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UNDERSTANDING AND MANAGINGYOUR TINNITUS
PRESENTATION TO
THE CANADIAN HARD OF HEARINGASSOCIATION
2009 CONFERENCE
May 22, 2009
Halifax, Nova Scotia
Mark Gulliver, MSc., Aud(C)
Nova Scotia Hearing and Speech Centers
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WHAT ARE WE GOING TO TALK ABOUTTODAY???
The Good, the Bad and the Funny
The ProblemTinnitus What is it?
Tinnitus What causes it?
Tinnitus How do we treat it
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The Scream (The Bad)
Edward Munch
Has become an universalsymbol of human suffering
An international Facial Painsupport group has claimedthe central figure as a logo
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The Funny
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Another Funny
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The Good
THERE IS
HOPE
FOR PEOPLE WITH
SEVERE TINNITUS
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The Problem
It is difficult to find health professionalswith the necessary skills (beyond basicinformation) to help those with tinnitus
in particular
Majority of other health professionalspoorly trained in how to help
ie. family doctor (go home and live with it)
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TINNITUS WHAT IS IT?
Tinnitus is the term used for noises or soundsthat are heard in one or both ears or in the headwhich do not come from an external source
Often referred to as ringing in the ears but isalso described as roaring, hissing, buzzing,humming, etc.
Tinnitus can be intermittent or continuous and
the perceived volume can range from barelynoticeable to severe and debilitating
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TINNITUS
Tinnitus affects approximately
15-17% of the general population
> 30% over the age of 65BUT, only causes suffering in 4-5 % ofthose with tinnitus
That is still >!
million Canadiansseriously affected by tinnitus!!!
Objective tinnitus vs subjective tinnitus
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TINNITUS WHAT IS IT?
The prevalence of tinnitus increaseswith age and is seen more often in
men versus women
Tinnitus is more often than not
associated with a hearing loss
Tinnitus is a , not a disease
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Famous People & Musicians withTinnitus
Neil YoungPete Townshend
William ShatnerLeonard Nimoy
David LettermanPaul SchafferLeslie NielsenRonald ReaganSting
The Edge Eric ClaptonGeorge HarrisonSylvester StalloneTed Nugent
Dwight D. EisenhowerMartin LutherJoan of ArcOscar Wilde
Phil CollinsCherHuey LewisDon ImusVincent Van GoghFrancisco de GoyaLudwig Van BeethovenGarrison KeillorPeter Jennings
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Tinnitus In Song
Peter Framptom- Show me the way- "I wonder howyou're feeling....there's ringing in my ears....and no oneto relate to...cept the sea
Robert Plant- Stairway to Heaven- "Youre head ishumming and it wont go in case you dont know..."
Bob Dylan- Call Letter Blues- "My ears are ringing,ringing like empty shells"
Bob Seger- Turn the Page- "Later in the evening asyou lie awake in bed, with the echo from the amplifiersringing in your head."
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Tinnitus in Art
VincentVan Goghsaid to have cut off his
ear during an excruciating
bout of tinnitus
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Tinnitus Personality
Barbra Streisand- "Streisandhas ascribed her volatiletemperament to the tinnitusfrom which she has suffered
since she was seven."
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TINNITUS WHAT CAUSES IT?
Noise exposure
Presbycusis (aging of the hearing system)
Ear disease (middle ear or inner ear)Medication
Head or neck injury
Acoustic Neuroma
Wax buildup
TMJ disorder
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COMMON SYMPTOMS ASSOCIATED WITHSEVERE TINNITUS
Difficulty getting to sleep or maintaining sleep
Difficulty concentrating (ie. reading)
Increased anxiety, stress
Depression/suicide/hopelessnessWork may be affected
Sensitivity to sound
Pressure/fullness in ears
Difficulties with balance
Internet
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EXACERBATING FACTORS
STRESS
Lack of sleep/fatigue
Noise exposure
Sodium/saltCaffeine
Alcohol/nicotine
Medications/drugs
Over exertion/strenuous exercise
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TINNITUSWHERE DOES IT COME FROM?
We now know that the underlying origin oftinnitus is , not peripheral
Evidence from 8thnerve surgery, PET scansand functional MRI
The exact mechanisms of tinnitus arenumerous but none have yet to be proven
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ORIGINS OF TINNITUS
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ORIGINS OF TINNITUS
Unilateral temporal
cortex hyperactivity onPET supports Central vsPeripheral origins ofTinnitus
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TREATMENTS
FORTINNITUS
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In most cases of tinnitus there is
We try to find ways to help you better
your tinnitus
There are many successful treatments
There are also many false treatments
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TREATMENTS FOR TINNITUS
Complete audiological evaluation
Evaluation of your tinnitus (if needed)
Counseling
Sound TherapyTinnitus Retraining Therapy (TRT)
Hearing Aids
Maskers or Tinnitus Instruments
Medication
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TREATMENTS FOR TINNITUS
Protection from loud noises
Support Groups
Stress Management/Psychology
Diet ConsiderationsAlternative Approaches
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Counseling
And
Sound Therapy
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COUNSELING
your tinnitus is important
Provides hope and reassurance that tinnitus can bemanaged successfully
Most of the difficulty you are experiencing is beingcaused by your to the tinnitus
Need to accept that you have tinnitus and that it probablywill not go away (no cure)
You need to know that you will get better even if yourtinnitus does not go away
The need to understand the of your tinnitus so youwill not fear it reduces emotional reaction
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COUNSELING
Important to understand that the tinnitus will not getpermanently louder but it may fluctuate in loudnessdepending on other factors such as:
- stress/anxiety
- fatigue
- noise exposure
- diet
- medication - level of background/environmental noise
- worsening hearing loss (quieter environment)
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COUNSELING
The need to understand that your hearing will notchange just because you have tinnitus you will not godeaf. Many people think that it is their tinnitus causingtheir difficulty hearing; actually it is their hearing loss
- tinnitus does not cause hearing loss and hearing lossdoes not cause tinnitus, they are both symptoms.
! You have control over your tinnitus, not the other wayaround
!AVOID SILENCE
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SOUND THERAPY
Most people suffering from tinnitus are only significantlybothered by it when it is quiet, especially at bedtime
They feel that tinnitus gets louder when it is quiet
The perception of the loudness of your tinnitus is afunction of the between the background noiseand the level of the tinnitus
The loudness of the tinnitus is not actually changingeven though the perception of the loudness is
Retirement Syndrome
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Do you hear your Tinnitus in placeslike This?
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Noises of Everyday Life
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Silence/Quiet
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SOUND THERAPY
Sound therapy is used to reduce the contrast betweenthe tinnitus and the level of the noise
- relaxation/nature sounds
- favorite instrumental music
- fan
- radio/TV
- use of a pillow speaker (at bedtime)
- fish tank/running water - experiment with sounds that work for you
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Picking a Face out of the Crowd
Sound Therapy is
an attempt towrap the noise ina more pleasantsound
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SOUND THERAPY
Important that sound therapy is played at a low level
Not necessary to completely mask the sound better ifyou dont for long term results
AVOID SILENCE
Have as few episodes of silence as you can throughoutthe day
Sound therapy can also be obtained through othermeans:
- noise generators/maskers - hearing aids
- combination instruments
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TINNTIUS RETRAINING THERAPY (TRT)
Neurophysiological Model of Tinnitus (Dr. P. Jastreboff)
Uses intensive counseling and sound therapy (noisegenerator)
Purpose is to achieve the
Long term goal be unaware that the tinnitus is thereexcept when you focus on it
Attempts to reduce the to the tinnitus
The loudness of the tinnitus is secondary to itssignificance (negative counseling)
Fridge Example
Formal TRT typically only used for severe cases of
tinnitus theory behind it used for all
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HEARING AIDS
Hearing aids are an extremely important part inthe management of tinnitus
Important to treat the hearing loss and the
problems that arise out of the hearing lossThey are a form of sound therapy
Amplify the environment around you
Reduces contrast
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MASKERSTINNITUS INSTRUMENTS
Maskers are another form of sound therapy
Reduces contrast between tinnitus and masking noise
Tinnitus Instrument is a combination hearing aid and masker
Typically only used in severe cases of tinnitus
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MEDICATION
Medication can quite often be successfully used toindirectly treat the symptoms resulting from tinnitus orother life stressors
Sometimes it cannot be avoided (vicious circle)
Anti-depressants, anti-anxiety, sleeping medication
Consult with family doctor
Herbal medications and tinnitus
Be careful of the internet and cures
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PROTECTION FROM LOUD NOISE
Exposure to loud noises can make your tinnitus worse
Usually the increase in loudness is temporary
Important to wear hearing protection, both at work and athome
- lawn mower/leaf blower/whipper snipper
- power tools
- snow blower
- hunting - turn the music down
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SUPPORT GROUPS
Provide support, education and HOPE
Meet others with the same problem
In person or on-line
- Tinnitus Support Group of Atlantic Canada - American Tinnitus Association
- Tinnitus Association of Canada
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Stress Management
PossiblePsychological Referral
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ALTERNATIVE APPROACHES
Herbal medications over the counter and internet
- ie. ginko biloba, lipoflavinoids
Acupuncture
HypnosisHomeopathy/Naturopathy
Laser Therapy
Biofeedback
Electrical stimulation
Magnetotherapy
Relaxation/Massage therapy
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Ring Stop: active ingredientscracking noises, stitches and pulsing sensations in the ears.
Cimicifuga racemose (Black Cohosh Root) is helpful for tinnitussymptoms, and for people who are very sensitive to noise.
Carbo vegetabilis (vegetable charcoal) is a natural remedy forringing in the ears, especially if it occurs during flue or otherconditions involving vertigo and nausea.
China (Cinchona officinalis) (Peruvian bark) helps ringing in theears and hearing sensitive to noise.
Chinimum sulphuricum (Sulphite of quinine) helps relieve violentringing, buzzing, and roaring sounds that are loud enough to impaira person's hearing.
Coffea cruda (Unroasted coffee) is for people with tinnitusaccompanies by extremely sensitive hearing and a buzzing feelingin the back of the head.
Graphites (Plumbago) is a remedy beneficial for tinnitus withassociated hearing loss, and for hissing and clicking sounds in the
ears.Kali carbonicum (Potassium carbonate) is for tinnitus with ringingor roaring, accompanied by cracking noises and itching in the ears.
Lycopodium (Club moss) is for a humming and roaring in the ears,along with impairment of hearing, and sounds that seem to echo inthe ears.
Natrum salicylicum (Sodium salicylatae) is a beneficial remedy if
ringing in the ears is like a low, dull hum, and for loss of hearingdue to bone conduction, as well as nerve interference.
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TINNITUS
THERE IS HOPE
THERE IS HELP
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QUESTIONS???
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THANK-YOU!!!