Tinnitus is the perception of sound without an external source. It is commonly caused by hearing loss which leads to changes in neural activity that are interpreted as sound. While prevalent, only 20% of tinnitus cases are bothersome. Treatment options aim to mask the tinnitus sound or retrain the brain's reaction to it through counseling, sound therapy, and more. Approaches include masking, medication, cognitive behavioral therapy, tinnitus retraining therapy, and sound treatments like neuromonics.

1. Tinnitus
Ozarks Technical Community College
HIS 120

2. What is tinnitus?
• Any sound that is perceived by the
listener that does not originate from an
external sound source
• May be perceived in one or both ears
(peripheral) and/or in the head
(central)
• From latin word, tinnire, which means
“to ring”

3. Descriptive Labels
• Ringing
• Hissing
• Buzzing
• Roaring
• Clicking
• Ocean sound
• Cicadas
• Pulsing
• Heartbeat

4. Causes of Tinnitus
• Most commonly caused by some sort
of change to the auditory system
• Hearing loss results in changes in the
neural activity of the auditory system,
which the auditory cortex interprets as
sound
– Much like phantom limb syndrome.
Areas of the cochlea where there is hair
cell damage can no longer amplify
sounds where damage has occurred so a
phantom sound is interpreted at the brain.

5. Other Causes of Tinnitus
• Hearing loss, especially in cases of noise-
induced hearing loss (NIHL)
• External or middle ear issues (wax, fluid)
• Acoustic neuroma (UNILATERAL tinnitus)
• Medications
• Sinus/allergy issues
• Dental issues (TMJ-temporal-mandibular
joint syndrome)
• Cardiovascular
• Neurological (MS)
• Stress/anxiety
SEE FIGURE 15.5 IN
YOUR MARTIN AND
CLARK TEXT

6. Medications that cause
tinnitus
• Anti-inflammatories
• Antibiotics
• Antidepressants
• Aspirin
• Quinine
• Loop diuretics
• Chemotherapy drugs

7. Some musician’s consider
it a badge of honor…
• Peter Frampton
– “I wonder how you‟re feeling. There‟s
ringing in my ears. And no one to relate
to, „cept the sea.”
• Bob Seger
– “With the echoes of amplifiers ringing in
your head.”

8. Prevalence of Chronic Tinnitus
NIDCD.NIH.GOV
•~22 Million Americans
•10% of adult population

9. Types
• Subjective
– Can only be perceived by the patient
• Objective
– Rare
– Can be heard by others
– Causes: vascular (glomus tumor),
myoclonus (involuntary muscle reflex)

10. Myoclonus
• Quick, involuntary muscle jerk
– Hiccups, sleep start
• Palatal (roof of mouth) myoclonus
results in clicking and popping in the
ear

11. Bothersome Tinnitus
• Only about 20% of people with tinnitus
are bothered by it
• The tinnitus itself isn‟t the problem.
The person‟s REACTION to it is what
is problematic.
– Tinnitus may result in irritability,
fatigue/sleep disturbance, depression,
suicidal thoughts
– These patient‟s need to be referred to a
mental health professional

12. A Viscious Cycle
• Attentional Factors (patient chooses to
attend to tinnitus)
• Emotional reaction
– Limbic system: negative emotional
labeling of the tinnitus
– Autonomic system: activation of the fight-
or-flight mechanism (Can this tinnitus
harm me?)
• Stress
– Amplification of tinnitus signal (louder)

13. Hyperacusis
• Everyday sounds seem “too loud” or
“uncomfortable”
• About ½ of those with tinnitus, also
have hyperacusis
– Affects 1 in 50,000
• Sound clip

14. Hyperacusis Causes
• Hearing loss
• Head injury (i.e air bag deployment)
• Ototoxicity
• Lyme disease
• Viral infections involving the inner ear or facial
nerve (Bell‟s palsy)
• TMJ
• PTSD (post-traumatic stress disorder)
• Chronic fatigue syndrome
• Epilepsy
• Depression
• Migraine headaches

15. Other sound disorders
• Misophonia
– Dislike of sound
• Phonophobia
– Fear of sound
– Often these patients come in reporting
that they use earplugs in everyday
circumstances. This is NOT
recommended. It will actually worsen
problem.

16. Tinnitus Treatment
• Masking
• Medication
• Counseling
• Cognitive Behavioral Therapy
• Tinnitus Retraining Therapy
• Sound treatment
– Neuromonics

17. Masking
• Use of noise to temporarily mask or “cover
up” the tinnitus so it cannot be perceived
• This is often successfully accomplished
when patient‟s with hearing loss use
traditional hearing aids. The amplification
of environmental noises often reduces or
completely masks tinnitus.
– Our newest generation hearing aids have
optional tinnitus maskers built-in for when
hearing aids aren‟t enough to mask tinnitus

18. Masking
• There are companies that manufacture
tinnitus maskers for those with normal
hearing. May be in-the-ear
with a very large vent or a behind-the-
ear, open-ear device
www.ata.org www.siemens.com

19. Masking
• The use of a sound machine or
external noise source (i.e. ceiling fan)
can be very helpful at night
• Different types of noise are utilized in
masking: white noise, pink noise,
brown noise, grey noise (all have
varying complexity based on frequency
components)

20. Tinnitus Handicap
Inventory
• Patient self-survey
• Sample questions
– Do you feel you have no control over your
tinnitus?
– Because of your tinnitus do you feel tired?
– Because of your tinnitus do you feel depressed?
– Does your tinnitus make you feel anxious?
• Quantifies the severity of tinnitus
– Rates degree of handicap from slight to
catastrophic

21. Tinnitus Retraining
Therapy
• Jastreboff created TRT
• Combines counseling with use of noise
generators
– Counseling: reclassify tinnitus to a
category of neutral signals
– Sound therapy: weaken the tinnitus-
related neural activity
• Goal: Habituation to the tinnitus (no
longer pay attention to it)

22. Neuromonics
• Six to eight month therapy protocol
– Uses spectrally modified music that has
been tailored according to each patient‟s
hearing and tinnitus characteristics
– Combined with an underlying neural
stimulus
– Retrains the brain to filter out
tinnitus disturbance
Very expensive~$5000 for treatment that
lasts less than a year