Tinnitus Diagnosis and Treatment: Hossein Talebi PHD of Audiology
Tinnitus Diagnosis and Treatment: Hossein Talebi PHD of Audiology
Tinnitus Diagnosis and Treatment: Hossein Talebi PHD of Audiology
AUDITORY ALTERED
DEPRIVATION SPONTANEOUS
AND CENTRAL NEURONAL
GAIN ACTIVITY
TINNITUS
Pathophysiology
• When the perception of tinnitus is associated with
negative reinforcement, the autonomic nervous system is
activated.
• Ear examination
Rule out outer/middle ear disease
Tuning fork tests
Normal Ear vs. Diseased Ear
Evaluation of Tinnitus
• Audiological (hearing) Tests
Audiogram, tympanogram
Specialized hearing tests: SOAE, ECochG, ABR
• MRI
Associated symptoms
Asymmetric hearing loss
Evaluation - Subjective Tinnitus
• Audiometry - assymetrical hearing loss,
unilateral tinnitus - MRI r/o post fossa
• Complete questionnaire for perceived
severity:THI
Measurement of Tinnitus
• Pitch, loudness, minimum masking level,
residual inhibition/post masking
• Minimum masking level most clinical use
• Pitch - match most prominent pure tone, poor
reliability, octave difference
• Loudness - Adjust pure tone to tinnitus
• Most < 7 dB SL, may be 2 dB
Measurement of Tinnitus
• Minimal masking level - number of decibels to
cover tinnitus
• Residual inhibition - response of patients
tinnitus post masking
ENT Referral
ENT Referral
Acoustic Neuroma
Treatment
• Aim to improve habituation rather than “cure”
tinnitus
• Medication
Psychological and behavioural
support
INTERVENTION DESCRIPTION
Antipsychotics sulpiride
• Laser Therapy
Germany
Thought to increase ATP in cochlea
Alternative Therapies
• Hypnotherapy
• Acupuncture
• Ear canal magnets
Transcranial Magnetic Stimulation
• Brain stimulation
▫ Identify active areas with PET
▫ Apply magnetic stimulation (rTMS)
▫ Evidence in small trials that there is some effect on tinnitus
▫ More detailed research awaited
• Questions
▫ Can this be clinically useful or is it just an
experimental technique?
▫ Long term safety?
Conclusion
Tinnitus is a common condition