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Topics In Audiology > 4) Tinnitus Management > Flashcards

4) Tinnitus Management Flashcards

1
Q

What are 3 components of optimizing HA fittings for tinnitus management?

A

1) Hearing Aid Suggestion
2) Recommended Hearing Aid Features and Settings
3) Recommendations for Hearing Aid Fitting and Follow-ups

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2
Q

____ is the key to tinnitus management.

A

Directed instruction

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3
Q

What is directed instruction?

A
  • Often understanding what tinnitus is, is all needed to reassure clients of its usually benign nature.
  • If you can provide good information for bothersome tinnitus at the beginning, it is going to help a lot
  • Provides some relief
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4
Q

Regarding the source of tinnitus, clients could be told what 2 things?

A

1) Tinnitus often results from altered neural activity in auditory pathways.
̶2) Tinnitus is the sound that is magnified/over-represented/amplified by the auditory cortex.

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5
Q

Tinnitus distress is NOT associated with (3):

A

̶- The extent of ear damage
̶- The results of auditory tests
- Tinnitus loudness.

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6
Q

Tinnitus distress IS associated with (2):

A

̶- Maladaptive brain plasticity
̶- Individual differences in reacting to tinnitus

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7
Q

What 2 things can HAs do for tinnitus?

A

1) Improve communication
2) Amplify background sound (external low-level sounds) and divert attention away from tinnitus.
̶- Therefore, reduce stress

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8
Q

In addition to HAs, we advise individuals:

A

To enrich the listening environment with music or other sounds

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9
Q

Overall, suggested approach to adapt to tinnitus:

A

Sound therapy (ST) using HAs + enriching listening environment + counseling

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10
Q

In contrast to hearing loss without tinnitus, ____ is desirable and recommended

A

low-level noise

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11
Q

What 2 reasons are HAs Recommended?

A

1) Reduce hearing handicap/enhance speech audibility
2) Amplify ambient sounds to mask tinnitus

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12
Q

What are the 2 preferred HA options?

A

HAs offering:
̶- Programming flexibility
̶- Sound streaming options to access ST apps

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13
Q

A Rough Guide for HA Suggestion for Tinnitus (picture)

A

̶The area in which the audiogram falls suggests the device type:
- Blue: ST
̶- White: HAs
̶- Red: HAs and assistive devices
̶- Grey: Cochlear implants (CIs)

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14
Q

What are the 10 recommendations for HA features and settings for tinnitus?

A

1) Open Fitting Is preferred When Possible
2) Omnidirectional Microphone Setting in Quiet Environments
3) HAs with Flexible Compression Settings to Amplify Quiet Background Noise
4) Not Activating Noise Reduction Algorithms
5) Frequency Lowering
6) Manual Volume Controls
7) Multiple Programs
8) Sound Streaming
9) Datalogging
10) Remote HA Programming, could be useful

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15
Q

What is an open fitting?

A

With thin tube receivers or receiver in-the-ear HAs

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16
Q

Why omnidirectional mics?

A

We want sound from everywhere to mask the tinnitus

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17
Q

Why do individuals with tinnitus need an open fitting?

A

̶- To avoid occlusion effect
̶- For targeted high-frequency amplification

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18
Q

What 2 things are recommneded regarding compression?

A

Low compression knee points + wide dynamic range compression (WDRC)

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19
Q

hat do we offer if circuit noise or amplified environmental noise is insufficient or bothersome?

A

ST

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20
Q

Why do those with tinnitus not have activating NR algorithms?

A

Noise is needed for tinnitus masking.

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21
Q

Why do those with tinnitus need FL?

A

Evidence supports the effectiveness of frequency lowering for tinnitus.

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22
Q

Why do those with tinnitus need to manage VC?

A

To manage ST and adjust amplification in different environments.

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23
Q

Why do those with tinnitus need multiple programs?

A

For gradual adjustments over time as the user becomes more accustomed to amplification.

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24
Q

Why do those with tinnitus need sound streaming?

A

To access wireless devices like smartphones and use a variety of ST apps.

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25
Q

Why do those with tinnitus need data logging?

A
  • It provides information on compliance, program usage, volume settings, and environments.
    ̶- Helpful during follow-up appointments to evaluate the impact and negotiate the outcomes.
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26
Q

Remote HA Programming, could be useful:

A

̶- For clients who prefer fewer face-to-face consultations.
̶- OR reversely, for anxious clients requesting frequent consultations.

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27
Q

What are the 5 recommendations for HA fittings and follow-ups?

A

1) Start with directed instructions and need assessment.
2) Offer a HA trial 2 weeks after the need assessment.
3) Use real-ear measures (RAMs) for HA fitting and follow-ups.
4) Set regular follow-ups using outcome measures, for 6 and 12 months
5) Develop online resources

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28
Q

What outcome should be done at follow-up appointments (3)?

A

̶- Tinnitus-related questionnaires
̶- Hyperacusis questionnaires
̶- Psychiatric symptoms assessments

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29
Q

HAs usually show maximum benefit by ____ weeks.

A

9 to 12

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30
Q

Why do we need to develop online resources?

A

It can reduce frequent inquiries and provide ongoing support outside clinic hours

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31
Q

In follow-up sessions we do what 3 things?

A

1) Gradually increase amplification, by taking into account potential loudness recruitment.
̶2) Fine-tune self-reported difficulties.
̶3) Onward referrals as needed.

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32
Q

What 4 things should you do f HAs make tinnitus worse?

A

̶1) Turn gain down
̶2) Reduce maximum output
̶3) Many people with tinnitus also have loudness hyperacusis. It should be measured and incorporated into the prescription formula.
̶4) Suggest other therapies for tinnitus management.

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33
Q

What 3 things do we need to consider when combining ST with amplification?

A

1) Overview of Sounds Available for ST
2) Suggested ST Approach Based on Individuals’ Goals
3) ST Protocol

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34
Q

Why do people need ST when they already have HAs?

A

HAs aren’t enough to mask the tinnitus

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35
Q

ST aims to ____ or ____ mask tinnitus.

A
  • Partially, totally
  • Depending on the therapy goal, you may decide on TM or PM.
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36
Q

Strong evidence supports the ____ for tinnitus.

A

use of HAs

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37
Q

However, additional benefits from combining ____ with ____ are not as strong

A

HAs, ST

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38
Q

Does everyone benefit from combining ST with amplification?

A

Some individuals benefit significantly while others do not.

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39
Q

What are the 8 types of sounds available for ST?

A

1) Onboard Sounds
2) Apps
3) Broadband Noise (BBN)
4) Threshold Adjusted Noise/Filtered BBN
5) Simulated Water Sounds
6) Recorded Nature Sounds
7) Music
8) Fractal Tones

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40
Q

What are onboard sounds?

A

Sounds streamed from a smartphone and apps, without external devices.

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41
Q

What sounds do apps use?

A
  • Providing sounds and activities for relaxation and distraction.
    ̶- Available by HA manufacturers and third-party developers
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42
Q

What is BBN (3)?

A

̶- It may have a low acceptance rate.
̶- If tolerable, it can provide significant tinnitus improvement (partial or total masking).
̶- It holds superior effectiveness than recorded nature sounds.

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43
Q

What is Threshold Adjusted Noise/Filtered BBN

A
  • It mirrors the audiogram, providing more energy in hearing loss regions.
    ̶- Widely adopted by hearing aid manufacturers.
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44
Q

What are simulated water sounds?

A

Random amplitude-modulated surf is more effective than constant surf in reducing tinnitus audibility

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45
Q

Why recorded nature sounds?

A

Well-tolerated, evoke positive emotional responses.

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46
Q

Why music?

A

Preferences for calming and relaxing music.

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47
Q

What are fractal tones?

A
  • Fractal tones are harmonic and melodic tones that sound like “wind chimes”.
    ̶- Adapted by some HA manufacturers as part of their tinnitus platform.
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48
Q

Goal: cover tinnitus, control tinnitus, reduce tinnitus volume, make tinnitus less obvious
a) what is the theme?
b) what is the suggested ST?

A

a) presence of sound
b) BBN, threshold adjusted noise

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49
Q

Goal: improved hearing, socialize more, reduce focus on tinnitus, want to ignore tinnitus, hear speech better, better sound localization, want to hear real sounds, sleep better
a) what is the theme?
b) what is the suggested ST?

A

a) context of sound
b) environmental sounds, modulated noise

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50
Q

Goal: want to relax, sounds to be comfortable, dont want to stress, need to be calmer
a) what is the theme?
b) what is the suggested ST?

A

a) reaction to sound
b) nature sounds, music, fractal sounds

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51
Q

Goal: i dont want to hear tinnitus so oftern
a) what is the theme?
b) what is the suggested ST?

A

a) adaptation to sound
b) sum of all above with instruction and counselling

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52
Q

Therapy goal is too (3):

A
  • To cover/control tinnitus
  • To reduce distress and psychiatric symptoms
  • To adapt with tinnitus
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53
Q

Problems caused by hearing loss and tinnitus (5):

A

1) Reduced communication,
2) Localization,
3) Socialization,
4) Focused attention
5) Sleep quality

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54
Q

4 Key principles of ST:

A

̶1) Most sounds are beneficial for tinnitus relief.
̶2) Silence is generally not helpful.
̶3) Amplification is often needed.
̶4) The sound alone is incomplete without instructions and counseling.

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55
Q

ST Protocol comprises four aspects:

A

1) Directed instructions (about the cause of tinnitus)
2) Counseling (for distress and comorbid symptoms)
3) Sensory management (choice of ST and amplification)
4) Perceptual training

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56
Q

What are the 9 components of ST protocol?

A

1) Tinnitus Measurements
2) Goal Setting
3) Directed Instructions & Counseling
4) Sensory Management
5) The Client-Oriented Scale of Improvement in Tinnitus (COSIT)
6) Device Selection and Fitting
7) Addressing Negative Reactions to ST
8) Perceptual Training (PT)
9) Follow-up

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57
Q

ST protocol - tinnitus measurements…

A

To determine if tinnitus is maskable and beneficial.

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58
Q

ST protocol - Goal Setting…

A
  • based on Searchfield’s Approach and considering that:
    ̶- There is no priority for one sound type or strategy over others.
    ̶- Individuals’ preferences may not always meet therapy goals.
    ̶- A trial of various sounds is often necessary.
    ̶- The Client Oriented Scale of Improvement in Tinnitus (COSIT) can be used for goal setting.
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59
Q

ST protocol - Directed Instructions & Counseling:

A

̶- Informational counseling/directed instructions about the cause of tinnitus is often sufficient.
̶- Referrals to psychologists or physicians are advised for those with mental health concerns.

60
Q

ST protocol - Sensory Management: Choosing Between

A
  • Normal hearing: ST
  • Mild to moderate hearing loss: HAs
  • Severe: HAs and assistive devices
  • Profound: CIs
61
Q

ST protocol - The Client-Oriented Scale of Improvement in Tinnitus (COSIT)

A
  • helps decide the goals of therapy
  • the patient lists 5 goals based on needs
  • rate the effectiveness of therapy over time based on degree of change and final result
62
Q

ST protocol - Device Selection and Fitting
a) preferred HA options (3):

A

̶- Open-fitting
̶- Programming flexibility
̶- Bluetooth pairing capability for sound streaming.

63
Q

ST protocol - Device Selection and Fitting
b) Choice of Partial or Total Masking:

A

̶- Total masking: Cover/control tinnitus
̶- Partial masking: Adaptation/habitation with tinnitus

64
Q

ST protocol - Device Selection and Fitting
c) ST Duration (4):

A

̶- It can be intermittent or constant, as needed.
̶- Recommended to be used during awake hours.
̶- Duration depends on the therapy goal; shorter or longer than 12 months.
̶- Patient may progress from total to partial masking, from constant to intermittent use.

65
Q

ST protocol - Addressing Negative Reactions to ST: where should therapy start?

A

̶- In those with hyperacusis.
̶- Therapy should start with managing hyperacusis.

66
Q

ST protocol - Perceptual Training (PT) (5):

A

̶- Most ST is passive.
̶- Perceptual training is an active process.
̶- PT is a short-term structured ST, 20 to 30 min per day over several weeks.
̶- It involves listening and then documenting potential changes (through questionnaires).
̶- It is used for clients who are struggling to adapt to ear-level devices regularly.

67
Q

ST protocol - Follow-up:
a) suggested timeline

A

2-3 times over the first 2 months, at 6-12 months.

68
Q

ST protocol - Follow-up:
b) follow up is the time for (3):

A

̶- Further instruction and counseling to encourage perseverance.
̶- Addressing common issues such as dislike of maskers, device intolerance, streaming issues, cognitive struggles, and battery drain.
̶- Referrals for tinnitus comorbid symptoms.

69
Q

ST During Sleep:

A
  • ST could be as part of the bedroom
  • ST can help get to sleep
  • Provides relief once wake up in the night/morning
  • Recommended: NOT having an automatic turn-off
70
Q

What are the 2 long-term goals of ST?

A

1) Breaking the vicious cycle of tinnitus-stress in some cases.
2) Adapt with tinnitus, and discontinue masker use after a few months.

71
Q

Do not use ST for what 3 patients?

A

1) Non-bothersome tinnitus
2) If noise makes tinnitus worse
̶ - Starting with acclimatization to noise at very low levels may be helpful.
3) In those with hyperacusis
̶ - Start with hyperacusis therapy
̶ - Try first acclimatization to noise at very low levels

72
Q

What is the overall goal when using meditation, mindfulness, or guided imagery for tinnitus?

A

To Manage stress, anxiety, and emotional reactions related to tinnitus

73
Q

What are 9 options for meditation, mindfulness, guided imagery for tinnitus management?

A

1) Meditation
2) Mindfulness
3) Guided Imagery
4) Biofeedback
5) Progressive Muscle Relaxation
6) Art Therapy
7) Music Therapy
8) Yoga
9) A New Hobby

74
Q

How does meditation work for TM?

A

̶- Meditation involves focused contemplation on one thing in a calm and relaxed manner.
̶- Practiced for 20 minutes, one or two times a day.
̶- The individual wears loose clothing, sits or lies on a comfortable surface, and may close their eyes or gaze at a distant object.

75
Q

How does mindfulness work for TM?

A

̶Mindfulness Refers to:
̶- A mental state focusing on the present moment.
̶- Acknowledging and accepting feelings, thoughts, and bodily sensations without labeling, evaluating, or judging them.
̶- Mindfulness has shown promising results in patients with tinnitus.

76
Q

How does guided imagery work for TM?

A
  • Definition: Is a mindfulness technique, by visualizing relaxing sights and sounds to lower stress, pain, or other negative feelings.
    ̶- It creates a calming sensory experience to control reactions to tinnitus and enhance self-coping.
77
Q

How does biofeedback work for TM?

A

̶- Definition: A process that helps gain control over physiological functions and reduce stress by receiving information.
̶- During a biofeedback session, some physiological signals are measured by painless electrodes, such as heart rate, breathing
patterns, brainwaves (EEG), skin temperature, muscle tension, etc.
̶- The idea is that anything that could be measured could be controlled.
̶- Biofeedback helps take control over physiological functions and reduce stress.

78
Q

How does progressive muscle relaxation work for TM?

A
  • It helps manage stress, anxiety, and emotional reactions related to tinnitus.
    ̶- Teaches patients to systematically tense and relax groups of muscles.
79
Q

How does art therapy work for TM?

A

̶- Actively engaging individuals in artistic endeavors (drawing, painting) for emotional release.
̶- Various materials such as paint, markers, paper, and clay can be used.

80
Q

How does music therapy work for TM?

A

Low-level music is calming and relaxing for many people with tinnitus.

81
Q

The Heidelberg Model of Music Therapy Can (2):

A

̶- Reduce tinnitus severity and distress.
̶- Lead to cortical reorganization

82
Q

How does yoga work for TM?

A
  • Yoga, particularly Hatha yoga, helps engage the body and relax the mind.
    ̶- Group exercises like Pilates, yoga, Tai Chi, weight training, and cross-training.
    ̶- Individual exercises like walking, running, swimming, and biking.
83
Q

How does finding a new hobby work for TM?

A

̶- Trying new activities is beneficial for mental well-being.
̶- Engaging in activities like book clubs, writing, pottery, etc., helps put tinnitus in the background.

84
Q

What are 4 considerations when using apps for tinnitus?

A

1) Apps in the Healthcare System
2) Apps for Tinnitus Assessment and Management
3) Apps for Wellness
4) Barriers to Use APPS

85
Q

What can apps be used for?

A

Apps can be used for teaching, data collection, record-keeping, and patient assessment and treatment

86
Q

In audiology, there is a notable surge in apps for hearing-related issues, such as:

A
  • Audiometric testing: uHear, AudCal, EarTrumpet
    ̶- Otoscopy: CellScope (a smartphone otoscope system)
    ̶- Sound amplification: For the intervention and rehabilitation: Ear Machine and PocketLab
    ̶- Assessment and management of tinnitus
87
Q

Audiologists are required to provide ____ and use the apps as ____.

A

patient-centered care, supplementary tools

88
Q

What are a few apps that can be used for tinnitus management?

A

1) Tinnitus Sound Finder app by Desyncra:
̶- Help estimate tinnitus pitch and loudness.
2) Tinnitus Functional Index (TFI) App (Henry et al. 2015).
3) ReSound Relief App: For tinnitus management, including:
̶- ST, Informational counseling, Relaxation exercises
4) Additional Apps for Tinnitus Management:
̶- Tinnitus Retraining Therapy (TRT) using iTinnitus, Tinnitus Balance from Phonak, Zen Therapy using Widex Zen, Starkey Relax
5) Customized Notched Music Therapy App: For ST, used daily for 3 months (Kim et al. 2017).
6) Additional Apps for ST:
̶- White Noise Free, Headspace, Relax Melodies, ReSound Relief, Sleep Pillow, Tinnitus Therapy Lite, Tinnitus Therapy Tunes, ReSound Relief
7) Sound-Level Meter Apps
̶- Such as DB volume, Advanced Decibel, SPLnFFT Noise Meter, SPL, and SoundMeter
̶- Useful to educate patients about sound exposure and dangerous noise levels.

89
Q

What do apps for wellness do?

A

They deliver the techniques discussed to control tinnitus distress and mental health conditions.

90
Q

What are 6 apps for wellness?

A

1) Beltone Tinnitus Calmer:
̶- Provides guided meditation.
̶- Offers imagery techniques.
2) Headspace:
̶- Provides guided meditation
3) Relax Melodies
4) ReSound Relief:
̶- Offers guided meditation and imagery techniques.
̶- Contains relaxation and breathing exercises.
̶- Guides deep breathing exercises with a visual aid.
5) Zenways:
̶- Provides guided meditation.
6) Oticon Tinnitus Sound:
̶- Provides progressive muscle relaxation technique

91
Q

4 barriers to practitioners use for using apps:

A

̶1) Age-Related Gap in App Use: Younger practitioners are more likely to use apps in clinical practice.
̶2) Cost: Some apps add costs, which may have no notable difference from the freely available apps.
̶3) High number of available apps can be overwhelming for healthcare professionals.
̶4) Irrelevant apps in search and challenges in finding suitable apps.

92
Q

3 barriers to patient’s use for using apps:

A

̶1) Limited knowledge of smartphone technology
̶2) Lack of awareness of available apps.
̶3) Difficulty finding a helpful app.

93
Q

Research on the ____ of health-related apps is limited

A

effectiveness and accuracy

94
Q

What is cognitive behavioural therapy (CBT)

A
  • Developed by Beck and colleagues (1979) in the treatment of depression.
  • CBT has been designed to address emotional reactions to tinnitus leading to Habituation
95
Q

CBT addresses tinnitus distress such as:

A

̶- Irritability
̶- Sadness (the loss of your health/hearing ability)
̶- Anger (towards things that may have caused tinnitus)
̶- Guilt (if you believe your careless actions may have caused tinnitus).
̶- Health Anxiety
̶- Generalized Anxiety
̶- Depression
̶- Insomnia
̶- Panic
̶- Phobias

96
Q

How does CBT differ from ST?

A
  • Instead of avoiding or reducing exposure to tinnitus, CBT exposes the person to environments where tinnitus is bothersome, such as:
  • Try to sleep in a quiet room.
  • Try to focus on reading in a quiet room.
97
Q

Two Main Components of CBT for Tinnitus:

A

1) Acceptance and Commitment Therapy
2) Mindfulness-based Cognitive Therapy

98
Q

Best Practice CBT for Tinnitus Distress Aims to (5):

A

̶- Change your thinking (the way of perceiving tinnitus)
̶- Change your behavior (gradually re-engaging all the avoided areas of life)
̶- Change your attention (mindfulness)
̶- Address factors causing distress
̶- Promote habituation

99
Q

Who Offers CBT?

A
  • Clinical psychologist
    ̶- Clinical social workers
    ̶- Licensed Mental Health Counselors
    ̶- Certified audiologists
100
Q

Agencies that provide CBT Certificates:

A

̶- Academy of Cognitive Therapy
̶- American Board of Professional Psychologists (ABPP)
̶- Tinnitus & Hyperacusis Therapy Master Class Based on Cognitive Behavioral Therapy (CBT)

101
Q

What did Systematic Review and Network Meta-analysis of Cognitive and/or Behavioral Therapies (CBT) for Tinnitus find?

A

̶- CBT is an effective tinnitus therapy.
̶- Showing improvement in HRQOL (75%), depression (83%), and anxiety (87%).

102
Q

The ePlatform, iTerapi, was designed in ____

A

Sweden

103
Q

What is the aim of iCBT?

A

Using the Internet to deliver CBT

104
Q

What is the platform for iCBIT?

A

The communication between a therapist and a user can be:
̶- Synchronous (e.g., through Zoom, Skype, Teams, etc.)
̶- Asynchronous (e.g., e-mail)
̶- Blended approach (e.g., email supplemented with telephone calls).

105
Q

Main aims and components of iCBT:

A

Main aims and components are the same as traditional CBT.
̶- Focus on the link between tinnitus and psychological distress.
̶- To modify unhelpful thoughts and behaviors.

106
Q

What is the success rate of iCBT?

A

Several clinical trials support iCBT effectiveness.

107
Q

How does the iCBT program work?

A

It comprises 22 modules
̶- 17 general and 5 optional.
- An overview
- Applied relaxation
- CBT strategies
- Sound enrichment
- Optional modules
- Sleep guidelines
- Improving focus
- Listening tips
- Two to three modules are released weekly.
- It takes 6-10 weeks.

108
Q

What did Telehealth in treating tinnitus: a systematic review and meta-analysis find?

A

Telemedicine, iCBT, is an effective intervention in reducing tinnitus distress.

109
Q

What is the overall aim for tinnitus retraining therapy?

A

Habituation and Desensitization to Tinnitus

110
Q

What is TRT?

A
  • TRT is a clinical method based on Jastreboff’s Neurophysiological Model of Tinnitus (1990).
    ̶- The model distinguishes between tinnitus as “a neutral sound” and “negative stimulus” causing emotional reactions.
111
Q

TRT Aim: Habituation and Desensitization:

A

̶- Habituation refers to a reduction in the emotional response to tinnitus over time.
̶- Desensitization is a state where the tinnitus is no longer perceived as a threat.

112
Q

TRT Holds Two Major Components:

A

1) Counseling, aimed at reclassification of tinnitus to a category of neutral signals.
2) Sound therapy:
̶- Using ST at a low level, “mixing level”, aiming at:
̶- Weakening tinnitus-related maladaptive plasticity

113
Q

ST is personalized based on ____

A

individual preferences.

114
Q

What is TRT mixing level (ML)?

A

Thee sound intensity level will be adjusted at the Mixing Level, positioned just below or close to the perceived loudness of the tinnitus

115
Q

TRT ML Strategy aims at (4):

A

̶- Partially masking tinnitus.
̶- Reducing its intrusiveness and bother
̶- Improving overall well-being
̶- Leading to long-term habituation and desensitization to tinnitus.

116
Q

What does TRT ML allow?

A

ML strategy allows the brain to filter out tinnitus gradually

117
Q

How quickly are improvements seen with TRT ML?

A

Improvements typically observed over several months.

118
Q

What 3 things do we have to think of when considering pharmacotherapy for tinnitus?

A

1) List of Drugs Used for Tinnitus Relief
2) Medicines and Materials That Exacerbate Tinnitus
3) Current Limitations for Pharmacotherapy

119
Q

12 drugs for tinnitus relief

A

1) Anesthetics and Antiarrhythmics
2) Anticonvulsants
3) Antidepressants
4) Antihistamines
5) Anxiolytics
6) Calcium Channel Blockers
7) Diuretics
8) NMDA Antagonists: N-Methyl-D-Aspartate Receptor Antagonist
9) Muscle Relaxants
10) Vasodilators
11) Vitamins
12) Others

120
Q

What are 5 Medicines and Materials That Exacerbate Tinnitus?

A

1) Ototoxic Drugs
2) Heavy Metals
3) Alcohol (Reports of increased tinnitus)
4) Caffeine (Associated with tinnitus perception and anxiety)
5) Oral Contraceptives (a few studies)

121
Q

Has any drug been approved for tinnitus?

A

No effective drug has yet been approved for tinnitus medication.

122
Q

What 5 reasons is it difficult to suggest a drug for tinnitus?

A

1) Complex nature of tinnitus
̶2) Unknown neurophysiological mechanisms
̶3) Diversity in tinnitus characteristics among people experiencing tinnitus
̶4) Large diversity in pharmacogenetics
̶5) Lack of well-designed clinical trials

123
Q

What is the most broadly used herbal medicine for over two thousand years?

A

Ginkgo Biloba

124
Q

What are 4 applications of ginkgo biloba?

A

1) Central nervous system illnesses, including Alzheimer’s disease
̶2) Metabolic syndromes
̶3) Cardiovascular diseases
̶4) A variety of other conditions

125
Q

Ginkgo biloba protects against (Pharmacodynamics):

A
  • Oxidative stress
    ̶- Inflammation
    ̶- Amyloid aggregation
126
Q

____ is the most widely investigated herbal medicine for tinnitus, but clinical trials have yielded conflicting results.

A

G. Biloba

127
Q

What are the limitations for herbal tinnitus therapies?

A
  • It is difficult to conclude the effectiveness of herbal medicines for tinnitus treatment due to:
  • Limitation of Available Evidence
    ̶ - Insufficient quality RCTs
    • Inadequate sample sizes
    • Conflicting/contradictory results
128
Q

What is a type of bimodal neuromodulation approach for tinnitus?

A

Leniere

129
Q

What is leniere?

A
  • Lenire is a recent FDA-approved bimodal (electro-acoustic) neuromodulation device.
  • It combines ST (acoustic) and tongue electric stimulation for tinnitus treatment.
130
Q

What did the results on Leniere show?

A

̶- 12 weeks of device usage led to a significant reduction in THI score.
̶- Sustained treatment effect 12 months post-treatment.

131
Q

Bimodal stimulation may lead to ____ with long-term exposure.

A

positive adaptive neuroplasticity

132
Q

What are the 3 components of leniere?

A
  • tongue tip: sit in the mouth and deliver pulses to the surface of the tonge
  • leniere controller: used to adjust the timing, volume, and tongue stimulation intensity during treatment
  • wireless headphones: paired to the controller to play calming music in tandem with tongue stimulation
133
Q

How does leniere work?

A
  • Based on current studies, often animal research
  • Electrical stimulation of the vagus or trigeminal nerves can
    ̶ - Alter brain patterns relevant to tinnitus treatment
    ̶ - Reduce tinnitus severity.
  • Bimodal neuromodulation can drive significant plasticity
    • In the auditory brainstem, midbrain, and cortex
134
Q

What is a contributing factors for lenire:

A
  • Inter-stimulus delay between electric and acoustic stimulations
    ̶- Better results with shorter (tens of msec ) vs. longer (hundreds of msec) interstimulus delays between sound and tongue stimulations.
135
Q

What is VR based tinnitus therapy?

A

Virtual reality (VR) has recently been used as a clinical treatment for tinnitus.

136
Q

What is the idea behind the use of VR?

A

Capable of creating immersive environments, VR can efficiently simulate situations that are difficult to control in real-world settings.

137
Q

What can VR add to research on tinnitus treatment (Novelty)?

A

Giving the patients the subjective feeling of controlling tinnitus through VR, which is an impossible experience in real life.

138
Q

What is the conclusion on VVR based tinnitus therapy?

A

Additional studies with quality research design are needed

139
Q

____ and ____ are the most successful therapies assisting to cope with tinnitus distress.

A

CBT, TRT

140
Q

For many individuals, especially at the onset of tinnitus, ____ is all they need.

A

informational counseling

141
Q

What does informational counselling focus on?

A

Informational counseling focuses on the cause of tinnitus (using a brain picture), emphasizing the benign nature of tinnitus

142
Q

In those with normal hearing or slight hearing loss:

A

ST + informational counseling

143
Q

In those with HL:

A

ST + HAs + informational counseling.

144
Q

In those with comorbid symptoms:

A

Referrals for counseling focused on psychiatric symptoms

145
Q

Follow-up is the time for:

A
  • Addressing questions
    ̶- Necessary adjustments
    ̶- Referrals for potential comorbid symptoms.
146
Q

The therapy duration varies depending on ____ + ____

A

therapy goals, the individual’s response and progress.

Topics In Audiology (6 decks)

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