Transcript DSPT - Acquired deafness

Tinnitus
Objectives
 To understand current theories on the cause of tinnitus
 To understand the effects of tinnitus
 To understand how tinnitus is managed
 Relevant for: Assignment 1d Information pack for clients
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What is tinnitus?
Latin ‘tinire’ = to ring
Perception of noises in the head or ear(s)
which has no external source
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buzzing
jet engine
hissing
whistling
humming/ shhhhh
singing
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How tinnitus might sound
Simulations of tinnitus from the Nottingham Hearing Biomedical
Research Unit
http://www.hearing.nihr.ac.uk/public/auditory-examples-soundsof-tinnitus
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Statistics
 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)
 Limbic system - giving each sound an ‘emotional
label’ – tuning in to significant sounds
 Autonomic nervous system - getting the body ready
for action
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
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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
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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.
 Misphonia (extreme = phonophobia)
Some particular sounds are extremely irritating
– more than for other people
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Common physical triggers
 Medical conditions:
Everyday life:
 Noise damage
Medication
 Age-related deafness
(presbyacusis)
Illness
 Ménière’s disease
 Ear infection
 Wax
 Tumour (acoustic
neuroma/vestibular
schwannoma)
 Change in blood flow (pulsatile)
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Tiredness
Stress
Air travel
Loud noise
Diet
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
Become
anxious
Tinnitus
gets louder
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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
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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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