What is tinnitus and how can we best manage it?

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1 What is tinnitus and how can we best manage it? Deborah Hall Nottingham Hearing Biomedical Research Unit

2 Nottingham: The UK s interdisciplinary hub for hearing research Basic Translational Clinical Advancing insight, innovation, and impact

3 What is tinnitus? Describe your tinnitus sound in words! tsssssssss+bzzzzzzzzzz+beeeeeeeee like a washing machine on very fast spin dog barking in distance like gas escaping from a bottle mmunity/forums/tinnitus.aspx?g=posts&t=7 433

4 Hearing loss can cause tinnitus Cochlear damage Altered auditory nerve activity Cascade of neuroplastic changes Tinnitus percept

5 Neurophysiological correlates 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)

6 Hearing threshold (db HL) Homeostatic plasticity Mean neural activity Spontaneous neural activity Schaette R, Kempter R (2006) European Journal of Neuroscience, 23:

7 Hearing threshold (db HL) Mean neural activity Spontaneous neural activity Deprivation is known to alter the balance of neural activity in the central auditory pathway

8 Hearing threshold (db HL) Mean neural activity Spontaneous neural activity Increasing the central gain rebalances the neural activity in the central auditory pathway

9 Hearing threshold (db HL) Mean neural activity Spontaneous neural activity

10 Hearing threshold (db HL) Mean neural activity Spontaneous neural activity Increasing the central gain can give rise to hyperactivity in the central auditory pathway

11 Tinnitus Alleviating the neural cause (drug treatments) Change reaction to the percept (counselling, relaxation therapy) Perceptual characteristics Pitch and loudness Masking the percept (noise masking) Sound enrichment (hearing aids) Psychological reactions Cognitive and emotional responses Individual personality Susceptibility characteristics

12 Top 10 tips 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 Do children experience tinnitus? - Yes, it can occur at any age, including childhood.

13 Top 10 tips 2 Most tinnitus is mild - It is relatively rare for it to develop into a chronic problem of life-altering severity.

14 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

15 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.

16 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.

17 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.

18 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.

19 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.

20 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.

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22 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 as well as offering advice through its website