2. Tinnitus

3. City Lit Objectives To understand current theories on the cause of tinnitus To understand the effects of tinnitus To understand how tinnitus is managed Relevant for: Assignment 1d Information pack for clients

4. City Lit What is tinnitus? Latin ‘tinire’ = to ring Perception of noises in the head or ear(s) which has no external source

5. City Lit jet engine hissing humming/ shhhhh singing buzzing whistling

6. City Lit How tinnitus might sound Simulations of tinnitus from the Nottingham Hearing Biomedical Research Unit http://www.hearing.nihr.ac.uk/public/auditory-examples-sounds- of-tinnitus

7. City Lit Statistics An estimated 6 million people in the UK have tinnitus to varying degrees (source: Action on hearing loss) For over 3.5 million people tinnitus is a permanent problem (source: Deafness Research UK) Around 1% of people in the U.K. - about 600,000 people – have tinnitus that affects their quality of life. (source: Action on hearing loss)

8. City Lit Tinnitus models Prior to 1990s, the main cause was thought to be damage to the hair cells in the cochlea. Nerve fibres firing off indiscriminately.

9. City Lit Tinnitus models A new way of looking at tinnitus….. Jastreboff Neurophysiological Model (1990) Limbic system - giving each sound an ‘emotional label’ – tuning in to significant sounds Autonomic nervous system - getting the body ready for action Subconscious filters in the auditory pathway between ear and brain enhance or suppress the signal – we unconsciously block them out if not important, or turn them up if significant.

10. City Lit Heller and Bergman experiment 1953 80 people with normal hearing spent 5 minutes in a soundproofed room. 93% of them reported hearing buzzing, pulsing or whistling sounds in their head or ears. source: deafness research uk

11. City Lit Tinnitus is not a disease or an illness, it is a symptom generated within a person's own auditory pathways.

12. City Lit Dr Roland Schaette, British Tinnitus Association’s Senior Research Associate at the UCL Ear Institute in London talks about tinnitus research http://www.tinnitus.org.uk/the-search-for-a-cure

13. City Lit Tinnitus and sound tolerance Many people with tinnitus are also more sensitive than normal to everyday sounds Hyperacusis With normal hearing, sounds seem uncomfortably loud, but they don’t bother other people Recruitment Common with presbyacusis – sensitivity to loud sounds. Misphonia (extreme = phonophobia) Some particular sounds are extremely irritating – more than for other people

14. City Lit Common physical triggers Medical conditions: Noise damage Age-related deafness (presbyacusis) Ménière’s disease Ear infection Wax Tumour (acoustic neuroma/vestibular schwannoma) Change in blood flow (pulsatile) Everyday life: Medication Illness Tiredness Stress Air travel Loud noise Diet

15. City Lit Common emotional triggers Bereavement Redundancy Retirement Depression Life-changers Stress

16. City Lit The vicious circle of tension and tinnitus Tinnitus gets louder Tinnitus starts Become anxious Tinnitus gets louder Become more anxious Brain turns up tinnitus

17. City Lit David Baguley, a member of the British Tinnitus Association’s Professional Advisers' Committee, explains the possible causes and effects tinnitus often has, such as stress and anxiety, plus how to deal with them. Ashleigh, who was diagnosed with tinnitus in 2005, describes how she copes with it. http://www.tinnitus.org.uk/tinnitus---the-video

18. City Lit Tinnitus management – towards habituation Diagnosis by ENT Consultant Explanation/education/ reassurance → acceptance Sound therapy (enrichment) Sound generators (maskers) Hearing aids/C.I’s Relaxation techniques Hypnotherapy, aromatherapy, acupuncture Changes in diet Support groups

19. City Lit Tinnitus management – towards habituation Tinnitus re-training therapy (TRT) - training the brain to ‘tune out’ tinnitus - combines counselling and sound therapy. Cognitive behavioural therapy (CBT) - understanding how our beliefs and behaviour influence how we feel

20. City Lit Current research for a cure Drugs Local anaesthetic -Licodaine Anti-depressants Electro-magnetic stimulation An elecromagnet against the skull Acoustic or electric stimulation Of brain stem Neuromodulation Delivering sequences of sound to the ears to break up the patterns of nerve firing in the brain that may be responsible for generating tinnitus

21. City Lit Useful sources Action on Hearing Loss British Tinnitus Association The Ear Foundation Hush (Hull tinnitus self-help group) Dunmore, K., Riddiford, G., Tait, V., Understanding Tinnitus: living with the noises in your ears or in your head, RNID (2006) Baguley, D., McFerran, D.J., McKenna, L., Living with Tinnitus and Hyperacusis, Sheldon Press. ISBN: 978-1-84709-083-6