Tinnitus is defined as sensations of hearing in the absence of external sounds
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
Vincent van Gogh
Charles Darwin
Neil Young
Eric Clapton
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
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
Patients with tinnitus exhibit enhanced auditory sensitivity
Patients with tinnitus exhibit enhanced auditory sensitivity
This is caused by hyperactivity of the auditory central nervous system
In patients with tinnitus and hearing loss, the tinnitus pitch and the hearing loss frequency spectrum are usually matched
The decreased input from the cochlea, due to outer hair cell damage, results in readjustments in the central auditory system resulting in abnormal neural activity including hyperactivity, bursting discharges and increases in neural synchrony.
The decreased input from the cochlea, due to outer hair cell damage, results in readjustments in the central auditory system resulting in abnormal neural activity including hyperactivity, bursting discharges and increases in neural synchrony.
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
Reports of the use of hearing aids in the management of tinnitus go back over 60 years
Reports of the use of hearing aids in the management of tinnitus go back over 60 years
Because hearing loss is often associated with tinnitus, at least partial restoration of hearing should help to reduce the central gain in auditory perception that is a feature of tinnitus
A recent scoping review of studies of hearing aids in tinnitus revealed that 17/18 publications showed improvements in tinnitus symptoms by fitting hearing aids
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
No approved drugs (European Medicines Agency [EMA] or US Food and Drug Administration [FDA])
Some psychopharmacological agents may help reduce the severity of psychological issues associated with tinnitus, and some may also lessen tinnitus symptoms
