Lecture 1 Flashcards
“tinnitus” is derived from the Latin word _______, which means “to ring.”
tinniere
what was the first sign of tinnitus and how it was interpreted
consider ears buzzing a sign of love
if you are in love with someone expect that your ears will start ringing
figures known in history who experienced tinnitus
f
Martin Luther King
Tinnitus & severe headaches around 44yrs
“When I try to work, my head becomes filled with all sorts of whizzing, buzzing, thundering noises, and if I did not leave off in the instant, I should faint away.” “We should live high and drink wine when we are not well.”
Beethoven’s deafness
Didn’t affect his ability to write music
Age 29 his started to lose it and also complained of noises in his ears and head
“my ears hum and buzz continuously day and night. I can tell you that I lead a miserable existence”
tinnitus is a disease
FALSE it is a symptom
what is tinnitus
perception of sound occurring in the ear(s) and/or the head when no external sound is present; phantom auditory perception.
phantom auditory perception
tinnitus
where can tinnitus occur
Perceived in one ear, both ears, inside the head, or even
outside the head
forms of auditory phantom perceptions
Auditory imagery, auditory hallucinations, and musical hallucinations
what differs from tinnitus
Auditory imagery, auditory hallucinations, and musical hallucinations (auditory phantom perceptions)
what should you ask patients for tinnitus
Is it one or two ears?
When did it start?
What does it sound like?
ability to imagine sounds; recalling music or phone #s; can occur consciously or involuntarily; generally normal cognitive function
auditory imagery
describe auditory imagery
ability to imagine sounds; recalling music or phone #s; can occur consciously or involuntarily; generally normal cognitive function
perceptions of sound that are experienced as real like voices or noises without any external source; can occur in both psychiatric & nonpsychiatric populations; can arise from various life experiences
auditory hallucinations
describe auditory hallucinations
perceptions of sound that are experienced as real like voices or noises without any external source; can occur in both psychiatric & nonpsychiatric populations; can arise from various life experiences
specific type of auditory hallucination involving the perception of music or melodies that are not present; often in older adults w/ HL and not necessarily linked to mental health issues
musical hallucinations
describe musical hallucinations
specific type of auditory hallucination involving the perception of music or melodies that are not present; often in older adults w/ HL and not necessarily linked to mental health issues
30% of people will experience tinnitus during their lifetime.
true
10% of people live with persistent tinnitus. _____ of these are significantly impacted by tinnitus in their daily life.
10%
_________ of people suffering from tinnitus also have some degree of hearing loss.
80%
13-18%
depression
35%
anxiety
25%
psychiatric disorder
what is epidemiology
study of how diseases and health-related conditions are distributed within populations
Serves as foundation for interventions made in public health & preventive medicine
epidemiology
prevalence of tinnitus
of people who suffer from tinnitus at any given time
incidence of tinnitus
of new cases per fiven time period (usually a year)
Harder to estimate
HL can cause tinnitus to be worse because the mechanisms are related
true
what percentage of those with HL also have tinnitus
80-90%
PT may come in with primary complaint of tinnitus and they do not experience HL but chances are they will
true
why do epidemiology measurements vary
Fluctuating symptoms over time which complicates consistent assessment
Descriptions of symptoms are different bw people
Different diagnosis approaches that leads to varied results
Tinnitus & hyperacusis are often underreported especially in kids & adolescents which leads to gaps in understanding their prevalence and impact
prevalence increases with
age and severity of HL
factors related to prevalence
HL
age
gender
genetic predisposition
socioeconomic status & occupation
Other factors - increases risk of having tinnitus
Ototoxic medication
Stressful life events
Noise exposure
Alcohol consumption
Coffee consumption
Smoking
Single most common predictor especially HFHL
HL factor
how does age impact tinnitus
tinnitus increases with increasing age
Highest in ages >85yrs
Annoyance of it is a function of age
gender impact on tinnitus
Some show no differences
Others show more common in females than males but not a significant difference
Monogenic disorders associated with secondary chronic tinnitus
`Neurofibromatosis type II
Von-Hippel-Lindau Syndrome
Low frequency sensorineural hearing loss
Osteogenesis imperfecta type I
Autosomal dominant non-syndromal hearing loss
describe socioeconoic status & occupation
Those who are professionals have tinnitus vs unskilled classes - could be because you have more access to healthcare and aware of health so you go and check the things that bother you
Just because you are not professional doesn’t mean you dont have it, just means you may not have access to healthcare like those who are professionals
definite risk factors examples
acoustic neuroma
age
drugs/meds
otsc
meniere’s
ear infections
sudden deafness
presbycusis etc
possible risk factors
alcohol
anxiety
depression
health status
heavy weight
smoking
sounds of tinnitus descriptions
ringing, buzzing, hissing, whistling, swooshing, screeching, clicking, cicadas, crickets, winds, falling tap water, grinding steel, musical tinnitus/musical hallucinations
what can tinnitus be
Acute or chronic
Bothersome or not
Centered in head or localized outside of head
Constant, pulsing or intermittent
Variable in pitch or loudness
Present in one or both ears
when is tinnitus becoming louder significant
Louder at night - not significant this is because you become aware of it and the environment is quiet
Significant if it is during the day or activities
Majority are monaural
true
is tinnitus only one sound
no
can hear one or two or more
what is the point of tinnitus assessment
learns what they are experiencing as a PT but not diagnosing their tinnitus
tinnitus origin
within auditory nervous system (somatic)
outside the auditory nervous system (sensorineural tinnitus)
somatic tinnitus
has nothing to do with hearing; for ex TMJ that can cause tinnitus
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 and neck.
They can manipulate their muscles which causes the tinnitus to change in frequency or intensity
Capable of moving and doing something to change the tinnitus (TMJ, head and neck, etc.)
Refer and if they get treated usually can go away
what is associated with somatic tinnitus
vascular, muscular, skeletal, respiratory, or located in the temporomandibular joint.
types of somatic tinnitus
Pulsatile tinnitus: Pulses in synchrony with the heartbeat; most common type.
Beats with the heart
Need accurate intake from the PT to understand what is going on and refer if needed
Nonpulsatile somatosounds: Arise from nonvascular sources (e.g., muscle spasms, patulous eustachian tube).
Neurophysiologic tinnitus
Majority
Originates in the auditory nervous system
The cochlea is often implicated, as damage from noise exposure frequently leads to tinnitus.
Numerous theories about the pathophysiology of sensorineural tinnitus exist!
Majority
Originates in the auditory nervous system
The cochlea is often implicated, as damage from noise exposure frequently leads to tinnitus.
Numerous theories about the pathophysiology of sensorineural tinnitus exist!
neurophysiologic tinnitus
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 and neck.
Associated with vascular, muscular, skeletal, respiratory, or located in the temporomandibular joint.
somatic tinnitus
objective tinnitus
Not only PT who can hear it but also you
Due to vascular disturbance
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.
true
subjective tinnitus
not necessarily something physical causing it and you cannot hear it just the PT
Most common
Perceived only by PT
source of this type of tinnitus is often complex or difficult to determine as a variety of factors may be involved.
It is unique to each patient; tinnitus can be bothersome, significantly affecting quality of life, or nonbothersome, having minimal impact.
acute tinnitus
Short duration, less than 3 mos
Associated w/ recent exposure triggers (e.g. loud noise, ear injury, meningitis etc.)
Higher chance of spontaneous recovery
Short duration, less than 3 mos
Associated w/ recent exposure triggers (e.g. loud noise, ear injury, meningitis etc.)
Higher chance of spontaneous recovery
acute tinnitus
Persists for 3-6 mos or longer
Involves sustained neurobiological changes & may require ongoing management
HL
Less chance of spontaneous recovery
chronic tinnitus
chronic tinnitus
Persists for 3-6 mos or longer
Involves sustained neurobiological changes & may require ongoing management
HL
Less chance of spontaneous recovery
recent onset tinnitus
Lasts weeks to a few months
Vestib schwannoma, stress, noise exposure
Often fear serious conditions - need + counseling
Lasts weeks to a few months
Vestib schwannoma, stress, noise exposure
Often fear serious conditions - need + counseling
recent onset
delayed onset tinnitus
Weeks, months or years after triggering event
Loud noise exposure, traumatic brain injury
Need detailed hx to explore all possible causes - mostly for legal reasons
Weeks, months or years after triggering event
Loud noise exposure, traumatic brain injury
Need detailed hx to explore all possible causes - mostly for legal reasons
delayed onset
what is the economic burden of tinnitus
substantial burden on society with health costs exceeding billions of dollars annually
Tinnitus is the most common VA disability claim
how does tinnitus affect quality of life
can be devastating and can include adverse effects like:
Sleep disorders
Working memory impairment
Mental fatigue
Depression & anxiety
Psychological distress
Suicide or suicidal behaviors
what are common complaints of tinnitus
Very tired, slow, fatigued
Difficulty concentrating
Persistent sad mood
Doesn’t enjoy things like before
restless/irritable
Nervousness
Persistent headaches, stomach aches or chronic pain
Sleeping and/or eating less
Excessive crying
Hopelessness - Life isn’t worth living
Absence of pleasures or joys
audiologist role with tinnitus
Case history
Appropriate referral
Comprehensive audiologic assessment
Validated tinnitus questionnaires
Hearing aid assessment
Fitting of hearing aids and combination instruments
Brief tinnitus education
Follow-up assessment with relevant questionnaires at least 1 month following any device fittings
audiologist responsibility
Assess, diagnose, and manage tinnitus and hyperacusis.
Provide clinical and educational services, including diagnosis and intervention.
Promote hearing wellness through education and prevention.
Educate other professionals about audiologists’ roles in tinnitus management.
Collaborate with interdisciplinary teams.
Identify individuals with bothersome tinnitus or hyperacusis.
Conduct comprehensive assessments of hearing and related systems.
Screen for mental health issues as needed.
Refer patients for further evaluation and care.
Fit and orient patients 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.
barriers of tinnitis
Lack of knowledge
No objective testing
No standardized measures to assess improvement after intervention
No universal subjective outcome measures
Many treatments are available but lack evidence from high-quality research
why do we need tinnitus reserach
What management strategies are most effective beyond audiological care?
Is Cognitive Behavioral Therapy (CBT) delivered by audiology professionals effective?
What management strategies are most effective for improving tinnitus-related insomnia?
Do any of the available complementary therapies improve outcome for people with tinnitus?
What type of digital hearing aid or amplification strategy provides the most effective tinnitus relief?
What is the optimal set of guidelines for assessing children with tinnitus?
How can tinnitus be effectively managed in people who are Deaf or have a profound hearing loss?
Are there different types of tinnitus and can they be explained by different mechanisms in the ear or brain?
What is the link between tinnitus and hyperacusis (over-sensitivity to sounds)?
Which medications have proven to be effective in tinnitus management?
