Overview of Tinnitus Management Flashcards
Does tinnitus affect individuals in varying degrees?
Yes
Approximately 80% of people experience tinnitus as benign and non-disruptive, whereas 20% may face cognitive and emotional challenges that require clinical intervention.
The most common functional effects include sleep disturbances, difficulties with concentration, and various emotional impacts
Is there a cure for tinnitus?
No
Leads to a focus on reducing distress and improving quality of life
What are some management options for tinnitus patients?
Hearing aids
Sound therapy
Masking devices
Music therapy
Sound apps
Lifestyle modifications
Education and counseling
TRT
CBT
Mindfulness
Physiotherapy
Transcranial magnetic stimulation
Bimodal neuromodulation
Drug therapies
Supplements
Can hearing aids be helpful for those with minimal hearing difficulties and tinnitus?
Yes
The presence of troublesome tinnitus suggests that hearing aids would benefit these patients—amplified sound would be therapeutic for their tinnitus, and their hearing difficulties would be mitigated
How can hearing aids help with tinnitus?
Improves hearing-related quality of life
Reduces attention to tinnitus
Reduce the stress and fatigue associated with straining to hear
Enables masking by ambient sound
Provide stimulation to the auditory system that is deprived of input as a result of hearing loss
May prevent maladaptive neuroplastic changes in the auditory system
When do hearing aids work best for managing tinnitus?
Good low-frequency hearing
Strong reaction to tinnitus
Tinnitus pitch within the fitting range of hearing aids (below 8 kHz)
What prescription procedure is recommended when fitting hearing aids to a tinnitus patient?
DSL V.5
Higher targets for low intensity levels
What are the recommended features for fitting tinnitus patients with hearing aids?
Open fit when possible to avoid LF occlusion
Low compression TK to ensure audibility of low-intensity sounds
Expansion off
Omnidirectional mic setting
Noise reduction algorithms off
Therapeutic sound option with programming flexibility
Wireless communication for access to a wide range of therapy sounds
Frequency lowering may be useful
Does the tinnitus perception (frequency) impact whether hearing aids will be an effective management option?
Yes
If the tinnitus perception is below 8000 Hz, a hearing aid might help
It would not be helpful if the tinnitus perception is higher than 8000 Hz
This is because hearing aids cannot produce sounds that are over 8000 Hz
What is sound therapy?
Uses sound to decrease the loudness or prominence of tinnitus
Can use music, noise, or relaxation-type sounds (ocean waves, breeze, rain, etc.)
What is the reasoning behind sound therapy?
Reduce the audibility of tinnitus by replacing tinnitus with a pleasant sound
Provide consistent stimulation of auditory pathways, replacing spontaneous activity lost with hearing loss, to facilitate adaptation
Sound therapies may change a person’s reactions to tinnitus (e.g. soothing music)
What is music therapy?
Used for music’s calming and healing effects
Can distract from negative feelings
Uses a structured, neuromusic therapy provided through individualized, hour-long sessions over the course of days or weeks
Studies have shown that music therapy reduces tinnitus severity, pitch, loudness, alleviates depression, and improve cortical reorganization and increasing gray matter volume in the brain areas involved in sound processing
Are sound apps a cost-effective option for sound therapy?
Yes
Also many apps to choose from
Examples: white noise baby and relax melodies
What are some examples of commercial sound therapies?
Acoustic CR neuromodulation (therapy that uses special tones matched to the patients tinnitus and plays them through a device)
Hush ear plugs (designed to block out noise to help people sleep while allowing them to be woken up by sounds louder than 70 dB)
Neuromonics (acoustic desensitization protocol; combines spectrally modified music with ongoing counseling)
Sound pillow (pillow with two speakers that are buried deep inside; plays sound from a pre-loaded MP3 player with different sounds)
What education about tinnitus should you include during counseling?
Basic information explaining what tinnitus is and the different types
Reassurance that tinnitus is not a dangerous or life-threatening condition
Information on the link between tinnitus and hearing loss, including the value of audiological assessments
An explanation that, although there is no cure for tinnitus, there are various management strategies that can reduce its impact and improve quality of life
Referral to resources
What are some counseling strategies that may be implemented?
Helping people to recognize how their beliefs impact their reactions
Provide coping/management strategies
What are some lifestyle factors that can exacerbate the symptoms of tinnitus?
Stress and fatigue
Consistent noise exposure
Use of aspirin in high doses
Alcohol and high caffeine consumption
Tobacco
High sodium intake
*Lifestyle modifications may help minimize the unfavorable effects of tinnitus
What is cognitive behavioral therapy?
Goal is to reduce the negative responses to tinnitus by transforming negative thoughts into positive, realistic ones
Aims to decrease anxiety and depression
Needs a dedicated multidisciplinary team for effective management
Requires a time commitment (can extend up to 30 months)
Consistency is the key
What is mindfulness?
A technique that can help people manage tinnitus by teaching them to be more present and accepting of their experience
A mental state that is achieved by focusing one’s attention on the present moment without judgement
Accepting one’s feelings, thoughts, and bodily sensations
Has mindfulness meditation shown promising results for managing tinnitus?
Yes
What is mindfulness-based cognitive therapy?
Mindfulness treatments that have been adapted for tinnitus (originally done for depression)
Combines mindfulness practices, such as meditation and conscious breathing, with elements for cognitive therapy
Used to help manage psychological conditions
Structured 8-week program, weekly sessions
What is repetitive transcranial magnetic stimulation?
A device that delivers short magnetic pulses through a magnetic coil placed near the scalp to modulate brain activity in specific areas associated with mood
Aims to alleviate symptoms of mental health conditions
Success rates up to 65-70%
Uses electromagnetic signals to reduce neural hyperactivity in the cortex
What is the lenire?
Bimodal neuromodulation
Combines auditory stimulation via headphones with somatosensory stimulation through a tongue device
Targets both the trigeminal and the auditory nerve to potentially alter the tinnitus pathways in the brain
Done daily, 95% experience improvement after 12 weeks, 91% maintaining benefits after 12 months
Can physiotherapy and head and neck manipulation help alleviate tinnitus?
Yes
Are there FDA-approved drugs to treat tinnitus?
No, not currently
Drugs are frequently used off-label to relieve tinnitus
Many of these treatments have severe side effects are are often ineffective
What are the different off-label drugs that are used to alleviate tinnitus?
Antidepressants (used to reduce loudness and improve quality of life, especially in patients with co-morbid depression)
Anticonvulsants (aims to stabilize neural activity)
Benzodiazepines (aims to alleviate tinnitus related anxiety and insomnia)
Glutamate receptor antagonists (reduces neural hyperactivity and tinnitus annoyance)
Otoprotectants (explored for preventing NIHL and tinnitus)
Why is it difficult discovering drugs that treat tinnitus?
Tinnitus is a heterogeneous disorder (symptoms and underlying pathologies vary greatly among individuals)
Tinnitus involves complex and overlapping brain networks that are difficult to study and target
Animal studies don’t fully mimic human tinnitus, which limits their usefulness in finding new treatments
What supplements have been shown to improve tinnitus?
Vitamin B, zinc, iron, and magnesium can be helpful
Ginko biloba can decrease tinnitus in some patients (works better if tinnitus is recent, works to increase circulation to the cochlea)
Melatonin can improve tinnitus symptoms and sleep
*AAO-HNSF guidelines instruct us not to suggest these to patients
