Introduction Flashcards
What is the word tinnitus derived from?
Derived from the Latin word tinniere
Means “to ring”
Was the first mention of tinnitus in a medical setting?
No, but a romantic setting
Sappho described tinnitus as a symptom of love (Sappho of Lesbos in 600 BC)
Catullus also wrote about it
Did Martin Luther report having tinnitus?
Yes
He experienced debilitating headaches and tinnitus shortly after leaving the catholic church
Did Beethoven have tinnitus when he started to lose his hearing at the age of 29?
Yes
What is tinnitus?
The perception of sound occurring in the ear(s) and/or the head when no external sound is present
Phantom auditory perception
A symptom, not a disease
Several theories regarding the underlying mechanism of tinnitus
Perceived in one ear, both ears, inside the head, or outside the head
Do phantom auditory perceptions differ from tinnitus?
Yes
What are the different types of phantom auditory perceptions?
Auditory imagery (imagine sounds such as recalling music or phone numbers; can occur consciously or involuntarily)
Auditory hallucinations (perceptions of sound that are experienced as real without an external source (voices and noises))
Musical hallucinations (perceiving music or melodies that are not present; mostly in older adults with hearing loss)
What percentage of people will experience tinnitus during their lifetime?
30%
What percentage of people live with persistent tinnitus?
10%
10% of these are significantly impacted by tinnitus in their daily lives
What percentage of people suffering from tinnitus also have some degree of hearing loss?
About 80%
What is epidemiology?
The study of how diseases and health-related conditions are distributed within populations
Serves as the foundation of interventions made in public health and preventative medicine
What does prevalence of tinnitus mean?
The number of people who suffer form tinnitus at any given time
Prevalence is between 10-15% of the adult population worldwide
What does the incidence of tinnitus mean?
The number of new cases arising per given time period (usually a year)
Much harder to estimate than prevalence
Why do epidemiological measures for tinnitus vary significantly?
Symptoms can fluctuate over time, complicating consistent assessment
Symptoms are described differently by individuals
Different diagnostic approaches lead to varied results
Tinnitus and hyperacusis are often underreported, particularly in children and adolescents, resulting in gaps in understanding their prevalence and impact
Does the prevalence of tinnitus significantly increase with age and the severity of hearing loss?
Yes
How many patients with sudden sensorineural hearing loss, presbycusis, and noise induced hearing loss are estimated to have tinnitus?
SSNHL - 50%
Presbycusis - 70%
NIHL - 90%
Are tinnitus assessments difficult to do in children?
Yes, because of their limited ability to communicate symptoms
Estimating the prevalence of tinnitus in children is challenging due to reliance on parental questionnaires and difficulties in directly interviewing children
Unlike tinnitus in adults, is there a higher gender prevalence of tinnitus in children?
Yes
Higher prevalence of tinnitus among girls with higher prevalence of anxiety and depressive symptoms
What are the factors related to the prevalence of tinnitus?
Hearing loss (90% of individuals suffering from tinnitus have a measurable hearing loss)
Age (increases with age; annoyance from tinnitus is also a function of age)
Gender (slightly more females report it, though the difference is small and not strongly clinically significant)
Genetic predisposition (limited evidence; some genetic disorders have been identified to be associated with secondary chronic tinnitus)
Socioeconomic and occupational factors (noise exposure and stress from work contribute to tinnitus)
What are some other (secondary) factors for tinnitus?
Ototoxic medication
Stressful life events
Noise exposure
Alcohol consumption
Coffee consumption
Smoking
Are there some conductive pathologies that are associated with tinnitus?
Yes
Such as impacted cerumen, external otitis, OM, perfs, cholesteatoma, etc.
What are some definite risk factors for tinnitus?
Acoustic neuroma
Age
Cardiovascular and cerebrovascular disease
Drugs or medications
Ear infections/inflammation
Head/neck trauma and injury
Hyper and hypothyroidism
Loud noise exposure
Menieres
Otoscelrosis
Presbycusis
Sudden deafness
What are some possible risk factors for tinnitus?
Alcohol
Anxiety
Depression
Familial inheritance
Geographic region
Health status
Heavy weight or high BMI
Limited education
Low height
Low socioeconomic status
Low weight or low BMI
Rural residence
Smoking
What are some of the many sounds of tinnitus?
Ringing (most common)
Buzzing
Hissing
Whistling
Swooshing
Screeching
Clicking
Cicadas
Crickets
Winds
Falling tap water
Grinding steel
Musical tinnitus/musical hallucinations
Can tinnitus be acute or chronic?
Yes
Can tinnitus be bothersome or non-bothersome?
Yes
Can tinnitus be constant, pulsing, or intermittent?
Yes
Can tinnitus vary in pitch or loudness?
Yes
Can tinnitus be present in one ear or both?
Yes
Important to ask a patient this question
How many tinnitus cases are believed to be monaural?
37%
Why is monaural tinnitus hard to diagnose?
Intense tinnitus in one ear can mask binaural nature
Patients cannot “unplug” tinnitus like external sounds, complicating self-assessment
Low-intensity tinnitus is less likely to be misidentified as monaural
How many people only hear one tinnitus sound?
About 53%
How many patients hear two tinnitus sounds?
26%
How many patients heard three or more tinnitus sounds?
16%
How many patient cannot discern how many tinnitus sounds they are hearing?
5%
What is the final destination of the tinnitus neural signal?
The auditory cortex
What can the origin of tinnitus be?
Within the auditory nervous system (somatic tinnitus)
Outside the auditory nervous system (neurophysiologic tinnitus or sensorineural tinnitus)
What is somatic tinnitus?
A type of subjective tinnitus in which the frequency or intensity is altered by body movements such as clenching the jaw, turning the eyes, or applying pressure to the head or neck
Associated with vascular, muscular, skeletal, respiratory, or located in the temporomandibular joint
What are the types of somatic tinnitus?
Pulsatile tinnitus (pulses in synchrony with heartbeat)
Non-pulsatile somatosounds (arise from non-vascular sources)
What is neurophysiologic tinnitus?
Originates within the auditory nervous system
The cochlea is often implicated
Damage from noise exposure frequently leads to tinnitus
What is objective tinnitus?
Rare
Used to describe sounds that are generated within the body; can be audible to another person
May be vascular or mechanical in origin
Always a somatosound with an internal acoustic source
Not all somatosounds are detectable by the examiner, so they may not qualify as objective tinnitus
What is subjective tinnitus?
Most common
Perceived only by the patient
Source is often complex or difficult to determine
Unique to each patient
What is acute tinnitus?
Tinnitus lasting for a short duration, typically less than 3 months
Often associated with recent exposure to triggers (e.g., loud noise, ear injury)
Have a higher chance of spontaneous recovery
What is chronic tinnitus?
Tinnitus persisting for 3 to 6 months or longer
Usually involves sustained neurobiological changes and may require ongoing management
Spontaneous recovery is less likely
What is recent-onset tinnitus?
Occur after an event, such as noise exposure or brain injury
Lasting weeks to a few months, requires ruling out conditions like vestibular schwannoma
What is delayed-onset tinnitus?
Can happen weeks, months, or even years after a triggering event, like loud noise exposure or a traumatic brain injury
Is there an economic burden of tinnitus on society?
Yes
Total healthcare costs for tinnitus exceeds billions of dollars annually
Most common VA disability claim
Can tinnitus have a substantial impact on an individuals quality of life?
Yes
Some negative effects associated with tinnitus are sleep disorders, working memory impairment, mental fatigue, depression and anxiety, psychological distress, suicide
What are the roles and responsibility of audiologists for tinnitus?
Assess, diagnose, and manage tinnitus and hyperacusis
Provide clinical and educational services
Promote hearing wellness through education and prevention
Educate other professionals
Collaborate with interdisciplinary teams
Identify individuals with bothersome tinnitus or hyperacusis
Conduct comprehensive assessments of hearing and related systems
screen for mental health issues
Refer patients for further care
Fit and orient patient with hearing technologies
Recommend sound therapy and tinnitus maskers
Counsel patients and families on management strategies
Document findings and use outcome measures to evaluate interventions
Advocate for individuals with tinnitus and hyperacusis
What are some barriers of tinnitus treatment?
There is a lack of knowledge about tinnitus
No objective test
No standardized measures to assess improvement after intervention
No universal subjective outcome measure
Many treatment options, but they lack a robust evidence base from high-quality research
In general, is tinnitus overlooked despite its prevalence?
Yes
Received limited research interest and has remained underfunded
This lack of funding hinders both the understanding of tinnitus mechanisms and the development of effective treatments
