tinnitus: what is it & what can be done for it? · tinnitus management • learning about...
TRANSCRIPT
09/02/2016
1
People Centred
Positive
Compassion
Excellence
Tinnitus: what is it & what can be
done for it?
Mr Vikas Malik
Mr Alan Kenyon 9th February 2016
People Centred
Positive
Compassion
Excellence
Introduction
Tinnitus = ‘to ring’ (Latin)
“Perception of sound in absence of external stimuli”
09/02/2016
2
People Centred
Positive
Compassion
Excellence
• Subjective
• Objective
People Centred
Positive
Compassion
Excellence
• Ringing, whistling, buzzing, hissing, humming, pulsing, clicking…
• Generally not thought to originate from the ear
• Affects around 10 million people in the UK
• ENT referral to exclude rare underlying causes
• Management via audiology, BTA, self help
09/02/2016
3
People Centred
Positive
Compassion
Excellence
ENT Appointment
People Centred
Positive
Compassion
Excellence
• Asymmetrical hearing loss
• Unilateral Tinnitus
• Pulsatile Tinnitus
09/02/2016
4
People Centred
Positive
Compassion
Excellence
Medical Causes
People Centred
Positive
Compassion
Excellence
Causes of Pulsatile Tinnitus
09/02/2016
5
People Centred
Positive
Compassion
Excellence
Ear Anatomy
People Centred
Positive
Compassion
Excellence
• https://www.youtube.com/watch?v=flIAxGs
V1q0
09/02/2016
6
People Centred
Positive
Compassion
Excellence
Inner ear hair cells
People Centred
Positive
Compassion
Excellence
Auditory pathway
09/02/2016
7
People Centred
Positive
Compassion
Excellence
Auditory cortex
People Centred
Positive
Compassion
Excellence
Emotional brain
09/02/2016
8
People Centred
Positive
Compassion
Excellence
What is tinnitus?
• Mainly electrical - brain activity
• Sometimes vibrational – blood flow
• Very occasionally due to muscle spasm – myoclonus
• Hearing receptors in brain overactive, straining too much, pick up
on internal activity / interference rather than just outside sound.
People Centred
Positive
Compassion
Excellence
Triggers
• Subtle damage or change to auditory activity from ear to brain.
• Auditory brain filters less as it strains for adequate stimulation, effectively tinnitus is interference.
• Stress or emotion related factors triggering flight or flight type response.
• More meaning is given to the sound.
• Tinnitus problematic when associated with negative thoughts, behaviours, experiences.
09/02/2016
9
People Centred
Positive
Compassion
Excellence
Tinnitus management
People Centred
Positive
Compassion
Excellence
Tinnitus management
• Learning about tinnitus - understanding vicious
circles, challenging misconceptions, reducing
perceived threat, normalizing experience.
• Audiology + sound based treatments - aid hearing
loss to reduce central gain. Sound enrichment,
distraction, masking, feeling of control.
• Psychologically based treatments - CBT based,
mindfulness, feel safe in presence of tinnitus
09/02/2016
10
People Centred
Positive
Compassion
Excellence
Tinnitus management
• Learning about tinnitus - understanding vicious
circles, challenging misconceptions, reducing
perceived threat, normalizing experience.
• Audiology + sound based treatments - aid hearing
loss to reduce central gain. Sound enrichment,
distraction, masking, feeling of control.
• Psychologically based treatments - CBT based,
mindfulness, feel safe in presence of tinnitus
People Centred
Positive
Compassion
Excellence
Learning about tinnitus
• Group information sessions for first visit – Blackpool, Clifton & Fleetwood Hospitals
• Improve understanding of tinnitus
• Make choices about further management
• Individual follow up with hearing therapist
• Quarterly support group meetings – ongoing peer support, discussion, research updates
09/02/2016
11
People Centred
Positive
Compassion
Excellence
Tinnitus management
• Learning about tinnitus - understanding vicious
circles, challenging misconceptions, reducing
perceived threat, normalizing experience.
• Audiology + sound based treatments - aid hearing
loss to reduce central gain. Sound enrichment,
distraction, masking, feeling of control.
• Psychologically based treatments - CBT based,
mindfulness, feel safe in presence of tinnitus
People Centred
Positive
Compassion
Excellence
Auditory cortex
09/02/2016
12
People Centred
Positive
Compassion
Excellence
People Centred
Positive
Compassion
Excellence
09/02/2016
13
People Centred
Positive
Compassion
Excellence
Tinnitus management
• Learning about tinnitus - understanding vicious
circles, challenging misconceptions, reducing
perceived threat, normalizing experience.
• Audiology + sound based treatments - aid hearing
loss to reduce central gain. Sound enrichment,
distraction, masking, feeling of control.
• Psychologically based treatments - CBT based,
mindfulness, feel safe in presence of tinnitus
People Centred
Positive
Compassion
Excellence
Emotional brain
09/02/2016
14
People Centred
Positive
Compassion
Excellence
Neighbour noise analogy
People Centred
Positive
Compassion
Excellence
Bumps in the night analogy
09/02/2016
15
People Centred
Positive
Compassion
Excellence
Psychologically based treatments
• Aim to reduce tinnitus distress, rather than the volume
of the tinnitus.
• Cognitive Behavioural Therapy – change the way we
view tinnitus to change the way we feel and react to it.
• Mindfulness – involves periods of intentional focus on
the tinnitus. Less reaction emotionally & physically
with persistence.
People Centred
Positive
Compassion
Excellence
Responses to tinnitus
Route A
• Under-stimulation • Tinnitus as enemy • Negative thoughts • Emotional response
• Heightened awareness • Persisting distress • Disturbed sleep /
concentration
• Sensitization
Route B
• Adequate stimulation • Tinnitus is part of me • Neutral thoughts • Calm acceptance
• Reduced awareness • Minimal distress • Improved sleep /
concentration
• Habituation
09/02/2016
16
People Centred
Positive
Compassion
Excellence
Research summary
• No current safe and effective drug treatments for tinnitus
• Emerging evidence for role of hearing aids / sound generators.
• Lack of controlled studies in to many private treatments
• Studies show tinnitus distress more linked to thoughts and
interpretation of tinnitus then to the volume or tone or the noise
itself.
• Beneficial effect of CBT based treatments in reducing tinnitus and
hyperacusis related distress.
• Mindfulness based cognitive therapy RCT preliminary data suggests
it is an effective treatment particularly when initial distress is high
• Ongoing studies looking at vagus nerve stimulation, neuro-
modulation..
People Centred
Positive
Compassion
Excellence
Patient experiences
09/02/2016
17
People Centred
Positive
Compassion
Excellence
What does your tinnitus sound like?
• High pitched tone
• Hissing
• Buzzing
• Whistling
• Ringing
• Sizzling
• Pulsing
• Drumming
• Humming
• Low rumble
• Whining
• Rasping
• Tweeting
• Radio
interference
• Static
• Metallic tone
• Camera flash
• Crackling
• Clacking
• Tumble dryer
• Machinery
• Angry bees
• Screaming
• Screeching
• Roaring
People Centred
Positive
Compassion
Excellence
How did you feel when the tinnitus started?
• Scared
• Angry
• Why me?
• Worried would
go deaf
• Stressed
• Anxious
• Depressed
• Panicked
• Isolated
• Lonely
• Devastated
• Bewildered
• Cursed
• Tired
• Frustrated
• Awful
• Distressed
• Unhappy
• Confused
• Shocked
09/02/2016
18
People Centred
Positive
Compassion
Excellence
How did your tinnitus effect you at worst?
• Couldn’t sleep
• Not able to
concentrate
• Short tempered
• Appetite affected
• Anxious
• Depressed
• Hopeless
• Not able to think of
anything else
• Debilitated
• Bad tempered
• Withdrawn
• On edge
• Don’t know what to
do with myself
• Signed of work
• Makes me want to
scream
• Unable to talk or
think clearly
• Memory problems
• Lying in bed – no
motivation
• No peace
• Sad
• Cant hear clearly
• Outside noises feel
very loud
• Feel like banding
head against wall
• Overwhelmed
• Despair
• Suicidal thoughts
People Centred
Positive
Compassion
Excellence
How do you react to your tinnitus at best?
• Can forget about it
• Feels like any other
background sound
• Carry on as normal
• Hear it but feel ok now
• I don’t react to it any more
• No effect, still enjoy day
• Still struggle at times, but it
is getting easier
• The sound is normal now
so I think of it less
• Use mindfulness
• Avoid quiet environments
• Think of tinnitus as part of
me
09/02/2016
19
People Centred
Positive
Compassion
Excellence
Has the way you view your tinnitus changed?
• No – I still hate it!
• Reaction milder – still irritated at
times, but not angry, anxious or
depressed.
• Yes, but I wish people would
understand more
• Less threatened
• Not so scary now
• Less worried
• Slowly changing for the better
• Feel ok about having T
• Feel I have some control back
• Still struggle at times but it is
getting easier
• I would almost miss it if it went
• I’m not running from T now
• No longer afraid to listen to it
• See T as an indicator of how
fatigued or stressed I am
• Can forget it more often than not
now
People Centred
Positive
Compassion
Excellence
What things have helped you to deal with your tinnitus?
• Understanding T
• Understanding my thoughts &
reactions to T
• Talking to others with T
• Hearing aid
• Sound generator
• Bedside / pillow sound
• Nature sounds
• Background sounds
• Support group
• Mindfulness
• Relaxation
• Time
• Hearing protection
• Company
• Doing things I like
• Activity / distraction
• Giving the T short periods of
attention
• An understanding family
• CBT for anxiety
• Help with depression
09/02/2016
20
People Centred
Positive
Compassion
Excellence
What would be your message to anyone
struggling with tinnitus?
• Seek help!
• Get hearing checked
• Don’t ignore hearing
problems
• Try the sound based devices
• Try support group
• Hang in there, it gets easier
• It’s normal to struggle at first
• Take one day at a time
• Talk to a professional
• Think of tinnitus as part of
you
• Don’t put life on hold while
focussing on T
• Keep doing everything you
love
• Learn about T and
mindfulness
People Centred
Positive
Compassion
Excellence
• Any questions?
• Enquiries – [email protected]
• British Tinnitus Association – www.tinnitus.org.uk