1. M.P.Manoj, MESIARC, Calicut. Tin-nit-us (or) Tin-night-us in Latin meaning ringing of the bell

2. Definition  Tinnitus is defined as the sensation of sound in the absence of any relevant external stimuli  Do not classify into objective and subjective!

4. Do We Turn a Deaf Ear?  It may be the first symptom of various disease processes that threaten the patient’s health or physical well being.  Even if not, it severely affects the quality of life of the individual.  Only a concerned, knowledgeable physician can help.

5. Patient Needs  Emotional support  Realistic understanding of the tinnitus and it’s treatment  Positive and active attitude to pursue helpful activities  A battery of tactics and coping strategies

7. Two Major Categories  Generated from Para auditory structures  Generated within the sensory auditory system

8. Flow Chart for Diagnosis of Tinnitus Ringing sound in the ear Pulsatile Non pulsatile Hearing- N  Hearing BruitNo bruit Radiology WatchMyoclonus?Specific    TRT

9. Categorization  0- minimal symptoms, not requiring intervention  1- significant tinnitus  2- significant hearing loss with tinnitus  3- hyperaccusis  4- hyperaccusis with prolonged symptom enhancement by environmental sound exposure

10. Origin of Tinnitus

11. Difficulty in Assessment  Description may depend upon the vocabulary.  The side may not be specific.  Loudness may vary.  Many patients cannot match the pitch.

12. Venous Hum  Eddy currents in the jugular vein  Seen in normal individuals  Eliminated by gentle pressure  May not need any treatment

13. Myoclonus  Rapid repetitive contractions at 60 – 200 per minute.  Young people.  May be associated with neurological disorders.  Does not change with exercise or sedation.  Phenytoin, carbamazepine useful.

14. Drugs Producing Tinnitus  Anti cancer drugs  Antibiotics/ antiparasitic  Diuretics  Antipyretics  Oral contraceptives  Antidepressants  Narcotic analgesics

15. Hearing Loss and Tinnitus  Music in the brain – the 1953 Heller and Bergman experiment.  All causes of hearing loss cause tinnitus to some extent.  Correction of the hearing loss is to be attempted first.

19. The Jastreboff Model Perception and Evaluation ( Auditory cortex) Detection (subcortical) Emotional association ( Limbic system) Source (Tinnitus related neural activity) Annoyance ( autonomic nervous system)

20. Treatment Options  Medication.  Lidocaine @ 100 mg IV.  Carbamazepine @ 600 – 1000mg p.O.  Surgery?  Psychotherapy.  Electrical suppression.  Tinnitus retraining therapy.

21. Treatment by Category  0-no treatment  1- maskers  2- hearing aids  3- gradual introduction of wide band noise  4- the hardest group to treat

22. What Do We Tell the Patient?  Never say “ I do not know”  Never say “ you have to live with it”  Ask them to practice listening to the “music of the brain”  Do not say “it will go away”  Avoid medications as far as possible

23. Avoidance of Silence  Isolation of sound increases central auditory gain  24 hour enrichment of environment  Nature sounds best  Night-time enrichment is a must, but should not disturb partner

24. Tinnitus Retraining Therapy  Retraining the subconscious auditory system to accept the tinnitus as a natural phenomenon  Habituation of reaction and perception  Wide band noise generators  Silence may not be golden

25. Tinnitus  Tinnitus is real, not imagined and has a definite psychological basis  Tinnitus maybe permanent  The person’s reaction to tinnitus, not the sound itself, creates the problem  The person’s reaction to such a disorder is manageable and subject to modification

26. A MESIARC Presentation