Dr. Simon H.W. WongDr. Simon H.W. Wong

Specialist in OtorhinolaryngologySpecialist in Otorhinolaryngology

黃漢威耳鼻喉科專科醫生黃漢威耳鼻喉科專科醫生

TinnitusTinnitus

Subjective sensation Subjective sensation of sound in the earof sound in the ear

Rarely objectiveRarely objective

Associated with any Associated with any form of ear diseaseform of ear disease

Idiopathic in 20%Idiopathic in 20%

Management ObjectiveManagement Objective

Find causeFind cause

Treat causeTreat cause

Treat symptomTreat symptom

CausesCauses

Outer, Middle or Outer, Middle or Inner?Inner?

Central: Structural Central: Structural or Functionalor Functional

Systemic: Renal, Systemic: Renal, anaemiaanaemia

HistoryHistory

AgeAgeDurationDurationFrequencyFrequencyPositionalPositionalNasal symptomsNasal symptomsHearing lossHearing lossVertigoVertigo

ExaminationExaminationFull ENT examFull ENT exam

Must see the ear drumMust see the ear drum

Always check Always check nasopharynxnasopharynx

AudiometryAudiometry

MicroscopicMicroscopic ExamExam

Ear toiletEar toilet

Wax hook, suction, Wax hook, suction, forcepsforceps

CultureCulture

Grommet insertionGrommet insertion

Ear Wax ImpactionEar Wax Impaction

Otitis ExternaOtitis Externa

Suction clearanceSuction clearance

Topical antibioticsTopical antibiotics

Ear wickEar wick

Pain reliefPain relief

Fungal Otitis ExternaFungal Otitis Externa

Fungal Otitis ExternaFungal Otitis Externa

Repeated ear Repeated ear toilettoilet

Clotrimazole ear Clotrimazole ear dropdrop

Oral NystatinOral Nystatin

Foreign BodyForeign Body

Otitis Media with Otitis Media with EffusionEffusion

Adhesive OMAdhesive OM

Eustachian tube Eustachian tube dysfunctiondysfunction

AntihistaminesAntihistamines

Steroid nasal Steroid nasal sprayspray

Chronic Suppurative Otitis Chronic Suppurative Otitis MediaMedia

Suction clearanceSuction clearance

Topical antibioticsTopical antibiotics

AntihistaminesAntihistamines

TympanoplastyTympanoplasty

CholesteatomaCholesteatoma

Keratinized epithelium Keratinized epithelium in middle earin middle ear

Topical antibioticsTopical antibiotics

CT scanCT scan

MastoidectomyMastoidectomy

Nasal EndoscopyNasal Endoscopy

Nasopharyngeal Nasopharyngeal CarcinomaCarcinomaBiopsyBiopsy

TinnitusTinnitus

Hearing lossHearing loss

EpistaxisEpistaxis

Cervical LNCervical LN

Impedance Impedance TympanometryTympanometry

Eustachian Tube Dysfunction

Middle Ear Effusion

Impedance Impedance TympanometryTympanometry

Pure Tone AudiometryPure Tone Audiometry

Pure Tone AudiometryPure Tone Audiometry

Down sloping SNHLDown sloping SNHL

4 kHz dip4 kHz dip

Conductive HLConductive HL

Low frequency SNHL: Low frequency SNHL: Meniere’sMeniere’s

Asymmetrical SHNLAsymmetrical SHNL

Acoustic NeuromaAcoustic Neuroma

SchwannomaSchwannoma

Facial palsy or Facial palsy or numbnessnumbness

Gamma/X-knifeGamma/X-knife

SurgerySurgery

Medical ManagementMedical ManagementVasodilator: Betahistine, CaVasodilator: Betahistine, Ca2+2+ antagonist antagonist

Cerebral activator: Nicergoline (Sermion)Cerebral activator: Nicergoline (Sermion)

Almitrine : increase PaOAlmitrine : increase PaO22

GingkoGingko

Medical ManagementMedical Management

? Vitamin B12? Vitamin B12

SedativesSedatives

MaskersMaskers

Hearing aidHearing aid

Medical ManagementMedical Management

Self-help groupsSelf-help groupsPsychological counselingPsychological counseling

ConclusionConclusion

Tinnitus treatableTinnitus treatable

Underlying causeUnderlying cause

Treat symptomTreat symptom