Tinnitus

Question 1

Tinnitus general definition

Answer 1

Perception of noise within the head or ears with no external source

Question 2

Tinnitus clinical definition

Answer 2

Perception of sound that’s a result of activity within the nervous system with no correspondence from activity within the cochlea and is unrelated to external stimulation.

Question 3

Who is affected?

Answer 3

Emotional problems 
Auditory discrimination problems 
Insomnia 
Cognitive function difficulties 
Stress 
Hearing related disorders

Question 4

Prevalence

Answer 4

General population: 10-19%
Older population: about 25%
At risk populations: 35-50%

Question 5

Tinnitus cause

Answer 5

Idiopathic sometimes

Question 6

Tinnitus pathophysiological hypotheses

Answer 6

Associated with peripheral pathology:
Outer hair cell damage in the cochlea

Associated with central pathology:
Neurophysiological disturbance in the auditory systematic any point between periphery and cortex

Associated with neural pathology:
Caused by brain perceiving sounds that are no longer created by hair cells that are now dead.

Question 7

Neurophysiological model of tinnitus

Answer 7

Tinnitus perception results from the detection and perception of the neuronal activity within the auditory pathways.

Proposes that the process of increased auditory gain within auditory system during quiet periods may allow tinnitus to emerge: we react not to the loudness of the stimulus but to its relative loudness compared to background.

Question 8

How do we diagnose tinnitus

Answer 8

Case history
Medical history
Audiological assessments
Self assessment scales

Question 9

Advantages of tinnitus measurement

Answer 9

Reassurance that tinnitus is real
Determine if tinnitus has changed
Determine efficacy of treatment 
Provides treatment guidelines 
Determines who is more likely to benefit from which type of treatment

Question 10

Measurement goals (4)

Answer 10

Establish baseline characteristics of tinnitus
Define clients treatment needs
Offer guidance in selecting specific treatments
Provide quantitative measures for monitoring treatment effects

Question 11

Clinical evaluation

Answer 11

Pitch matching
Loudness matching
Minimum masking level to be able to mask the tinnitus completely
Residual inhibition: reduction of tinnitus after a period of making

Question 12

Tinnitus classifications

Answer 12

Subjective: “phantom” auditory perception attributed to activity in peripheral or central auditory system

Objective: ability to hear sounds that are mechanical in nature and are audible to both the client and clinician.

Temporary/permanent

Bothersome/unbothersome

Question 13

Tinnitus category 0

Answer 13

Low severity
Little impact on life
No negative associations 
Simple desire to understand what tinnitus is 
One session of directive counseling

Question 14

Tinnitus category 1

Answer 14

High severity as most complaint
No other hearing related problem
Tinnitus is subjective
Assure patient that it is not linked to any medical problem

Question 15

Tinnitus category 2

Answer 15

Tinnitus with hearing loss
HL significant to client
No significant hyperacusis
Hearing aids may improve hearing and tinnitus (sound enrichment)

Question 16

Tinnitus category 3

Answer 16

Significant hyperacusis with or without tinnitus

Phonophobia and hyperacusis might exist (each to be treated individually)

Question 17

Tinnitus category 4

Answer 17

Most difficult to treat
Hyperacusis is severe; tinnitus secondary or absent
Symptoms worsened by noise exposure

Question 18

Risk factors/ associations/ triggers

Answer 18

Age
Males more likely 
Increased noise exposure
Caffeine: CNS stimulant 
Medication: ototoxicity

Question 19

Tinnitus Retraining Therapy

Answer 19

Several, individual, interactive teaching/directive counseling sessions with the use of sound enrichment

Aims to induce and sustain habituation to reactions induced by tinnitus.
Eliminate physiological reaction to tinnitus signal and therefore minimizing perception of tinnitus
All connections are weakened

Question 20

How is habituation achieved?

Answer 20

Retraining feedback loops that have formed between auditory , limbic and autonomic nervous systems.

Uses 2 elements:
Directive counseling
Sound therapy

Question 21

Directive counseling

Answer 21

Altering the existing connections between the auditory cortex, limit and SAN systems.
Demystifies tinnitus and hyperacusis
Client is reassured and demonstrated a clear understanding of tinnitus and it’s benign nature
Acceptance and information leads to habituation of reactions

Question 22

Sound therapy

Answer 22

Enriching auditory background with external noise will reduce tinnitus detection
Helps achieve habituation
Can be enhanced by avoiding silence and or with the use of sound enrichment techniques, hearing aids or sound generators (instruments that emit broadband sound to open ear fit slightly above hearing threshold)

Question 23

Psychological management of tinnitus (4) types

Answer 23

Relaxation training
Hypnosis
Cognitive therapy
Acceptance commitment therapy

Question 24

Relaxation

Answer 24

Aims to enable patient to achieve relaxation in short periods of time and almost automatically when tension is detected

Question 25

Acceptance and commitment therapy

Answer 25

Teaches client to stay in contact with difficult internal experiences and encourages them to approach these sensations without resorting to avoidance.