Why do I name this article? Because tinnitus is like a ghost that haunts many people’s lives, it is everywhere, yet invisible. According to a study in the United States, 85% of people experience tinnitus, except that some people experience it as a transient condition that lasts only a few seconds and then subsides on its own, while others experience it for many days or even for a lifetime. The incidence of tinnitus accounts for about 15% or more of adults over 40 years of age, and there are quite a few cases of progressive aggravation and untreated tinnitus, which seriously affects the quality of life and work of many patients. Because of the special nature of tinnitus, there is still no machine in the world that can find out whether tinnitus exists and how loud it is, so patients’ tinnitus is often not taken seriously by their families or doctors, and they have to suffer the pain and suffering caused by tinnitus day and night in silence. Over time, a small number of patients suffer from depression or even suicide as a result. In order to let the majority of patients have a detailed understanding of tinnitus, I will introduce the definition, classification, etiology, grading, epidemiology, diagnosis, differential diagnosis and treatment of tinnitus one by one for your study and reference. (All contents are from professional books on otolaryngology, thesis literature and opinions of famous otologists in China) Tinnitus is a common clinical symptom and it is not a disease. Tinnitus is usually a subjective sensation of sound in the ear or head in the absence of any external corresponding sound source or electrical stimulation, i.e. subjective tinnitus, or tinnitus for short. In a broad sense, tinnitus also includes objective tinnitus, which has a corresponding sound source, such as a vasogenic or myogenic murmur. Tinnitus differs from hallucinations in that sounds with specific content, such as music or speech, heard by the patient in the absence of an external sound source are considered hallucinations.
There are various methods of classifying tinnitus, which have not been unified so far, but the following categories are commonly used.
Classification according to the duration of the disease Acute: <3 months; subacute: 3 to 12 months; chronic: >12 months.
Classification according to the symptoms produced by tinnitus Compensated tinnitus: tinnitus is mild, tolerated by the patient and does not require special treatment; decompensated tinnitus: tinnitus is severe, unbearable by the patient and requires active treatment to reduce the loudness of tinnitus.
It is usually classified according to whether the examiner can hear the sound of tinnitus or not: subjective tinnitus and objective tinnitus.
Objective tinnitus is classified as.
1. abnormal open eustachian tube tinnitus
2. tinnitus with muscle contracture. It is easily missed clinically and is caused by the abnormal movement and contracture of the tympanic membrane tensor muscle, stapedius muscle, palatal sail tensor muscle and pharyngeal tube pharyngeal muscle, resulting in a special sound transmitted to the ear, and the patient hears “bartar”, “kartar”, “cackle”, and “cackle” in one or both ears. “The patient may hear a similar sound in one or both ears.
3. Vascular tinnitus is mainly caused by anatomical variations of the internal carotid artery and vein, carotid aneurysm, jugular vein bulb aneurysm, arteriovenous fistula, and giant hemangioma around the ear, which produce pulsating tinnitus during blood flow.
4. Temporomandibular joint disorder tinnitus. Most often occurs during mouth opening movements and eating.
Tinnitus can be classified by lesion site into otogenic tinnitus and non-otogenic disorders.
Otogenic tinnitus refers to tinnitus caused by lesions within the auditory system, including external ear lesions: cerumen embolism in the external ear canal or swelling or foreign body in the external ear canal; middle ear lesions: otitis media, otosclerosis, occupying lesions in the tympanic chamber, high jugular vein bulb or jugular vein bulb tumor; inner ear lesions: Meniere’s disease, noise-related hearing loss, age-related hearing loss; postcochlear and central auditory pathway lesions: auditory nerve posterior cochlea and central auditory pathways: auditory neuroma, multiple sclerosis, brain tumors, vascular lesions, etc.
Non-auricular diseases are diseases that originate from outside the auditory system such as anemia, hypertension, hyperthyroidism, kidney disease, etc.
Tinnitus can be classified by patient complaints as tinnitus or cranial tinnitus; single tinnitus versus compound tinnitus; pulsatile and non-pulsatile tinnitus; pulsatile tinnitus can be further classified etiologically into: vascular tinnitus and non-vascular tinnitus. Vascular can be subdivided into arterial and venous pulsatile tinnitus. Venous pulsatile tinnitus can be caused by benign intracranial pressure, jugular venous bullae, hydrocephalus, etc. Arterial pulsatile tinnitus is caused by atherosclerosis, arterial malformations and variants, arteriovenous fistulas, and hypertensive disease.
Non-vascular tinnitus is mainly myogenic tinnitus and abnormal opening of the eustachian tube. Myogenic tinnitus is related to the clonus of the tympanic membrane tensor, palatal muscle and stapedius muscle.
Physiological tinnitus by etiology: Under normal circumstances, when the human body is in an extremely quiet environment, we can hear the pulsating sound or breathing sound produced by the pressure on the arteries when the internal organs and organs of the body maintain their natural activity state and blood flow, and the sound of the opening of the eustachian tube, etc. These are all sub-body sounds, which are physiological tinnitus.
Pathological tinnitus: Any tinnitus caused by external mechanical, noise, toxic, infectious, allergic reaction, drug ototoxicity and systemic diseases belong to the category of pathological tinnitus. Drug-induced tinnitus: High doses of salicylic acid can cause hearing loss and induce reversible tinnitus. Tinnitus characteristics: It is mostly medium to high frequency tinnitus, bilateral, and can disappear after stopping the drug. Tinnitus symptoms usually occur only when more than 400 mg of salicylic acid is taken orally daily. Traumatic tinnitus mostly occurs after traumatic brain injury and may be related to vagal oscillations as well as brain oscillations. Tinnitus can occur in the cochlea, nerve or auditory center, or in a combination. There is evidence of local scarring of brain tissue in some patients with traumatic brain injury, causing abnormal discharges.
Grading is based on the Tinnitus Disability Inventory (THI) score which classifies tinnitus into 5 grades l (mild), THI score. 1 to 16; 2 (mild), THI score 18 to 36; 3 (moderate), THI score 38 to 56; 4 (severe), THI score 58 to 76; 5 (catastrophic), THI score 78 to 100.
Exhibit – Tinnitus Disability Inventory tinnitus handicap inventory (THI) The following questionnaire will help us to understand the extent of your tinnitus so that we can provide you with better services. Please answer the questions item by item. Yes: 4 points; No: 0 points; Sometimes: 2 points.
1. Does tinnitus make it difficult for you to concentrate?
2. Does the sound of tinnitus make it difficult for you to hear others?
3. Does tinnitus make you angry?
4. Does tinnitus make you confused (annoyed)?
5. does tinnitus make you feel hopeless?
6. Do you always complain about tinnitus?
7. Does tinnitus make it difficult for you to sleep at night?
8. Do you have the feeling that you can’t get rid of your tinnitus?
9. Does tinnitus interfere with your social activities? (e.g. going out for dinner or watching a movie, playing cards, meeting friends) 10. Does tinnitus make you depressed?
11. do you think tinnitus is a terrible disease?
12. does tinnitus make it difficult for you to enjoy your life?
13. does tinnitus interfere with your work and household chores?
14. does tinnitus make you lose your temper easily?
15. Does tinnitus make it difficult for you to read? Can you work quietly?
16. does tinnitus make you upset?
17. does tinnitus strain your relationship with friends or family?
18. do you have trouble shifting your attention from tinnitus to other things?
19. do you feel that you cannot control your tinnitus?
20. Does tinnitus make you feel tired a lot?
21. Does tinnitus make you depressed? (Can’t get interested in doing things?) 22. does tinnitus make you anxious?
23. do you feel that there is nothing you can do about tinnitus?
24. Does tinnitus get worse when you are under stress? (e.g. exams, promotion or end-of-year exams, children going to school or getting married and needing money) 25. Does tinnitus make you feel insecure? (instability, insecurity) EpidemiologyThere is a wide variation in the prevalence statistics of tinnitus, and different research methods may lead to different conclusions. One author analyzed 1453 tinnitus patients to present information about the prevalence of tinnitus. Based on follow-up data, the prevalence of tinnitus was found to be 17.8%, with 49.1% of patients experiencing occasional tinnitus. At least 70% of the patients with hearing loss were reported to have tinnitus symptoms. If those with tinnitus of less than 5 minutes are included, approximately 60% of people have had tinnitus at some point in their lives. Patients with tinnitus as a primary complaint account for about 10-20% of ENT visits. In the United States and Europe, 17% of people experience tinnitus for more than 5 minutes, and 7% of those with tinnitus frequently seek medical care. According to conservative estimates, 10% of people in China experience tinnitus, 5% of people with tinnitus seek medical treatment, and 2% of people with tinnitus have severe effects on their lives, sleep, concentration, ability to work, and social activities. With the increase in cardiovascular system diseases caused by factors such as changing dietary habits, an aging population, and the increase in industrial and environmental noise, the incidence of tinnitus is increasing year by year, seriously affecting people’s quality of life. Therefore, tinnitus has become an urgent clinical problem to be solved.
The pathogenesis of tinnitus is not well understood, and as research progresses, many possible mechanisms have been proposed by academics. Studies have shown that synchronized excitatory emissions between adjacent neurons and the inward flow of excess cations from hair cells may be the mechanism of tinnitus, while changes in neuroplasticity are the structural basis for the different forms of tinnitus. Therefore, altered 5-HT system function plays an important role in the mechanism of tinnitus development. Tinnitus has also been reported to be an auditory disorder caused by abnormal discharges in any part of the auditory conduction pathway. Jastreboff et al. proposed a neurophysiological model of tinnitus based on neurophysiological and psychological principles. This model suggests that different planes of the auditory pathway and some non-auditory systems (especially the limbic system) are the basic sites of tinnitus occurrence. The spontaneous electrical activity of nerve fibers is detected by subcortical centers and is transmitted up to the auditory cortex to be perceived as tinnitus. The activation of the subcortical centers transmits the detected tinnitus signals to the limbic system and the vegetative nervous system, which, on the one hand, makes it easier for the subcortical centers to detect tinnitus signals and, on the other hand, makes tinnitus closely associated with negative emotions and forms a conditioned reflex, which is reinforced by prolonged severe tinnitus and eventually forms a vicious circle between tinnitus and bad emotions. The third aspect is that the activation of the limbic system also initiates the memory process, and the tinnitus signal is stored by the center as an unpleasant signal, and the tinnitus and unpleasant sensations may remain in the center after the cochlear function is fully restored.
It is generally believed that the cochlea is the primary lesion site for tinnitus, but a large body of evidence suggests that the central nervous system cerebral cortex is involved in the production and maintenance of tinnitus. Tinnitus can persist after complete recovery of the cochlear lesion, especially after vagus destruction or hearing nerve severance, and some patients still have tinnitus or the existing tinnitus is instead aggravated.
Therefore, the central hypersensitivity is an important mechanism for long-term severe tinnitus, which we tentatively call the “central hypersensitivity theory”. It is clear that the early lesion can be in the cochlea, but the main pathological process or late outcome is in the center. Recent functional brain imaging studies have also confirmed the presence of hypermetabolic activity or increased local cerebral blood flow in the temporal auditory cortex of tinnitus patients, which may suggest that there is a “tinnitus center” in the brain responsible for tinnitus.
The mechanism by which systemic diseases cause tinnitus remains unclear. To be sure, systemic diseases are associated with tinnitus, but the two are not in a one-to-one relationship. For example, some patients with hypertension have tinnitus while others do not, some patients with hyperlipidemia have tinnitus while others do not, and the same is true for other disorders. The level of central sensitivity is related to innate and acquired qualities, and like the pain threshold, some people have a low threshold and show intolerance to pain or tinnitus.
Diagnosis and differential diagnosis of tinnitus should include diagnostic procedures: history taking, ENT examination, audiological examination such as high frequency hearing loss and the degree of auditory communication impairment due to hearing loss, psychological quality diagnosis: such as personality traits, psychological tolerance and degree of depression and anxiety, and imaging examination. Tinnitus is a clinical symptom, differential diagnosis is mainly for the differential diagnosis of etiology, looking for the etiology of tinnitus as much as possible, and if the etiology of tinnitus can be clarified, treating the etiology for the primary cause.
The measurement for tinnitus includes 3 aspects.
1, Psychoacoustics of tinnitus (Psychoacoustics): tone test, octave confusion test, tinnitus loudness test, subjective assessment of tinnitus loudness, tinnitus masking audiogram, tinnitus residual suppression or masking after-effect test.
2, Patient response to tinnitus (Reaction to tinnitus): This is usually obtained using a questionnaire. Examples include the Tinnitus Disability Questionnaire (THI) mentioned earlier, in addition to the Tinnitus Disability Questionnaire (THQ) and the Tinnitus Activity Questionnaire (TAQ) used by the University of Iowa, USA. There are also commonly used scales such as the TQ, TFI, and TSI.
3, Overall psychology of patient: This is also usually obtained in the form of a questionnaire. For example, Beck Anxiety Questionnaire and other psychiatric and psychological assessments.
Based on the history, audiological examination data, general examination data and psychological assessment, a four-part diagnosis is made, including localization, qualitative, quantitative and causative.
Localization means determining the site of the lesion. There is no separate test to determine the site of the tinnitus lesion, and audiological examination is usually used clinically to determine the site of the tinnitus and deafness lesion. For example, secretory otitis media, cochlear lesions and postcochlear lesions.
Qualitative means to determine the nature of tinnitus classification. In addition, tinnitus should be distinguished from auditory hallucinations and phantom hearing. Tinnitus can only be defined as an auditory hallucination, not as a hallucination. Hallucinations are common in psychiatric patients and consist of meaningful speech, while tinnitus is a monotonous and non-verbal noise. Another condition, called auditory hallucinations or auditory images, is often unique to musicians or singers, who often have the sense of a full score or song during meditative music or song composition.
Quantitative physician evaluation of tinnitus: Tinnitus matching results are used. Subjective assessment by the tinnitus patient themselves: The tinnitus tone is assessed as low, medium, or high. The assessment of tinnitus loudness is described in the classification of tinnitus. Assessment of psychological reactions due to tinnitus is the Tinnitus Questionnaire, which covers hearing, health, life, and emotions.
Determining the cause determines the etiology or predisposing factors of tinnitus. For example, noise, medication, sudden deafness and sequelae of cranio-cerebral trauma. Because elderly people often have multiple diseases of the ear and the body at the same time, such as arteriosclerosis, hypertension, cervical spondylosis, senile deafness, diabetes, etc., the etiology of tinnitus in the elderly is complex, also known as “syndromic tinnitus”.
Tinnitus is a clinical symptom, and it is difficult to identify the cause of most tinnitus. There is no one way to eliminate tinnitus. Of course, tinnitus can be caused by a number of clear causes, such as noisy hearing loss, sudden deafness, or auditory neuroma. Therefore, patients with tinnitus should first undergo a medical examination to eliminate these pathologies. For most cases of tinnitus with unknown causes, there are treatments for tinnitus that can reduce the tinnitus or lessen its effects on the patient.
For most patients with unexplained tinnitus, there are a number of tinnitus treatments that can be received to reduce the tinnitus or lessen its effects on the patient. We are often in an environment where we are surrounded by a variety of sounds, but most of these sounds do not affect us adversely because we perceive them from our subjective consciousness as naturally occurring and they are not harmful. The same is true for tinnitus, which often causes fear and anxiety in people with tinnitus and affects their emotional well-being, hearing, sleep and concentration abilities. Although we cannot eliminate tinnitus completely, if a person with tinnitus can develop a proper understanding of tinnitus, it will reduce the impact of tinnitus on the patient. The treatment of tinnitus can be broadly divided into the following categories.
1 Counseling, 2 Sound Therapy, 3 Hearing Aids, 4 Psychological Therapies, 5 Medications, 6 Tinnitus retraining therapy, and 7 Tinnitus activity therapy. 7Tinnitus Activities Treatment8Tinnitus Self~treatment9Electrical stimulation to reduce tinnitusTinnitus counselingTinnitus Tinnitus counseling is the first step in the treatment of tinnitus. Many patients with mild tinnitus simply go through tinnitus counseling and do not need any other treatment. Tinnitus counseling, an important aspect of tinnitus treatment, has been widely practiced abroad, but has not received sufficient attention in China due to the large number of patients seen. The main elements of a tinnitus consultation are: first, explaining to the patient what tinnitus is and what causes it. What causes tinnitus? What are the possible treatments for tinnitus? The first step is to give the patient a basic understanding of tinnitus. Tinnitus counseling is usually conducted by an audiologist or psychologist and is not intended to eliminate the tinnitus, but rather to help the patient not notice their tinnitus as much; if the patient still notices their tinnitus, treatment can help the patient feel that the tinnitus is not interfering with their life as much as it was; if the patient still feels that the tinnitus is interfering with their life, tinnitus counseling can also help the patient understand that they can seek If the patient still feels that the tinnitus is interfering with their life, tinnitus counseling can also help the patient understand the possible ways to deal with the tinnitus – to seek professional help. Tinnitus counseling can also examine the patient’s psychological response to the tinnitus and tell the patient what positive attitude to adopt in dealing with the tinnitus. Often patients may experience tinnitus-related conditions such as hearing, sleep, concentration and emotional problems. Some counseling sessions can examine the patient’s level of concern about tinnitus and discuss with the patient how to change their response; tinnitus counseling can also examine the patient’s awareness of tinnitus and help them come to terms with it. The now widely used Tinnitus Trance Therapy (TRT) and Tinnitus Activity Therapy (TAT) mentioned below both use tinnitus counseling as an important part of their treatment.
Sound Therapy Most tinnitus patients feel that the presence of background noise or music can reduce tinnitus, and sound masking can reduce the volume of the tinnitus or distract the patient from the tinnitus. Sounds used for tinnitus masking include: sounds that partially mask the tinnitus, background masking sounds and tinnitus at the same time, and the patient is able to hear the tinnitus all the time. This reduces the volume of the tinnitus and diverts the patient’s attention from the tinnitus. Completely masking the sound of tinnitus means that the background masking sound completely covers the tinnitus. Types of sounds used to mask tinnitus include: Broadband noise, such as ssssshhhh, and musical sounds, usually using soothing and relaxing music. In addition, specific sounds can be chosen for relaxation or distraction, such as the sound of waves or falling leaves, which can be accompanied by music. Sound masking devices include wearable devices like hearing aids, portable CD headphones or plug-in headphones, non-wearable devices including CD players or tinnitus masking specific sound generators.
Hearing aids Some people with tinnitus also have hearing loss, and hearing aids will help them with both. Hearing aids improve verbal communication while reducing tension to reduce tinnitus. Hearing aids also amplify background noise, and many people with tinnitus feel that low levels of background noise can reduce their tinnitus. The neural activity in the auditory system generated by the amplified sound from hearing aids can interfere with the auditory center’s perception of tinnitus, diverting the patient’s attention to more important information, such as speech, music, etc.
Hearing aids were proposed by Saltzman and Ersner as early as 1947 for the treatment of tinnitus. Hearing aids were used for partially masked and completely masked treatment of tinnitus, and hearing aids were included in Jastreboff’s tinnitus habituation therapy for tinnitus patients, and hearing aids were also used as a supplement to psychotherapy for tinnitus. A survey of tinnitus patients in the United States showed that 1/3 of tinnitus patients wear hearing aids to relieve their tinnitus at the time of their medical visit. The benefits of hearing aids for tinnitus patients can include:1 Improving the patient’s hearing status can improve their psychological state.2 Hearing improvement diverts the patient’s attention from hearing and tinnitus.3 Hearing aid improvement allows the patient to understand that communication impairment is primarily due to hearing loss rather than tinnitus.4 Surrounding noise and noise amplified by the hearing aid masks tinnitus.5 Wearing a hearing aid In conjunction with tinnitus counseling, the tinnitus patient builds a correct understanding of tinnitus. The specific operation emphasizes the amplification of speech at a comfortable level by the hearing aid to distract the patient from the tinnitus, and the amplification of ambient sounds so that the tinnitus is not easily heard. The early goal is to amplify ambient and speech sounds to partially mask the tinnitus, and the longer-term goal is to reduce the patient’s attention to the tinnitus to the point of ignoring it.Grant recommends five to six patient appointments over a six-month period, including five parts: 1, audiological diagnosis and tinnitus evaluation; 2, tinnitus consultation; 3, allowing the patient to try various sound therapies; 4, hearing aid fitting for those who are suitable for hearing aids; and 5, follow-up. 5, Follow-up visits.
Cognitive Behavior Modification (CBM) of tinnitus by psychotherapy can help tinnitus patients change their perception of tinnitus and their response to tinnitus. Relaxation Therapy can help tinnitus patients relax from the tension caused by tinnitus, such as some soothing music or the use of biofeedback therapy. Cognitive Behavior Therapy for tinnitus is based on the treatment of other areas of cognitive behavior, such as anxiety, depression, chronic pain, and insomnia.
Medications, although not yet proven to be effective for tinnitus, can be used to relieve tension and help with sleep. I personally believe that for the Chinese context, medication is essential and acts as a psychological cue and placebo to some extent.
Tinnitus habituation treatment Based on the current understanding of tinnitus, different theories and approaches have been proposed by different scholars for the treatment of tinnitus. For example, Jastreboff proposed Tinnitus retraining therapy (TRT) in 1990 based on the neurophysiological model of tinnitus. Tinnitus retraining therapy has been widely used in China and abroad, but it is a highly controversial treatment method. This therapy is mainly based on neurophysiological and psychological models and emphasizes: 1. tinnitus counseling to enable the patient to attribute tinnitus to unimportant neural signals; 2. sound therapy to attenuate tinnitus-related neural activity through incomplete masking of tinnitus.
Tinnitus activity treatment Professor Tyler of the University of Iowa has proposed tinnitus activity treatment (TAT) in recent years, and has conducted more clinical observations. Tinnitus activity treatment is based on the individual differences and needs of the patient, and begins with counseling that focuses on thoughts and emotions, hearing and communication, sleep, and attention. Partially masked sound therapy with noise or music is used, picture-based tinnitus counseling is applied to facilitate patient participation in treatment, comprehensive and structured counseling is provided, and patients are encouraged to complete appropriate homework assignments to promote patient understanding of treatment and accelerate treatment outcomes.
Tinnitus activity therapy addresses tinnitus and the problems associated with tinnitus, and provides patients with appropriate treatment methods that take into account their individual condition. Patients should first be made aware that tinnitus is not a life-threatening prognosis and that it is a common occurrence. Providing counseling to tinnitus patients can be accompanied by a tinnitus questionnaire, which can be used to focus the patient’s attention on tinnitus-related issues.
Partial masking of tinnitus: Partial masking of tinnitus with low level noise allows the tinnitus patient to hear both the tinnitus and the noise, which is not necessarily constant, as the noise may affect the hearing of patients with hearing loss, and it is not recommended to change the masking noise frequently, as this may make the tinnitus easier to notice. A single low level of noise is more recommended. Establish reasonable expectations for the tinnitus patient. Using a picture format for tinnitus counseling makes the tinnitus counseling more organized, easier for the patient to understand, and easier for the audiologist not to forget important elements. Tinnitus activity therapy consists of three components: direct tinnitus counseling, patient participation in treatment activities, and sound therapy if needed.
According to Professor Tyler, tinnitus affects four main areas of the patient: thoughts and emotions, hearing and communication, sleep, and concentration. Tinnitus causes problems in all four of these areas, which can lead to further personal and social problems. If a person with tinnitus does not have any of these problems, the audiologist’s consultation can ignore the problems. The first step in treatment is therefore to decide which of the above four areas require intervention.
To determine which of these four areas require intervention, the Tinnitus Activities Questionnaire is administered to the patient to determine which of the four areas require intervention: thoughts and emotions, hearing and communication, sleep, and attention. The questionnaire scored each of these four areas that affect tinnitus patients. Based on the results of the questionnaire, a complete treatment plan is developed in conjunction with a discussion with the patient.
Patients with thought and emotional tinnitus often have other problems unrelated to tinnitus, and the physician first needs to determine the patient’s top concerns related to tinnitus. For some patients, their problems may be beyond the physician’s expertise, so it may be necessary to seek the help of a psychologist or psychiatrist. There are four specific steps: listening to the patient; providing relevant counseling information about hearing, deafness, tinnitus and attention; introducing ways to ignore tinnitus; and changing the response to tinnitus.
A higher proportion of patients with sleep tinnitus have sleep problems. Some patients have difficulty falling asleep, wake up in the middle of sleep, wake up earlier or are sleepy during the day. Inability to concentrate and difficulty listening can lead to emotional stress and fatigue.
The following steps are divided into the following: understanding normal sleep; factors that affect sleep; proper bedroom arrangement; daytime routines and nighttime activities that facilitate sleep; using background sounds to make tinnitus less noticeable; and learning exercises that can relax.
Another goal of tinnitus activity therapy to improve hearing and communication is to help the patient understand the impact of tinnitus on communication. Therefore, the physician should discuss with the patient how to improve the patient’s hearing. Improving hearing should include: improving communication difficulties due to hearing loss; improving communication difficulties due to tinnitus; and relieving the tension caused by communication difficulties. Specific steps are divided into the following: explaining hearing and hearing loss; understanding hearing communication difficulties due to tinnitus and hearing loss; and ways to improve hearing and relieve tension including using hearing aids, changing the environment, and enhancing communication skills.
Attention Many people with tinnitus have difficulty focusing their attention. In tinnitus activity therapy, three areas need to be emphasized to improve the patient’s attention: providing relevant information and counseling, making the tinnitus less noticeable, and enhancing attention to what is currently engaged. Specific steps include: explaining the reasons for decreased attention; reducing distracting distractions; and promoting concentration.
Self-help treatment for tinnitus Information about tinnitus provided through books or pamphlets can supplement the counseling the patient receives from a physician. For tinnitus, there are pamphlets with information about tinnitus that can help tinnitus patients understand tinnitus, remove the fear of tinnitus, and build a correct understanding of tinnitus. This change in understanding of tinnitus itself allows some tinnitus patients to eventually come to accept tinnitus without the need for additional treatment.
These pamphlets for tinnitus sufferers usually include the following: Explanation of what tinnitus is? What causes tinnitus? What are the possible treatments for tinnitus? The role of tinnitus counseling and sound therapy. Explaining that tinnitus is not a serious illness (having first undergone the necessary medical tests). Explain how it can cause tinnitus and that focusing too much on tinnitus can make it worse. Explain that knowledge of tinnitus will gradually reduce its effects and learn to ignore it. Lower expectations of rapid tinnitus reduction. Recommend the use of a noise generator or other sound source that provides low volume background noise during quiet days or nights.
Some tinnitus treatment facilities offer tinnitus counseling booklets to their patients, while these booklets are usually approved by the author to be copied without copyright, but usually the author requires the copyist to credit the original publication. Examples include “Tinnitus Self-treatment” by David M, Addenbrooke’s Hospital, Cambridge, UK, and “Tinnitus: How you can help yourself!” by Tyler, University of Iowa, USA.
Electrical stimulation for tinnitus was proposed by Kuk et al. as early as the 1980s as a possible treatment for tinnitus. Electrical stimulation can produce hearing – electrical hearing – which is the basis for cochlear implants. As the number of patients with cochlear implants increased, it was discovered that an additional effect of cochlear electrical stimulation to produce hearing was electrical stimulation to suppress tinnitus. Many patients with deafness are accompanied by tinnitus, and 77% or more of tinnitus patients who receive cochlear implants have reported that their tinnitus disappears or is significantly relieved. The mechanism by which electrical stimulation suppresses tinnitus is unclear, and the current preference is to explain it in terms of a central mechanism of tinnitus. One explanation for the mechanism of tinnitus is that tinnitus is the result of altered spontaneous firing in the auditory center, and electrical stimulation may alter this spontaneous firing: increasing spontaneous firing, decreasing spontaneous firing, depolarization of neuronal spontaneous firing, etc. A current study at the University of Iowa in the United States, in patients with cochlear implants, sought to discover the parameters of electrical stimulation that could suppress tinnitus and to explore the possibility of applying an electrical stimulation device that specifically suppresses tinnitus.