Tinnitus is defined as sensations of hearing in the absence of external sounds

Tinnitus is defined as sensations of hearing in the absence of external sounds

• Tinnitus is defined as sensations of hearing in the absence of external sounds

• 155 million Americans have sought treatment

• 1/3 of the population have had tinnitus at some stage in their lives

• Up to 20% of the population currently experience tinnitus

• “Google” search for tinnitus identified 4.2 million sites!

Prevalence increases with age

• Prevalence increases with age

• 80% of people don’t seek help

• 6-8% of those affected are severe

• 40% of patients experience depression

• Can vary between barely perceptible noise to a deafening roar

• Very little is understood about its cause or cure

Ludwig van Beethoven

• Ludwig van Beethoven

• Joan of Arc

• Oscar Wilde

• Vincent van Gogh

• Charles Darwin

• Neil Young

• Eric Clapton

• Bono

• Sting

• Barbara Streisand

• William Shatner

• Ronald Regan

Objective: caused by sounds generated somewhere in the body

• Objective: caused by sounds generated somewhere in the body

• Subjective: perception of meaningless sounds without any physical sound being present

• Auditory hallucinations: perceptions of meaningful sounds such as music or speech

• Noise exposure
• Medication
• Infection
• Older age hearing loss
• Meniere’s Disease
• Outer/Middle ear disease
• Acoustic neuroma
• Unknown (by far the most common)

Concentration

• Concentration

• Hearing

• Insomnia

• Psychological

Poorly understood

• Poorly understood

• Range of theories from loss of outer hair cell function to increased spontaneous activity of central nerves

• Can be generated from any part of the auditory system from the ear to the Central Nervous System (CNS)

• This then may become modified by the CNS

When the perception of tinnitus is associated with negative reinforcement the autonomic nervous system is activated

• When the perception of tinnitus is associated with negative reinforcement the autonomic nervous system is activated

• Physiological and psychological reactions then lead to enhancement of the tinnitus signal

• Often compared with chronic pain

Thorough evaluation to rule out significant pathology

• Thorough evaluation to rule out significant pathology

• Treatment of other ear disorders eg. infection

• Explanation of test results

• Explanation of tinnitus mechanisms

• Treatment options

• Treatment of severe psychological disorders

• Follow-up

Idiopathic (most common)

• Idiopathic (most common)

• Outer ear disease

• Wax, foreign body, infection

• Middle ear disease

• Infection, perforated eardrum, ossicular problems, tumour

Inner ear disease

• Inner ear disease

• Presbyacusis (older age hearing loss)
• Meniere’s disease
• Acoustic neuroma
• Noise exposure
• Drugs

Thorough history

• Thorough history

• Duration, nature, effects
• Non vs pulsatile
• Noise exposure
• Other ear symptoms

• Ear examination

• Rule out outer/middle ear disease
• Tuning fork tests

Audiological (hearing) Tests

• Audiological (hearing) Tests

• Audiogram, tympanogram
• Specialised hearing tests

• MRI

• Associated symptoms
• Asymmetric hearing loss

Aim to improve habituation rather than “cure” tinnitus

• Aim to improve habituation rather than “cure” tinnitus

• Most people don’t seek treatment

• Multitude of potential treatments

• Problems with scientific evidence

Basic advice

• Basic advice

• Hearing Aid

• Tinnitus Masking Device

• Tinnitus Instrument

• Tinnitus Retraining Therapy

• Psychological Treatment

• Medication

• Alternative Treatments

Reassurance

• Reassurance

• The first step is to understand the problem

• Avoid aggravating factors eg. noise, NSAIDs

• Decreased intake of stimulants eg. caffeine and nicotine

• Relaxation

• Avoiding silence

• White noise eg. Detuned radio

Irish Tinnitus Association

• Irish Tinnitus Association

• DeafHear.ie

• Hearing Aid Specialist

• www.tinnitus.org

Basic advice

• Basic advice

• Hearing Aid

• Tinnitus Masking Device

• Tinnitus Instrument

• Tinnitus Retraining Therapy

• Psychological Treatment

• Medication

• Alternative Treatments

Essentially for poor hearing

• Essentially for poor hearing

• Increases ambient noise

• Decreases stress of poor hearing

• Various shapes and sizes

• Cost

• Limitations

• Up to 90% may benefit

Basic advice

• Basic advice

• Hearing Aid

• Tinnitus Masking Device

• Tinnitus Instrument

• Tinnitus Retraining Therapy

• Psychological Treatment

• Medication

• Alternative Treatments

Essentially counteracts tinnitus

• Essentially counteracts tinnitus

• Generate noise bands

• Tinnitus Instruments

• Combination of hearing aid and masker

Emit ‘white noise’

• Emit ‘white noise’

• Elimination of silence

• White noise boring: tendency to ignore

• Gives the tinnitus sufferer something tangible to work with

• Reduce the starkness of the tinnitus signal

Basic advice

• Basic advice

• Hearing Aid

• Tinnitus Masking Device

• Tinnitus Instrument

• Tinnitus Retraining Therapy

• Psychological Treatment

• Medication

• Alternative Treatments

Based on evidence that a person can habituate to acoustic noise in the environment

• Based on evidence that a person can habituate to acoustic noise in the environment

• Goal is to weaken or remove the functional connections between the auditory pathways

• Key elements: counseling and sound therapy

May take several months to take effect

• May take several months to take effect

• Minimum 12 months treatment

• Involves wearing ear noise generator, table top generator

Basic advice

• Basic advice

• Hearing Aid

• Tinnitus Masking Device

• Tinnitus Instrument

• Tinnitus Retraining Therapy

• Psychological Treatment

• Medication

• Alternative Treatments

Relaxation therapy

• Relaxation therapy

• Hypnosis

• Cognitive Behavioural Therapy

• Information, managing aggravating factors
• Applied relaxation
• Cognitive restructuring of thoughts and beliefs
• Sleep management advice
• Improvement in quality of life, not tinnitus itself

• Medication

Basic advice

• Basic advice

• Hearing Aid

• Tinnitus Masking Device

• Tinnitus Instrument

• Tinnitus Retraining Therapy

• Psychological Treatment

• Medication

• Alternative Treatments

No magical cure

• No magical cure

• Serc

• Lignocaine

• Temporary, intravenous

• Alprazolam

• Xanax
• Side effects

Basic advice

• Basic advice

• Hearing Aid

• Tinnitus Masking Device

• Tinnitus Instrument

• Tinnitus Retraining Therapy

• Psychological Treatment

• Medication

• Alternative Treatments

Herbs

• Herbs

• Ginkgo biloba (over 100 studies), black cohosh, Mullein

• Vitamins

• B1, B3, B6, B12, folate, zinc, calcium, Mg, Mn

• Laser Therapy

• Germany
• Thought to increase ATP in cochlea

Hypnotherapy

• Hypnotherapy

• Acupuncture

• Ear canal magnets

• Hopi ear candles

Brain stimulation

• Brain stimulation

• Identify active areas with PET
• Apply magnetic stimulation (rTMS)
• Evidence in small trials that there is some effect on tinnitus
• More detailed research awaited

• Questions

• Can this be clinically useful or is it just an experimental technique?
• Long term safety?

Tinnitus is a common condition

• Tinnitus is a common condition

• Main role of ENT Surgeon is to exclude major illness and co-ordinate further treatment

• Basic advice and counseling as well as empathic support is paramount

• More severe cases may require psychological support, masking devices or Tinnitus Retraining Therapy