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Tinnitus & Hyperacusis

Tinnitus

Tinnitus is a hearing condition where people hear noises, hisses or hums that have no external source – this unreal sensation is often described as a ‘ringing in the ears,’ which can either be low or high-pitched. It can be intermittent or continuous and can occur in one or both ears and is often most noticeable in quiet listening environments. In almost all cases, tinnitus is a subjective noise, meaning that only the person who has tinnitus can hear it.

Tinnitus can be a symptom of a condition that is related to many forms of hearing loss, or it may exist without hearing loss. Tinnitus is not a disease. Tinnitus is a symptom that may result from a number of medical conditions. Tinnitus may result from age-related hearing loss (presbycusis typically begins after the age of 55), ear injury, or a physiological condition.

Tinnitus may have a physiological or biochemical origin. Common causes of tinnitus include impacted wax near the tympanic membrane (eardrum), hearing loss, exposure to excessive noise (either ongoing or one time noise trauma), head/neck trauma, whiplash, large doses of ototoxic drugs such as aspirin (over 200 medications have tinnitus as a listed potential side effect), problems in the neck or jaw, or any type of physical or emotional stress. Less common causes include a non-malignant tumour on the vestibular nerve (vestibular schwannoma), a fixation of the middle ear bones, or other relatively rare medical conditions. The following blood vessel disorders MAY cause pulsatile tinnitus.

Atherosclerosis is a large build-up of cholesterol and other fatty deposits in major blood vessels close to your middle and inner ear. The blood vessels lose some elasticity and therefore the ability to flex and expand with each heartbeat. This causes the blood flow to become more forceful and turbulent, making it easier for the ear to detect heart beats. High blood pressure, including hypertension and factors that increase blood pressure such as stress, alcohol, and caffeine, may make tinnitus more noticeable. Repositioning your head may cause the sound to disappear. Narrowing of the carotid artery or jugular vein can result in turbulent blood flow and head noises. Malformation of capillaries, also called arteriovenous malformations, can occur in the connections between arteries and veins which can result in head noise.

Individuals with normal hearing can also suffer from tinnitus. Having tinnitus does not mean that one will lose their hearing.

Although there are many theories about how sounds in the ears or head are produced, the exact process is not fully understood. The most widely accepted theory, when tinnitus occurs with hearing loss, is damage in the cochlea. More specifically, damage to outer hair cells. Many researchers believe that when the structure of the hair cell collapses, random stimulation of the auditory pathways occurs. More current research of Martin Pienkowski, suggests that tinnitus results from a locking of spontaneous neuronal firings at the level of the cochlea and brainstem. All individuals have spontaneous neuronal activity, however; in individuals with tinnitus, the “locking” of this activity enhances the sound signal.

Protect your Hearing from Damage

Within the auditory system, thousands of auditory cells maintain an electrical charge. Microscopic hairs form a fringe on the surface of each auditory cell (Outer Hair Cells-OHC and Inner Hair Cells-IHC).

When healthy, the hairs on top of the hair cells move as a result of the pressure of sound waves moving through the fluid in the inner ear. Both the inner and outer hair cells are connected to the auditory nerve through the basilar membrane. Depending upon the movement of the cochlear fluids from sound stimulation, different hair fibers are put into motion. The movements of these hairs cause the auditory cell to discharge electricity to the auditory nerve, which is connected to the auditory centre of the brain. The brain translates these electrical impulses into sounds, which we recognize and understand. As a consequence, these hair fibers are essential to our hearing ability.

When these hair cells are damaged, they move randomly in a constant state of irritation. They are unable to hold their charge and leak random electrical impulses to the brain where it is interpreted as noise. The nerves that carry impulses to the brain are adjacent to the base of the hair cells but are not quite embedded into the basilar membrane. 90% of the nerves derive from the inner hair cells (despite the fact that they are smaller in number). Each inner hair cell has approximately 10 nerve endings attached to it which results in approximately 30,000 nerve fibers that transmit the electrical equivalents of the sound waves to the brain.

 

 

Tinnitus Treatments: First Steps

The First Step in Getting Help

Since tinnitus is a symptom, the first step in finding some form of resolution should be to try to determine or diagnose the underlying cause. A comprehensive medical examination can rule out causative factors related to blood pressure, kidney function, drug intake, diet and allergies. Unfortunately, the cause of tinnitus cannot often be identified, so, in some cases, the tinnitus itself may need to be treated.

Our audiologist Mini Gupta  is specialised in Tinnitus assessment and Management. Patients can call and arrange for a comprehensive tinnitus evaluation. We will need a complete list of current and past medications and an in-depth description of the tinnitus, including when it happens, and what seems to make it worse.

Before the advent of Tinnitus Retraining Therapy and Tinnitus Habituation Therapy, most health care professionals would tell sufferers to “learn to live with it” and that “there is nothing that we can be done”. We now know that there is much more to understand and do about this problem. Tinnitus treatments serve to restore life to the pre-existing tinnitus level.

What Does our Testing Involve?

Our clinic has one of the most comprehensive protocols for tinnitus assessments in Melbourne. Our Audiologist will perform an otoscopic examination of your ear canals to ensure there is no wax or debris build up in the ear canals.

The first test involves conventional pure tone testing to determine if there is a hearing loss. The intensity and frequency of the tinnitus will also be measured as closely as possible.

We will also perform tests of residual inhibition to try to determine what treatment method would be most beneficial to you. We will assess your middle ear system to ensure your eardrums and attached middle ear bones are functioning appropriately. Perhaps the most valuable test in our tinnitus protocol is that of Otoacoustic emissions testing. It will be done to assess the integrity of the cochlea (assess outer hair cell function) as damage to the cochlea typically can be detected before hearing loss is found with conventional testing.

Auditory brainstem response testing can be done to rule out tumours on the vestibular nerve, or anomalies within that area of the auditory system.Typically, once a comprehensive evaluation has been performed, most individuals who suffer from tinnitus feel reassured and find it somewhat easier to adjust and adapt to the tinnitus. Individuals with mild tinnitus or longstanding tinnitus that is not life affecting generally do not require intervention or treatment. Most just need to be reassured that they do not have a rare disease, serious brain disorder, or are not going deaf. In such cases, individuals usually find that they can cope well with their tinnitus or can easily ignore it. Sometimes, further tinnitus treatment methods may be required

Coping with Tinnitus

Tinnitus, or our reaction to tinnitus may improve with time. This improvement is not the
result of physical changes, as damage to the auditory system that has been measured is
typically permanent and irreversible. Rather, many individuals learn to make adjustments
to lessen the symptoms of tinnitus. There are a variety of techniques that may reduce the
severity of the tinnitus while increasing your tolerance to it which include:

Avoiding possible irritants.

Tinnitus can be aggravated by excessive noise, nicotine, caffeine, tonic water that contains quinine, alcohol, and excessive doses of aspirin. Nicotine and caffeine constrict the blood vessels, which increases the speed of blood flow through the veins and arteries. Alcohol increases the force of blood by dilating the blood vessels, which causes greater blood flow, especially in the inner ear area.

If you work in loud noise or partake in loud recreational noise, wear ear effective ear protection. Noise- induced hearing loss may occur by a one-time exposure to a loud sound or by repeated exposure to loud sounds over an extended period of time. An individual cannot “toughen up” their hearing by repeatedly listening to loud noises. The effects of loud noises may exacerbate tinnitus in addition to further damaging hearing. Learn how to protect your hearing when you are in adverse listening situations. The stressful nature of some occupations can contribute to tinnitus, increase the severity of existing tinnitus, increase the individual’s reaction to the severity of tinnitus, and hinder coping mechanisms. Our Audiologist will be happy to discuss the most appropriate custom protection for the noise levels to which you are exposed.

Partially mask the tinnitus.

In a quiet setting such as the bedroom at night, the use of a noise generator may be beneficial. Noise generators are recommended for Tinnitus retraining and Habituation Therapy. The noise generator creates a soothing surf, waterfall or rainfall sound that should be used at a level slightly below the level of the tinnitus.

 

Wear a hearing aid.

If the tinnitus is accompanied by hearing loss, hearing aids are an effective way to deal with tinnitus for a small portion of sufferers. Hearing aids amplify other sounds which draws attention away from the tinnitus. Hearing aids are used in Tinnitus Habituation Therapy.

Manage stress.

Stress can exacerbate tinnitus levels. Learning relaxation techniques can be helpful if the tinnitus frustrates you. Stress management (relaxation therapy, biofeedback, etc.) may provide relief. We can provide you with a list of psychologists who deal with stress management techniques and/or depression. Cognitive Behavioural therapy is also an effective addition for those that suffer from the deleterious effects of Tinnitus and Hyperacusis.

Deep breathing, hypnosis, biofeedback, systematic relaxation, therapeutic massage, yoga, and some forms of physical exercise such as swimming or walking can reduce tension, stimulate endorphins, and promote better sleep.

Tinnitus Retraining Therapy/Tinnitus Habituation Therapy.

With the proper mix of counselling and noise generators, tinnitus management can be very effective. Auditory retraining uses sound generators that are set to a level that is below the intensity of the tinnitus (just audible and not masking the tinnitus). When used for an extended period of time, it induces subconscious habituation so that the tinnitus is not perceived as an intrusive or disturbing presence. This method is also effective in reducing hyperacusis or sensitivity to sounds. In some cases, masking of tinnitus can be effective.

Our Audiologist, Mini Gupta, is trained to help you to learn to cope with tinnitus, explore viable treatment/reduction options, or provide you with appropriate referrals.

 

 

 

 

Tinnitus and Sound Therapy

Science has now shown that remapping the auditory pathways using the stimulation of sound can alleviate tinnitus

For many sufferers, tinnitus interferes with sleep, makes socialising difficult, and may cause isolation and depression. You may feel as though no one understands what you are going through, as tinnitus is invisible and it’s hard for others to understand its impact.

 

When you first have tinnitus it is quite confusing and distressing. You will be looking for answers, but many people are told by their doctors that nothing can be done and you just have to learn to live with it. However, this is no longer the case.

There are some specialised tinnitus clinics which offer treatments such as counselling or a form of sound generator for masking. It’s important to find a treatment that is convenient, affordable and that actually treats the cause of the tinnitus. This is where Sound Therapy comes in.

 

 

 

 

A real solution you can do at home

Sound Therapy is effective for tinnitus because it remaps the auditory pathways in the brain. The dynamically filtered music progressively activates all parts of the auditory system. This includes the ear drum, the bones and muscles of the middle ear, the tiny receptor cells in the inner ear, the auditory nerve and the auditory cortex in the brain.

Our specific Sound Therapy processing means the sound is actively stimulating and rehabilitating this entire pathway. In addition, our use of classical music means at least ten different brain centres are activated as part of the process.

In this way, Sound Therapy builds many new pathways, enhancing our brain plasticity, so that the repetitive tinnitus signals cease to fire and no longer capture our attention.

 

Mini Gupta at All ears Hearing is certified provider of Sound Therapy program .Please call us on 0402476713 if you want more information about our tinnitus management program.

 

 

 

 

 

 

 

HYPERACUSIS

What is Hyperacusis?

Hyperacusis is a disorder in loudness perception. Patients suffering from hyperacusis may appear overly sensitive to a range of sounds, finding many noises unbearable and painfully loud. Hyperacusis is not the same as "recruitment," a disorder that can be a normal consequence of hearing loss and is associated with abnormal perception of sound as the volume increases.

The hallmark symptom of hyperacusis is having a reduced tolerance and increased sensitivity to everyday sounds in your normal environment. People who suffer from the disease often complain of living in a world in which the volume seems to be turned up too high. Because of this, their quality of life is affected, and they may begin to wear earplugs or earmuffs in public situations where they cannot control the noise.

For people with hyperacusis, the everyday, normal sounds that most people hardly notice suddenly become irritating and painful. Often the most disturbing sounds are sudden, high-pitched noises, such as alarms, bus brakes, the clanging of silverware and dishes, children's screams and clapping.

 

Types of Hyperacusis

      The two most common types are:

  • Cochlea Hyperacusis – damage to the sound sensing organ (cochlea) that results in the brain having sound sensitivities around certain pitches; and
  • Vestibular Hyperacusis – a form of Hyperacusis that also affects a person’s Vestibular (balance) system resulting in nausea, dizziness and the sensation of falling, in addition to sound hypersensitivity and/or Tinnitus and hearing loss.

 

 

CAUSES OF HYPERACUSIS

Pre-existing tinnitus, Misophonia and High levels of anxiety are factors that can predispose towards the development of hyperacusis. Some of the other Common causes include:

  • Head injury
  • Ear damage from toxins or medication
  • Fibromyalgia
  • Lyme disease
  • Air bag deployment( acoustic Shock)
  • Viral infections involving the inner ear or facial nerve (Bell’s palsy)
  • Temporomandibular joint (TMJ) syndrome
  • Autistic Spectrum disorders
  • Meniere’s disease
  • Otosclerosis
  • History of childhood middle ear infections
  • Vestibular migraines.

There are also a variety of neurologic conditions that may be associated with hyperacusis, including:

  • Post-traumatic stress disorder
  • Chronic fatigue syndrome
  •  Tay-Sach's disease
  •  Some forms of epilepsy
  • Valium dependence
  • Depression
  • Migraine headaches

How is hyperacusis diagnosed?

The audiological test battery used at our clinic consists of the following tests.

  • Our audiologist will begin by conducting a thorough physical examination and asking you about medical history, including questions about the length and severity of symptoms.
  • Pure tone audiometry and speech audiometry.
  • Measuring Uncomfortable loudness levels for both the ears at all the frequencies.
  • Tympanometry and Acoustic reflexes (Certain types of hyperacusis may have abnormal acoustic reflexes.)
  • OtoAcoustic Emissions
  • Auditory brainstem response(for brainstem lesions)

 

After the assessment is completed your results would be discussed with you. Audiologist will give you an opinion about the type of your hyperacusis. In order to rule out any potential medical cause of your symptoms you might be referred to be evaluated by a physician expert in ear disease, usually an otologist, neurologist, or otoneurologist.

 

 

TREATMENT FOR HYPERACUSIS

There’s little value in assessing a problem if the assessment doesn’t lead to some form of treatment. In the past, patients with decreased sound tolerance rarely received evidence-based or adequate care for their problem. The management plan for patients with decreased sound tolerance is based directly on information from the history, inventories, questionnaires, and audiologic testing. Often a multi-disciplinary management strategy is needed.

  • A patient with a history suggesting possible central nervous system disorder like migraine or depression is referred to a neurologist or a psychiatrist.
  • A child with sensory disturbances in addition to hyperacusis, including intolerance to light and tactile stimulation, is referred to an occupational therapist for evaluation of possible sensory integration disorder.
  • Patients taking medications that are associated with hyperacusis need to consult with their family physician or the physician prescribing the drugs.
  • And some patients with hyperacusis benefit from consultation with a psychologist who has expertise in cognitive behavioural therapy.

For most hyperacusis patients we begin the management process with intensive counselling and recommendations for sound enrichment. Audiologic test results almost always confirm that the patient’s hearing sensitivity is entirely normal. Most patients with hyperacusis are worried about loud sounds damaging their hearing. Therefore, Counselling is essential for any patient with decreased sound tolerance. And, it’s directed to the specific problems the patient is experiencing. Counselling inevitably includes a recommendation for sound enrichment. In response to their discomfort with loud sounds, patients with hyperacusis tend to reduce their exposure to environmental sound stimulation. Some patients even regularly use earplugs or earmuffs to “protect” their ears from loud sounds. Unfortunately, these well-intentioned strategies further decrease tolerance to sound. Patients are strongly encouraged to surround themselves with soft and relaxing sound, and to progressively increase their exposure to typical everyday sounds.

 Patients are regularly followed either with clinic visits or at least email communication to monitor progress.  A small proportion of patients with debilitating hyperacusis might show inadequate progress. We then recommend consultation with a psychologist, and preferably one with expertise in cognitive behavioural therapy

 

 

What to do if you have hyperacusis?

  1. Avoid exposure to extremely loud noises and sounds. Don't overdo it however, as keeping things very quiet may increase your sensitivity.
  2. Avoid stimulants such as caffeine, chocolate and nicotine. We also suggest avoiding ADD drugs such as amphetamines, Provigil, and medications that increase vigilance. 
  3. Avoid migraine triggers -- MSG, alcohol, aged cheese, chocolate (in other words, follow migraine diet).
  4. Exercise daily, get adequate rest, and avoid fatigue.
  5. Avoid ototoxic medications that might damage your ears such as aspirin, non-steroidals and quinine containing preparations.