Tinnitus.ppt
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lecture about tinnitus
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Tinnitus.ppt
- 1. TINNITUS Dr. Mohammed Subhan Hawramy Otolaryngologist Ph.D. candidate in Neuro-otology 2022-2023 5/28/2023 Tinnitus/ University of Sulaimani 1
- 2. INTRODUCTION • Tinnitus is defined as sensations of hearing in the absence of external sounds 5/28/2023 Tinnitus/ University of Sulaimani 2
- 3. 5/28/2023 Tinnitus/ University of Sulaimani 3
- 4. THE BURDEN OF TINNITUS 5/28/2023 Tinnitus/ University of Sulaimani 4
- 5. PREVALENCE • Prevalence increases with age • 1/3 of the population have had tinnitus at some stage in their lives • Up to 15% of the population currently experience tinnitus • 80% of people don’t seek help • 6-8% of those affected are severe • 40% of patients experience depression • Can vary between barely perceptible noise to a deafening roar 5/28/2023 Tinnitus/ University of Sulaimani 5
- 6. SOUND FEATURES OF TINNITUS NOISE CRITERIA POSSIBLE FEATURES Onset Sudden, gradual Pattern Pulsatile, intermittent, constant, fluctuating Site Right or left ear, both ears, within head Loudness Wide range, varying over time Quality Pure tone, noise, polyphonic Pitch Very high, high, medium, low 5/28/2023 Tinnitus/ University of Sulaimani 6
- 7. TINNITUS SUFFERERS • Ludwig van Beethoven • Vincent van Gogh • Charles Darwin • Neil Young • Eric Clapton • Ronald Regan • Keanu Reeves • Sylvester Stallone 5/28/2023 Tinnitus/ University of Sulaimani 7
- 8. TYPES OF TINNITUS • Objective: caused by sounds generated somewhere in the body • Subjective: perception of meaningless sounds without any physical sound being present • Auditory hallucinations: perceptions of meaningful sounds such as music or speech 5/28/2023 Tinnitus/ University of Sulaimani 8
- 9. CAUSES 5/28/2023 Tinnitus/ University of Sulaimani 9
- 10. EFFECTS OF TINNITUS • Concentration • Hearing • Insomnia • Psychological 5/28/2023 Tinnitus/ University of Sulaimani 10
- 11. EAR ANATOMY 5/28/2023 Tinnitus/ University of Sulaimani 11
- 12. MECHANISM OF HEARING 5/28/2023 Tinnitus/ University of Sulaimani 12
- 13. MECHANISM OF HEARING 5/28/2023 Tinnitus/ University of Sulaimani 13
- 14. PATHOPHYSIOLOGY OF TINNITUS • Poorly understood • Range of theories from loss of outer hair cell function to increased spontaneous activity of central nerves • Can be generated from any part of the auditory system from the ear to the Central Nervous System (CNS), This then may become modified by the CNS. 5/28/2023 Tinnitus/ University of Sulaimani 14
- 15. PERIPHERAL EVENTS LEAD TO CENTRAL NEUROLOGICAL CHANGES 5/28/2023 Tinnitus/ University of Sulaimani 15
- 16. BRAIN RESPONSE TO AUDITORY DEPRIVATION • Patients with tinnitus exhibit enhanced auditory sensitivity • This is caused by hyperactivity of the auditory central nervous system • 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. DECREASED SOUND INPUT INCREASED SOUND SENSITIVITY 5/28/2023 Tinnitus/ University of Sulaimani 16
- 17. • When the perception of tinnitus is associated with negative reinforcement, the autonomic nervous system is activated. • Physiological and psychological reactions then lead to enhancement of the tinnitus signal 5/28/2023 Tinnitus/ University of Sulaimani 17
- 18. PSYCHOLOGICAL ASSOCIATIONS WITH TINNITUS 5/28/2023 Tinnitus/ University of Sulaimani 18
- 19. DIFFERENTIAL DIAGNOSIS • Idiopathic (most common) • Outer ear disease – Wax, foreign body, infection • Middle ear disease – Infection, perforated eardrum, ossicular problems, tumour • Inner ear disease – Presbyacusis (older age hearing loss) – Meniere’s disease – Acoustic neuroma – Noise exposure – Drugs 5/28/2023 Tinnitus/ University of Sulaimani 19
- 20. EVALUATION OF TINNITUS • Thorough history • Duration, nature, effects • Non vs. pulsatile • Noise exposure • Other ear symptoms • Ear examination • Rule out outer/middle ear disease • Tuning fork tests 5/28/2023 Tinnitus/ University of Sulaimani 20
- 21. NORMAL EAR VS. DISEASED EAR 5/28/2023 Tinnitus/ University of Sulaimani 21
- 22. EVALUATION OF TINNITUS • Audiological (hearing) Tests • Audiogram, tympanogram • Specialized hearing tests: SOAE, ECochG, ABR • MRI • Associated symptoms • Asymmetric hearing loss 5/28/2023 Tinnitus/ University of Sulaimani 22
- 23. EVALUATION OF SUBJECTIVE TINNITUS • Audiometry - assymetrical hearing loss, unilateral tinnitus - MRI r/o post fossa • Complete questionnaire for perceived severity:THI, IOWA, TFI 5/28/2023 Tinnitus/ University of Sulaimani 23
- 24. MEASUREMENT OF TINNITUS • Pitch • Loudness • minimum masking level • residual inhibition/post masking • Minimum masking level most clinical use • Minimal masking level - number of decibels to cover tinnitus • Residual inhibition - response of patients tinnitus post masking 5/28/2023 Tinnitus/ University of Sulaimani 24
- 25. ENT Referral ENT Referral 5/28/2023 Tinnitus/ University of Sulaimani 25
- 26. ACOUSTIC NEUROMA 5/28/2023 Tinnitus/ University of Sulaimani 26
- 27. TREATMENT • Aim to improve habituation rather than “cure” tinnitus • Most people don’t seek treatment • Multitude of potential treatments • Problems with scientific evidence 5/28/2023 Tinnitus/ University of Sulaimani 27
- 28. TREATMENT • Basic advice • Hearing Aid • Tinnitus Masking Device • Tinnitus Instrument • Tinnitus Retraining Therapy • Psychological Treatment • Medication • Alternative Treatments 5/28/2023 Tinnitus/ University of Sulaimani 28
- 29. BASIC ADVICE • Reassurance • The first step is to understand the problem • Avoid aggravating factors eg. noise, NSAIDs • Decreased intake of stimulants eg. caffeine and nicotine • Relaxation • Avoiding silence • White noise eg. Detuned radio 5/28/2023 Tinnitus/ University of Sulaimani 29
- 30. TREATMENT • Basic advice • Hearing Aid • Tinnitus Masking Device • Tinnitus Instrument • Tinnitus Retraining Therapy • Psychological Treatment • Medication • Alternative Treatments 5/28/2023 Tinnitus/ University of Sulaimani 30
- 31. TINNITUS RETRAINING THERAPY • Based on evidence that a person can habituate to acoustic noise in the environment • Goal is to weaken or remove the functional connections between the auditory pathways • Key elements: counseling and sound therapy 5/28/2023 Tinnitus/ University of Sulaimani 31
- 32. PSYCHOLOGICAL AND BEHAVIOURAL SUPPORT INTERVENTION DESCRIPTION Counselling and education • Delivered in person, to groups and via the internet • Variable results may depend on personal characteristics Cognitive behavioural therapy • Designed to modify maladaptive behavioural and emotional responses • One-to-one and group settings, delivered by psychologists or psychiatrists, or via internet • Statistically significant reductions in severity of tinnitus symptoms (P<0.05) Relaxation therapy • May help reduce tinnitus symptoms and depressive symptoms 5/28/2023 Tinnitus/ University of Sulaimani 32
- 33. MEDICATIONS • 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 DRUG CLASS EXAMPLES OF DRUGS USED IN TINNITUS Antidepressants tricyclics, selective serotonin reuptake inhibitors Antipsychotics sulpiride Mood stabilisers gabapentin, valproate Sedatives/hypnotics benzodiazepines 5/28/2023 Tinnitus/ University of Sulaimani 33
- 34. ALTERNATIVE THERAPIES • Vitamins • B1, B3, B6, B12, zinc, calcium, Mg • Laser Therapy • Germany • Thought to increase ATP in cochlea • Hypnotherapy • Acupuncture • Ear canal magnets 5/28/2023 Tinnitus/ University of Sulaimani 34