Definition:
Tinnitus is defined as abnormal sound heard in the ear. It can be divided into two types:
Subjective tinnitus: where the sound is heard only by the patient and not by the physician.
Objective tinnitus: Is heard both by the patient as well as the examining physician. One common example of
objective tinnitus is palatal myoclonus.
The term tinnitus is derived from the Latin word tinnire which translated means ringing sound. Tinnitus
can occur alone or in combination with sensorineural hearing loss. People affected belong to the 5th and 6th
decade age groups. It is a very difficult condition to manage because of its multifactorial etiology.
Management of tinnitus an overview:
Tinnitus could be managed by:
1. Hearing amplification (use of hearing aids)
2. Use of tinnitus maskers
3. Use of oral drugs
4. Tinnitus retraining therapy
To this list recently intra tympanic medications have also been added. This should infact be considered in
selected cases.
Schuknecht first used intra tympanic aminoglycosides (Streptomycin) for treatment of Meniere’s disease.
Because of its ototoxic effects this therapy had immediate effect on tinnitus. Beck later used gentamycin in
tinnitus management. This drug gained in popularity because of its ability to preserve hearing. Lignocaine
and steroids were also used with success in the management of tinnitus.
Use of intratympanic lignocaine in the management of tinnitus:
Lignocaine belongs to a drug group called amides. Its mechanism of action is through sodium channel blockade
at the level of neurons. It also has a profound analgesic, antiarrythmic and anticonvulsant properties. It
has this unique ability to silence the hyperactive neurons responsible for the production of tinnitus.
Eventhough it was highly effective in the management of tinnitus, it had certain unpleasant side effects like
vertigo, nausea and vomiting which necessitated hospitalisation of the patient.