A presentation for ent specialists



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tarix25.03.2017
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A presentation for ENT specialists

  • A presentation for ENT specialists


To describe the key features of tinnitus

  • To describe the key features of tinnitus

  • To show how tinnitus is a substantial health burden

  • To reveal the role of hearing loss in tinnitus

  • To present the options for management, including the central role of hearing aids



Perception of sound but no external source

  • Perception of sound but no external source

  • Usually experienced as buzzing, hissing or ringing

    • Not fully-formed sounds e.g. speech or music
    • Not sound hallucinations experienced during bouts of mental illness
    • Occurs in one or both ears, or arising within the head
  • It can have a profound effect on the sufferer

  • “… perceived severity of tinnitus correlates closer to psychological and general health factors, such as pain or insomnia, than to audiometrical parameters …” (Zoger et al, 2006)





Tinnitus is highly variable. Some patients are able to cope with the noise and their lives continue as normal.

  • Tinnitus is highly variable. Some patients are able to cope with the noise and their lives continue as normal.





A range of peripheral events can lead to central neuronal changes that manifest as tinnitus

  • A range of peripheral events can lead to central neuronal changes that manifest as tinnitus

  • Other factors can be involved in either the development or the persistence of tinnitus



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

    • Homeostatic pathways cause increased central ‘gain’ (i.e. sensitivity) in response to auditory deprivation to:
    • Maintain central nervous system activity during low sensory input
    • Ensure nerve activity is modulated to respond to changes in sensory input
  • 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.



Most patients with tinnitus have some degree of hearing loss

  • Most patients with tinnitus have some degree of hearing loss



Experiencing sound in the absence of an external stimulus can be emotionally upsetting

  • Experiencing sound in the absence of an external stimulus can be emotionally upsetting

  • This reaction can make the sounds appear worse

  • This results in a vicious cycle of worsening tinnitus and increasing distress



Tinnitus is associated with increased levels of psychological problems

  • Tinnitus is associated with increased levels of psychological problems

    • 24/90 (26.7%) versus 5/90 (5.6%) for age-matched controls without tinnitus






Currently, there is no cure for tinnitus, but management is possible

  • Currently, there is no cure for tinnitus, but management is possible



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



A scoping review identified 11 interventional studies of hearing aids

  • A scoping review identified 11 interventional studies of hearing aids

  • Six types of tinnitus evaluation were used:

    • THI x 4; THQ x 1; TRQ x 1; TSI x 1; TQ x 1; VAS x 3
  • Up to 50% reduction in tinnitus severity

  • 10/11 studies showed improvements >10%





Retrospective study of 70 patients with tinnitus in Australia

  • Retrospective study of 70 patients with tinnitus in Australia

  • Tinnitus severity measured using the tinnitus reaction questionnaire (TRQ)

  • Overall, 51% of patients experienced “clinically significant” change (≥40% change in TRQ score)





No approved drugs (European Medicines Agency [EMA] or US Food and Drug Administration [FDA])

  • 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



Tinnitus management should include hearing aids with appropriate frequency ranges together with psychological support and education

  • Tinnitus management should include hearing aids with appropriate frequency ranges together with psychological support and education

  • This requires a multidisciplinary care team

    • GP, ENT specialist, psychologist/psychiatrist and hearing-care professional
  • As a leading supplier of hearing aids, Phonak can be another member of your team, helping your patient to have the optimal hearing aid for their situation



Contact information

  • Contact information

  • Phone:

  • Email:

  • Website:



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