Two Types of Two Types of TinnitusTinnitusSubjective TinnitusSubjective Tinnitus

Objective TinnitusObjective Tinnitus

Two Types of Two Types of TinnitusTinnitusSubjective TinnitusSubjective Tinnitus

The experience of sound not originating from a source outside the body.

Needs to be differentiated from internally-generated somatosounds and from objective tinnitus

What are What are Somatosounds?Somatosounds?Sounds that are internally-generated in the

body or head and perceived by the patient

Pulsatile: caused by perception of bloodflow can be rhythmic with heartbeat

Ex: venous hum or vascular noise

Pulsatile and non-pulsatilePulsatile and non-pulsatile

Non-pulsatile: Ex: patulous eustachian tube, tensor tympani

muscle spasms, TMJ

Somatosounds can be objective or subjective

Somatosounds require medical evaluation

Two Types of Two Types of TinnitusTinnitusSubjective TinnitusSubjective Tinnitus

The experience of sound not originating from a source outside the body

Needs to be differentiated from internally-generated somatosounds and from objective tinnitus

Objective TinnitusObjective Tinnitus

Also known as - “audible” tinnitus

The person’s tinnitus can be heard by others (infant)

Relatively rare

Two Levels of Two Levels of TinnitusTinnitusAcute TinnitusAcute Tinnitus

Chronic TinnitusChronic Tinnitus

Two Levels of Two Levels of TinnitusTinnitusAcute Tinnitus

• Lasts days or weeks

• With appropriate evaluation, many underlying conditions can usually be identified and treated -sometimes resulting in resolution of tinnitus

Chronic Tinnitus• Persistent for 6 months or more

• Today there is no true CURE for tinnitus - there are effective tinnitus management programs available that helps patients get relief from tinnitus

Causes of TinnitusCauses of Tinnitus

according to the Oregon Tinnitus Data Registry (2000)

1- No known etiology or event (~ 40%)

2- Noise related

• Noise of long duration

• Explosion

• Noise of brief intensity

Causes of TinnitusCauses of Tinnitus

according to the Oregon Tinnitus Data Registry (2000)

1- No known etiology or event (~ 40%)

2- Noise related

3- Head and neck trauma

• Head injury• Cervical trauma or whiplash• Skull fracture• Concussion

Causes of TinnitusCauses of Tinnitus

according to the Oregon Tinnitus Data Registry (2000)

1- No known etiology or event (~ 40%)

2- Noise related

3- Head and neck trauma

4- Head and neck illness

• Sinus infection

• Ear infection or inflammation

• Other ear problems

• Sudden hearing loss

Causes of TinnitusCauses of Tinnitus

according to the Oregon Tinnitus Data Registry (2000)

1- No known etiology or event (~ 40%)

2- Noise related

3- Head and neck trauma

4- Head and neck illness

5- Other medical conditions• Medications, drugs• Surgery• Barotrauma

Factors That Exacerbate Factors That Exacerbate TinnitusTinnitus Caffeine

AlcoholSodiumFatigue

Stress (excercise)

Noise exposure

Characteristics of Characteristics of TinnitusTinnitus

according to the Oregon Tinnitus Data Registry (2000)

• Sudden or gradual onset

• Variety of sounds reported

• Constant or intermittent

• Vary in pitch, loudness and quality

• Perceived in one ear, both ears or in the head

Whom Does Tinnitus Whom Does Tinnitus Impact?Impact?

Patient

• Spouse / partner

• Family members

• Friends

• Colleagues / co-workers

Symptoms Associated with Symptoms Associated with TinnitusTinnitus

Confusion

Fear

Isolated

Stress

Fatigue

Inattentive

Anxiety

DEPRESSION

Individuals With Tinnitus Individuals With Tinnitus Have Lost TheirHave Lost Their

Needs of the Tinnitus Needs of the Tinnitus PatientPatient

The Tinnitus Patient Should The Tinnitus Patient Should See?See?

Audiologist

Otolaryngologist

Neurologist

Psychologist

PsychiatristNutrionistTMJ SpecialistBiofeedback Specialist

Audiologist’s RoleAudiologist’s Role

• Complete History

• Comprehensive Audiological Evaluation

Pure tone AC/BCHigh frequency: 9KHz – 20KHz (ideally)SRT / SDSMost Comfortable Loudness Level (MCL)

Audiologist’s RoleAudiologist’s Role

• Complete History

• Comprehensive Audiological Evaluation

Pure tone AC/BCHigh frequency: 9KHz – 20KHz (ideally)SRT / SDSMost Comfortable Loudness Level (MCL)Loudness discomfort levels (LDL)*

• 5dB increments – no hyperacusis reported• 2dB increments – hyperacusis reported• repeat twice

Audiologist’s RoleAudiologist’s Role

• Complete History

• Comprehensive Audiological Evaluation

Pure tone AC/BCHigh frequency: 9KHz – 20KHz (ideally)SRT / SDSMost Comfortable Loudness Level (MCL)Loudness discomfort levels (LDL)*Immitance testing

TympanometryAcoustic reflex thresholds**Acoustic reflex decay**

Audiologist’s RoleAudiologist’s Role

• Complete History

• Comprehensive Audiological Evaluation

Pure tone AC/BCHigh frequency: 9KHz – 20KHz (ideally)SRT / SDSMost Comfortable Loudness Level (MCL)Loudness discomfort levels (LDL)*Immitance testingOtoacoustic emissions – distortion product (DPOAE)

Invaluable tool in counseling session

Audiologist’s RoleAudiologist’s Role

• Complete History

• Comprehensive Audiological Evaluation

Pure tone AC/BCHigh frequency: 9KHz – 20KHz (ideally)SRT / SDSMost Comfortable Loudness Level (MCL)Loudness discomfort levels (LDL)*Immitance testingOtoacoustic emissions – distortion product (DPOAE)ABR – if necessary

Audiologist’s RoleAudiologist’s Role

• Complete History

• Comprehensive Audiological Evaluation

• Tinnitus Assessment

Pitch matchLoudness matchMinimum masking level (MML)