Tinnitus

1. Tinnitus
Ozarks Technical Community College
HIS 125

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)
60% bilateral
30% unilateral
10% central
From latin word, tinniere, 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
80% of patient’s with SNHL have tinnitus
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 by 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 TABLES 23-1 &
23-2 IN YOUR
NORTHERN 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
Most common type (95%)
Objective
Can be heard by others
Rare (<5% of all tinnitus cases)
Usually pulsatile (in sync with heartbeat)
Causes: vascular or muscular

10. Causes of Objective Tinnitus
Vascular
Arteriorvenous aneurysm
Glomus jugulare tumor
Muscular
Patent eustachian tube
Palatal myoclonus: involuntary muscle jerk of the roof of the
mouth
Spasm of stapedius or tensor tympani muscles

11. Bothersome/Uncompensated 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. Tinnitus Treatment
Surgery (uncommon option)
Medication (usually xanax, valium,
antidepressants)
Dietary restrictions (caffeine, alcohol, salt, MSG)
Masking
Counseling
Cognitive Behavioral Therapy
Tinnitus Retraining Therapy
Sound treatment
Neuromonics

14. 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

15. 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

16. 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)

17. 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

18. 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)

19. 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

20. Other Sound Disorders-Hyperacusis
Everyday sounds seem “too loud” or “uncomfortable”
About ½ of those with tinnitus, also have hyperacusis
Affects 1 in 50,000

21. 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

22. 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.