,-. !asha, M. Tinni*us. In Sa*al+, TR. Sa*al+,-. !earin/ #+ss. 0*h ed. Mar1el Deer In1,Ne 2+r. $330. p400544.
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!is*+ry
Sa*al+, TR. Sa*al+,-. !asha,
M. Tinni*us. In Sa*al+, TR.Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
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%!2SI>A#EAMINATION
3
Sa*al+, TR. Sa*al+,-. !asha,
M. Tinni*us. In Sa*al+, TR.Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
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DIAGNOSTI> E?A#UATION
Sa*al+, TR. Sa*al+,-. !asha, M. Tinni*us. In Sa*al+, TR. Sa*al+,-. !earin/ #+ss. 0*h ed. Mar1el Deer In1,Ne 2+r. $330. p400544. $(
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SUB-E>TI?E NON%U#SATI#E
TINNITUS
Noise-induced hearing loss, presbyacusis,
ototoxic medications, labyrinthitis, herpes zoster
oticus, Meniere's disease, and genetic hearing losses cause
inner ear hair cell damage resulting in hearing loss, which
can lead to nonpulsatile tinnitus. Chronic otitis media.
cholesteatoma, canal occlusion, and otosclerosis can cause
a conductive hearing loss that ultimately may result in tinnitus.
Lesions that aect the cochlear nerve and central
nervous system !CN"# such as acoustic neuroma, meningioma,
multiple sclerosis, and Charcot-Marie-$ooth disease
can also induce tinnitus, typically along with a coincident
hearing loss !%ig. &&.&, $able &&..Sa*al+, TR. Sa*al+,-. !asha,
M. Tinni*us. In Sa*al+, TR.Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
$$
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Ris 6a1*+r
The 9+s* prevalen* ris 6a1*+r 6+rsu7=e1*ive, n+npulsa*ile *inni*us ishearin/ l+ss.
Fre;uen*ly *his hearin/ l+ss in1ludessi/ni1an* sens+rineural l+sses a*hi/her 6re;uen1ies
' +6 pa*ien*s i*h pr+6+undsens+rineural hearin/ l+ss HSN!# illn+* have *inni*us.
Sa*al+, TR. Sa*al+,-. !asha, M. Tinni*us. In Sa*al+, TR. Sa*al+,-. !earin/ #+ss. 0*h ed. Mar1el Deer In1,Ne 2+r. $330. p400544. $'
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Su7=e1*ive N+npusa*ile*inni*us
The+ries +6 /enera*i+n +6 n+npulsa*ile*inni*us: (( speciically the role o certaincochlear structures such as outer hair cells.
observations that sub)ective nonpulsatile tinnitusis re*uently seen in individuals with measurable
hearing loss or ollowing +nown ototoxic in)uries.
!such as ototoxic medication exposure. noiseexposure,head in)ury#.
Sa*al+, TR. Sa*al+,-. !asha, M. Tinni*us. In Sa*al+, TR. Sa*al+,-. !earin/ #+ss. 0*h ed. Mar1el Deer In1,Ne 2+r. $330. p400544. $0
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E*i+l+/i 1+1hle+/eni1 J %ersis*en1e +6*inni*us 6+ll+in/ *run1a*i+n +6 *he audi*+rynerve +r a7la*i+n +6 *he 1+1hlea
Many studies have noted a decrease in inhibitory neural
input at multiple sites along the central auditory
pathways,including the dorsal cochlear nucleus .
This leads to a net increase in excitatory signaling in
the auditory pathway and hasbeen proposed as the
neurophysiologic basis or sub)ective tinnitus.Sa*al+, TR. Sa*al+,-. !asha,
M. Tinni*us. In Sa*al+, TR.Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
$4
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Meniere disease
>+ndu1*ive +r 9i8ed hearin/ l+ss 1anals+ 7e ass+1ia*ed i*h *inni*us,in1ludin/ *ha* 1aused 7y +*+s1ler+sis,+ssi1ular dis1+n*inui*ies, +r+7s*ru1*i+n +6 *he e8*ernal audi*+ry
1anal 7y 1eru9en +r +*her 6a1*+r. caeine, aspirin, ibuproen, and nicotine can
cause tinnitus and head in)ury.Sa*al+, TR. Sa*al+,-. !asha, M. Tinni*us. In Sa*al+, TR. Sa*al+,-. !earin/ #+ss. 0*h ed. Mar1el Deer In1, Ne
2+r. $330. p400544. $)
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$
Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.
Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
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$
Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.
Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
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E*i+l+/i1 6a1*+rs in su7=e1*ive *inni*us
Neurologic abnormalitiesSull 6ra1*ure +r 1l+sed head
*rau9aKhiplash in=uryMul*iple s1ler+sisMenin/i*i1 ee1*s
Pharmacologic factorsAspirin 1+9p+undsNSAIDA9in+/ly1+sides!eavy 9e*als
Psychologic factors Depressi+n
An8ie*y
MeniereLs diseaseO*+s1ler+sis
Otologic factors%res7y1usisN+ise5indu1ed hearin/ l+ss
Metabolic function!yp+*hyr+idis9!yper*hyr+idis9!yperlipide9ia
in1 de1ien1y?i*a9in de1ien1y
Dental factorsTM- syndr+9e
$. Sa*al+, TR. Sa*al+,-. !asha, M. Tinni*us. In Sa*al+, TR. Sa*al+,-. !earin/ #+ss. 0*h
ed. Mar1el DeerIn1, Ne 2+r. $330. p400544. $
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Dia/n+s*i1 Evalua*i+n
Sa*al+, TR. Sa*al+,-. !asha, M. Tinni*us. In Sa*al+, TR. Sa*al+,-. !earin/ #+ss. 0*h ed. Mar1el Deer In1,
Ne 2+r. $330. p400544. $3
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Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.
Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
'(
pa*ien*s i*h unila*eral *inni*us 9ay have aves*i7ular s1hann+9a +r +*her in*ra1ranialan+9aly re;uirin/ 6ur*her *rea*9en* HFi/.
$$.$ .
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TREATMENT
AM%#IFI>ATION
Use +6 a ell5**ed hearin/ aid, *ha* in1lude a ide,hi/h56re;uen1y a9pli1a*i+n 7and and +pen ear 9+ld.
Open 9+uld de1rease +1lusi+n ee1* and e8*end
a9pli1a*i+n a* hi/er 6reen1ies. Ideal hearin/ aid se**in/ 6+r pa*ien*s i*h hearin/ l+ss
and *inni*us !earin/ aid in1rese *he a97ien* n+ise per1eived 7y *he
pa*ien*s,*hus 9asin/ *he *inni*us.
TINITUS
MAS"ING
N+npulsa*ile and pulsa*ile *inni*us s+unds 1an
s+9e*i9es 7e 1+vered H+r 9ased 7y e8*ernal s+unds,*hus 7l+1in/ *he *inni*us per1ep* and *he unpleasan*sensa*i+ns ass+1ia*ed i*h *hese s+unds.
F+r 9any pa*ien*s, use +6 envir+n9en*al s+unds su1has a n+ise /enera*+r +r radi+ 1an ee1*ively andine8pensively 9as *heir *inni*us.
The addi*i+n +6 9asin/ *+nes *+ a9pli1a*i+ns 6r+9 ahearin/ aid 1an 9as *inni*us s+unds 9+re ee1*ivdy*han a hearin/ aid al+ne.
Residual inhi7i*i+n is hyp+*hesied *+ resul* 6r+9inhi7i*i+n +6 syn1hr+n+us a1*ivi*y i*hin *he audi*+*ypa*hay
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TINITUS RETRAININGTERAP!"at meminimalisir
TRT is base# on the conce"tthat habituation to theun"leasant stimulus canminimi$e the reactions thatthese "atients e%"erience&TRT #oes not see' tore#uce "ro#uction of thetinnitus soun# but instea#attem"ts to change thelin'age bet(een thetinnitus "erce"tion an#
autonomic an# limbic systemsusing e%tensi)e counselingan# soun# thera"i&
Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.
Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
''
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NEUROMONI*S Uses soun# thera"y& e%tensi)etinnitus e#ucation+ an# cogniti)ethera"y to treat "atients (ithtinnitus& Patients begin their
thera"y by listening to"re"rocesse# mi%e# ,calmingmusic- .a combination of baro/uean# ne( age0 combine# (ith noisemi%e# by "ro"rietary algorithm for1 to 2 hours #aily&
>O>!#EAR IM%#ANTATION 9+dera*e *+ severe *inni*us 1+1hleari9plan*
%!ARMA>OT!ERA%!2 in1ludin/ anes*he*i1 a/en*s HI?lid+1aine, an*i1+nvulsan*s,an*idepressan*s, an*ihis*a9ines,
7en+diaepines, diure*i1, GABAa/+nis*s HBa1l+6en, Gin+ 7il+7a,e8*ra1*s, his*a9ine,. s*er+ids, andvi*a9ins.
MI>RO?AS>U#ARDE>OM%RSION
9i1r+vas1ular de1+9pressi+n +6 *heves*i7ul+1+1hlear nerve su//es* sur/i1al
*rea*9en* +6 vas1ular l++p syndr+9e '0
Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.
Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
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Sa*al+, TR. Sa*al+,-. !asha, M. Tinni*us. In Sa*al+, TR. Sa*al+,-. !earin/ #+ss. 0*h ed. Mar1el Deer In1,Ne 2+r. $330. p400544.
'4
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PU3SATI3E TINNITUS
')
Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.
Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
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Sa*al+, TR. Sa*al+,-. !asha, M. Tinni*us. In Sa*al+, TR. Sa*al+,-. !earin/ #+ss. 0*h ed. Mar1el Deer In1,Ne 2+r. $330. p400544. '
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A
'Sa*al+, TR. Sa*al+,-. !asha, M. Tinni*us. In Sa*al+, TR. Sa*al+,-. !earin/ #+ss. 0*h ed. Mar1el Deer In1,Ne 2+r. $330. p400544.
4ascular anomalies
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4ascular anomalies
An+9ales +6 *he=u/ular7ul7
*he =u/ular 7ul7represen*s *he =un1*i+n7e*een *he pr+8i9alin*ernal =u/ular vein and
*he si/9+idsinus a* *he sull 7ase.
+7se99+n *+ s/i1al+r end+vas1ularin*erven*i+n. %u7lishedrep+r*s desai7e
su11e6ull i9pr+ve9en*+r eli9ina*i+n +6pulsa*ile *inni*us i*h9iddle ear ++rre1+ns*ru1*i+n, =u/ularvein li/a*i+n, and
endO2asO-iar ++ilE97+lia*i+n
Sigmoid SinusDiverticulum
'(+6 1ases +6 pulsa*ile*innis +ri/ina*in/ 6r+9a ven+usS+ur1e. hyp+*hesied*ha* *u:r7ulen*7l++d i*hin *he si/9+idsinus 9ay lead *+er+si+n +6 *he+verlyin/ 9as*+id 7+nei*h devel+p9en* +6 a
Su11ess6ul eli9ina*i+n +6pulsa*ilesy9p*+9s has 7eenrep+r*ed i*h*rans9as*+idre1+ns*ru1*i+n+6 *he si/9+id all andi*h end+vas1ular 1+ile97+lia*i+n ands*en*in/.
Sa*al+, TR. Sa*al+,-. !asha, M. Tinni*us. In Sa*al+, TR. Sa*al+,-. !earin/ #+ss. 0*h ed. Mar1el Deer In1,Ne 2+r. $330. p400544.
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Dural ArteriovenousMalformation/F'IStula
A?M&F 9ay 7e1+n/eni*al +r a1;uired,i*hsy9p*+9s pre1ipi*a*ed
7y *rau9a, in6e1*i+n,pu7er*y,+r pre/nan1y , pulsa*ile*inni*us, heada1he,neur+l+/i11+9pr+9ise, +r
in*ra1ranial he9+rrha/e
Trea*9en* 9+dali*iesin1lude end+vas1ulare97+lia*i+n, s/i1ale8.1isi+n +6 *he :s*ula .
Atherosderotic CarotidArtel)' Disease
Tinnis 9ay resul* 6r+9i9pair9en* +6 *he innerear9i1r+1ir1ulla*i+n due *+a*her+s1ler+*i1 disease+r 6r+9 *here6erred s+und +6*ur7ulen* + *hr+u/hs1ler+*i1 1ar+*idar*eries. In*ravas1ular*u:r7ulen1e due *+ a*+r*ur+us 1ar+*id ar*6ery
1ar+*id s*en+ses*ypi1ally res+lve6+ll+in/ 1ar+*idendar*ere1*+9y+r in*ravas1ular s*en*in/
'3Maura ", %a9ela >.. Tinni*us. In Bailey, -B. -+hns+n, T-. !ead and Ne1 O*+laryn/+l+/y. )*h ed. ?+l '. #ippin1+**Killia9s < Kilins. '($4..
Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.
Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
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Congenital CarotidAnomalies
in*rape*r+us 1ar+*idar*eiy is repla1ed 7yan enla*/edin6eri+r *y9pani1
ar*ery Ha 7ran1h +6*he as1endin/pharyn/eal.Ra*her *han en*erin/*he sull 7ase *hr+u/h*he
in6eri+r *y9pani11anali1ulus, *hein6eri+r *y9pani1ar*eryanas*+9+ses i*h *he1ar+*i1+*y9pani1
ar*ery in *he 9iddleear here i* is visi7le
li/a*i+n, ei*her viadire1* s/i1al+7li*era*i+n +re97+lia*i+n, 9us* 7e
pre1eded7y an/i+/raphy *+delinea*e anyin*ra1ranial *erri*+rysupplied 7y *hepersis*en* s*apedial
ar*ery and ensure*here is redundan*7l++d supply *+ *ha*re/i+n.
0(Sa*al+, TR. Sa*al+,-. !asha, M. Tinni*us. In Sa*al+, TR. Sa*al+,-. !earin/ #+ss. 0*h ed. Mar1el Deer In1,Ne 2+r. $330. p400544.
?as1ular Ne+plas9s
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?as1ular Ne+plas9s
Paragangliomas /l+9us *u9+rs, are *he9+s* 1+99+nvasallar *u9+r +6 *he*e9p+ral 7+ne. Believed
*+ arise6r+9 para/an/lia +n *he1+1hlear pr+9+n*+rySurr+undin/-a1+7s+nPs nerveH/l+9us *y9pani1u9 +r
6r+9 *headven*i*ia +6 *he =u/ular7ul7 i*hin *he =u/ular6+ra9enH/l+9us =u/ulare, *hesehi/hly vasallaried
*u9+rs *ypi1allypresen* i*h pulsa*ile*inni*us
+7serva*i+n, radia*i+n*herapy, and sur/ery.
0$Sa*al+, TR. Sa*al+,-. !asha, M. Tinni*us. In Sa*al+, TR. Sa*al+,-. !earin/ #+ss. 0*h ed. Mar1el Deer In1,Ne 2+r. $330. p400544.
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Hemangiomas Te9p+ral 7+nehe9an/i+9as,in1ludin/ 6a1ial nerveand
1avern+ushe9an/i+9as, arerare vas1ular *u9+rs+6 *he*e9p+ral 7+ne *ha*1an +11asi+nally 7e
ass+1ia*ed i*hpulsa*ile *inni*us.
>avern+ushe9an/i+9as arel+1a*edpred+9ina*ely in *he
9iddle ear and 1anrese97le a /l+9us*y9pani1u9 +n7+*h physi1al e8a9and radi+l+/i1i9a/in/.
Sa*al+, TR. Sa*al+,-. !asha, M. Tinni*us. In Sa*al+, TR. Sa*al+,-. !earin/ #+ss. 0*h ed. Mar1el Deer In1,Ne 2+r. $330. p400544.
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Non)ascularEtiologies
Idiopathic IntracranialHpertension
The pa*h+physi+l+/y+6pulsa*ile *inni*us in
II! is 1urren*lyunn+n. %+*en*ially,in1reased I>%1+9presses *hein*ra1ranial ven+ussinuses,
1rea*in/ *ur7ulen1e inn+r9ally la9inar7l++d + *ha*9ay lead *+ unila*eral+r 7ila*eral pulsa*ile*inni*us H
Trea*9en* +p*i+ns 6+rII! in1lude li6es*yle9+di1a*i+ns,
par*i1ularly ei/h*l+ss,A1e*a+la9ide,1+r*i1+s*er+ids, anddiure*i1s ,Sur/i1alin*erven*i+n.
Sa*al+, TR. Sa*al+,-. !asha, M. Tinni*us. In Sa*al+, TR. Sa*al+,-. !earin/ #+ss. 0*h ed. Mar1el Deer In1,
Ne 2+r. $330. p400544. 00
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Semicircular CanalDehis1en1e
S>D syndr+9e resul*s6r+9 a de1ien1yin *he 7+ny 1+verin/+verlyin/ +ne +6 *he
se9i1ir1ular>anals. pa*ien*s i*hp+s*eri+r 1analdehis1en1e resul*in/in 1+n*a1* 7e*een1+n*en*s +6 *he
p+s*eri+r 1anal and*he =u/ular 7ul7 +rsi/9+id sinus 9ayals+ lead *+ pulsa*ile*inni*us
Mana/e9en* +p*i+nsin1lude +7serva*i+n+r sur/i1al 1+rre1*i+n+6 *he dehis1en1e 7y
plu//in/ +rresur6a1in/ *hedehis1en1e H$$.
Sa*al+, TR. Sa*al+,-. !asha, M. Tinni*us. In Sa*al+, TR. Sa*al+,-. !earin/ #+ss. 0*h ed. Mar1el Deer In1,Ne 2+r. $330. p400544.
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Palatal and Middle EarMy+d+nus
Mus1le spas9 +6 *heleva*+rveli pala*ini +r *ens+rveli pala*ini 1ause ET
+penin/leadin/ *+ *inni*us,hi1h 1an 7esu7=e1*ive +r+7=e1*ive.
rea*9en* +p*i+nsin1lude +7serva*i+n,9asin/*e1hni;ues, lysis +6
*he s*apedial +r*ens+r *y9pani*end+n,and use +6 B+*+8 +npled/e*s pla1ed in*+*he 9iddle
ear
0)Sa*al+, TR. Sa*al+,-. !asha, M. Tinni*us. In Sa*al+, TR. Sa*al+,-. !earin/ #+ss. 0*h ed. Mar1el Deer In1,Ne 2+r. $330. p400544.
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Patulous !ustachianTu7e
%ulsa*ile *inni*usarisin/ 6r+9 apa*ul+us ET +ri/ina*es+u*side *he audi*+rypa*hay. N+r9allyd+sed in *heres*in/ p+si*i+n, apa*ul+us ET leads *+sy9p*+9s +6au*+ph+ny, aural6ullness and, in s+9e1ases, pulsa*ile*inni*us.
A varie*y +6 9edi1al*rea*9en* +p*i+nshave 7een pr+p+sed,in1ludin/ ei/h* /ain,dis1+n*inua*i+n+6 de1+n/es*an*s ands*er+id nasal sprays,9u1+us*hi1enin/ a/en*s,and nasal es*r+/endr+ps. Sur/i1alin*erven*i+nsin1lude 9yrin/+*+9yand *u7e inser*i+n,end+s1+pi1peri*u7alau/9en*a*i+n +6 ETvalve. and sur/i1al1l+sure +6 *he ETlu9en
0Sa*al+, TR. Sa*al+,-. !asha, M. Tinni*us. In Sa*al+, TR. Sa*al+,-. !earin/ #+ss. 0*h ed. Mar1el Deer In1,Ne 2+r. $330. p400544.
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0Sa*al+, TR. Sa*al+,-. !asha, M. Tinni*us. In Sa*al+, TR. Sa*al+,-. !earin/ #+ss. 0*h ed. Mar1el Deer In1,Ne 2+r. $330. p400544.
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Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.
Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
0
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03Maura ", %a9ela >.. Tinni*us. In Bailey, -B. -+hns+n, T-. !ead and Ne1 O*+laryn/+l+/y. )*h ed. ?+l '. #ippin1+**Killia9s < Kilins. '($4..
Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.
Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
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4(
Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.
Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
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Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.
Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
4$
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Tinni*us !andi1ap Inven*+ry s1+res:
I. Sli/h* T!I (Q$
II. Mild T!I $Q0
III. M+dera*e T!I 0Q)
I?. Severe T!I )Q
?. >a*as*r+phi1 T!I Q $((
4'Maura ", %a9ela >.. Tinni*us. In Bailey, -B. -+hns+n, T-. !ead and Ne1 O*+laryn/+l+/y. )*h ed. ?+l '. #ippin1+**Killia9s < Kilins. '($4..
Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.
Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
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Trea*9en*
Av+idan1e : Aspirin51+n*ainin/ 1+9p+unds, NSAID
Av+id dis*ur7in/ n+ise
N+ise pr+*e1*i+n
!+9e59asin/ *e1hni;uesBedside 9aser
%sy1h+l+/i1 *es*in/
40Maura ", %a9ela >.. Tinni*us. In Bailey, -B. -+hns+n, T-. !ead and Ne1 O*+laryn/+l+/y. )*h ed. ?+l '. #ippin1+**Killia9s < Kilins. '($4..
Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.
Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
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In a**e9p*in/ *+ *rea* pa*ien*s disa7led 7y *heirsy9p*+9s, 9easure9en* +6 *he *inni*us isi9p+r*an*. F+ur aspe1*s +6 *inni*us are 9easured in*he s*andard *inni*us pr+/ra9:
-Pitch
-Loudness
-Minimum masking level
-Residual inhibition
Tinni*us %r+/ra9
44Maura ", %a9ela >.. Tinni*us. In Bailey, -B. -+hns+n, T-. !ead and Ne1 O*+laryn/+l+/y. )*h ed. ?+l '. #ippin1+**Killia9s < Kilins. '($4..
Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.
Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
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%i*1h Masin/
Tinnitus synthesi$er
*+nal, hissin/, his*lin/ and 1ri1e*5lie
#+udness Ma*1hin/
Tinni*us is n+* usually l+ud
) less *han a 5dB sensa*i+n level
Tinni*us is 9a*1hed and *he 9a*1hin/ s+und is
in1reased 6r+9 *hresh+ld *+ *he level a* hi1h *hes+und is per1eived *+ 7e e;ual *+ *he *inni*us
4)Maura ", %a9ela >.. Tinni*us. In Bailey, -B. -+hns+n, T-. !ead and Ne1 O*+laryn/+l+/y. )*h ed. ?+l '. #ippin1+**
Killia9s < Kilins. '($4..
Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.
Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
Mini9al Masin/ #evel
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Mini9al Masin/ #evel
The nu97er +6 de1i7els +6 s+und re;uired
*+ 1+ver *he *inni*us
Residual Inhi7i*i+n
%hen+9en+n +6 pa*ien*s e8perien1in/peri+ds +6 de1reased +r n+ *inni*us a6*erhavin/ 7een e8p+sed *+ 9asin/
S+9e pa*ien*s a1*ually have l+n/ *inni*us56ree in*ervals a6*er vari+us 9asin/e8p+sures.
4Maura ", %a9ela >.. Tinni*us. In Bailey, -B. -+hns+n, T-. !ead and Ne1 O*+laryn/+l+/y. )*h ed. ?+l '. #ippin1+**Killia9s < Kilins. '($4..
Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.
Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
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4Maura ", %a9ela >.. Tinni*us. In Bailey, -B. -+hns+n, T-. !ead and Ne1 O*+laryn/+l+/y. )*h ed. ?+l '. #ippin1+**Killia9s < Kilins. '($4..
Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.
Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
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4Maura ", %a9ela >.. Tinni*us. In Bailey, -B. -+hns+n, T-. !ead and Ne1 O*+laryn/+l+/y. )*h ed. ?+l '. #ippin1+**Killia9s < Kilins. '($4..
Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.
Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
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43Maura ", %a9ela >.. Tinni*us. In Bailey, -B. -+hns+n, T-. !ead and Ne1 O*+laryn/+l+/y. )*h ed. ?+l '. #ippin1+**Killia9s < Kilins. '($4..
Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.
Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
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)(Maura ", %a9ela >.. Tinni*us. In Bailey, -B. -+hns+n, T-. !ead and Ne1 O*+laryn/+l+/y. )*h ed. ?+l '. #ippin1+**Killia9s < Kilins. '($4..
Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.
Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
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!IG!#IG!T
>+9plain*s +6 *inni*us sh+uld 7e dividedin*+ su7=e1*ive versus +7=e1*ive andn+npulsa*ile versus pulsa*ile 1a*e/+ries
*+ 6a1ili*a*e dia/n+sis and 9ana/e9en*. All pa*ien*s i*h *inni*us sh+uld have
a 1+9ple*e audi+/ra9 as par* +6 *heirevalua*i+n. I9a/in/ and +*her s*udies9ay 7e indi1a*ed 7ased +n ndin/s +nhis*+ry and physi1al e8a9ina*i+n.
)$Maura ", %a9ela >.. Tinni*us. In Bailey, -B. -+hns+n, T-. !ead and Ne1 O*+laryn/+l+/y. )*h ed. ?+l '. #ippin1+**Killia9s < Kilins. '($4..
Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.
Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
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!IG!#IG!T
N+npulsa*ile *inni*us 1an resul* 6r+9 avarie*y +6 1auses, in1ludin/ SN!#, >!#.in/es*i+n +6 s*i9ulan*s, head *rau9a, and
psy1hia*ri1 disease. Khen p+ssi7le,*rea*9en* +6 *he underlyin/ 1ause 1anallevia*e *inni*us.
Khen e*i+l+/y5spe1i1 9ana/e9en* +6
n+npulsa*ile *inni*us 6ails +r is n+*p+ssi7le. n+nspe1i1 9ana/e9en* +6*inni*us sh+uld 7e a**e9p*ed.
)'Maura ", %a9ela >.. Tinni*us. In Bailey, -B. -+hns+n, T-. !ead and Ne1 O*+laryn/+l+/y. )*h ed. ?+l '. #ippin1+**Killia9s < Kilins. '($4..
Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.
Sa*al+,-. !earin/ #+ss. 0*h ed.Mar1el Deer In1, Ne 2+r. $330.
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!IG!#IG!T
%ulsa*ile *inni*us 1an 7e /enera*ed 7ya varie*y +6 ar*erial and ven+us 1auses,vas1ular *u9+rs, uid i*hin *he 9iddle
ear, +*+s1ler+sis, and *u9+rs +6 *he lA>.In up *+ +ne5*hird +6 *hese 1ases, n+e*i+l+/i1 a/en* ill 7e iden*ied.
Trea*9en* +6 *he underlyin/ 1ause +6pulsa*ile *inni*us, hen p+ssi7le. 1anres+lve *his 1+9plain*.
Sa*al+, TR. Sa*al+,-. !asha,M. Tinni*us. In Sa*al+, TR.