occur at any age. Often, and especially in infants,
doctors do not know what disturbs the balance to
allow thrush to develop. Known causes include
treatment with ANTIBIOTIC MEDICATIONS, as antibi-
otics reduce the overall level of bacteria in the
body. IMMUNE DISORDERSsuch as HIV/AIDSoften pre-
vent the body from adequately controlling its bac-
terial balance.
Doctors generally diagnose thrush based on
appearance of the characteristic lesions (patches)
in the mouth. Sometimes the doctor will gently
scrape away the white surface of a LESION, which
reveals the underlying reddened sore and con-
firms the diagnosis. Treatment is rinsing the
mouth with an antifungal solution such as nys-
tatin oral suspension. For young infants, dabbing
the solution onto the lesions is sometimes more
effective. Treatment continues for 48 hours after
the last lesion disappears. C. albicansalso can erupt
as DIAPER RASHand vaginal infection.
See also LEUKOPLAKIA; VAGINITIS.
tinnitus The perception of a ringing, humming,
roaring, or rushing sound in the EARwhen there is
no external auditory stimulation. Tinnitus may
affect one ear or both ears. There is a growing
view among otolaryngologists that tinnitus is an
early indication of sensorineural HEARING LOSS,
heralding damage (temporary or permanent) to
the HAIR cells within the COCHLEAthat translate
sound waves into NERVEmessages. Tinnitus is a
common symptom of various vestibular disorders
such as ACOUSTIC NEUROMAand MÉNIÈRE’S DISEASE.
Numerous medications also can cause tinnitus,
notably ANTIBIOTIC MEDICATIONSknown as amino-
glycosides (such as gentamicin and streptomycin)
and loop diuretics (such as furosemide).
Occasionally tinnitus results from health condi-
tions that affect the flow of BLOODin the head, such
as HYPERTENSION(high BLOOD PRESSURE) and ATHERO-
SCLEROSIS. These conditions may increase the turbu-
lence of the blood, making it possible to hear the
blood as it flows through the arteries. When these
conditions are severe enough, the doctor can also
hear the sounds by listening through a stethoscope
placed at various locations on the head.
Tinnitus is common, with some experts assert-
ing that nearly every adult will experience the
symptom at some time in his or her life. Many
people live with low-grade tinnitus that, though
annoying when noticed, generally does not affect
daily living. For some people, however, tinnitus is
severe enough to interfere with concentration and
even hearing to the extent of causing disability.
Any health conditions that diminish the move-
ment of sound into the ear from the external
environment, such as accumulated CERUMENor an
ear INFECTION(OTITISmedia or otitis externa) can
intensify the tinnitus.
The diagnostic path begins with an otoscopic
examination to look for obvious blockages or
other physical causes. The doctor will also request
a comprehensive AUDIOLOGIC ASSESSMENTto deter-
mine whether any hearing loss exists; this helps
narrow the potential reasons for the tinnitus.
Treatment targets the underlying cause. There are
few effective treatments for idiopathic tinnitus
(tinnitus that is present without an apparent
cause) or for tinnitus that accompanies PRESBYCUSIS
(age-related hearing loss). Many people benefit
from using intentional background noise (sound
masking) to mitigate the tinnitus and from learn-
ing conscious refocusing methods.
See also HEARING AID; OTOTOXICITY.tonsillitis An INFECTION of the tonsils (lymph
structures at the back of the THROAT). Tonsillitis is
common and often recurrent in children. Conven-
tional wisdom holds that the tonsils (and the
nearby ADENOIDS) serve to produce antibodies to
help the body protect itself against invading
pathogens (disease-causing agents such as viruses
and BACTERIA). However, in the modern environ-
ment there is an overwhelming abundance of
pathogenic agents, which many health experts
believe accounts for the prevalence of tonsillitis.
Some researchers believe that the tonsils are
becoming, or have become, vestigial structures
akin to the appendix.
The characteristic symptoms of tonsillitis are- PAINand swelling at the back of the throat
- difficulty swallowing
- FEVER
- HEADACHE
The tonsils may appear enlarged and reddened,
and may ooze pus or be covered in small white58 The Ear, Nose, Mouth and Throat