Final Exam Flashcards
How hearing aids help with tinnitus
- Improves hearing related quality of life
- Reduces attention to tinnitus
- Reduces stress & fatigue
- Enables masking by ambient sound
- Provides stimulation to aduitory system that is deprived of input from HL
- Prevent maladaptive neuroplastic changes in auditory system
Hearing aids work best for managing tinnitus when…
- Good low frequency hearing
- Strong reaction to tinnitus
- Tinnitus pitch within the fitting range of the hearing aids (8k)
How does Tinnitus managment work if tinnitus is above 8k?
If Tinnitus is above 8k hz it will not be beneficial because amplifcation does not help extended high frequency hearing loss.
____ prescriptive procedure reccomeneded as a ____ point for ____.; _ _ _ _ targets for _____ intensity evels
DSL V.5 prescriptive procedures recommended as a starting point for amplfication; higher targets for low intensity levels
____verfication of output to ensure ____of quiet sounds
Real Ear verifcartion of output to ensure audibity of quiet sounds
Main instrument selection and fitting (3)
Hearing aids work best for managing tinnitus when.
* Good low frequency hearing
* Strong reaction to tinnitus
* Tinnitus pitch within the fitting range of the hearing aids (8k)
DSL V.5 prescriptive procedures recommended as a starting point for amplfication; higher targets fo low intensity levels
Real Ear verifcartion of output to ensure audibity of quiet sounds
Reccommended Tinnitus Hearing aid features
- Binaural fitting for bilateral HL
- Open fit when possible to avoid LF occlusion
- Low compreesion Kneepoint to ensure audibility of low intensity sounds
- Omnidirectional microphones
- Expansion Turned off
- Noise reduction tunred off
Tinnitus HA’s features
Do you want open or closed fit?
Open fit when possible to avoid LF occlusion
Tinnitus HA’s features
What kneepoint and why
Low compression kneepoint to ensure audibility to low intensity sounds
Tinnitus HA’s features
What type of expanion?
None, expansion should be turned off
* you don’t want to turn on expansion on those low level sounds. It can function as a type of tinnitus masker.
Tinnitus HA’s features
what type of directaionality
Omnidirectional microphone
* incraeses the range of sounds from the enviorment to help mask the tinnitus
Tinnitus HA’s features
What type of Noise reduction?
None, noise reduction should be turned off
* Noise reduction helps clean the signal
* when off it will help mask the tinnitus
Overview
Sound therapy rational
Sound therapy uses sound to decraese the loudness or prominence of tinnitus.
The types of sound to me used in sound therapy
- Music
- Noise (pink,white etc)
- Relaxation type sounds or enviormental sounds
Why is music an option for sound therapy?
Music is used widely for it’s calming and health effects.
Is music therapy helpful? why or why not?
Music therapy reduces tinnitus severity, pitch loudness, allevites depression, and improves cortical reorganiztion and increasing gray matter volume in the brain areas involved in sound.
Type of Relaxation - type sounds or enviomental sounds
Sound apps
any sound app like resound sound app we used
reasons for the use of sound therapy?
- reduces the audibility of tinnitus by replacing tinnitus with a pleasent sound
- provdes constant stimulation of auditory pathways replacing spontaous activity lost w/HL to faciliate adaptation.
- Aid relaxtion. can change a persons reaction to the tinnitus.
what should be included in education and counceling?
- Basic info expalining tinnitus
- Reassurance tinnitus is not dangerous or life threatening
- Link between HL and tinnitus and audio assessment
- expalin no cure but managment is availible
- Referral to resources
Counceling strategies
- Help people recgonize how their beliefs impact their reactions
- Provide coping/mangement strategies
Lifestyle modifcations
Name some factors that can exacerbate tinnitus symptoms
- stress and fatigue
- consistent noise exposure
- Asprin in high doses
- Alcohol & caffine
- Tobacco
- High Sodium intake
Lifestyle modifcations can help minimize tinnitus
What is mindfullness?
- mindfullness teaches people to be more present and accepting of their experince
**Mindfullness has shown results in managment of tinnitus **
What does MBCT stand for?
Mindfulness-based Cognitive Therapy
What is MBCT?
Mindfulness-based Cognitive Therapy is a theraputic approach that combines minfulness parctice with elements of cognitive therapy to help manage psychological conditions
how long is MBCT for?
MBCT for tinnitus involves structed 8-week programs where patients engage in weekly sessions taht teach and reinforce mindfullness practices.
What does rTMS stand for?
Repetitive Trancranial Magnetic Stimulation (rTMS)
what is rTMS?
- rTMS is a device that delivers short magnetic pulses though a magnetic coil placed near teh scalp to modulate brain activity in areas assoicited with mood
- aims to allevaite symtoms of mental health conditions
How does rTMS work?
rTMS using strong electromagnetic signals to reduce neural hyperactivity in the brains cortex, beleived to be associated with tinnitus
Sucess of rTMS is based on what
success depends on the correct application of treatment protocols, including coil placement, stimulation frequency & intensity
Are medications a managemnt option for tinnitus? why or why not?
- No FDA approved drugs to treat tinnitus
- However drugs are commonly used off label
- those treatmenst often have severe side effects and are ineffective for tinnitus
Are supplements a managemnt option for tinnitus? why or why not?
- they are used to help with associated symptoms not tinnitus
- Melatonin has been shown to improve tinnitus symptoms and particualy improve sleep
What are the challenegs in tinnitus drug discovery?
- Tinnitus is a very heterogeneous disorder; symptoms and underlying pathologies vary widely. making it hard to develop a one size fits all treatment
- Tinnitus involves complex & overlapping brain netowrks that are difficult to study and target
- animal studies dont fully mimic human tinnitus
Define CBT
CBT is a problem focused and action oriented psychological intervetion that combines principles from behavioral & cognitive psychology.
What does CBT do?
CBT uses a variety of cognitive and behvaioral techniques to help individuals identify and modify the realtionships between their thoughts, behviors and emotions
What is the purpose of CBT?
Reduces negative responses to tinnitus by transforming negative thoughts into positive realistic ones,
CBT aims too…
aims to decraese anxiety and depression, enhancing overall quality of life.
CBT challenges
Time commitment & expectations can impact the success of these treatments.
CBT principles
What we think, how we feel and how we behave are all connected and each factors has an influence on well-being
CBT Goals
- Monitor their negative automatic thoughts
- recognize relationships between thoughts,emotions and behaviors
- assess validity of distorted automatic thoughts
- Replace baised thoughts w/ reality oriented interpretations
- Identity & Modify dysfucntional beliefs that lead to distorted experinces
What are the components to CBT and how are they benefical?
- Cognitive restructuring
- Behavioral Modification
This combined approach helps patients identify & correct maladaptive behaviors, distorted conceptions and irrational beliefs
Name the elements of CBT
Relaxation Therapy
Cognitive Restucturing
Attention control Techniques
Imagery Techniques
Sleep Mangement
Relaxation Trainning
- Teaches tension reduction through muscle relaxation exercises
- Coping with tension and anxiety related to tinnitus
- Limited effectiveness alone; better w/comprehensive mangement program
Cognitive restructuring
is the identification of dysfunctional beliefs and negtive thoughts; that are a response of life events or distress
Attention Control Techniques
- redirect attention from tinnitus to other enviormental details
- Encourages engaging other senses (smell, taste) to distract
- Sound masking or amplifying background noises helps manage tinnitus more effectively
Imagery Techniques
- Modify negative associations w/tinnitus by “masking” or imagining positive scenes
- Masking: Imagine their tinnitus beging masked by a waterfall,ocean waves etc. without using actual sounds
- Pleasent scenes: Imagining scenariors such as walking in natures w/birds singing
Sleep management
SM techniques
* sleep hygiene
* bedtime restriction
* relaxation
* cognitive restructuring
what is involved in relapse prevention?
- this involves discussing potential risk factors for worsesning tinnitus and hearing loss
- creating a proactive plan for managing any escilation in symptoms
true or false
When doing tinnitus treatment, your tinnitus will get constiatnt downward trajectory.
False
* is it excpected to have flucutuations.
* Patienst should be notifed of this so they dont stop treatment
What is the most important aspect of tinnitus treatment?
Consistency is the most important
Techniques to prevent relapse?
- Identifying risk factors
- Importance of Continious practice
- Managing Temporay fluctuations
- Generalization of treatment benefits
- Post- Treatment support
CBT candidate selection
- 40 - 70 with or without HL
- No severe comorbid psychological conditons
- Had tinnitus &/or suffered from tinnitus for at least 3 months
- seeking to alleviate impact of tinnitus on quality of life and daily activities
TRT
Describe the interaction between the auditory system, limbic system and autonomic nervous system
- When tinnitus becomes associated with negative emotion, it triggers strong reactions in the limbic system and autonomic nervous system
- Once arousal of limbic and ANS is sufficaently high, the stimulus linked to this activation will dominate all other brain functions
TRT
How does the relationship between the auditory system, limbic system and autonomic nervous system lead to tinnitus vicious cycle?
- Auditory system provides the source of the signal
- Tinnitus through inappropriatly created functional connecetion casues activation of the Limbic and ANS
- This creates a vicious cycle involving auditoy, limbic and Autonomic nervous systems = distress and annoyance
TRT
Auditory system provides the ____ of the —– Tinnitus through —– —– —– —– casues activation of the Limbic and ANS
Auditory system provides the source of the signal Tinnitus through inappropriatly created functional connecetion casues activation of the Limbic and ANS
TRT
Development and passive extinction of the conditioned reflex in the normal system
- Once tinnitus acquires a negative emotion and starts to induce activation of the ANS
- Leading to progressively stronger activation of ANS and Limbic system through conditioned reflex arc.
- once negative assoication is made hard to revmove because apart of conditioned reflex arc.
TRT
Mechanism preventing spontaneous extinction of conditioned reflexes in tinnitus patients
- If signal is associated with high levels of emotional distress conditioned reflexes are created
- Tinnitus (stimulus) will activate limbic system & ANS (reaction)
- constant state of alertness causes tinnitus patients to be exhausted, lack of sleep, unable to focus on anythign else except the tinnitus.
Can the conditioned reflexes be revered? Why or why not?
Yes they can be reversed
* body reactions to any stimulus can be reversed & brain is able to learn
* Natural habituation of various stimuli is continlously taking place
* 3/4 of peopple who experinece tinnitus naturally habitaute to it.
Name the two types of Habitutaion
- Habitutaion of reaction
* retraining counceling - Habitiation of perception
* sound therapy
Habitiutaion of reaction
Retraining counceling
* you learn not to react to the tinnitus in a negative way
TRT
Habituation of perception
- repeative appearance of a particular sound, the subcortical pathways will block it and the individual will be unaware that the sound is present
- Habituation of perception prevents the signal from reaching higher cortical areas involved in signal awareness
* Repated sound - subcortical pathways block - unaware of sound = habituation of perception
TRT Overview
- Neurophysiological traetment by Jastreboff
- TRT is a habituation based treatment uses coucneling to decrease the strength in tinnitus evoked reactoions to decrease the strength of tinnitus signal
TRT Goals
- Induce & Facilitate the patients habituation to their tinnitus
- Eliminate reactions induced by tinnitus
- Prevent spread of tinnitus signal to other brain systems
Successful Outcome
* Still perceives tinnitus but not bothered by it anymore
* Enhanced quality of life through decreased tinnitus distress
What are the TRT components?
- Retraining Counceling (habituation of reaction)
- Sound Therapy ( Habituation of perception)
what is the TRT protocol?
- Introductory contact
- Inital visit: taking history of tinnitus, audiologic & medical assessment, assessing the category. for treatment & TRT counceling
- Instrument fitting
- Follow up Visits: Evaluation of the patients status and furtehr counseling
- Closing the treatment
TRT Inital Interview
- Determine TRT treatment category - will determine overall course of treatment best for the patient
- Assess tinnitus impact & severity
- Identify sensitivity to sounds & decreased sound tolerance (hyperacusis)
- Assess subjective hearing difficulties that could impact treatment
TRT
Key aspects of treatment to discuss with the patient
- Treatment objectives
- Schedule of treatment sessions
- Requirements for using ear-level devices
- Costs associated with treatment
- Any other pertinent details of the planned treatment
True or False
assigning the patient to the correct category of treatment is essential for successful therapy
TRUE
assigning the patient to the correct category of treatment is essential for successful therapy
- becuase inappropriate treatment could make symptoms worse.
TRT
Categorization of Patients
- all patients are placed in one of the 5 categories (0-4) may be changed during treatment
- determined by:
- Severity & duration
- Presence and extent of hyperacusis
- Subjetive significance of hearing loss
- prolonged exacerbation of symptoms follwing sound exposure
