clinical trial of its kind funded by the Veterans Affairs (VA) Rehabilitation Research and Development Service, researchers at the VA Portland Medical Center and Oregon Health & Science University found that transcranial magnetic stimulation significantly improved tinnitus symptoms for more than half of study participants. Masking in bedroom: bed side machines, sound pillow, headband headphones Sleep hygiene: sleep habit, factors affecting sleep Psychological conditions affecting sleep Other medical conditions affecting sleep: OSA, systemic medical diseases, etc.Magnetic pulses could provide tinnitus relief Improve Sleep Medications: alprazolam, zolpidem, melatonin receptor agonists, antidepressants, etc. Promote Tinnitus Habituation Acoustic stimulation (sound therapy): broadband noise (TRT), adjusted tonal sounds (Neuromoics) Patient education and counseling Long term follow ups Time Management of other contributing factors: sleep, anxiety, depression, stress, etc. Sound choices: band noises, tonal sounds, music, patterned sounds, etc Hearing aids: double benefits Combination units Cochlear implants Ultrasound devices Medications: benzodiazepines, etc. Reduce Tinnitus Perception Sound therapy (masking): sound generators, personal listening devices, sound pillow, bed side sound machines, etc. Management of Tinnitus with No Treatable Causes Reduce tinnitus perception Promote tinnitus habituation Improve sleep Address mood disturbances Counsel on life style changes and other related issues Judicious use of alternative medicine approaches Management goal: minimal tinnitus impact on patient, improved functioning and quality of life
Tinnitus Treatment Treat causal conditions Manage tinnitus and related problems when there is no treatable causes Identify Non-Auditory Factors Contributing to Complaints Personality Relational difficulties Emotional difficulties Economical difficulties Behavioral problems
How Tinnitus Affects Patients In addition to annoying auditory perception Involvement of non-auditory neural structures in the CNS Interactions between auditory and non- auditory activities Non-auditory symptoms are a major part of the tinnitus problemĮvaluation of a Tinnitus Patient Establish the diagnoses Look for treatable causes Determine severity of tinnitus Determine relations between tinnitus and non-auditory complaints Identify non-auditory factors that may contribute to tinnitus complaintsĮstablish Tinnitus Diagnoses Is it tinnitus Subjective or objective tinnitus Other qualities of tinnitus: acute/chronic, high/low pitches, unilateral/bilateral, constant/intermittent, pulsatile/non-pulsatile Possible causal/underlysing conditions Associated non-auditory diagnosesĭetermine Severity of Tinnitus Self-rated tinnitus loudness Matched tinnitus loudness Tinnitus severity evaluation questionnaires (THI, TSI, TQ, TFI, etc) Mild: education/reassurance/counseling, hearing aids or masking devices Moderate: plus habituation therapies, possibly medications and follow up Severe: plus referralsĭetermine Relations between Tinnitus and Non-Auditory Complaints Sleep: how insomnia and tinnitus affect each other Mood disturbances: how anxiety, stress and other mood changes affect tinnitus and vice versa Cognitive dysfunction: does tinnitus affect the patient’s concentration, memory, learning and other abilities Vicious circle How Tinnitus Is Generated Altered neuronal activities along the auditory pathway: de-afferentation loss of inhibition enhanced spontaneous activities rhythmic activities Abnormal activation of auditory cortex Self-sustaining and perpetuating activities Neuroplasticity in chronic tinnitus What Cause Tinnitus Changes in the auditory system: conductive hearing loss (outer and middle ear disorders), sensorineural hearing loss (inner ear/central auditory pathways) Systemic diseases: head/neck injury, anemia, renal diseases, hormonal disturbances Medications: ototoxic antibiotics, anti- inflammatories, quinine products, cytotoxic medications, and others What Tinnitus Is Definition: A perception of sound without external sound source A common symptom – 15% of population Subjective and objective tinnitus Tinnitus Clinic OHSU Department of Otolaryngology Head & Neck Surgery Tinnitus Clinic OHSU Department of Otolaryngology Head & Neck Surgery."- Presentation transcript:ĭiagnosis and Treatment/Management of Tinnitus Yongbing Shi, M.D., Ph.D. Presentation on theme: "Diagnosis and Treatment/Management of Tinnitus Yongbing Shi, M.D., Ph.D.