1. Name of the location of 90% of epistaxis
2. A genetic disorder that forms AV malformations in the skin, lungs, brain etc
3. Name of posterior vascular plexus in the nasal cavity causing posterior epistaxis
4. 1st line treatment for all epistaxis
5. The common brand name for anterior nasal packing
6. Chemical used in cautery sticks
7. Physically scaring complication of posterior nasal packing with foleys catheter
Most of us, at one point or another, will hear brief noises in our ears that disappear quickly. This is tinnitus, a sound that comes from within and usually cannot be heard by anyone else nearby.
Persistent tinnitus is a common symptom in the general population. About ten percent of the population hear it all of the time and one percent are sufficiently distressed about it to seek help.
The noise is described in a variety of ways: buzzing, rumbling, hissing, and ringing are common descriptions. Occasionally it is a pulsating noise suggesting a vascular origin.
Causes of tinnitus
Tinnitus is not a diagnosis. Instead, it is a symptom of an underlying problem. For our course in Swansea the following diseases are associated with tinnitus:
Hearing loss – any cause including presbyacusis, glue ear, acoustic neuroma
Acute otitis media
Tinnitus is associated with other conditions and drug usage too:
Temporomandibular joint problems
Head and neck injuries
Loud noise exposure
Pulsating tinnitus is associated with acoustic neuromas, vascular abnormalities and disease in the head and neck, anaemia, pregnancy and thyrotoxicosis.
What problem does the symptom cause for the patient?
For the majority, tinnitus is experienced but causes no suffering. It’s a noise that is there but that has no impact. For a minority, it has dramatic effects and causes sleep disruption, depression and anxiety, frustration, irritability, and poor concentration. It can interfere with social and leisure activities, disrupt family relationships and cause fatigue.
How is it treated?
While tinnitus cannot be switched off by drugs or therapy, its impact can be significantly lessened through a combination of approaches and the majority of patients do very well.
For patients with idiopathic bilateral tinnitus, we start by reassuring the patient that the tinnitus does not imply a serious underlying disease. Generally, the impact of the noise will lessen (through central adaptation to the sound). A simple step to assist with sleep is to play music at night either via a radio or pillow speaker.
For those who need more, sound generators, hearing aids and cognitive-behavioural therapy have benefits. Management of any underlying psychiatric disease is also helpful.
Should a patient attend with tinnitus on one side, they are referred for MRI scanning to exclude acoustic neuroma from the diagnosis. The chance of a patient referred with unilateral tinnitus having an acoustic neuroma is about 1-2% in Swansea.
If the noise varies in time with the pulse, it is called pulsatile tinnitus. Common causes are hyperdynamic states such as anaemia, hyperthyroidism and pregnancy, and the noise can be expected to resolve when these conditions are passed.
Other causes include valvular disease of the heart, carotid stenosis, vascular tumour of the temporal bone (such as paragangliomas), A-V malformations in the skull, acoustic neuromas, and the sound of venous flow in the jugular vein.
Pulsatile tinnitus is investigated with either CT and CTA or MRA.
Generally, no cause is found and the patient is reassured and then managed in the same way as for non-pulsatile tinnitus.