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What is tinnitus?
• Tinnitus is a sound that is perceived by the person inside one or both ears that does not originate from an external sound source.
Various ways in which patients express Tinnitus complaint:
• Ocean sound
• Pulsating Heartbeat
• Sound similar to the one made by insect Cricket
Types of tinnitus
Can only be perceived by the patient
Most common type (95%)
Can be heard by others
Rare (<5% of all tinnitus cases)
Usually pulsatile (in sync with heartbeat)
Causes: vascular or muscular
Causes of Tinnitus
• Most caused by some sort of change to the auditory system
80% of patients with SNHL (Sensorineural Hearing Loss) have tinnitus Hearing loss results in changes in the neural activity of the auditory system, which the auditory cortex interprets as sound
• Hearing loss, in cases of noise-induced hearing loss (NIHL)
• External or middle ear issues (wax, osteoma, ear drum perforation, otosclerosis, fluid behind ear drum)
• Internal ear (Meniere’s disease, Damage of hair cells in inner ear)
• Acoustic neuroma (UNILATERAL tinnitus)
• Sinus/allergy issues
• Dental issues (TMJ-temporal-mandibular joint syndrome)
• Neurological (Multiple sclerosis)
• Stress & anxiety
Reaction to Tinnitus aggravate it:
• 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
1. Hearing Aids for SNHL induced tinnitus
o Meniere’s disease
• Use of noise to temporarily mask or “cover up” the tinnitus so it cannot be perceived
• This is often successfully accomplished when patients with hearing loss use traditional hearing aids. The amplification of environmental noises often reduces or completely masks tinnitus.
• New generation hearing aids have optional tinnitus maskers built-in for when hearing aids aren’t enough to mask tinnitus
• Different types of noise are utilized in masking: white noise, pink noise, brown noise, grey noise (all have varying complexity based on frequency components)
• Maskers with or without hearing aid are available and customised for every patient according to hearing test and tinnitus mapping.
5. Tinnitus Retraining Therapy
· Jastreboff created TRT
· Combines counselling with use of noise generators
· Counselling: 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)
· Six to eight months 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
7. Recent Advances
· Acoustic coordinated reset neuromodulation
· Magnetic and Electrical brain stimulation
Take home Message:
Don’t deal with tinnitus by sitting at home. Kindly go and visit your doctor for finding the cause behind your tinnitus. Tinnitus is a symptom not a disease. We need to find the cause behind tinnitus to treat it.