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Welcome to the Tinnitus & Hyperacusis Group Education
Session
Richard Tyler, Ph.D., Audiologist
University of Iowa Hospitals and Clinics
Group session 1
Overview
• Introductions
• Discuss hearing, hearing loss, and tinnitus
• Review treatments for tinnitus
• Our options – counseling and sound therapy, hearing aids, tinnitus devices
Group session 2
Introductions
• Your first name
• What does your tinnitus sound like?
– (e.g. ringing, humming)?
• How long have you had tinnitus?
Group session 3
How do we hear?
• The Human Auditory System:
Group session 4
Hair cells in cochlea
Group session 5
Nerve carries information from cochlea to brain
Hair Cell
Nerve Activity
Nerve Fiber
To Brain
Group session 6
Testing your hearing
• Audiogram
– Softest level that you can detect sound
Group session 7
Audiogram of
Everyday Sounds
110
Group session 8
0
20
40
60
80
100
120
Frequency (Hz)
He
ari
ng
Lo
ss
(d
B H
L)
250 500 1000 2000 4000 8000
MILD
MODERATE
NORMAL
SEVERE
PROFOUND
Normal Hearing thresholds on an Audiogram
Group session 9
Hearing thresholds after noise exposure
Group session 10
Hair cells in normal ear
Group session 11
Damaged hair cells
Group session 12
Retrieved from: http://www.cdc.gov/niosh/topics/noise/factors.html
Normal vs. damaged auditory nerve fibers
Group session 13
Group session 14
Sound levels from soft to loud
Group session 15
Overview of tinnitus
– Causes
– Prevalence
– Mechanisms
Group session 16
What do you think caused your tinnitus?
Group session 17
There are many different causes of tinnitus
Causes
Head Injury
Medications
Age
Disease Your
Cause?
Noise
Unknown
Group session 18
Tinnitus is Common
• 15 in 100 (15%) people have tinnitus
• 1 in 100 (1%) people have troublesome tinnitus
• 30 in 100 (30%) people over 60 years old have tinnitus
Group session 19
Tinnitus is an Increase in Spontaneous Nerve Activity
Hearing Loss (No Tinnitus)
Normal Hearing
Tinnitus
Hear Silence
Hear Silence
Hear Sound
Group session 20
Nerve Fiber Response
Tinnitus does not…
• Make you deaf
• Lead to senility
• Imply a sign of mental illness
Group session 21
What is the biggest problem you have that you believe has resulted
from your tinnitus?
Group session 22
Reactions to tinnitus
• Thoughts and emotions
• Hearing difficulties
• Sleep
• Concentration
Group session 23
For those with tinnitus
• What is the most difficult thing to explain to others about tinnitus?
• What could others do to help you with your tinnitus?
Group session 24
For partners of someone with tinnitus
• What have you been able to do to help your partner with their tinnitus?
Group session 25
Treatments for tinnitus
• What have you tried?
• What has been successful?
Group session 26
Group session 27
Group session 28
Expectations for relief
• At this time, there are no widely accepted cures for tinnitus
• There are no studies that have shown a cure for tinnitus
– None using appropriate research designs and that have been replicated by others
Group session 29
Medications
• Currently no drug or surgery can reliably eliminate the source of tinnitus
• There are effective drugs for:
– Sleep, anxiety, and depression
Group session 30
Excellent options to treat tinnitus
• Individualized counseling
• Sound therapy
• Wearable tinnitus devices
• Hearing aids
Group session 31
Individualized counseling
• Tinnitus Activities Treatment (Tyler, 2006)
• Focus on areas impacted by tinnitus:
– Thoughts and emotions,
– Hearing,
– Sleep,
– Concentration
Group session 32
Counseling
• Private Consultation in Tinnitus Clinic (1 hour – $160)
• Private Multiple Sessions (three, 1 hour sessions - $320)
Group session 33
Our Thoughts and Emotions
Doorbell
Doorbell
Doorbell
Neutral
Anxiety
Happiness
Fire
Injury
Angry neighbor
Flowers
Friend
Delivery
Group session 34
Tinnitus and Attention
If brain determines tinnitus is not important, the tinnitus can be ignored
If brain determines tinnitus is important, we will pay attention to it
Group session 35
After Grant Searchfield
Group session 36
Group session 37
Group session 38
Sound Therapy Options
• Non-wearable sound generators
– Sound Pillow
– Sound Generators
– Smartphone applications
– CDs, radio, etc
Group session 39
Wearable tinnitus devices
• General Hearing Instruments
• Neuromonics
• Desyncra
• Widex
• GN Resound (combination unit)
• Levo
Group session 40
Hearing Aids • Improve hearing and communication
• Reduce stress of effortful listening
• Hearing aids often help tinnitus
– Facilitates positive reactions to tinnitus
– Helps to mask tinnitus sound
• UIHC Hearing Aid Center provides excellent service
Group session 41
Tinnitus
Low Level Noise
Tinnitus in Low Level
Noise
Low level noise makes tinnitus more difficult to detect
Group session 42
Tinnitus Level
Level Tinnitus
Decrease Prominence of Tinnitus
Group session 43
Background sound partially masks a barking dog
Group session 44
Self-Help books for tinnitus
Group session 45
Summary
• Hearing loss and tinnitus are related
• Tinnitus is a change in spontaneous activity of auditory nerve
• There is no cure for tinnitus
• Options include
– counseling and sound therapy,
– hearing aids,
– tinnitus devices
Group session 47
• Medical Clearance Stage 1
• Group Session Stage 2
• Counseling
• Sound therapy devices
• Counseling and sound therapy devices Stage 3
• Individual tinnitus evaluation and counseling Stage 4
Group session 48
Individual Tinnitus Evaluation and Counseling
• Audiogram
• Measure your tinnitus
– Pitch, loudness and ability to mask
• Tinnitus Questionnaires
• Discussion of results and next options – counseling, hearing aids, devices
Group session 49
How do you want to manage your tinnitus?
1. Focus on other areas of your life and put tinnitus in the background
2. Use low level sound in your environment (sound machine, CDs, App, television, etc)
3. Use wearable tinnitus devices
4. Use hearing aids with maskers for hearing loss
5. Begin individualized counseling
Group session 50
