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Year 2 Courses > Tinnitus Previous ?'s > Flashcards

Tinnitus Previous ?'s Flashcards

1
Q

Which of the following about tinnitus is accurate
Tinnitus can be the first symptom of hearing loss
Tinnitus may occur with a rhythm that matches your heartbeat
Tinnitus can develop without any clear cause
All

A

all

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2
Q

Your next PT for the afternoon is a 58 year old male who was referred to you with complaint of right constant acute tinnitus. Based on your tinnitus knowledge the time frame for acute tinnitus would mean the PT has been suffering for

A

6 months or less

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3
Q

Which NT receptor is involved in protecting against noise induced excitotoxicity in the auditory nerve fibers

A

nmda

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4
Q

According to Jasterboff neurophysiological model which system plays a secondary role to tinnitus

A

auditory system

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5
Q

What is the primary difference between subjective and objective tinnitus

A

objective can be heard by others

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6
Q

Primary function of the limbic system

A

Regulating emotions memory and behavior

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7
Q

The tymp below indicates pulsatile tinnitus secondary to which conditions

A

glomus jugulare

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8
Q

According to neurophysiological models what is considered a primary cause of how tinnitus is perceived

A

Increased spontaneous activity

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9
Q

When identifying tinnitus ear and stimulus ear for psychoacoustic testing which ear should be used for stimulus in a patient with bilateral tinnitus

A

ear with the quietest tinnitus

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10
Q

Which of the following is a primary goal of audiological assessment for PTs with bothersome tinnitus
Rule out or confirm any underlying disease or pathology
Define impact of tinnitus on quality of life
Diagnose tinnitus as primary disease
Quantify severity of PTs tinnitus

A

Rule out or confirm any underlying disease or pathology
Define impact of tinnitus on quality of life
Quantify severity of PTs tinnitus

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11
Q

When performing pitch matching for a PT with hearing loss at what level should the stimulus be presented at

A

5-10 dB sl

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12
Q

During loudness matching at what level should testing begin in relation to the PTs hearing threshold for matched frequency

A

5 dB below threshold

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12
Q

What role does selective attention play in McKenna’s cognitive behavioral model
It can intensify tinnitus perception, often leading to exaggerated descriptions and heightened distress
It reduces tinnitus distress by focusing on positive thoughts
It increases habituation by decreasing awareness of tinnitus sounds
It helps filter out tinnitus sounds as irrelevant stimuli

A

It can intensify tinnitus perception, often leading to exaggerated descriptions and heightened distress

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13
Q

According to the concept of safety seeking behaviors in McKena’s model, how might these behaviors impact tinnitus management
They reduce tinnitus intensity through avoidance and escape
They help decrease arousal by promoting distraction from tinnitus
They eliminate tinnitus perception by enhancing auditory focus
They reinforce negative beliefs about tinnitus and may delay habituation

A

They reinforce negative beliefs about tinnitus and may delay habituation

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14
Q

A 45 yr old woman reports new onset unilateral tinnitus in her right ear accompanied by mild hearing loss and occasional dizziness, she has not experienced tinnitus before and is concerned about what this might mean. What is the best course of action

A

Refer for an ENT evaluation due to unilateral tinnitus and hearing loss

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15
Q

Emma a 65 year old retiree has been diagnosed with Menieres disease. She experiences tinnitus, fluctuating hearing loss and vertigo. What type of tinnitus is commonly associated with Menieres

A

LF tinnitus

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16
Q

What is the recommended method to determine if a PTs pulsatile tinnitus is related to the cardiac cycle

A

Have the PT count the # of pulses they hear while the examiner silently counts the PTs cardiac pulse then compare the two counts

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17
Q

In cases where tinnitus can be modified by jaw clenching or head movements the phenomenon is referred to as

A

Somatic modulation

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18
Q

Which of the following factors can impede the habituation process in tinnitus according to Hallam’s model
Low levels of arousal and consistent tinnitus sound
Low auditory input and reduced neural response gain
High levels of arousal, sudden onset, or emotionally significant tinnitus
Consistent exposure to environmental noise

A

High levels of arousal, sudden onset, or emotionally significant tinnitus

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19
Q

Sara is a 45 yr old woman recently started experiencing a persistent ringing sound in her ears. She feels anxious about it worrying that it might signify a serious health issue and often finds herself focusing on the sound which makes it seem even louder. Her distress over the tinnitus is affecting her sleep, mood and daily activities. Her doctor explains two approaches to understanding and managing her tinnitus
Approach A: key to managing her tinnitus is to understand her cognitive and emotional reactions to the sound and work on changing her thoughts and beliefs about tinnitus
Approach B: suggests that over time her brain may naturally start ignoring the tinnitus sound treating it as a background noise that doesn’t require attention or emotional response
Based on the information provided which of the following statements best matches each approach to the respective model of tinnitus

A

Approach A aligns with McKenna’s Cognitive Behavioral Model, as it emphasizes addressing Sarah’s thoughts and reactions to tinnitus, while Approach B aligns with Hallam’s Habituation Model, which focuses on the brain’s natural tendency to tune out the tinnitus sound.

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20
Q

Which of the following are characteristic features of somatic tinnitus? (Select all that apply)
It is perceived as a high-pitched, constant ringing.
It is associated with hearing loss and balance issues.
It is always perceived in the ear on the same side as the somatic event.
It is associated with abnormalities in neurological examinations.

A

It is perceived as a high-pitched, constant ringing.

It is always perceived in the ear on the same side as the somatic event.

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21
Q

Tinnitus is always heard as a ringing sound.

A

false

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22
Q

The autonomic nervous system controls voluntary bodily functions.

A

false

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23
Q

Tinnitus models offer explanations for various tinnitus-related phenomena by focusing exclusively on peripheral auditory system dysfunction and ignoring central auditory processes.

A

false

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23
Q

Imaging techniques can often identify the underlying cause of objective tinnitus.

A

true

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24
Q

Neurophysiological models propose that tinnitus results from the auditory system’s interpretation of external sounds as abnormal neural activity, though the precise physiological mechanism remains unclear.

A

false

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25
Q

Dishabituation is defined as the re-emergence of tinnitus awareness due to stress or psychological change.

A

true

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26
Q

Hallam’s model addresses the perception of tinnitus, aiming to reduce awareness of the sound, whereas McKenna’s model focuses on managing reactions to tinnitus through cognitive and emotional interventions.

A

true

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27
Q

The autonomic nervous system controls voluntary bodily functions.

A

false
The ANS controls involuntary bodily functions

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28
Q

Somatic modulation refers to changes in tinnitus perception caused by physical movements, such as jaw clenching.

A

true

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29
Q

Reduced cochlear input can lead to increased neural activity in higher auditory centers through homeostatic modulation.

A

true

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30
Q

Imaging techniques can often identify the underlying cause of objective tinnitus.

A

true

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31
Q

Tinnitus models offer explanations for various tinnitus-related phenomena by focusing exclusively on peripheral auditory system dysfunction and ignoring central auditory processes.

A

false

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32
Q

Neurophysiological models propose that tinnitus results from the auditory system’s interpretation of external sounds as abnormal neural activity, though the precise physiological mechanism remains unclear.

A

false

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33
Q

Dishabituation is defined as the re-emergence of tinnitus awareness due to stress or psychological change.

A

true

34
Q

Discordant damage between inner and outer hair cells causes balanced neural activity in the auditory pathways, eliminating the perception of tinnitus.

A

false

34
Q

Hallam’s model addresses the perception of tinnitus, aiming to reduce awareness of the sound whereas mckenna’s model focuses on managing reactions to tinnitus through cognitive and emotional interventions

A

true

35
Q

The goal of MML testing is to identify the tone frequency and intensity closest to the patient’s tinnitus sound.

A

false

36
Q

According to the neural crosstalk theory, tinnitus can result from artificial connections between auditory nerve fibers and nearby cranial nerves.

A

true

37
Q

Displacement of the tectorial membrane can lead to tinnitus by causing prolonged depolarization of inner hair cells in damaged cochlear regions.

A

true

38
Q

Both hyperactivity and hypersynchrony can contribute to tinnitus, but hyperactivity involves an increase in individual neuron activity, whereas hypersynchrony involves neurons firing in a coordinated manner.

A

true

39
Q

Contralateral OAE suppression is measured by presenting white noise to the same ear as the OAE measurement.

A

false

40
Q

The residual inhibition (RI) test is conducted by presenting white noise 10 dB below the Minimum Masking Level.

A

false

41
Q

This model suggests that high levels of stress or arousal make it harder to filter out tinnitus-related information.

A

habituation

42
Q

This model suggests that negative thoughts can trigger arousal and emotional distress.

A

cognitive

43
Q

Used in Jastreboff’s model to illustrate difficulty in ignoring tinnitus perception.

A

tiger analogy

44
Q

Mechanism in which the brain attempts to restore balance by increasing neural activity to compensate for reduced auditory input, potentially leading to spontaneous activity and tinnitus

A

central gain

45
Q

This model emphasizes that tinnitus distress stems primarily from the individual’s reactions and perceptions of tinnitus rather than the sound itself, often creating a cycle of distress.

A

McKena’s cognitive behavioral model

46
Q

A feedback loop where anxiety, stress, and insomnia increase tinnitus perception and distress

A

vicious cycle of tinnitus

47
Q

A system that blocks tinnitus signals from reaching the auditory cortex, preventing the perception of tinnitus.

A

Inhibitory gating mechanism

48
Q

A 45-year-old teacher presents with a clicking sound in the left ear that started around four months ago. He notices the clicking a few times daily, with each episode lasting from 15 to 30 minutes. The patient can briefly stop the sound by yawning or moving the jaw, though it often returns shortly afterward. There is no history of loud noise exposure, ear infections, or recent health issues, and the sound does not interfere with sleep or concentration. Previous tests showed normal hearing.
Based on the case history provided, classify the patient’s tinnitus in terms of its impact, duration, and temporal characteristics. Provide a rationale for each classification. (3 pts)
What is the likely type of tinnitus the patient is experiencing? (1 pt)
What assessment would you use to confirm the clicking tinnitus? Describe the procedure. (3 pts)

A

Temporal characteristics to classifying tinnitus relates to how often the patient experiences the tinnitus. In this patients case, I would classify this as acute because his tinnitus started less than 6 months ago. For temporal characteristics, I would classify this patient’s tinnitus as intermittent tinnitus because the patient experiences his tinnitus every day a few times a day that lasts longer than 5 minutes which is the criteria for it to be intermittent. In terms of impact, he has nonbothersome tinnitus and this is because his tinnitus doesn’t impact his daily life or health and he is able to continue on in his everyday life without any impact from nis tinnitus. For duration classification, it refers to how long they are experiencing the tinnitus. In this patient’s case, he is expereincing it often and the episodes are lasting between 15-30 minutes every day.
The tinnitus that the patient is experiencing is most likely clicking tinnitus or somatosensory tinnitus. It could be somatosensory because he is able to get the tinnitus to stop when he moves his jaw in some way and it provides tinnitus relief. It could be clicking because he is describing it as a clicking sound.
The best way to confirm if this tinnitus is of clicking nature is to perform a reflex decay test. During the test, have the patient tap their leg with their finger or tap their foot everytime they hear the clicking sound during the testing. When they tap, the audiologist can see if this corresponds to a spike that will be visualized on the reflex decay screen. Reflex decay testing puts a continuous loud sound into the patients ear over a period of time to see if the muscles in the middle ear can hold their contraction for the normal amount of time. This is done at 10dB above their contralateral acoustic reflex threshold. If the patient’s reflex threshold contralaterally is too high, then reflex decay will not be able to be performed. The best way to confirm then if it is not clicking tinnitus and may be somatosensory is to perform jaw manipulations during 10 second increments to see if the tinnitus is relieved in anyway. This can be done by having the patient protrude their lower jaw out and hold it for 10 seconds. Then ask if the patient noticed any difference to their tinnitus. Or they can clench their jaw for 10 seconds to see again if there is any change.

49
Q

A 38-year-old woman with a known diagnosis of otosclerosis presents with a gradual bilateral hearing loss and tinnitus, which became worse over the past year. She describes the tinnitus as resembling white noise, primarily noticeable in quiet settings. The hearing loss initially affected only her left ear but has recently progressed to her right ear as well. She is now seeking hearing aids to manage the bilateral hearing loss and improve her hearing in daily life.
Tinnitus is a common symptom in otosclerosis patients and sometimes it can appear as the first symptom, explain. (2 pts)
What is the common description of tinnitus reported by patients with otosclerosis? (2 pt)
Discuss three additional theories proposed to explain how otosclerosis can result in tinnitus? (3 pts)

A

If tinnitus is the initial symptom it means that the patient hasn’t yet experienced CHL so there is no auditory deprivation triggering the brain to compensate for the reduced auditory input. OTSC initially causes pulsatile tinnitus which results from the increased blood flow around the affected area or the newly formed bone

The common description of those with tinnitus with otosclerosis is that it is high-pitched or pulsatile in nature or it can even sound like white noise.
This can be due to the conductive hearing loss and deafferentation, the bony growth in the middle ear space resulting in hyperactivity heard by the brain due to decrease in input, or the increased blood flow to the area resulting in the tinnitus the patient experiences with otosclerosis.

50
Q

How does sound therapy facilitate adaptation in individuals with tinnitus?
By intermittently blocking all external sounds
By providing consistent stimulation to auditory pathways, compensating for lost spontaneous activity
By stimulating visual pathways to divert attention from auditory symptoms
By enhancing the perception of high-frequency sounds that mask tinnitus

A

By providing consistent stimulation to auditory pathways, compensating for lost spontaneous activity

51
Q

What is the rationale for performing threshold testing as the initial step in a tinnitus assessment battery? (Select all that apply)
A patient’s tinnitus perception can be altered by acoustic stimulation
It helps the patient avoid octave confusion
Many patients are hypersensitive to sound
The results can be a prognostic indicator of success with treatment

A

A patient’s tinnitus perception can be altered by acoustic stimulation

Many patients are hypersensitive to sound

52
Q

MML refers to:

A

Minimum level of broadband noise that is used to mask an individual’s tinnitus

53
Q

The capacity of an excited neuron to reduce the activity of its neighboring neurons is known as:

A

lateral inhibition

54
Q

Which of the following symptoms would most strongly indicate the need for an immediate otolaryngologist referral for a tinnitus patient?

A

Pulsatile tinnitus

54
Q

Which aspects are commonly assessed by validated tinnitus questionnaires?
Only the physical health impacts of tinnitus
Only the psychiatric comorbidities associated with tinnitus
Reactions to tinnitus, distress, severity, primary functions affected, and other domains
Solely the patient’s medication tolerance levels

A

Reactions to tinnitus, distress, severity, primary functions affected, and other domains

55
Q

Which combination of symptoms is most suggestive of Meniere’s disease?
High-pitched tinnitus and sudden hearing loss
Pulsatile tinnitus and headaches
Low-pitched tinnitus and fluctuating low-frequency hearing loss, and vertigo
Unilateral tinnitus and facial weakness

A

Low-pitched tinnitus and fluctuating low-frequency hearing loss, and vertigo

55
Q

What is the relationship between DPOAE findings and perceived tinnitus pitch?

A

There is often a correlation, but it’s not always precise

56
Q

What is the primary purpose of conducting a tinnitus assessment for legal documentation?
To provide clinical management
To determine the cause of tinnitus
To prescribe treatment
To support a claim for financial compensation

A

To support a claim for financial compensation

57
Q

In what way do hearing aids affect the brain’s response to tinnitus?

A

They divert the brain’s attention from tinnitus to other sounds.

58
Q

A detailed case history helps identify whether the tinnitus a patient experiences is bothersome or not.

A

true

59
Q

A patient with asymmetrical tinnitus is more likely to have a sensorineural origin than a patient with symmetrical tinnitus.

A

false

60
Q

When making clinical judgments for legal claims, the results of each test, including loudness matching, pitch matching, MML, and RI, should be evaluated in isolation to determine the credibility of a patient’s tinnitus claim.

A

false

61
Q

Hearing aids are most effective for tinnitus management in patients with poor low-frequency hearing.

A

false

62
Q

High compression kneepoints are ideal for tinnitus management in hearing aids.

A

false

63
Q

What is considered a key mechanism contributing to the perception of tinnitus following hearing loss?

A

Increase in spontaneous activity due to heightened neural response gain

64
Q

In Jastreboff’s tiger analogy, what does the tiger represent?

A

The patient’s tinnitus perception

65
Q

What is the primary goal of Tinnitus Retraining Therapy (TRT) as suggested by Jastreboff’s model?

A

To reduce the perception and emotional distress of tinnitus through habituation.

66
Q

Which statement best describes the relationship between tinnitus and other psychological conditions?

Tinnitus, anxiety, and depression exist independently of each other and do not influence one another.

Tinnitus is primarily a psychological condition that directly causes both anxiety and depression.

Tinnitus, anxiety, depression, and insomnia are interconnected, with each potentially exacerbating the others.

Insomnia and lack of concentration are minor factors that do not significantly impact the severity of tinnitus.

A

Tinnitus, anxiety, depression, and insomnia are interconnected, with each potentially exacerbating the others.

67
Q

What is a key hypothesis regarding the role of the medial olivocochlear (MOC) system in tinnitus generation?

A

Decreased neural efferent input to the cochlear amplifier, potentially increasing spontaneous activity

67
Q

According to Hallam’s Model, what can impede the habituation process to tinnitus?

A

Emotional significance attached to tinnitus

68
Q

What role does the autonomic nervous system play in the habituation process to tinnitus according to Hallam’s Model?

A

High levels of autonomic nervous system arousal can impede the habituation process by enhancing tinnitus awareness.

69
Q

What is the role of excessive intracellular calcium in noise-induced hearing loss and tinnitus?

A

It leads to overactivation of cells, oxidative stress, and eventual cell death, contributing to hearing loss and tinnitus.

70
Q

What is a key limitation of the discordant damage theory in explaining tinnitus generation?

A

It fails to explain why some individuals with profound hearing loss do not experience tinnitus

71
Q

Increase in neural activity within the central auditory system as a compensatory response to decreased peripheral input, typically due to cochlear damage, which can manifest as tinnitus and hyperacusis.

A

central gain

72
Q

Unfavorable alteration in the central nervous system’s function and structure in response to injury or disruption, such as hearing loss, leading to detrimental conditions like tinnitus.

A

maladaptive plasticity

73
Q

The process where psychological changes or shifts in a person’s mental state cause them to become re-aware of tinnitus sounds to which they had previously adapted.

A

dishabituation

73
Q

Tinnitus arises from increased spontaneous neural activity at the boundary between normally functioning and damaged outer hair cells in the cochlea.

A

edge theory

74
Q

A neural process that prevents tinnitus signals from reaching the auditory cortex by potentially blocking them at the thalamic level, with its failure resulting in the perception of tinnitus.

A

inhibitory gating mechanism

75
Q

Tinnitus can result from abnormal interactions between adjacent nerve fibers, particularly when damage or compression causes ephaptic coupling, leading to synchronized firing patterns in auditory neurons that are interpreted by the brain as sound. What is this called?

A

cross talk theory

76
Q

acute tinnitus

A

anything occurring for less than 3 months

77
Q

chronic tinnitus

A

anything lasting for 3 to 6 months or longer

78
Q

recent onset tinnitus

A

lasting few weeks to a few months resulting from certain conditions

79
Q

delayed onset tinnitus

A

can be onset delayed after a triggering event such as noise exposure or a TBI

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