Welcome
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The Path to Better Life
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Introduction of Staff
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You Are Here Because You
or Someone You Love Has Tinnitus
You are Not Alone
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50 million Americans report tinnitus
17 million report significant or debilitating problem
#1 disability reported by veterans
Epidemiology statistics are consistent all over the world
Some are bothered more than others
What is Tinnitus?
• The perception of sound when no actual sound exists
– Commonly called “Ringing in the Ears”
– Described as ringing, hissing, crickets, etc.
• What is hyperacusis?
– Sound tolerance problem
– Can occur with tinnitus
Effects on Lifestyle
Results from Oregon Health Sciences University Tinnitus Clinic
Difficult to Concentrate
85%
Difficult to Relax
85%
Irritable or Nervous
83%
Uncomfortable in quiet
83%
Tired or Stressed
81%
Interfere with Social Activities
74%
Hard to Interact Pleasantly
73%
Problems with Sleep
73%
Cause you to feel depressed
70%
Interfere with work activities
66%
-Martin et al., 2002
Tinnitus can significantly alter your Lifestyle!
The fears and questions regarding tinnitus
are usually the same
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What caused my tinnitus?
Do I have a life threatening condition?
Am I going to lose my hearing?
Will it get worse?
What can I do to get rid of it?
Is there a Cure?
• You may have heard these words
– “Nothing can be done”
– “You need to learn to live with it!”
• You may have already tried many of the methods for treating
tinnitus such as
– medication, surgery, masking, electric stimulation, laser
stimulation, acupuncture, relaxation therapy….. just to name
a few
It can be very confusing
But….There is Hope!
• Our current knowledge of the ear and the auditory system
has lead to numerous clinical trials and validation that a
combination of counseling and sound therapy can remove
or reduce the perception of tinnitus
• Audiologists have had much success in improving the
lifestyle of their patients, even those that are completely
debilitated by their condition
What is an Audiologist?
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Audiologists (Au-di-ol-o-gists) are the primary health-care
professionals to evaluate, diagnose, treat, and manage hearing loss,
tinnitus and balance disorders in adults and children.
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Audiology is a highly recognized profession and has been ranked by
U.S. News and World Report as one of the Best Careers in 2006, 2007,
and 2008.
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Most audiologists earn a doctor of audiology (AuD) degree, but, there
are also other doctoral degrees that audiologists can obtain (i.e., PhD,
ScD, etc) from accredited universities with special training in the
prevention identification, assessment, and treatment of hearing
disorders.
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Audiologists must be licensed in most states.
What is the TPA?
• Although all audiologists are educated and skilled in
hearing loss, tinnitus and balance disorders, some choose
to “specialize” in tinnitus
• An association was created to certify and to support the
audiologists dedicated to tinnitus care
• I have met the qualifications of the TPA
What Causes Tinnitus?
Medical
Non-Medical
Meniere’s Disease
Cardiovascular Disease
Noise Induced
Diabetes
Hearing Loss
Head Trauma
Hypertension
Post Surgical
Barotrauma
Hyperthyroidism
Allergies
Hydrotrauma
TMJ
Anemia
Whiplash
Vascular
Otosclerosis
Stress Induced
Drug Induced
Ear Wax
Substance Induced
Ear Disease
High Impact Aerobics
Tumors, neuromas
Loose Hairs in the Ear Canal
Most of the time, these conditions have made structural
changes in the delicate structures of the inner ear and this is
the source of the problem.
Anatomy of the Ear
The Inner Ear
• The microscopic “hair cells” of the inner ear have structural
changes and are not able to send a clear signal to the brain
• It’s like walking on the grass, if you continue to walk on the
grass, it can be weakened and no longer spring back
The brain tries to compensate for the weakened signal and
patterns begin. Non auditory structures may begin to
exacerbate the situation.
The Neurophysiological Model
of Tinnitus
Dr. Pawel Jastreboff, a Neurophysiologist, described what is happening in the
brain by developing The Neurophysiological Model of Tinnitus.
It postulates that:
• the abnormalities in the cochlear function (damage to the inner ear)
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along with auditory central pathways (nerve sending the message to
the auditory part of the brain)
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and some of the non-auditory related brain structures (subconscious
and conscious brain)
….have to be included in the emergence and maintenance of the phenomenon
of tinnitus.
The Neurophysiological Model of Tinnitus
• Although the original “insult” may have occurred in the ear, ….
tinnitus continues because of what is happening in the
subconscious and conscious parts of the auditory system
• It’s what happens between the ears that creates the ongoing
and continuing problems with tinnitus
There is Hope
• Now that we know this, we know that we can do things to
reduce the perception of tinnitus
• This happens many times a day with all of our perceptions, and
also sometimes with tinnitus. That is why you may hear from
some people “yes, I have tinnitus, but it doesn’t really bother
me”
• If this doesn’t happen automatically, and people are “bothered”
by tinnitus, we have some tools to help it along to occur
naturally
Individualized Treatment
Each patient has a unique set of circumstances and treatment
is most effective when it is individualized
Therefore, we need to consider your unique situation
What will happen?
– Evaluation
– Consultation
– Recommendation
Evaluation
The purpose of the Initial Evaluation is to determine the extent
of your tinnitus problem in three specific areas
• Hearing sensitivity
• Reaction to tinnitus
• Sound tolerance
Evaluation
We will use a series of subjective and objective measurements
to develop a comprehensive individualized treatment plan
• Self-administered questionnaires and handicap inventories
• Case history, interview and review of self-administered
questionnaires
• Audiological assessment including hearing, tinnitus and
sound tolerance testing
Consultation
We will discuss the results of your testing with you
• Review of subjective measurements (questionnaires, case
history, inventories)
• Review of objective measurements (hearing, tinnitus and
sound tolerance evaluations)
• Instructional Counseling based on individualized correlation
of subjective and objective measurements
Recommendations
We will consider all the information gathered about your
tinnitus and the problems associated with the tinnitus to
develop an individualized treatment plan for you
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Instructional and Cognitive Counseling
Sound Therapy
Lifestyle Recommendations
Follow Up Schedule
Treatment Components
• Counseling
– Instructional (how tinnitus happens)
– Cognitive (how your thinking and reaction to your
thinking affects tinnitus)
• Sound therapy
– Generalized (sound enrichment)
– Individualized (instrumentation)
Counseling
• During instructional counseling the tinnitus patient participates
in an in-depth discussion in which the source and meaning of
his or her tinnitus is explained through demonstrations of
anatomy (structure), physiology (function) and real examples to
make the tinnitus phenomenon understandable
• Cognitive counseling identifies negative thoughts and
emotions and teaches techniques which enable you to change
the way you view and react to the tinnitus
Sound Therapy
• Decrease the contrast between the tinnitus and
background sound (dark auditory room; brightening of
the auditory room)
• Interfere with the detection of the tinnitus (distract,
divert, deflect)
• Decrease the gain in the auditory system
• De-tune activity in the autonomic nervous system
• Create distraction
• Provide relaxation
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TINNITUS
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1010101010000000000000000000101000101010100010101010
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Sound Therapy
• Generalized Acoustic Environmental Enrichment
• Table top sound machine
• Sleep pillow
• Music (ipod, MP3, radio)
• Fans, water fountains
• Individualized
• Sound generators
• Amplification
• Combination units
• Neuromonics
What Can You Do Now?
If you have tinnitus
• Avoid silence (provide low level sound enrichment)
• Do not “overprotect” your ears, but, use ear protection in
loud environments (lawn mowing, loud music, power tools,
factory, hunting)
• Do things you enjoy
• Do things which will take your mind away from tinnitus
• Get enough sleep, exercise regularly
• Make an appointment for a complete evaluation
What Can You Do Now?
If you do not have tinnitus but you know someone who does
• Protect your ears in excessively loud environments
• Come with your loved one to the appointment to learn about
tinnitus
• Be supportive and encourage them to get an evaluation
There is Hope
There is Help
You are in the Right Place!
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