mark_gulliver-tinnitus the canadian hard of hearing association 2009 conference

8/11/2019 Mark_gulliver-tinnitus the Canadian Hard of Hearing Association 2009 Conference

1/50

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


2/50

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


3/50

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


4/50

The Funny


5/50

Another Funny


6/50

The Good

THERE IS

HOPE

FOR PEOPLE WITH

SEVERE TINNITUS


7/50

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)


8/50

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


9/50

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


10/50

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


11/50

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


12/50

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."


13/50


14/50

Tinnitus in Art

VincentVan Goghsaid to have cut off his

ear during an excruciating

bout of tinnitus


15/50

Tinnitus Personality

Barbra Streisand- "Streisandhas ascribed her volatiletemperament to the tinnitusfrom which she has suffered

since she was seven."


16/50

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


17/50

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


18/50

EXACERBATING FACTORS

STRESS

Lack of sleep/fatigue

Noise exposure

Sodium/saltCaffeine

Alcohol/nicotine

Medications/drugs

Over exertion/strenuous exercise


19/50

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


20/50

ORIGINS OF TINNITUS


21/50

ORIGINS OF TINNITUS

Unilateral temporal

cortex hyperactivity onPET supports Central vsPeripheral origins ofTinnitus


22/50

TREATMENTS

FORTINNITUS


23/50

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


24/50

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


25/50

TREATMENTS FOR TINNITUS

Protection from loud noises

Support Groups

Stress Management/Psychology

Diet ConsiderationsAlternative Approaches


26/50

Counseling

And

Sound Therapy


27/50

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


28/50

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)


29/50

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


30/50


31/50

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


32/50

Do you hear your Tinnitus in placeslike This?


33/50

Noises of Everyday Life


34/50

Silence/Quiet


35/50

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


36/50

Picking a Face out of the Crowd

Sound Therapy is

an attempt towrap the noise ina more pleasantsound


37/50

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


38/50

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


39/50

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


40/50

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


41/50

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


42/50

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


43/50

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


44/50

Stress Management

PossiblePsychological Referral


45/50


46/50

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


47/50

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.


48/50

TINNITUS

THERE IS HOPE

THERE IS HELP


49/50

QUESTIONS???


50/50

THANK-YOU!!!

mark_gulliver-tinnitus the canadian hard of hearing association 2009 conference

Documents