Tinnitus!

1. M.P.Manoj, MESIARC, Calicut. Tin-nit-us (or) Tin-night-us in Latin meaning ringing of the bell Tinnitus!

2. Definition • Tinnitus is defined as the sensation of sound in the absence of any relevant external stimuli • Do not classify into objective and subjective!

3. Bewildering!

4. Do We Turn a Deaf Ear? • It may be the first symptom of various disease processes that threaten the patient’s health or physical well being. • Even if not, it severely affects the quality of life of the individual. • Only a concerned, knowledgeable physician can help.

5. Patient Needs • Emotional support • Realistic understanding of the tinnitus and it’s treatment • Positive and active attitude to pursue helpful activities • A battery of tactics and coping strategies

7. Two Major Categories • Generated from Para auditory structures • Generated within the sensory auditory system

8. Flow Chart for Diagnosis of Tinnitus Ringing sound in the ear Pulsatile Non pulsatile     Bruit No bruit Hearing- N Hearing      Watch Myoclonus? Specific TRT Radiology

9. Categorization • 0- minimal symptoms, not requiring intervention • 1- significant tinnitus • 2- significant hearing loss with tinnitus • 3- hyperaccusis • 4- hyperaccusis with prolonged symptom enhancement by environmental sound exposure

10. Origin of Tinnitus Peripheral Central Brainstem

11. Difficulty in Assessment • Description may depend upon the vocabulary. • The side may not be specific. • Loudness may vary. • Many patients cannot match the pitch.

12. Venous Hum • Eddy currents in the jugular vein • Seen in normal individuals • Eliminated by gentle pressure • May not need any treatment

13. Myoclonus • Rapid repetitive contractions at 60 – 200 per minute. • Young people. • May be associated with neurological disorders. • Does not change with exercise or sedation. • Phenytoin, carbamazepine useful.

14. Drugs Producing Tinnitus • Anti cancer drugs • Antibiotics/ antiparasitic • Diuretics • Antipyretics • Oral contraceptives • Antidepressants • Narcotic analgesics

15. Hearing Loss and Tinnitus • Music in the brain – the 1953 Heller and Bergman experiment. • All causes of hearing loss cause tinnitus to some extent. • Correction of the hearing loss is to be attempted first.

19. The Jastreboff Model Consciousness Perception and Evaluation ( Auditory cortex) Sub consciousness Detection (subcortical) Emotional association ( Limbic system) Source (Tinnitus related neural activity) Annoyance ( autonomic nervous system)

20. Treatment Options • Medication. • Lidocaine @ 100 mg IV. • Carbamazepine @ 600 – 1000mg p.O. • Surgery? • Psychotherapy. • Electrical suppression. • Tinnitus retraining therapy.

21. Treatment by Category • 0- no treatment • 1- maskers • 2- hearing aids • 3- gradual introduction of wide band noise • 4- the hardest group to treat

22. What Do We Tell the Patient? • Never say “ I do not know” • Never say “ you have to live with it” • Ask them to practice listening to the “music of the brain” • Do not say “it will go away” • Avoid medications as far as possible

23. Avoidance of Silence • Isolation of sound increases central auditory gain • 24 hour enrichment of environment • Nature sounds best • Night-time enrichment is a must, but should not disturb partner

24. Tinnitus Retraining Therapy • Retraining the subconscious auditory system to accept the tinnitus as a natural phenomenon • Habituation of reaction and perception • Wide band noise generators • Silence may not be golden

25. Tinnitus • Tinnitus is real, not imagined and has a definite psychological basis • Tinnitus maybe permanent • The person’s reaction to tinnitus, not the sound itself, creates the problem • The person’s reaction to such a disorder is manageable and subject to modification

26. Thank you! A MESIARC Presentation