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we best manage it? Deborah Hall Nottingham Hearing Biomedical - - PowerPoint PPT Presentation
we best manage it? Deborah Hall Nottingham Hearing Biomedical - - PowerPoint PPT Presentation
What is tinnitus and how can we best manage it? Deborah Hall Nottingham Hearing Biomedical Research Unit Nottingham: The UKs interdisciplinary hub for hearing research Basic Translational Clinical Advancing insight, innovation, and
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Nottingham Hearing Biomedical Research Unit
What is tinnitus?
Describe your tinnitus sound in words! https://www.actiononhearingloss.org.uk/co mmunity/forums/tinnitus.aspx?g=posts&t=7 433
- “tsssssssss+bzzzzzzzzzz+beeeeeeeee”
- “like a washing machine on very fast
spin”
- “dog barking in distance”
- “like gas escaping from a bottle”
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Nottingham Hearing Biomedical Research Unit
Hearing loss can cause tinnitus
Cochlear damage Altered auditory nerve activity Cascade of neuroplastic changes Tinnitus percept
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Nottingham Hearing Biomedical Research Unit
- Increased spontaneous activity
– Auditory cortex (e.g. Norena
and Eggermont, 2003)
– Inferior colliculus (e.g.
Mulders and Robertson, 2009)
– Cochlear nucleus (e.g.
Kaltenbach et al., 1998)
- Decreased spontaneous
activity – Auditory nerve (e.g. Liberman
et al., 1984)
Neurophysiological correlates
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20
20 40 60 80
- 20
Hearing threshold (dB HL)
Mean neural activity Spontaneous neural activity
Schaette R, Kempter R (2006) European Journal of Neuroscience, 23: 3124-3138.
Homeostatic plasticity
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20
20 40 60 80
- 20
Hearing threshold (dB HL)
Mean neural activity Spontaneous neural activity
- Deprivation
is known to alter the balance of neural activity in the central auditory pathway
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20
20 40 60 80
- 20
Hearing threshold (dB HL)
Mean neural activity Spontaneous neural activity
- Increasing
the central gain rebalances the neural activity in the central auditory pathway
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20
20 40 60 80
- 20
Hearing threshold (dB HL)
Mean neural activity Spontaneous neural activity
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20
20 40 60 80
- 20
Hearing threshold (dB HL)
Mean neural activity Spontaneous neural activity
- Increasing
the central gain can give rise to hyperactivity in the central auditory pathway
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Perceptual characteristics Pitch and loudness Psychological reactions Cognitive and emotional responses Individual personality ‘Susceptibility’ characteristics Change reaction to the percept (counselling, relaxation therapy)
Tinnitus
Sound enrichment (hearing aids) Masking the percept (noise masking) Alleviating the neural cause (drug treatments)
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Nottingham Hearing Biomedical Research Unit
1 At any point in time around 10% of the population experience
tinnitus
- Both sexes are equally
affected
- Tinnitus is more common
in the elderly
Top 10 tips
- Yes, it can occur at any age, including childhood.
Do children experience tinnitus?
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Nottingham Hearing Biomedical Research Unit
2 Most tinnitus is mild
- It is relatively rare for it to develop into a chronic problem of life-altering
severity.
Top 10 tips
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Nottingham Hearing Biomedical Research Unit
Top 10 tips 3 Tinnitus is more common in people with hearing loss
- Tinnitus is greater among people with hearing impairment
- It is possible to have tinnitus with a completely normal hearing
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Nottingham Hearing Biomedical Research Unit
Top 10 tips 4 Tinnitus can be associated with a blocked sensation
- For reasons that are not clear tinnitus and sensorineural hearing loss
can give rise to a blocked feeling in the ears
- Decongestants and antibiotics are
rarely helpful.
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Nottingham Hearing Biomedical Research Unit
Top 10 tips 5 Giving a negative prognosis is actively harmful
- It is all too common to hear that patients have been told nothing can be
done about tinnitus.
- Negative statements are not only unhelpful but also tend to focus
attention on the tinnitus and exacerbate the distress.
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Nottingham Hearing Biomedical Research Unit
Top 10 tips 6 Enriching the sound environment is helpful
- Useful sources of sound to reduce the starkness of tinnitus include
quiet uneventful music, a fan or a water feature.
- There are inexpensive devices that produce environmental sounds,
and these are particularly useful at bedtime.
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Nottingham Hearing Biomedical Research Unit
Top 10 tips 7 Hearing aids are helpful
- Hearing aids are useful even if the hearing loss is relatively mild and
an aid would not normally be considered.
- Straining to listen causes increased central auditory gain and this
increased sensitivity can allow tinnitus to emerge or, if already present, to worsen.
- Correcting any associated hearing loss reduces this central auditory
gain and thereby reduces the level of the tinnitus.
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Nottingham Hearing Biomedical Research Unit
Top 10 tips 8 Underlying pathology is rare, but be vigilant
- Tinnitus is often due to heightened awareness of spontaneous
electrical activity in the auditory system that is normally not perceived.
- But it can be a symptom of treatable and significant otological
pathology, such as a vestibular schwannoma or otosclerosis.
- Be especially vigilant if the tinnitus
is unilateral, or if it has a pulsatile quality.
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Nottingham Hearing Biomedical Research Unit
Top 10 tips 9 There is no direct role for drugs
- Drugs can treat associated symptoms such as vertigo, insomnia,
anxiety or depression, but not tinnitus itself.
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Nottingham Hearing Biomedical Research Unit
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Nottingham Hearing Biomedical Research Unit
Top 10 tips 10 Self-help is often effective
- The British Tinnitus Association provides excellent information on
tinnitus and common sense advice on managing symptoms.
- It runs a telephone helpline 0800 018 0527 as well as offering advice