Understanding tinnitus in residents

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Lauren Conte, Eosera Inc.
Lauren Conte, Eosera Inc.

Tinnitus is an audiological and neurological condition that about affects 15% of the general public. Nearly 50 million Americans have some form of tinnitus making it one of the most common health conditions in the country. Roughly 20 million people struggle with chronic tinnitus, while 2 million have extreme and debilitating cases.

According to the American Tinnitus Association, tinnitus is the perception of sound when no actual external noise is present. Although tinnitus is commonly referred to as "ringing in the ears," the condition can manifest different types of sounds. These sounds can include:

  • Ringing
  • Buzzing
  • Clicking

Tinnitus can be both an acute (temporary) condition or a chronic health malady. There are two main forms of tinnitus:

  1. Subjective Tinnitus
  2. Objective Tinnitus

Subjective tinnitus is head or ear noises that are perceivable only to the specific patient.

This kind of tinnitus is usually traceable to auditory and neurological reactions to hearing loss, but can also be caused by an array of other catalysts. More than 99% of all tinnitus cases reported are of the subjective variety.
A few disorders linked to tinnitus include:

  • Presbycusis
  • Noise induced hearing loss
  • Genetic predisposition
  • Endolymphatic hydrops/Meniere's disease
  • Otosclerosis

Objective tinnitus, on the other hand, is linked to a mechanical source. Head or ear noises are audible to the examiner, by placing a stethoscope on the patient's external auditory canal. These sounds are usually produced by internal functions in the body's circulatory (blood flow) and somatic (musculo-skeletal movement) systems. However, less then 1% of total tinnitus cases are objective tinnitus.

Can tinnitus be cured?

If the patient is suffering from an active disease that causes the tinnitus and can be eliminated, then the tinnitus is curable. There are others issues that require more intensive medical treatment, such as surgery, that will correct the tinnitus.

Whenever possible, active diseases should be identified and treated prior to tinnitus management. For patients suffering from subjective tinnitus, healthcare providers can help manage their residents' symptoms through a more holistic approach.

William H. Martin, a professor of Otolaryngology at the National University of Singapore created a guide for tinnitus management. The goal of Martin's management plan is to “reduce the perception of and the reaction to tinnitus until it is no longer a controlling factor in the person's life.”

First, care providers must help patients differentiate their symptoms between bothersome and non-bothersome tinnitus.

Martin notes that around 75% of the population that suffer from tinnitus are not bothered by it. Only in quiet environments do they notice it. The rest of the population experiencing tinnitus are bothered—so much that It prevents them from sleeping. It creates anxiety, insomnia, and depression.  

For those with bothersome tinnitus: Do an audiometric evaluation if they are complaining of hearing loss.

In fact, if a person reports faint to noticeable tinnitus but no trouble sleeping and no anxiety or depression issues and you diagnose them with hearing loss, a simple thing you can do is to treat the hearing loss with binaural amplification. A lot of times you will get lucky and the symptoms go away. Start simple.

Group education can be beneficial as the third stage of management. This is different than a support group. Group education explains the neurophysiological model and talks about simple things they can do to improve their quality of life, such as how to avoid complete silence or introduce background stimulation; it gives tips without any other formal intervention.

Interdisciplinary evaluation

If the person has TMJ (temporomandibular) disorders, a neck injury, or any kind of psychological issues, then you want to bring in the other members of your team to evaluate them. 

Individualized support

The people who have chronic and multi-faceted problems need intensive, individualized support. This is the highest level of management, where you are custom-applying the sound therapy, psychological therapy, and the other aids they may need in an intensive, long-term manner.

When coming up with a management plan, consideration needs to also be given to the tools necessary for relieving tinnitus symptoms. Sound generators are small devices, that can be placed behind-the-ear like hearing aids, but make a gentle background noise. The sound competes with the tinnitus and can provide relief. You can also use fans and white-noise machines, or a Bluetooth earbuds that can connect to a patient's iPod, or phone to play therapeutic sounds of their choice. There are also many phone apps that can be used to create ambient noise to compete with the tinnitus.

Lauren Conte is an undergraduate studying Strategic Communication at Texas Christian University. She works at Eosera Inc. in Fort Worth, TX.

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