Final Exam Flashcards
what is tinnitus
Tinnitus is the perception of sound occurring in the ear or head when no external sound is present
Phantom auditory perception
It is a symptom, not a disease/disorder
what are the theories of peripheral mechanisms
cellular mechanisms
edge theory
discordant damage of IHC & OHC
tectorial membrane displacement
NTs & receptors
Synaptopathy
what are the theories of central mechanisms
auditory deprivation
inhibitory gating mechanism
hyperactivity & hypersynchrony
neural crosstalk
MOC dysfunction
complex sensory network that allows our brain to perceive and interpret sensations from the body
Somatosensory mechanisms
triggers for tinnitus of Somatosensory mechanisms
temporomandibular joint syndrome or whiplash
Anything related to the head and neck
what is the limbic system
Involved in our behavioral and emotional responses - feeding, reproduction, caring for our young, and fight or flight responses
what is the limbic systems role in tinnitus perception
Mediates the emotional response to tinnitus
Those with strong emotional responses often show enhanced sympathetic nervous system activity - fight or flight response
When it is heard there is a reaction and the reaction is controlled by this system and it can make it worse which explains why some cannot ignore it while others can
what can make the tinnitus worse in regards to the limbic system
Anatomical or physiological abnormalities in the limbic system - lead to emotional reactions to the tinnitus
if there is any lesion or damage, limbic system will not block the tinnitus signal meaning that all of it reaches the cortex and perceived causing it to be loud and clear
Greater brain connectivity between auditory and limbic areas =
more distress levels
subjective tinnitus
most common
heard only by the PT
can be bothersome or nonbothersome
common causes of subjective tinnitus
Ototoxicity - high-pitched sound
Meniere’s - LF tinnitus with vertigo & HL that fluctuates
OTSC - high-pitched, white noise and can initially be pulsatile
ototoxicity tinnitus
high pitched
meniere’s tinnitus
LF tinnitus with vertigo & HL that fluctuates
OTSC tinnitus
high-pitched
often white noise
can initially begin as pulsatile
how does OTSC cause tinnitus
CHL causing deafferentation (reduced auditory information going to the brain)
Reduction of masking effect - ex if you cover your ears you miss hearing the environmental noise
Environmental noise can mask the tinnitus but if you have CHL this is not the case so you hear it more
Rich blood supply causing pulsatile
Arteriovenous malformations
Cochlear tinnitus caused by toxic enzymes produced by otosclerotic bone, bony invasion of the cochlea, and damage to the cochlear blood supply
What is the common description of tinnitus reported by patients with otosclerosis?
Usually the first symptom noted is pulsatile in nature.
Tinnitus is a common symptom in otosclerosis patients and sometimes it can appear as the first symptom, explain.
If tinnitus is the initial symptom, it suggests that the patient hasn’t yet experienced conductive hearing loss. This means there’s no auditory deprivation triggering the brain to compensate for the reduced auditory input.
objective tinnitus
heard by the PT and examiner; sounds generated within the body and can be audible to another person
Rare
Vascular or mechanical in origin - Usually due to vascular disturbances or muscular spasms in the head/neck
causes of objective tinnitus
Glomus tumors
ME muscle spasms
Palatal myoclonus
ETD
acute vs chronic tinnitus
acute - short duration, <6 mos, associated w/ recent exposure triggers, high chance of spontaneous recovery
chronic - persistent, >6mos, involved in sustained neurobiological changes, less chance of spontaneous recovery
bothersome vs nonbothersome tinnitus
bothersome - significantly impacts quality of life
nonbothersome - has minimal impact
primary tinnitus
Tinnitus that is idiopathic & may or may not be associated with SNHL (source is unknown)
If we do not know the cause or disorder that caused it
secondary tinnitus
Tinnitus that is associated with a specific underlying cause (other than SNHL) or an identifiable organic condition
If we do know the cause of the tinnitus
auditory and non-auditory cauess of secondary tinnitus
Auditory causes: impacted cerumen, ME diseases, cochlear abnormalities, auditory nerve pathology
Non-auditory causes: vascular anomalies, myoclonus, intracranial hypertension, tonic tensor tympani syndrome, TMJ disorder