RCMP and VETERANS AFFAIRS CANADA Kingston, NS October 18th, 2016 Hearing Loss, Tinnitus, Hyperacusis & PTSD

Transcription

1 RCMP and VETERANS AFFAIRS CANADA Kingston, NS October 18th, 2016 Hearing Loss, Tinnitus, Hyperacusis & PTSD Dr. David Lyon

2 TOP REASONS FOR DISABILITY PENSIONS/CLAIMS FOM CURRENT/FORMER MOUNTIES TO VETERANS AFFAIRS CANADA 1. Tinnitus 2. Hearing Loss 3. PTSD 1. PTSD 2. Depressive Disorder Men Women 3. Chronic Lower Back Pain

3 OVERVIEW Hearing Loss, causes, measurement and effects Noise induced hearing loss (NIHL) _ Tinnitus Hyperacusis The application process

4 Sensorineural Conductive Mixed

5 HEARING LOSS Hearing loss is measured using an audiometer which assesses the threshold (quietest Decibel level) at which an individual can detect each of the frequencies from 250Hz-8,000Hz. Results are plotted on an audiogram ( slide 13 ) Normal hearing < =25 B across the frequencies Mild, moderate, severe, profound hearing loss

6 AUDIOGRAM Frequency is measured in Hertz (Hz) Intensity is measured in Decibels (db)

7

8 NIHL

9 NOISE INDUCED HEARING LOSS Noise normally first damages the frequencies 3,000Hz -6,000Hz. The typical NIHL audiogram shows a clear notch at these frequencies in early stages. The loss spreads to other frequencies over time. Hearing loss disability for VAC purposes is measured at frequencies from 500Hz-3,000Hz on the basis that these are the most important frequencies for understanding speech.

10 RCMP NOISE-INDUCED HEARING LOSS (NIHL) Factors that contribute to NIHL: High levels of continuous and impulse noise Traffic noise, sirens, radios, headsets, planes, boats helicopters, snowmobiles Firearms use and training Inappropriate hearing protection or inability to use it in some duties.

11 CONSEQUENCES OF HEARING LOSS Impact: Complain that people mumble, while their significant others and/or co-workers complain that he s (she s) not listening, or ignores me or has selective hearing. Have to strain to understand what is said a lot of the time very tiring Misunderstandings, confusion and irritation Particularly difficult to understand in groups or noise especially in NIHL

12 TINNITUS DISABILITY Tinnitus is the perception of sound in one or both ears or in the head in the absence of external sound. Damage to the nerves of hearing or more central parts. Common causes: noise,aging, disease, drugs. Perceived differently: ringing, buzzing or hissing Continuous or intermittent; vary in loudness or pitch; one or more different sounds.

13 TINNITUS ASSESSMENT Self report Tinnitus Handicap Inventory Tinnitus matching procedure volume and pitch

14 EFFECTS OF TINNITUS Concentration; sleep; understanding speech Emotional stability Anxiety Depression Withdrawal social activities Overall quality of life Stress

15 HYPERACUSIS Decreased tolerance to loud sounds; loud sound causes startle response, stress, discomfort even pain Very narrow range between threshold ( quietest sound heard) and tolerance level (loudest sound can tolerate) Usually triggered by sudden high-pitched noises like alarms, bus brakes, silverware and dishes, children s crying, and clapping.

16 HYPERACUSIS Those reporting hyperacusis often, but not always also have tinnitus and vice-versa VAC eligibility criteria consider the two disabilities together (that hyperacusis is subsidiary symptom of tinnitus) but symptoms are different. Rely on 25dB on a service audiogram 3,000Hz-6,000Hz.

17 EFFECTS OF HYPERACUSIS Fear of going to places that may be noisy Avoidance of social situations, restaurants, movie theatres, concerts etc. Difficulty listening to speaker announcements e.g. in airports, planes Difficulty concentrating in noise Feel emotionally drained and tired after being in sound

18 HYPERACUSIS ASSESSMENT With hearing assessment Measure uncomfortable listening levels and tolerance levels on the audiogram Measure acoustic reflexes reaction of ear muscles to sound Self reported effects questionnaire

19 VAC CRITERIA CLAIMS FOR DISABILITY MUST MEET THREE SPECIFIC CRITERIA SET OUT BY VAC FOR THE DISABILITY CLAIMED. 1. DIAGNOSIS OF CONDITION/DISABILITY 2. SERVICE RELATED CAUSE 3. EFFECT OF THE DISABILITY ON QUALITY OF LIFE

20 VAC HEARING LOSS DISABILITY Hearing loss disability exists when the discharge audiogram shows Decibel Sum Hearing Loss (DSHL) 100dB or greater across the frequency range 500, 1000, 2000 and 3000Hz in either ear OR 50dB or more in both ears at 4000Hz AND A hearing loss of 100dB is present on application

21 NON DISABLING HEARING LOSS VAC also defines a non-disabling hearing loss or lesser degree of hearing as a decibel loss >=30dB at any frequency from 250Hz-8000Hz i.e. there is slight loss but the loss is not sufficient to meet VAC s definition of a hearing loss disability VAC will consider a hearing disability to be to be partially caused by service when the service discharge audiogram shows non-disabling hearing loss AND a disabling hearing loss is established after discharge

22 VAC CRITERIA for TINNITUS Exposure to at least one episode of acoustic trauma just prior or prior to onset Exposure to noise of sufficient intensity and duration to cause hearing loss of 25dB or more at 3000, 4000 or 6000Hz in the ear(s) with tinnitus prior to onset. On any service audiogram Head trauma; illness or drug recorded in service

23 VAC CRITERIA FOR TINNITUS Other criteria related to injury, head trauma, barotrauma, middle ear disease and malfunction a number of medications and illnesses. If applicable these must be detailed in the applicant statement for Tinnitus. Hopefully these factors are mentioned in the medical records. 20% of tinnitus patients do not demonstrate hearing loss from 250Hz-8000Hz.

24 VAC CRITERIA FOR HYPERACUSIS None Considered a sub condition of tinnitus Decisions and appeals

25 PEN 923 APe First section A (p1-2) requires personal details of service, family etc. Second section B. (p.3) requires you to Clearly state how you relate each claimed condition to your service or to a specific service period For hearing loss, tinnitus and hyperacusis you need to provide details of the specific types of noise exposure you experienced in service.

26 APPLICANTS STATEMENT Section B. P.3. You must fill in a separate section B each disability claimed. Hearing Loss, Tinnitus and Hyperacusis applications requires three completed section B statements. The information in each may be the same, as all three are a result of noise exposure and related to service in the same way but repeat it.

27 PEN 923 APe Section C ( P 4 ) is the Quality of Life Questionnaire Requires you to indicate how the claimed condition affects your everyday life E.g. I can shop and do errands Check: Yes; yes with assistance/adaptations; no. Comments for each one and section for additional comments.

28 PEN (23 APe) Fill in a section C QOL for each condition claimed For most of the questions the answer will be yes with assistance or adaptations Can be anything that is different than it would be without the claimed condition e.g. asking people to repeat themselves, turning up the volume, avoiding noisy places, needing help to sleep etc.

29 PEN 923 APe & VAC 928 Section D is more personal information VAC 928 is Consent for VAC to collect personal information from Third Parties this should be completes with the information for whoever did the assessments of the conditions.

30 TREATMENT Hearing loss hearing aids adjusted for your loss. Need to adjust to them and work at it not like pair of glasses!! Have to wear them!

31 Tinnitus hyperacusis management options Currently, there is no cure for tinnitus or hyperacusis, but management is possible HEARING AIDS DRUGS SOUND THERAPY TINNITUS Hyperacusis EVIDENCE BASED TINNITUS MANAGEMENT APPROACHES e.g. TINNITUS RETRAINING THERAPY COUNSELLING COGNITIVE BEHAVIOURAL THERAPY Belli H, et al. (2012) Gen Hosp Psychiatry. 34:282-9; Langguth B, et al. (2013) Lancet Neurol.12: ; Shekhawat 10/24/2016 GS, et al. (2013) J Am Acad Audiol. 24: Slide 31

32 QUESTIONS