Tinnitus

Objectives

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To understand current theories on the cause of tinnitus

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To understand the effects of tinnitus

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To understand how tinnitus is managed

 Relevant for:

Assignment 1d Information pack for clients City Lit

What is tinnitus?

Latin ‘tinire’ = to ring Perception of noises in the head or ear(s) which has no external source City Lit

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buzzing jet engine hissing humming/ shhhhh whistling singing

How tinnitus might sound

Simulations of tinnitus from the Nottingham Hearing Biomedical Research Unit http://www.hearing.nihr.ac.uk/public/auditory-examples-sounds of-tinnitus City Lit

Statistics

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An estimated 6 million people in the UK have tinnitus to varying degrees

(source: Action on hearing loss) 

For over 3.5 million people tinnitus is a permanent problem

(source: Deafness Research UK) 

Around 1% of people in the U.K. - about 600,000 people – have tinnitus that affects their quality of life.

(source: Action on hearing loss)

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Tinnitus models

Prior to 1990s, the main cause was thought to be damage to the hair cells in the cochlea.

Nerve fibres firing off indiscriminately.

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Tinnitus models

A new way of looking at tinnitus…..

Jastreboff Neurophysiological Model (1990)

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Limbic system

giving each sound an ‘emotional label’ – tuning in to significant sounds 

Autonomic nervous system -

for action getting the body ready Subconscious filters in the auditory pathway between ear and brain enhance or suppress the signal – we unconsciously block them out if not important, or turn them up if significant.

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Heller and Bergman experiment 1953

80 people with normal hearing spent 5 minutes in a soundproofed room.

93% of them reported hearing buzzing, pulsing or whistling sounds in their head or ears

.

source: deafness research uk City Lit

Tinnitus is not a disease or an illness, it is a symptom generated within a person's own auditory pathways.

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Dr Roland Schaette , British Tinnitus Association’s Senior Research Associate at the UCL Ear Institute in London talks about tinnitus research

http://www.tinnitus.org.uk/the-search-for-a-cure City Lit

Tinnitus and sound tolerance

Many people with tinnitus are also more sensitive than normal to everyday sounds 

Hyperacusis

With normal hearing, sounds seem uncomfortably loud, but they don’t bother other people 

Recruitment

Common with presbyacusis – sensitivity to loud sounds.

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Misphonia (

extreme = phonophobia) Some particular sounds are extremely irritating – more than for other people

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Common physical triggers

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Medical conditions:

 Noise damage

Everyday life:

Medication  Age-related deafness (presbyacusis)  M énière’s disease Illness Tiredness Stress  Ear infection  Wax Air travel Loud noise  Tumour (acoustic neuroma/vestibular schwannoma)  Change in blood flow (pulsatile) Diet

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Common emotional triggers

• Bereavement • Redundancy • Retirement • Depression • Life-changers • Stress

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The vicious circle of tension and tinnitus

Tinnitus gets louder Brain turns up tinnitus Become more anxious Tinnitus gets louder Become anxious

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David Baguley, a member of the British Tinnitus Association’s Professional Advisers' Committee, explains the possible causes and effects tinnitus often has, such as stress and anxiety, plus how to deal with them. Ashleigh, who was diagnosed with tinnitus in 2005, describes how she copes with it.

http://www.tinnitus.org.uk/tinnitus---the-video City Lit

Tinnitus management – towards habituation

Diagnosis by ENT Consultant Explanation/education/ reassurance → acceptance Sound therapy (enrichment) Sound generators (maskers) Hearing aids/C.I’s Relaxation techniques Hypnotherapy , aromatherapy, acupuncture Changes in diet Support groups

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Tinnitus management – towards habituation

Tinnitus re-training therapy (TRT)

training the brain to ‘tune out’ tinnitus - combines counselling and sound therapy.

Cognitive behavioural therapy (CBT)

- understanding how our beliefs and behaviour influence how we feel

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Current research for a cure

Drugs

• Local anaesthetic -Licodaine • Anti-depressants

Electro-magnetic stimulation

• An elecromagnet against the skull

Acoustic or electric stimulation

• Of brain stem

Neuromodulation

• Delivering sequences of sound to the ears to break up the patterns of nerve firing in the brain that may be responsible for generating tinnitus

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Useful sources

Action on Hearing Loss British Tinnitus Association The Ear Foundation Hush (Hull tinnitus self-help group)

Dunmore, K., Riddiford, G., Tait, V.,

Understanding Tinnitus: living with the noises in your ears or in your head,

RNID (2006) Baguley, D., McFerran, D.J., McKenna, L.,

Living with Tinnitus and Hyperacusis,

Sheldon Press. ISBN: 978-1-84709-083-6

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