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20.06.2015

Causes of tinnitus radiology, cure tinnitus germany - .

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Definition: Tinnitus could be defined as perception of noise in the absence of acoustic stimuli. Prevalance: Studies have shown that nearly 20% of adults experience tinnitus in one form or the other. Hearing loss: Studies conducted in Canada showed people with deafness had increased incidence of tinnitus. Tinnitus in children: Increased incidence of otitis media in pediatric age group plays an important role in high prevalance of tinnitus in children. Classification of tinnitus: One simplistic classification of tinnitus could be Subjective and Objective tinnitus.
Pulsatile tinnitus: May be classified into vascular and non vascular types according to its etiology. Non vascular types of pulsatile tinnitus include palatal myoclonus, tensor tympani myoclonus, and stapedial myoclonus. Nodar's classification: This classification was based on the importance of 6 factors related to tinnitus.
Subjective tinnitus can be compared to phantom sensations which occur after amputation of limb. Auditory feed back system and its role in tinnitus generation: The optimal operation of auditory system is dependent on very sensitive and complex feed back mechanisms involving the afferent (ascending), efferent (descending) pathways. Nervous system as the site of tinnitus: Most forms of severe tinnitus have been shown to be caused by abnormal functioning of the nervous system.
Vascular contact with the intracranial portion of auditory nerve is regularly associated with tinnitus. A good history is a must for accurate diagnosis of the underlying pathology leading on to tinnitus.
Etiology of objective tinnitus include: intracranial vascular anamolies, atherosclerosis of aorta, pseudotumor cerebri, chemodectomas involving the middle ear. Pitch estimation: Pitch estimation of tinnitus helps in the probable etiology for tinnitus. Masking: Refers to the reduction of audibility of tinnitus when the patient is exposed to another sound. Most cases of tinnitus are subjective, but occasionally the tinnitus can be heard by an examiner. Factors affecting the prevalance of tinnitus include: age, gender, race, economic status, hearing loss and noise exposure. It includes history and physical examination, audiological testing, vestibular evaluation and radiologic studies. Alteration in the stereocilia that are attached to the outer hair cells could be the exact cause. This disorder includes a triad of symptoms which include fluctuating hearing loss, roaring tinnitus and vertigo. Noise and ototoxic drugs cause damage to hair cells of cochlea depriving auditory input to the brain.


Infact tinnitus could be the first symptom of a vestibular schwannoma, it becomes worse after surgical removal of schwannoma.
Severity of tinnitus should be assessed (ie whether present throughout the day - severe tinnitus, present only in the absence of ambient noise - night times - mild tinnitus). High pitched tinnitus is common in patients with noise induced hearing loss, and low pitched tinnitus is commonly seen in Menier's disease.
Otologic problems, especially hearing loss, are the most common causes of subjective tinnitus. The stiffness of the stereocilia is altered causing its decoupling from the tectorial membrane.
This indicates that tinnitus could be generated by the brain in response to lack of normal stimuli from the auditory system. This type of tinnitus occur due to irritation to the nerve by the offending vessel (kindling phenomenon).
Subjective tinnitus is usually high pitched and ringing in nature and can only be perceived by the patient.
In Meniere's disease it is low frequency, while in noise indued tinnitus it is of high frequency. Measurments of tinnitus include assessment of the pitch, bandwidth, loudness, maskability of tinnitus and residual inhibition.
In tinnitus loudness match the patient is instructed to match the loudness of tinnitus with that of narrow band noise generated at about the same frequency as the tinnitus.
Common causes of conductive hearing loss include external ear infection, cerumen impaction, and middle ear effusion. Venous causes include benign intracranial hypertension, high jugular bulb and hydrocephalus.
These features are caused by changes in the function of nuclei in the ascending pathways, or by redirection of information to regions of CNS that normally donot receive inputs from the auditory system. Whereas objective tinnitus is commonly pulsatile in nature and is also heard by the examiner. Sensorineural hearing loss may be caused by exposure to excessive loud noise, presbycusis, ototoxic medications, or Meniere's disease. A single pure tone masking tone of any frequency may mask a broad band spectrum of tinnitus. Objective tinnitus usually is caused by vascular abnormalities of the carotid artery or jugular venous systems. Bad plasticity causes hypersensitivity and hyperacitivity by redirecting information to other parts of central nervous system by unmasking dormant synapses. Initial evaluation of tinnitus should include a thorough history, head and neck examination, and audiometric testing to identify an underlying etiology. It has also been suggested that phase locking of the activity in many nerve fibers can also be a cause for tinnitus.
Unilateral or pulsatile tinnitus may be caused by more serious pathology and typically merits specialized audiometric testing and radiologic studies.


In patients who are discomforted by tinnitus and have no remediable cause, auditory masking may provide some relief. Epidemiologic data reveal that approximately one fourth of persons with tinnitus are discomforted by it, whereas the remaining three fourths experience the condition without significant symptoms.3Tinnitus takes different forms and has different classification proposals.
One classification system stresses distinctions between vibratory and nonvibratory types, while another system groups the different forms of tinnitus into subjective or objective classes.Vibratory tinnitus is caused by transmission to the cochlea of vibrations from adjacent tissues or organs.
Nonvibratory tinnitus is produced by biochemical changes in the nerve mechanism of hearing.Subjective tinnitus, which is more common, is heard only by the patient.
Objective tinnitus can be heard through a stethoscope placed over head and neck structures near the patient's ear.The mechanism that produces tinnitus remains poorly understood. Tinnitus may originate at any location along the auditory pathway from the cochlear nucleus to the auditory cortex.
Some leading theories include injured cochlear hair cells that discharge repetitively and stimulate auditory nerve fibers in a continuous cycle, spontaneous activity in individual auditory nerve fibers, hyperactivity of the auditory nuclei in the brain stem, or a reduction in the usual suppressive activity of the central auditory cortex on peripheral auditory nerve activity.4This article discusses the causes of subjective and objective tinnitus, and techniques used for evaluating tinnitus. Conductive hearing loss is caused by the inhibition of sound transmission to the inner ear.
It is continuous and less disturbing than the tinnitus of Meniere's disease.14Ototoxic medications or substances are another common cause of bilateral tinnitus. Temporomandibular joint disorder has been associated with vertigo and tinnitus, although the exact mechanism is unclear.Various metabolic abnormalities may be associated with tinnitus. These abnormalities include hypothyroidism, hyperthyroidism, hyperlipidemia, anemia, and vitamin B12 or zinc deficiency.Many patients with tinnitus exhibit signs of psychologic disorders.
Although tinnitus may be a contributing factor to the development of depression, the common association of tinnitus and depression may be the result when depressed patients, particularly those with sleep disturbances, focus and dwell on their tinnitus more than patients who are without an underlying psychologic disorder.OBJECTIVE TINNITUSObjective tinnitus is rare.
Patients with objective tinnitus typically have a vascular abnormality, neurologic disease, or eustachian tube dysfunction.4Patients with vascular abnormalities complain of pulsatile tinnitus.
This type of tinnitus is a soft, low-pitched venous hum, which can be altered by head position, activity, or pressure over the jugular vein.4Congenital arteriovenous shunts are usually asymptomatic, while the acquired type often are associated with pulsatile tinnitus. The symptoms may disappear with Valsalva's maneuver or when the patient lies down with the head in a dependent position.Evaluation of TinnitusHISTORYThe evaluation of a patient with tinnitus begins by taking a thorough history. Precipitous onset can be linked to excessive or loud noise exposure or head trauma.LocationUnilateral tinnitus can be caused by cerumen impaction, otitis externa, and otitis media.
Tinnitus associated with unilateral sensorineural hearing loss is the hallmark of acoustic neuroma.PatternContinuous tinnitus accompanies hearing loss. Tinnitus of venous origin can be suppressed by compression of the ipsilateral jugular vein.Specific testing for sensorineural or conductive hearing loss is the next part of the examination.
Patients with unilateral or pulsatile tinnitus are more likely to have serious underlying disease and typically merit referral to an otolaryngologist.2,5 A full clinical evaluation should precede radiologic studies. Because pulsatile tinnitus suggests a vascular abnormality, the preferred imaging study is contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) of the brain21 (Figure 2).



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Comments to “Causes of tinnitus radiology”

  1. Anjelika:
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  2. LiYa:
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