his 120 tinnitus
TRANSCRIPT
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Tinnitus
Ozarks Technical Community College
HIS 120
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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”
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Descriptive Labels• Ringing• Hissing• Buzzing• Roaring• Clicking• Ocean sound• Cicadas• Pulsing• Heartbeat
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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.
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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
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Medications that cause tinnitus• Anti-inflammatories • Antibiotics • Antidepressants • Aspirin • Quinine • Loop diuretics • Chemotherapy drugs
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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.”
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Prevalence of Chronic Tinnitus
NIDCD.NIH.GOV
• ~22 Million Americans• 10% of adult population
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Types
• Subjective– Can only be perceived by the patient
• Objective– Rare– Can be heard by others– Causes: vascular (glomus tumor),
myoclonus (involuntary muscle reflex)
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Myoclonus
• Quick, involuntary muscle jerk– Hiccups, sleep start
• Palatal (roof of mouth) myoclonus results in clicking and popping in the ear
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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
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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)
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Hyperacusis
• Everyday sounds seem “too loud” or “uncomfortable”
• About ½ of those with tinnitus, also have hyperacusis– Affects 1 in 50,000
• Sound clip
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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
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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.
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Tinnitus Treatment
• Masking• Medication• Counseling• Cognitive Behavioral Therapy• Tinnitus Retraining Therapy• Sound treatment
– Neuromonics
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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
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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
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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)
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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
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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)
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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