Hearing aid research for Meniere

1
Tinnitus
Celene McNeill Audiologist Vice-President of ATA
2005 Annual Conference for Nurse Audiometrists
2
TINNITUS

• Perception of sound even when no sound is
  entering the ear

• Ringing
• Hissing
• Humming
• Roaring
• Buzzing
• Cicadas

3
For some people

• its more than just a sound

4
The distressing noise can be constant

• leading to frustration,
• lack of concentration,
• difficulty sleeping,
• anxiety and
• depression

5
A significant proportion of people with tinnitus

• suffer from anxiety and depression

Holgers et al Psychiatric Profile of tinnitus
patients referred to an audiological clinic
Sixth International Tinnitus Seminar, 1999
6
PREVALENCE OF TINNITUS

• 30 of population over 55 years of age

• 45 of population over 70 years of age

5 of people over 55 years of age find their
tinnitus bothersome and upsetting.
BLUE MOUNTAINS STUDY
7
Tinnitus maybe a symptom of different ear
disorders
External ear -Wax -Foreign body -Otitis externa

• Middle ear
• Otosclerosis
• Otitis Media

Cochlea -Noise induced -Presbyacusis -Menieres
disease -Ototoxicity
Retro-cochlear -Acoustic Neuroma
8

• A consultation with an Ear,
• Nose and Throat specialist
• is mandatory in diagnosing any
• existing ear disease
• which may be causing
• the hearing loss tinnitus.

9

• Non treatable cause of tinnitus
• Noise induced hearing loss
• Acoustic trauma
• Ototoxicity
• Presbyacusis

• Treatable causes of
• tinnitus
• Impacted cerumen
• Ear infection
• Ruptured tympanic membrane
• Otosclerosis
• Menieres disease
• Acoustic neuroma
• TMJ dysfunction

10
Treating ear disorder will not necessarily
eliminate tinnitus perception.
11
TINNITUS DOES NOT CAUSE HEARING LOSS
12
Slide courtesy of Dr Klaus Ebbling - Oticon
13

Hearing Loss aggravates Tinnitus

• the worse the hearing the louder the
  tinnitus may be perceived

14
Hearing Loss
Effort to Hear
Stress
Tinnitus Perception
15
Hearing Aids
16
Hearing Aid Tinnitus SurveyMcNeill, C et al
2005Healthy Hearing Balance Care

• Surveyed 126 clients who had been fitted with
  hearing aids at our clinic and 96 replied.
• 1.Do you wear your hearing aid(s) on a regular
  basis?
• 2.Do you have tinnitus?
• 3.How does the hearing aid affect your tinnitus
  while wearing it?

17
3. How do the aids affect your tinnitus?
McNeill, C. 2005
18
Hearing Aids
reduce
Tinnitus Perception
(When fitted appropriately)
19
Hearing aids may not reduce tinnitus distress.
20
2 - 5 of tinnitus sufferers continue to be
distressed by the tinnitus noise even after
perception has been reduced by hearing aid usage
Brain cannot stop focusing on the tinnitus noise
affecting sleep, concentration and quality of life
21
The Neuro-physiological model of
tinnitus Jastreboff, 1993
Basis of Tinnitus Retraining Therapy TRT Implement
ed by Dr Jonathan Hazel in the mid 90s
22
Neuro-Physiological Model of Tinnitus
(Developed by Dr Pavel Jastreboff in 1993)
The physiological cause of tinnitus is
irrelevant
23
Mechanism of tinnitus perception - Jastreboff
(1996)
Perception EvaluationAuditory other Cortical
Areas
No Emotional AssociationsNo Limbic System
Response
DetectionSubcortical
SourceAppearance of abnormal auditory activity
in the Cochlea
Habituation to tinnitusExperiences but does not
suffer
24
Neuro-Physiological Model of Tinnitus
(Developed by Dr Pavel Jastreboff in 1993)
- Negative Counselling by health professionals is
one of the main causes of Tinnitus distress
25
Mechanism of tinnitus distress Jastreboff (1996)
Perception EvaluationAuditory other Cortical
Areas
DetectionSubcortical
Emotional AssociationsLimbic System
SourceCochlea
AnnoyanceAutonomic Nervous System
26
Approaches to treat tinnitus distress

• Pharmacological CNS suppressants
• (very addictive)

• Psychological counselling, CBT, stress
  management, hypnosis

• Audiological TRT, Neuromonics

27
Tinnitus Retraining Therapy T.R.T

• Directive counselling
• Aim to reverse tinnitus noise into a neutral
  sound.
• Understanding of tinnitus mechanisms
• Identifying negative emotions and feelings
  towards tinnitus

• Auditory Therapy
• Aim to stimulate neuro-auditory pathways and
  reduce contrast between tinnitus and
  environmental sounds.
• Fitting of hearing aids when there is any hearing
  loss
• Noise generators when hearing is not aidable.

Limitation noise generators are not tailored for
hearing profile and may not be effective in many
cases
28
TRT
Noise generators are used at a levels where the
tinnitus can also be heard in order to promote
habituation
Habituation is not achieve by masking the tinnitus
29
Noise Generators, sound machines, music players
may have no effect in the presence of a hearing
loss.
Hearing assessment is needed before recommending
noise generators.
30
Unilateral hearing loss
31
Asymmetrical bilateral hearing loss
32
Low frequency hearing loss
33
High frequency hearing loss
34
Normal hearing (?)
35
Ultra-high frequency hearing loss
36
Neuromonics Tinnitus Treatment
By Australian audiologist Dr Paul Davies
An advancement over TRT
Directive Counselling and Customised Auditory
Therapy
Limitation expensive (rebate not yet available
from health funds)
37
Tinnitus treatment aims to promote habituation
to tinnitus signal
Positive counselling and early
intervention helps habituation
38
ATA and Hearing Health Professionals Dilemma
- Raise tinnitus awareness to prevent increase of
tinnitus sufferers
- Tinnitus awareness also creates tinnitus
sufferers
39
Thank you!
www. tinnitus.asn.com.au Tel. [phone]