Sound Hearing Clinic Inc offers effective tinnitus treatment in Vancouver. Ringing, buzzing, whistling, hissing, pulsing, high pitched screeches, or other noise in the ears or head is called tinnitus. It is a medical condition. Typically tinnitus is most noticed and seems loudest in a quiet setting. It is estimated that 13 to 15% of the population has prolonged tinnitus (greater than 5 minutes). It may occur in one ear or both ears, it may be constant or intermittent. In some cases, tinnitus becomes so bothersome that it affects sleep patterns, ability to work, communicate, and eat. 50 to 70% of tinnitus sufferers also report decreased sound tolerance. This is different from hyperacusis, which is a collapsed tolerance for everyday sounds. Get in touch with us for more for more information or to book an appointment.
The condition is not uncommon, and you are not alone in suffering with it.
Tinnitus may be objective – where the tinnitus sufferer and others hear it. The use of amplification may worsen this tinnitus. It is likely due to middle ear spasm. Subjective tinnitus is audible only to the sufferer. If subjective tinnitus is pulsatile it may be arterial (pressure on the neck has no effect) or venous (pressure on the neck does have an effect).
Causes of Tinnitus:
Research continues on finding why some people have tinnitus and others do not. This will be the first solution to a cure. The most common theory on the cause of tinnitus is that it is a result of cochlear hair cell damage. Within the cochlea (the end organ of hearing) outer hair cells serve to inhibit inner hair cell function. As outer hair cell damage increases (such as with increased hearing loss) more spontaneous neural activity increases which in turn likely leads to greater perceived tinnitus.
Associated conditions may include Meniere's Disease, middle ear problems with associated conductive hearing loss, metabolic imbalances, circulatory disturbances such as hypertension, hematologic disorders, chronic muscular contractions, head trauma, acoustic nerve lesions, infections of the inner ear, Bell's Palsy, a malfunctioning eustachian tube, otosclerosis, drug ingestion, excessive use of alcohol, and disorders of the vertebrae. One of the most common causes of tinnitus is exposure to loud noises such as shooting, rock concerts, or chainsaw use.
A tinnitus evaluation should include assessment of tinnitus quality; handicapping effect; % of the time of awareness; % of the time distressed by tinnitus; assessment of sleep hygiene; and severity and loudness rating.
Tinnitus questionnaires include the tinnitus handicap inventory; tinnitus questionnaire; tinnitus reaction questionnaire; tinnitus handicap questionnaire; and the tinnitus functional index.
Management of Tinnitus:
Management of tinnitus may include treatment of tinnitus alone, and/or in conjunction with hearing loss, hyperacusis, assessment of motivation.
Structured therapies include Tinnitus Re-Training Therapy (TRT), SoundOptions, Neuromonics, Progressive Tinnitus Training, and other non-structured approaches such as cognitive and behavioural based therapies.
1) Therapies include:
The goal of sound therapy is to reduce tinnitus audibility by increasing the level of external sounds.
a) Sound Options
At Sound Hearing Clinic Inc, we encourage our clients to trial sound conditioning. If sound conditioning proves successful in the suppression of tinnitus, we then encourage our clients to consider www.SoundOptions.ca as an evidence-based treatment method.
b) Tinnitus Masking
This is meant for clients with normal hearing. The goal is to make tinnitus inaudible/change its characteristics to become non-bothersome. There is little data to support use. Refused by up to 50% of clients. Should always be accompanied/offered with counselling.
c) Tinnitus Retraining Therapy
This therapy attempts to eliminate the negative feelings associated with tinnitus. It aims to habituate the client to tinnitus with the goal to ensure tinnitus does not interfere with the clients’ life. It begins with a period of habituation and informal counselling (18-24mos) and sound enrichment, followed by directive counselling. 3rd is a phase of sound enrichment followed by outcome measurement. There has only been one low-quality controlled study showed its benefit over masking.
d) Progressive Audiologic Tinnitus Management
There are three objectives to PATM. 1) soothing sound to produce stress relief (environmental sound), 2) to passively divert attention from tinnitus (music), and 3) sound to actively divert attention from tinnitus (speech). It involves extensive counselling.
e) Neuromonics Tinnitus Treatment (Paul Davis)
This treatment uses a broadband sound stimulus using Neuromonics processor two hours/day for six months. Cost is approximately $4-5000 USD for device and sessions. There is one study: mean improvement of 74% after 1 year.
Anecdotally, it is well known that ambient noise can make tinnitus less audible and divert attention to external sounds. Two studies – one showed “strongly positive results” (Trotter and Donaldson, 2008); and a second showed “slight reduction of prominence” (Noble 2008). Hearing instruments would serve to amplify background noise (counselling) and use many programs (quiet and normal), open-fit where possible, low kneepoint, expansion and noise-reduction off, automatic volume control, DSL preferred because it provides greater low-intensity/low-frequency amplification.
No studied drug has been shown to provide replicable, long-term reduction of tinnitus impact in excess of placebo effects (Langguth, 2009).
Lidocaine/Lignocaine, which is an anesthetic, provides temporary relief in +/- 50% of tinnitus sufferers. There can be both short- and long-term side effects.
Hypnotics, benzodiazepines and zopiclone decrease excitability; diazepam – relief of sleep, no benefit to tinnitus; alprazolam – high dose is a last resort; clonazapam – helpful in 32% of patients. These drugs may cause dependency; personality changes, withdrawal effects.
Antidepressants, include tricyclics (TCAs).
Anti-convulsants, carbamazepine (unilateral “typewriter tinnitus”); gabapentin; anti-glutamatergic (acamprosate – in alcoholism, decreases tinnitus).
3) Cognitive Behavioural Therapy (CBT)
These therapies consist of relaxation (deep breathing 3x3/day; yoga; tai chi); imaging; cognitive restructuring; exposure to exacerbating situations; and self-help groups.
Alcohol exacerbates tinnitus. Vitamin deficiency – zinc, niacin may also exacerbate tinnitus. Herbal remedies: gingo biloba (decreases stress, increases memory – helps rats tinnitus, controversial in humans). Acupuncture: no consistent benefit.
5) Positive Counselling
Often discussing feeling evoked by tinnitus is helpful. Many people find that the tinnitus gets better over time with no treatment whatsoever. You should discuss how to make your tinnitus less of a problem for you with your audiologist. Discussion of stressors in one’s life is often helpful.
6) Helpful information
Information gathered from:
Tinnitus Management and Measurement, R. Tyler and J. Stouffler; The American Tinnitus Association; Tinnitus, D. Shrewsbury and W. Meyerhoff, in Diagnosis and Management of Hearing Loss, Meyerhoff
The American Tinnitus Association, Post Office Box 5, Portland, Oregon, USA, 97207, Tel #: 503-248-9985, www.ata.org
Glynnis Tidball – St. Paul’s Hospital, Widex Workshop, 2010, Vancouver, BC
Tinnitus Handicap Inventory
Please complete the questionnaire prior to a tinnitus assessment by an audiologist. The purpose of these questions is to gauge your reaction to your tinnitus. It does not in any way replace the need for a full and complete audiology evaluation by an audiologist.
Please complete and submit your responses to the clinic prior to your appointment. Thank you.
McCombe A, Baguley D, Coles R, McKenna L, MicKinney C & Windle-Taylor P. (2001) Guidelines for the Grading of Tinnitus Severity: The results of a Working Group commissioned by the British Assoc. of Otolaryngologists, Head and Neck Surgeons, 1999. Clinic Otolaryngology 26, 388-393.
Frequently Asked Questions
Does tinnitus cause hearing loss?
No. Tinnitus is a symptom of any number of conditions, including hearing loss.
What tests are done to diagnose and measure tinnitus?
Trained audiologists and other hearing health professionals have tools and clinical protocols to help evaluate and diagnose tinnitus. Because tinnitus is so often caused by hearing loss, most audiologists will begin with a comprehensive audiological evaluation that measures the patient’s overall hearing health. General hearing tests include:
Speech recognition test: A subjective measure of how well the patient hears and can repeat certain words. Sometimes called speech audiometry.
Pure tone audiogram: A subjective test that measures the patient’s hearing across multiple frequencies (measured in Hertz) and volumes (measured in decibels).
Tympanogram: An objective test that measures the functioning of the middle ear, specifically the mobility of the tympanic membrane and the conduction bones.
Acoustic reflex testing: An objective test that measures the contraction of the middle ear muscles in response to loud sounds.
Otoacoustic emission testing: The use of very sensitive microphones to objectively measure the movement of hair cells within the middle ear.
It is important to determine the specific gaps in a tinnitus patient’s hearing because this often correlates to the nature and quality of their particular tinnitus. (For instance, high-frequency hearing loss often corresponds with high-frequency tinnitus.) Moreover, specific hearing markers may inform different potential treatment options for tinnitus.
When evaluating tinnitus cases, hearing health professionals use a supplemental set of tests. While there is currently no way to objectively test for tinnitus, there are several protocols to measure the patient’s subjective perception of tinnitus sound, pitch, and volume. Specifically, the doctor may test:
Tinnitus sound matching: The presentation of common tinnitus sounds back to patients, to help them identify their specific perception of tinnitus. The health professional may adjust the pitch and layer multiple sounds to create an exact audio recreation of the tinnitus. Sound matching provides an important baseline for subsequent tinnitus management therapies, which are often customized for each patient.
Loudness discomfort level: The volume at which external sound becomes uncomfortable or painful for a tinnitus patient. This measurement informs the feasibility of sound therapy, masking, and hearing aids as potential tinnitus treatments. Determining loudness discomfort levels is particularly important for patients with hyperacusis, extreme sensitivity to noise.
A hearing health professional may administer additional tests, depending on the patient’s specific symptoms, medical history, and/or attenuating risk factors. In some extreme situations, an MRI (magnetic resonance imaging) may be appropriate for someone experiencing tinnitus; however, MRIs should only be administered in cases when independent clinical evaluation suggests specific (and rare) tinnitus etiologies.
Tests To Measure Tinnitus Burden
Tinnitus doesn’t just impact hearing; it can cause a cascade of negative mental, cognitive, and physical consequences. The difference between tinnitus being a minor or major issue of the patients' is less often related to how loud tinnitus is, but rather how the tinnitus impacts other facets of patients' lives.
As such, clinicians and researchers have developed inventory tests to measure the subjective burden a patient experiences because of tinnitus. There are several varieties of these tests, but they all operate by quantifying the patient’s personal reaction to tinnitus:
Tinnitus handicap inventory
Tinnitus reaction questionnaire
Tinnitus functional index
Tinnitus severity index
Visual analog scales
American Tinnitus Association. (2018). Measuring tinnitus. Audiometric evaluations for hearing loss and tinnitus. Retrieved from https://www.ata.org/understanding-facts/measuring-...
Can tinnitus be cured?
Current research by neurologists suggests that altering certain areas of the brain that respond to sound - or a lack thereof - may provide relief.
Experiments to regrow broken hair cells have also been performed. Regrowth of hair cells means that hearing is restored, which prevents the brain from attempting to fill the void left by a lack of hair cells, ultimately ending tinnitus.
Both theories are likely years away from clinical trials, which means a greater period of time until any possible cure hits the market. Curing tinnitus may be possible, but likely not in the near future.
Which tinnitus treatment is best for my situation?
Some patients question the value of treatments that fall short of an absolute cure. We believe patients should do everything possible to lessen the burden of tinnitus until a definitive cure is found. An appropriate analogy may be the use of ibuprofen for a headache. Ibuprofen itself does not cure the underlying cause of most headaches, but it does reduce the pain that makes headaches feel so awful. Likewise, the most effective tinnitus treatment tools address the aspects of tinnitus that so often make the condition feel burdensome: anxiety, stress, social isolation, sound sensitivity, hearing difficulties, and perceived volume.
No two patients and no two tinnitus cases are alike. As such, the “best” treatment option is often contingent on an array of factors unique to each patient. Moreover, successful management of tinnitus may require overlapping layers of treatment. It is recommended that patients work with their healthcare provider(s) to identify and implement the treatment strategy that is best suited to their particular needs.
American Tinnitus Association. (2018). Treatment options. Retrieved from https://www.ata.org/managing-your-tinnitus/treatme...
Are there medications for tinnitus?
Almost all of the "surefire" remedies for tinnitus found on the internet are based on junk science, case studies, or no real evidence at all. But there are some things you can try to help lessen symptoms, including:
Limiting exposure to loud noises
Lowering your blood pressure
Ingesting less salt
Limiting exposure to alcohol
What are the effects of untreated tinnitus?
Tinnitus incurs significant personal, social, and financial costs. It can be a debilitating condition that negatively affects a patient’s overall health and social well-being. Even moderate cases can interfere with the ability to work and socialize. People with tinnitus often experience:
Frequent mood swings
Irritability or frustration
Pain (particularly when tinnitus is accompanied by hyperacusis)
The human impact of tinnitus extends beyond the patient. Family, friends, and coworkers may also be affected as they attempt to support someone with tinnitus. Loud ringing and sensitivity to noise can make it difficult for tinnitus patients to socialize and communicate normally with others — even with spouses, children, and close friends. As such, supporters often have their own feelings of irritability, frustration, and confusion as they struggle to understand and help the tinnitus patient.
The financial consequences of tinnitus are significant. Personal economic loss to an individual with tinnitus--including lost earnings, productivity, and health expenses.
American Tinnitus Association. (2018). Impact of tinnitus. Retrieved from https://www.ata.org/understanding-facts/impact-tin...