Tinnitus & Hyperacusis

Question 1

When evaluating tinnitus, what are the red flags that require attention?

Answer 1

sudden onset and pulsatile

Question 2

What are the common causes of tinnitus?

Answer 2

Idiopathic
Noise exposure
Ototoxicity
Hypertension
Tumor

Question 3

How is tinnitus measured?

Answer 3

Pitch matching - highly variable
Loudness matching - adjust intensity of tone

Question 4

How is reaction time to tinnitus measured?

Answer 4

Tinnitus Handicap Inventory - questions on quality of life

Question 5

Define hyperacusis

Answer 5

Intolerance to certain sounds; often accompanies tinnitus

Question 6

What are the types of hyperacusis?

Answer 6

Loudness, Annoyance, Fear, and Pain

Question 7

What are known causes and associations of hyperacusis?

Answer 7

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

Question 8

What are goals and interventions for hyperacusis?

Answer 8

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

Question 9

What is the most prevalent cause of tinnitus?

Answer 9

Idiopathic

Question 10

What kind of tinnitus requires urgent attention?

Answer 10

Sudden, Pulsatile

Question 11

T/F: subjective non-pulsatile tinnitus is common

Answer 11

True

Question 12

T/F: chronic non-pulsatile tinnitus is debilitating

Answer 12

False

Question 13

When would you refer a patient with tinnitus for further evaluation?

Answer 13

Sudden onset
Worsening tinnitus
Asymmetry
Ear diseases

Question 14

Describe the Tinnitus Handicap Inventory

Answer 14

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.

Question 15

Describe annoyance hyperacusis

Answer 15

Negative emotional reaction to certain sounds

Question 16

Describe fear hyperacusis

Answer 16

Aversive response to certain sounds

Question 17

Describe loudness hyperacusis

Answer 17

Intolerance to mild-moderate sounds

Question 18

Describe pain hyperacusis

Answer 18

Physical perception of pain to certain sounds

Question 19

What is the difference between phonophobia and mesophonia?

Answer 19

Phonophobia is the fear of certain sounds while mesophonia is annoyance of certain sounds

Question 20

Name three possible causes of hyperacusis

Answer 20

1. Idiopathic
2. NIHL
3. Bell’s palsy

Question 21

Define tinnitus

Answer 21

Involuntary perception of sound that originates is not externally produced

Question 22

What is objective tinnitus and what is it associated with?

Answer 22

Sound is amplified and heard by the examiner. Associated with abnormal middle-ear blood flow or middle-ear muscle contraction.

Question 23

What are the two basic treatment strategies for tinnitus?

Answer 23

1. Reduce or eliminate the physical perception of the sound
2. Change the patient’s reaction to the sound

Question 24

What are (3) ways to improve coping, management and behavioral change with tinnitus for mild tinnitus?

Answer 24

1. Tinnitus Activities Treatment - help patient recognize the difference between
2. 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
3. Tinnitus Cognitive Behavior Therapy - assist patient to focus away from their tinnitus; refocus on other enjoyable and engaging activities

Question 25

What can a clinician do for a curious tinnitus patient?

Answer 25

Provide basic information

Question 26

What can a clinician do for a concerned tinnitus patient?

Answer 26

Provide basic information and review treatment options

Question 27

What can a clinician do with a distressed tinnitus patient?

Answer 27

Counseling and sound therapy; provide a referral when appropriate. Requires more specific treatment.

Question 28

What is Tinnitus Activities Treatment?

Answer 28

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)

Question 29

What are the four sections of hyperacusis activities treatment?

Answer 29

1. Emotional well-being - recognize difference between the sound and their reaction
2. Hearing and communication - set max output of hearing aids temporarily lower and gradually increase over time
3. Sleep - do not sleep well due to anticipation of loud sound (partial masking sound therapy helpful; playing music)
4. Concentration - anticipating intense sound