His 120 tinnitus

Tinnitus

Ozarks Technical Community College

HIS 120

What is tinnitus?

• Any sound that is perceived by the listener that does not originate from an external sound source

• May be perceived in one or both ears (peripheral) and/or in the head (central)

• From latin word, tinnire, which means “to ring”

Descriptive Labels• Ringing• Hissing• Buzzing• Roaring• Clicking• Ocean sound• Cicadas• Pulsing• Heartbeat

Causes of Tinnitus• Most commonly caused by some sort

of change to the auditory system• Hearing loss results in changes in the

neural activity of the auditory system, which the auditory cortex interprets as sound– Much like phantom limb syndrome. Areas

of the cochlea where there is hair cell damage can no longer amplify sounds where damage has occurred so a phantom sound is interpreted at the brain.

Other Causes of Tinnitus• Hearing loss, especially in cases of noise-

induced hearing loss (NIHL)• External or middle ear issues (wax, fluid)• Acoustic neuroma (UNILATERAL tinnitus)• Medications• Sinus/allergy issues• Dental issues (TMJ-temporal-mandibular

joint syndrome)• Cardiovascular• Neurological (MS)• Stress/anxiety

SEE FIGURE 15.5 IN YOUR MARTIN AND CLARK TEXT

Medications that cause tinnitus• Anti-inflammatories • Antibiotics • Antidepressants • Aspirin • Quinine • Loop diuretics • Chemotherapy drugs

Some musician’s consider it a badge of honor…• Peter Frampton

– “I wonder how you’re feeling. There’s ringing in my ears. And no one to relate to, ‘cept the sea.”

• Bob Seger– “With the echoes of amplifiers ringing in

your head.”

Prevalence of Chronic Tinnitus

NIDCD.NIH.GOV

• ~22 Million Americans• 10% of adult population

Types

• Subjective– Can only be perceived by the patient

• Objective– Rare– Can be heard by others– Causes: vascular (glomus tumor),

myoclonus (involuntary muscle reflex)

Myoclonus

• Quick, involuntary muscle jerk– Hiccups, sleep start

• Palatal (roof of mouth) myoclonus results in clicking and popping in the ear

Bothersome Tinnitus

• Only about 20% of people with tinnitus are bothered by it

• The tinnitus itself isn’t the problem. The person’s REACTION to it is what is problematic.– Tinnitus may result in irritability,

fatigue/sleep disturbance, depression, suicidal thoughts

– These patient’s need to be referred to a mental health professional

A Viscious Cycle

• Attentional Factors (patient chooses to attend to tinnitus)

• Emotional reaction– Limbic system: negative emotional

labeling of the tinnitus– Autonomic system: activation of the fight-

or-flight mechanism (Can this tinnitus harm me?)

• Stress– Amplification of tinnitus signal (louder)

Hyperacusis

• Everyday sounds seem “too loud” or “uncomfortable”

• About ½ of those with tinnitus, also have hyperacusis– Affects 1 in 50,000

• Sound clip

Hyperacusis Causes• Hearing loss  • Head injury (i.e air bag deployment)

•  Ototoxicity

•  Lyme disease

•  Viral infections involving the inner ear or facial nerve (Bell’s palsy)

•  TMJ

•  PTSD (post-traumatic stress disorder)

•   Chronic fatigue syndrome• Epilepsy• Depression• Migraine headaches

Other sound disorders• Misophonia

– Dislike of sound

• Phonophobia– Fear of sound

– Often these patients come in reporting that they use earplugs in everyday circumstances. This is NOT recommended. It will actually worsen problem.

Tinnitus Treatment

• Masking• Medication• Counseling• Cognitive Behavioral Therapy• Tinnitus Retraining Therapy• Sound treatment

– Neuromonics

Masking

• Use of noise to temporarily mask or “cover up” the tinnitus so it cannot be perceived

• This is often successfully accomplished when patient’s with hearing loss use traditional hearing aids. The amplification of environmental noises often reduces or completely masks tinnitus.– Our newest generation hearing aids have

optional tinnitus maskers built-in for when hearing aids aren’t enough to mask tinnitus

Masking

• There are companies that manufacture tinnitus maskers for those with normal hearing. May be in-the-ear with a very large vent or a behind-the-ear, open-ear device

www.ata.org www.siemens.com

Masking

• The use of a sound machine or external noise source (i.e. ceiling fan) can be very helpful at night

• Different types of noise are utilized in masking: white noise, pink noise, brown noise, grey noise (all have varying complexity based on frequency components)

Tinnitus Handicap Inventory

• Patient self-survey• Sample questions

– Do you feel you have no control over your tinnitus?

– Because of your tinnitus do you feel tired? – Because of your tinnitus do you feel depressed? – Does your tinnitus make you feel anxious?

• Quantifies the severity of tinnitus– Rates degree of handicap from slight to

catastrophic

Tinnitus Retraining Therapy

• Jastreboff created TRT• Combines counseling with use of

noise generators– Counseling: reclassify tinnitus to a

category of neutral signals– Sound therapy: weaken the tinnitus-

related neural activity• Goal: Habituation to the tinnitus (no

longer pay attention to it)

Neuromonics

• Six to eight month therapy protocol– Uses spectrally modified music that has

been tailored according to each patient’s hearing and tinnitus characteristics

– Combined with an underlying neural stimulus

– Retrains the brain to filter out

tinnitus disturbance

Very expensive~$5000 for treatment that lasts less than a year