2. What is tinnitus?
Any sound that is perceived by the listener that does not
originate from an external sound source
May be perceived in one or both ears (peripheral) and/or
in the head (central)
60% bilateral
30% unilateral
10% central
From latin word, tinniere, which means “to ring”
4. Causes of Tinnitus
Most commonly caused by some sort of change to
the auditory system
80% of patient’s with SNHL have tinnitus
Hearing loss results in changes in the neural activity
of the auditory system, which the auditory cortex
interprets as sound
Much like phantom limb syndrome. Areas of the
cochlea where there is hair cell damage can no longer
amplify sounds where damage has occurred so a
phantom sound is interpreted by the brain.
5. Other Causes of Tinnitus
Hearing loss, especially in cases of noise-induced hearing loss
(NIHL)
External or middle ear issues (wax, fluid)
Acoustic neuroma (UNILATERAL tinnitus)
Medications
Sinus/allergy issues
Dental issues (TMJ-temporal-mandibular joint syndrome)
Cardiovascular
Neurological (MS)
SEE TABLES 23-1 &
Stress/anxiety
23-2 IN YOUR
NORTHERN TEXT
7. Some musician’s consider it a badge of
honor…
Peter Frampton
“I wonder how you’re feeling. There’s ringing in my ears. And
no one to relate to, ‘cept the sea.”
Bob Seger
“With the echoes of amplifiers ringing in your head.”
8. Prevalence of Chronic Tinnitus
•~22 Million Americans
•10% of adult population
NIDCD.NIH.GOV
9. Types
Subjective
Can only be perceived by the patient
Most common type (95%)
Objective
Can be heard by others
Rare (<5% of all tinnitus cases)
Usually pulsatile (in sync with heartbeat)
Causes: vascular or muscular
10. Causes of Objective Tinnitus
Vascular
Arteriorvenous aneurysm
Glomus jugulare tumor
Muscular
Patent eustachian tube
Palatal myoclonus: involuntary muscle jerk of the roof of the
mouth
Spasm of stapedius or tensor tympani muscles
11. Bothersome/Uncompensated Tinnitus
Only about 20% of people with tinnitus are bothered by
it
The tinnitus itself isn’t the problem. The person’s
REACTION to it is what is problematic.
Tinnitus may result in irritability, fatigue/sleep disturbance,
depression, suicidal thoughts
These patient’s need to be referred to a mental health
professional
12. A Viscious Cycle
Attentional Factors (patient chooses to attend to
tinnitus)
Emotional reaction
Limbic system: negative emotional labeling of the tinnitus
Autonomic system: activation of the fight-or-flight mechanism
(Can this tinnitus harm me?)
Stress
Amplification of tinnitus signal (louder)
14. Masking
Use of noise to temporarily mask or “cover up” the
tinnitus so it cannot be perceived
This is often successfully accomplished when patient’s with
hearing loss use traditional hearing aids. The amplification
of environmental noises often reduces or completely
masks tinnitus.
Our newest generation hearing aids have optional tinnitus
maskers built-in for when hearing aids aren’t enough to mask
tinnitus
15. Masking
There are companies that manufacture tinnitus maskers
for those with normal hearing. May be in-the-ear
with a very large vent or a behind-the-ear,
open-ear device
www.ata.org
www.siemens.com
16. Masking
The use of a sound machine or external noise source (i.e.
ceiling fan) can be very helpful at night
Different types of noise are utilized in masking: white
noise, pink noise, brown noise, grey noise (all have
varying complexity based on frequency components)
17. Tinnitus Handicap Inventory
Patient self-survey
Sample questions
Do you feel you have no control over your tinnitus?
Because of your tinnitus do you feel tired?
Because of your tinnitus do you feel depressed?
Does your tinnitus make you feel anxious?
Quantifies the severity of tinnitus
Rates degree of handicap from slight to catastrophic
18. Tinnitus Retraining Therapy
Jastreboff created TRT
Combines counseling with use of noise generators
Counseling: reclassify tinnitus to a category of neutral signals
Sound therapy: weaken the tinnitus-related neural activity
Goal: Habituation to the tinnitus (no longer pay attention
to it)
19. Neuromonics
Six to eight month therapy protocol
Uses spectrally modified music that has been tailored
according to each patient’s hearing and tinnitus
characteristics
Combined with an underlying neural stimulus
Retrains the brain to filter out
tinnitus disturbance
Very expensive~$5000 for treatment that lasts less than a
year
21. Hyperacusis Causes
Hearing loss
Head injury (i.e air bag deployment)
Ototoxicity
Lyme disease
Viral infections involving the inner ear or facial nerve (Bell’S
palsy)
TMJ
PTSD (post-traumatic stress disorder)
Chronic fatigue syndrome
Epilepsy
Depression
Migraine headaches
22. Other sound disorders
Misophonia
Dislike of sound
Phonophobia
Fear of sound
Often these patients come in reporting that they use
earplugs in everyday circumstances. This is NOT
recommended. It will actually worsen problem.
