Tinnitus, Hyperacusis, and Misophonia – Flashcards
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What is tinnitus?
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perception of sounds without external source lasting longer than 5 minutes
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Transient Ear noise
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Brief spontaneous tinnitus
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Hyperacusis
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subjective decreased tolerance for sounds that would otherwise be tolerable to individuals with normal hearing
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Misophonia
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abnormally strong reaction to a sound with a specific pattern and meaning to a given subject.
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The most common tinnitus is _____________.
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Subjective
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Objective tinnitus
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Can be heard by the examiner and is very rare. Less than 5% of overall tinnitus cases are objective tinnitus and results from noise generated from other structures near the ear
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What is tinnitus classified as?
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Primary and Secondary Tinnitus
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Primary Tinnitus
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Used to describe tinnitus that is idiopathic (unknown) and may or may not be associated with sensorineural hearing loss (SNHL).
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Secondary Tinnitus
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Tinnitus that is associated with a specific underlying cause (other than SNHL) or an identifiable organic condition
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What are some tinnitus classifications?
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ringing, buzzing, roaring, hissing, chirping, and etc.
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The prevalence of tinnitus is higher among individuals....
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With a history of noise exposure, With a body mass index (BMI) of > 30 kg/m2, and with a diagnosis of hypertension, diabetes mellitus, dyslipidemia, and anxiety disorder
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What causes tinnitus?
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Unknown but it likely that there are many causes.
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What are more specific causes of tinnitus?
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Outer ear: cerumen, foreign body touching the TM Middle ear: otosclerosis, muscle spasms, ET dysfunction, vascular abnormalities, benign tumors, infection Inner ear: damage from noise exposure, presbycusis, labryinthitis, meniere's disease, superior canal dehiscence Vestibular schwannoma (acoustic neuroma), Vascular tumors, and TMJ
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The current theory for tinnitus suggests...
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that tinnitus results from the compensatory adaptation of the central auditory system to hearing loss
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Effects of tinnitus
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Insomnia, impaired understanding of speech, depression, impaired concentration, problems with work and family life
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Diagnosis of Tinnitus includes:
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Case history, standardized questionnaires, audiogram, tinnitus assessment, LDLs, OAEs
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What are some tinnitus assessments?
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Pitch-match frequency, tinnitus loudness match, minimal masking level, residual inhibition,
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When to refer for tinnitus?
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Unilateral tinnitus, pulsatile tinnitus, tinnitus with normal hearing, possible associated emotional disturbance, for medical clearance if amplification or assistive devices will be pursued
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What are treatment options for tinnitus?
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Sound Therapy for tinnitus is the use of any sound intended to alter the tinnitus perception and/or reactions to tinnitus for clinical benefit.
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What are sound therapy devices?
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environmental enrichment devices, sound generators, hearing aids, combination tinnitus instruments
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What is the clinical application of sound therapy?
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Clinical application of sound therapy have generally focused on managing reactions to tinnitus and suppressing the perception of tinnitus.
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When should imaging be recommended?
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When 1 or more of these symptoms are present: 1. Tinnitus that localizes to one ear 2. Pulsatile tinnitus 3. Focal neurological abnormalities 4. Asymmetric HL
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What is key for helping patients with tinnitus?
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1. Counseling 2. Patient Education
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What is tinnitus masking therapy?
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uses sound, primarily broadband noise, to induce tinnitus relief and promote habituation
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What is tinnitus habituation?
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An adaptation process of the auditory system that reduces the perceived signal intensity of the tinnitus as well as an individual's reaction to the tinnitus
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What is tinnitus retraining therapy?
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modified version of habituation therapy composed of 2 major components. 2 major therapies: 1. Maskers set that the point where the masking noise and tinnitus blend together 2. Directive counseling that is primarily educational in content
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What is cognitive behavioral therapy (CBT)?
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Teaches skills to identify negative thoughts that result in distress and restructure them so the thoughts are more accurate or helpful
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What are some prognoses of tinnitus?
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1. They majority do in fact learn to live with their tinnitus 2. The general pattern of 'severity' is likely to decrease gradually 3. Sometimes, the tinnitus itself gets softer, and occasionally, it disappears all together 4. Tinnitus does not often markedly get worse
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What is hyperacusis?
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Defined as present when negative reactions to a sound depend only on its physical characteristics (i.e., its spectrum and intensity). The sounds meaning and the context in which it occurs are irrelevant. Does not have any relation to hearing threshold.
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What is misophonia?
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Is defined as an abnormally strong reaction to a sound with a specific pattern and meaning to a given subject. Reactions to the sound depend on the patients past history and on non-auditory factors such as the patient's previous evaluation of the sound, if he/she is afraid of the sound, and the context in which the sound is presented. Does not have any relation to hearing threshold.
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A specific category of __________ occurs when fear is the dominant emotion and patients are afraid of the sound.
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misophonia
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What is the etiology in hyperacusis?
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Abnormal enhancement of cochlear basilar membrane vibration by the outer hair cells (OHCs) at the peripheral level are thought to result in hyperacusis
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What are the etiologies for misophonia and hyperacusis?
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Existing theories suggest a potential involvement of both peripheral and/or central mechanisms
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What are the effects of decreased sound tolerance?
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Discomfort, dislike, distress, annoyance, anxiety, fear, pain, physical discomfort, and aural fullness
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What is the diagnosis for hyperacusis?
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Diagnosis is complex and there is no agreement on how it should be done. There is general agreement that PT LDLs must have decreased values for hyperacusis. LDL values can be helpful but alone are insufficient to diagnose. Diagnosis should include a detailed interview to assess the relative contribution of hyperacusis and misophonia to decreased sound tolerance.
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What are hyperacusis questionnaires?
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1.Hyperacusis Questionnaire 2. Multiple-Activity Scale for Hyperacusis (MASH)
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What is a misophonia questionnaire?
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Misophonia Assessment Questionnaire (MAQ); not clinically validated
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What are treatment options for hyperacusis?
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1. Most common approach is to advise patients to avoid sounds and use ear protection, however, it can be argued that this increases sensitivity to sound. 2. The opposite approach is to treat hyperacusis using desensitization, where patients are exposed to a variety of different sounds 3. "Pink noise therapy"
