A common clinical situation where a high-frequency sensorineural hearing loss (the result of degenerative hair cell disease associated with age or excessive noise exposure) is associated with a tonal or narrow band tinnitus of a frequency just below that of a maximum area of hair cell loss. If healthy outer hair cells adjacent to an area of inactivity were being encouraged to contribute more mechanical activity to the basilar membrane, this acoustical energy might be heard as tinnitus.

A large number of ototoxic antibiotics, diuretics and anti neoplastic drugs are in use.

Common medical conditions that predispose to tinnitus are Hypothyroidism, Anaemia, VitaminB12 and Zinc Deficiency, Diabetes, Hypoglycaemia, Hypertension, Hyperlipidaemia, Food And Drink Allergies, Migraine Etc.

Factors affecting ototoxicity include dose, duration of therapy, concurrent renal failure, infusion rate, lifetime dose, co-administration with other drugs having ototoxic potential, and genetic susceptibility.

Here we present a retired bus conductor (Fig.1) who underwent a cardiac bypass surgery and was started on post op standard cardiac medications. He developed agonizing tinnitus which was disturbing his sleep and routine activity. His tinnitus didn’t respond for medical treatment he became estranged from his family due to his intolerable tinnitus. He underwent ITT with gentamycin elsewhere which was of minimal help. With the opinion of a cardiologist monotrate the vasodilator was withdrawn. There was a drastic reduction in his tinnitus and now he is able to do his routine activity and sleep.If the patient is on any known ototoxic medicine or drugs increasing blood flow rate ( here a vasodilator) it should be reconsiderd unless the medicine is vitally important

Treatment & Prevention

Fig. 1 : Psychological overlay present in many cases. Here the patient was very depressed and dejected

• Ototoxic antibiotics should be avoided in pregnancy.
  
• Ototoxic drugs should not be used for otic topical application when the tympanic membrane is perforated, least the drugs enter the inner ear
  
• The elderly and people with preexisting hearing loss should not be treated with ototoxic drugs if other effective drugs are available,The lowest effective dosage of ototoxic drugs should be used and levels should be closely monitored.
  
• If possible before treatment with an ototoxic drug, hearing should be measured and then monitored during treatment; symptoms are not reliable warning signs.
  
• Treatment of predisposing medical conditions may result in diminution of the tinnitus or at least prevent it from becoming worse.