Title: Hearing aid research for Meniere
1 Tinnitus
Celene McNeill Audiologist Vice-President of ATA
2005 Annual Conference for Nurse Audiometrists
2 TINNITUS
- Perception of sound even when no sound is
entering the ear
- Ringing
- Hissing
- Humming
- Roaring
- Buzzing
- Cicadas
3For some people
- its more than just a sound
4The distressing noise can be constant
- leading to frustration,
- lack of concentration,
- difficulty sleeping,
- anxiety and
- depression
5A significant proportion of people with tinnitus
- suffer from anxiety and depression
Holgers et al Psychiatric Profile of tinnitus
patients referred to an audiological clinic
Sixth International Tinnitus Seminar, 1999
6PREVALENCE OF TINNITUS
- 30 of population over 55 years of age
- 45 of population over 70 years of age
5 of people over 55 years of age find their
tinnitus bothersome and upsetting.
BLUE MOUNTAINS STUDY
7Tinnitus maybe a symptom of different ear
disorders
External ear -Wax -Foreign body -Otitis externa
- Middle ear
- Otosclerosis
- Otitis Media
Cochlea -Noise induced -Presbyacusis -Menieres
disease -Ototoxicity
Retro-cochlear -Acoustic Neuroma
8- A consultation with an Ear,
- Nose and Throat specialist
- is mandatory in diagnosing any
- existing ear disease
- which may be causing
- the hearing loss tinnitus.
9- Non treatable cause of tinnitus
- Noise induced hearing loss
- Acoustic trauma
- Ototoxicity
- Presbyacusis
- Treatable causes of
- tinnitus
- Impacted cerumen
- Ear infection
- Ruptured tympanic membrane
- Otosclerosis
- Menieres disease
- Acoustic neuroma
- TMJ dysfunction
-
10Treating ear disorder will not necessarily
eliminate tinnitus perception.
11TINNITUS DOES NOT CAUSE HEARING LOSS
12Slide courtesy of Dr Klaus Ebbling - Oticon
13Hearing Loss aggravates Tinnitus
- the worse the hearing the louder the
tinnitus may be perceived
14Hearing Loss
Effort to Hear
Stress
Tinnitus Perception
15Hearing Aids
16Hearing Aid Tinnitus SurveyMcNeill, C et al
2005Healthy Hearing Balance Care
- Surveyed 126 clients who had been fitted with
hearing aids at our clinic and 96 replied. - 1.Do you wear your hearing aid(s) on a regular
basis? - 2.Do you have tinnitus?
- 3.How does the hearing aid affect your tinnitus
while wearing it?
173. How do the aids affect your tinnitus?
McNeill, C. 2005
18Hearing Aids
reduce
Tinnitus Perception
(When fitted appropriately)
19Hearing aids may not reduce tinnitus distress.
202 - 5 of tinnitus sufferers continue to be
distressed by the tinnitus noise even after
perception has been reduced by hearing aid usage
Brain cannot stop focusing on the tinnitus noise
affecting sleep, concentration and quality of life
21The Neuro-physiological model of
tinnitus Jastreboff, 1993
Basis of Tinnitus Retraining Therapy TRT Implement
ed by Dr Jonathan Hazel in the mid 90s
22Neuro-Physiological Model of Tinnitus
(Developed by Dr Pavel Jastreboff in 1993)
The physiological cause of tinnitus is
irrelevant
23Mechanism of tinnitus perception - Jastreboff
(1996)
Perception EvaluationAuditory other Cortical
Areas
No Emotional AssociationsNo Limbic System
Response
DetectionSubcortical
SourceAppearance of abnormal auditory activity
in the Cochlea
Habituation to tinnitusExperiences but does not
suffer
24Neuro-Physiological Model of Tinnitus
(Developed by Dr Pavel Jastreboff in 1993)
- Negative Counselling by health professionals is
one of the main causes of Tinnitus distress
25Mechanism of tinnitus distress Jastreboff (1996)
Perception EvaluationAuditory other Cortical
Areas
DetectionSubcortical
Emotional AssociationsLimbic System
SourceCochlea
AnnoyanceAutonomic Nervous System
26Approaches to treat tinnitus distress
- Pharmacological CNS suppressants
- (very addictive)
- Psychological counselling, CBT, stress
management, hypnosis
- Audiological TRT, Neuromonics
27 Tinnitus Retraining Therapy T.R.T
- Directive counselling
- Aim to reverse tinnitus noise into a neutral
sound. - Understanding of tinnitus mechanisms
- Identifying negative emotions and feelings
towards tinnitus
- Auditory Therapy
- Aim to stimulate neuro-auditory pathways and
reduce contrast between tinnitus and
environmental sounds. - Fitting of hearing aids when there is any hearing
loss - Noise generators when hearing is not aidable.
Limitation noise generators are not tailored for
hearing profile and may not be effective in many
cases
28TRT
Noise generators are used at a levels where the
tinnitus can also be heard in order to promote
habituation
Habituation is not achieve by masking the tinnitus
29Noise Generators, sound machines, music players
may have no effect in the presence of a hearing
loss.
Hearing assessment is needed before recommending
noise generators.
30Unilateral hearing loss
31Asymmetrical bilateral hearing loss
32Low frequency hearing loss
33High frequency hearing loss
34Normal hearing (?)
35Ultra-high frequency hearing loss
36Neuromonics Tinnitus Treatment
By Australian audiologist Dr Paul Davies
An advancement over TRT
Directive Counselling and Customised Auditory
Therapy
Limitation expensive (rebate not yet available
from health funds)
37Tinnitus treatment aims to promote habituation
to tinnitus signal
Positive counselling and early
intervention helps habituation
38ATA and Hearing Health Professionals Dilemma
- Raise tinnitus awareness to prevent increase of
tinnitus sufferers
- Tinnitus awareness also creates tinnitus
sufferers
39Thank you!
www. tinnitus.asn.com.au Tel. 8382 3331