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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
Nottingham Hearing Biomedical Research Unit
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”
Nottingham Hearing Biomedical Research Unit
Hearing loss can cause tinnitus
Cochlear damage
Altered auditory nerve activity
Cascade of neuroplastic changes
Tinnitus percept
Nottingham Hearing Biomedical Research Unit
• 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
20
20
40
60
80
0
-20
Hearin
g t
hre
shold
(dB
HL)
Mean neural
activity
Spontaneous
neural activity Schaette R, Kempter R (2006)
European Journal of
Neuroscience, 23: 3124-3138.
Homeostatic plasticity
20
20
40
60
80
0
-20
Hearin
g t
hre
shold
(dB
HL)
Mean neural
activity
Spontaneous
neural activity
• Deprivation
is known to
alter the
balance of
neural
activity in
the central
auditory
pathway
20
20
40
60
80
0
-20
Hearin
g t
hre
shold
(dB
HL)
Mean neural
activity
Spontaneous
neural activity
• Increasing
the central
gain
rebalances
the neural
activity in
the central
auditory
pathway
20
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)
Nottingham Hearing Biomedical Research Unit
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?
Nottingham Hearing Biomedical Research Unit
2 Most tinnitus is mild
- It is relatively rare for it to develop into a chronic problem of life-altering
severity.
Top 10 tips
Nottingham Hearing Biomedical Research Unit
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
Nottingham Hearing Biomedical Research Unit
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.
Nottingham Hearing Biomedical Research Unit
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.
Nottingham Hearing Biomedical Research Unit
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.
Nottingham Hearing Biomedical Research Unit
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.
Nottingham Hearing Biomedical Research Unit
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.
Nottingham Hearing Biomedical Research Unit
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.
Nottingham Hearing Biomedical Research Unit
Nottingham Hearing Biomedical Research Unit
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
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