Tinnitus & Hyperacusis Flashcards
When evaluating tinnitus, what are the red flags that require attention?
sudden onset and pulsatile
What are the common causes of tinnitus?
Idiopathic
Noise exposure
Ototoxicity
Hypertension
Tumor
How is tinnitus measured?
Pitch matching - highly variable
Loudness matching - adjust intensity of tone
How is reaction time to tinnitus measured?
Tinnitus Handicap Inventory - questions on quality of life
Define hyperacusis
Intolerance to certain sounds; often accompanies tinnitus
What are the types of hyperacusis?
Loudness, Annoyance, Fear, and Pain
What are known causes and associations of hyperacusis?
Causes: anything that causes SNHL
- idiopathic
-Bell’s palsy
-Auditory nerve lesions
Contributing factors:
NIHL
Associations:
Anxiety
Autism
Depression
PTSD
OME
Meniere’s disease
Head injury
Downs syndrome
TMJ
Tinnitus
What are goals and interventions for hyperacusis?
Goal: know the type of hyperacusis and habituation
Approaches:
Counseling - cognitive behavior modification model (focus on response, emotions, thoughts)
Sound therapies - partial masking, continuous level broadband noise
What is the most prevalent cause of tinnitus?
Idiopathic
What kind of tinnitus requires urgent attention?
Sudden, Pulsatile
T/F: subjective non-pulsatile tinnitus is common
True
T/F: chronic non-pulsatile tinnitus is debilitating
False
When would you refer a patient with tinnitus for further evaluation?
Sudden onset
Worsening tinnitus
Asymmetry
Ear diseases
Describe the Tinnitus Handicap Inventory
THI is a questionnaire to identify and evaluate difficulties with tinnitus. Patient ranks difficulty by Yes, Sometimes, No. Each question is scored and degree of difficulty is graded 1-5 with 5 being a catastrophic handicap.
Describe annoyance hyperacusis
Negative emotional reaction to certain sounds
Describe fear hyperacusis
Aversive response to certain sounds
Describe loudness hyperacusis
Intolerance to mild-moderate sounds
Describe pain hyperacusis
Physical perception of pain to certain sounds
What is the difference between phonophobia and mesophonia?
Phonophobia is the fear of certain sounds while mesophonia is annoyance of certain sounds
Name three possible causes of hyperacusis
- Idiopathic
- NIHL
- Bell’s palsy
Define tinnitus
Involuntary perception of sound that originates is not externally produced
What is objective tinnitus and what is it associated with?
Sound is amplified and heard by the examiner. Associated with abnormal middle-ear blood flow or middle-ear muscle contraction.
What are the two basic treatment strategies for tinnitus?
- Reduce or eliminate the physical perception of the sound
- Change the patient’s reaction to the sound
What are (3) ways to improve coping, management and behavioral change with tinnitus for mild tinnitus?
- Tinnitus Activities Treatment - help patient recognize the difference between
- Tinnitus Retraining Therapy - decrease attention given tot he tinnitus with help of background sound; the way a patient thinks about tinnitus can influence their reaction to it
- Tinnitus Cognitive Behavior Therapy - assist patient to focus away from their tinnitus; refocus on other enjoyable and engaging activities
What can a clinician do for a curious tinnitus patient?
Provide basic information
What can a clinician do for a concerned tinnitus patient?
Provide basic information and review treatment options
What can a clinician do with a distressed tinnitus patient?
Counseling and sound therapy; provide a referral when appropriate. Requires more specific treatment.
What is Tinnitus Activities Treatment?
Provide information in collaborative fashion to ensure understanding and recognize difference between tinnitus and reaction to it. Suggest changes in behavior and lifestyle to facilitate acceptance and habituation.
Provide hearing aid information and review assertive communication vs passive or aggressive communication styles.
Understand sleep patterns, learning relaxation techniques. Arrange bedroom to promote sleep.
Discuss importance of concentration and things that affect it such as environment and personal factors. Activities in “attention diversion” give patients practice switching attention from on engaging task to another (patients can control sounds, images, and other stimuli they consciously focus on)
What are the four sections of hyperacusis activities treatment?
- Emotional well-being - recognize difference between the sound and their reaction
- Hearing and communication - set max output of hearing aids temporarily lower and gradually increase over time
- Sleep - do not sleep well due to anticipation of loud sound (partial masking sound therapy helpful; playing music)
- Concentration - anticipating intense sound
