ENT Referral Guidelines For The Ear

Tinnitus

Tinnitus is the sensation of sound which does not come from an external source.

Tinnitus is a troublesome and common condition which is not always curable. It can occur in any age group but is more common with increasing age. According to ENT Consultant in Lahore Persistent tinnitus occurs in about 10% of the population. It is essential to exclude serious pathology (such as an acoustic neuroma if the tinnitus is unilateral) and then to treat and to support the sufferer as best one can.

Etiology Local:               Any hearing loss.
General:               Hyperdynamic circulations (as in hypertension or anemia), carotid bruits (associated with a carotid artery stenosis).
Drugs: eg. NSAIDs, caffeine, alcohol.

Symptoms: Tinnitus affects people in different ways. On the one hand, it may be nonintrusive or on the other can contribute to suicide. Most patients recognize the link between their level of emotional and physical stress and the perceived “loudness” of the tinnitus. ENT Doctor in Lahore

Treatment: A full otological and general history must be taken to exclude other pathologies. Exclude obvious local causes such as wax impaction. A pure tone audiogram is of use in establishing the degree of hearing loss that may be associated with the tinnitus. The importance of unilateral tinnitus (versus bilateral symmetrical tinnitus) is that it is sometimes a symptom of an acoustic neuroma.

Direct the patient towards specialized help such as a hearing therapist, self-help groups and the British Tinnitus Association. Relaxation techniques help some patients.

When to refer: Refer to the routine ENT Specialist in Lahore clinic if the tinnitus becomes intrusive (sleep disturbance), if it is unilateral, or if the tympanic membranes are abnormal.

Vertigo And Dizziness

The majority of dizziness in the elderly is of vascular or degenerative origin. Unsteadiness and lightheadedness are usually non-otological.

Aetiology         Medical:            Cardiovascular, metabolic and neurological conditions, anaemia, ocular disease,medications and cervical spine problems.
                                  Psychological: Anxiety and hyperventilation                                  Otological:        Benign paroxysmal positional vertigo, acute vestibular failure (labyrinthitis), Meniere’s disease, some middle ear disease and very rarely acoustic neuroma.

Symptoms: If the symptoms are from the inner ear then the patient will describe a hallucination of movement, usually rotational in nature and frequently accompanied by nausea, vomiting, and nystagmus. Meniere’s syndrome consists of a triad of episodic vertigo, associated tinnitus, and a fluctuating hearing loss. In benign paroxysmal positional vertigo (BPPV), short-lived episodes of rotational vertigo usually occur when turning over in bed

Loss of consciousness is unlikely to be caused by inner ear problems.

Treatment: A general medical examination, a careful history, and blood pressure measurement may point to the cause of the dizziness.

If “the room is spinning” the patient may find it helpful to focus on a fixed object. Maintain hydration if nausea and vomiting are a feature. Vestibular sedatives such as prochlorperazine or cinnarizine are usually helpful in acute vertigo (eg. acute labyrinthitis, acute episode of Meniere’s), but long term use does not help with vestibular rehabilitation. Longer-term treatment with betahistine may be helpful in Meniere’s disease.

When to refer: Some ENT Surgeon in Lahore departments run special neurotology clinics. Refer to ENT if there are ear symptoms or signs such as a discharging ear as some chronic ear disease can cause vertigo. For patients with BPPV, most can be helped by “repositioning” maneuvers, performed in the ENT/audiology department. In the absence of otological signs or symptoms accompanying the dizziness, the patient may benefit from a neurological opinion.

Published By: Facial Plastic Surgeon in Lahore