What is tinnitus and how can we best manage it? · Nottingham Hearing Biomedical Research Unit Top...

Deborah Hall

Nottingham Hearing Biomedical Research

Unit

What is tinnitus and how can

we best manage it?

Nottingham Hearing Biomedical Research Unit

Nottingham:

The UK’s interdisciplinary hub

for hearing research

Advancing insight, innovation, and impact

Basic Translational Clinical


What is tinnitus?

Describe your tinnitus sound in words!

https://www.actiononhearingloss.org.uk/co

mmunity/forums/tinnitus.aspx?g=posts&t=7

433

• “tsssssssss+bzzzzzzzzzz+beeeeeeeee”

• “like a washing machine on very fast

spin”

• “dog barking in distance”

• “like gas escaping from a bottle”


Hearing loss can cause tinnitus

Cochlear damage

Altered auditory nerve activity

Cascade of neuroplastic changes

Tinnitus percept


• Increased spontaneous activity

– Auditory cortex (e.g. Norena

and Eggermont, 2003)

– Inferior colliculus (e.g.

Mulders and Robertson, 2009)

– Cochlear nucleus (e.g.

Kaltenbach et al., 1998)

• Decreased spontaneous

activity

– Auditory nerve (e.g. Liberman

et al., 1984)

Neurophysiological correlates

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(dB

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Mean neural

activity

Spontaneous

neural activity Schaette R, Kempter R (2006)

European Journal of

Neuroscience, 23: 3124-3138.

Homeostatic plasticity

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Mean neural

activity

Spontaneous

neural activity

• Deprivation

is known to

alter the

balance of

neural

activity in

the central

auditory

pathway

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Hearin

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Mean neural

activity

Spontaneous

neural activity

• Increasing

the central

gain

rebalances

the neural

activity in

the central

auditory

pathway

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20

40

60

80

0

-20

Hearin

g t

hre

shold

(dB

HL)

Mean neural

activity

Spontaneous

neural activity

20

20

40

60

80

0

-20

Hearin

g t

hre

shold

(dB

HL)

Mean neural

activity

Spontaneous

neural activity

• Increasing

the central

gain can give

rise to

hyperactivity

in the central

auditory

pathway

Perceptual characteristics Pitch and loudness

Psychological reactions

Cognitive and emotional responses

Individual personality ‘Susceptibility’ characteristics

Change reaction to the percept (counselling, relaxation therapy)

Tinnitus

Sound enrichment (hearing aids)

Masking the percept (noise masking)

Alleviating the neural cause (drug treatments)


1 At any point in time around 10% of the population experience

tinnitus

- Both sexes are equally

affected

- Tinnitus is more common

in the elderly

Top 10 tips

- Yes, it can occur at any age, including childhood.

Do children experience tinnitus?


2 Most tinnitus is mild

- It is relatively rare for it to develop into a chronic problem of life-altering

severity.

Top 10 tips


Top 10 tips

3 Tinnitus is more common in people with hearing loss

- Tinnitus is greater among people with hearing impairment

- It is possible to have tinnitus with a completely normal hearing


Top 10 tips

4 Tinnitus can be associated with a blocked sensation

- For reasons that are not clear tinnitus and sensorineural hearing loss

can give rise to a blocked feeling in the ears

- Decongestants and antibiotics are

rarely helpful.


Top 10 tips

5 Giving a negative prognosis is actively harmful

- It is all too common to hear that patients have been told nothing can be

done about tinnitus.

- Negative statements are not only unhelpful but also tend to focus

attention on the tinnitus and exacerbate the distress.


Top 10 tips

6 Enriching the sound environment is helpful

- Useful sources of sound to reduce the starkness of tinnitus include

quiet uneventful music, a fan or a water feature.

- There are inexpensive devices that produce environmental sounds,

and these are particularly useful at bedtime.


Top 10 tips

7 Hearing aids are helpful

- Hearing aids are useful even if the hearing loss is relatively mild and

an aid would not normally be considered.

- Straining to listen causes increased central auditory gain and this

increased sensitivity can allow tinnitus to emerge or, if already present,

to worsen.

- Correcting any associated hearing loss reduces this central auditory

gain and thereby reduces the level of the tinnitus.


Top 10 tips

8 Underlying pathology is rare, but be vigilant

- Tinnitus is often due to heightened awareness of spontaneous

electrical activity in the auditory system that is normally not perceived.

- But it can be a symptom of treatable and significant otological

pathology, such as a vestibular schwannoma or otosclerosis.

- Be especially vigilant if the tinnitus

is unilateral, or if it has a pulsatile

quality.


Top 10 tips

9 There is no direct role for drugs

- Drugs can treat associated symptoms such as vertigo, insomnia,

anxiety or depression, but not tinnitus itself.


Top 10 tips

10 Self-help is often effective

- The British Tinnitus Association provides excellent information on

tinnitus and common sense advice on managing symptoms.

- It runs a telephone helpline 0800 018 0527 as well as offering advice

through its website www.tinnitus.org.uk

What is tinnitus and how can we best manage it? · Nottingham Hearing Biomedical Research Unit Top...

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