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Understanding the Process of Tinnitus Distress
Lucy Handscomb UCL Ear Institute & NIHR Nottingham Hearing Biomedical Research Unit
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Tinnitus Survey
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How does tinnitus make you feel?
“I have felt suicidal with very negative dark thoughts, panic attacks and so on” “knowing I could have this condition for another 50 years is the most terrifying scary thing I can imagine, as it never seems to get better, only worse”
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How does tinnitus make you feel?
“I find it easy to just ignore it at any time, it has never really bothered me.” “if I listen, then the noise is still there but I can ignore and forget about it.”
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“I get annoyed but not depressed with my tinnitus
“I get annoyed but not depressed with my tinnitus. When the hissing is very loud, it drives me mad a short while but otherwise I get on with it……But there are times I don`t think of it, as external noise blocks it out. Or your mind is otherwise occupied.”
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What makes the difference?
Only weak relationship between loudness and distress (eg Baskill and Coles, 1999, Ooms et al, 2012) More severely deaf may not be most affected (Tyler, 1995)
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Padesky & Mooney, 1990
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In other words….. “There is nothing either good or bad, but thinking makes it so.” Shakespeare: Hamlet, Act 2, Sc.2.
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See McKenna, Handscomb et al, 2014
Cognitive model of tinnitus distress See McKenna, Handscomb et al, 2014
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Attention drawn towards tinnitus all evening
Feeling sad, resentful “Tinnitus will stop me enjoying this evening out”
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Additional contributors:
Underlying beliefs: “tinnitus is the start of deafness”: Or “I can’t enjoy myself if I don’t feel 100%”
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Safety behaviour: Eg: avoiding events Constant background noise
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Distorted perception Tinnitus seems louder/ more prominent due to increased attention
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Evidence behind different components
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Negative Automatic Thoughts
Common negative thoughts are: “Why me? Why do I have to suffer this horrible noise?” “I can't enjoy what I'm doing because of the noise” “the noise will drive me crazy.” (Wilson and Henry, 1998: Tinnitus Cognitions Questionnaire)
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Catastrophizing correlated with more severe tinnitus distress/ lower QoL (Weise et al, 2013, Cima et al, 2011.)
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Unknown Do people with non bothersome tinnitus think positively, or not at all?
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Arousal and Distress In general population, tinnitus is a risk factor for anxiety/ depression (krog et al, 2010, Gopinath et al, 2010) Many people attending tinnitus clinics have anxiety/ depression (Marciano et al, 2003, Goebel & Floetzinger, 2008) But not all! Depression/ anxiety associated with more bothersome tinnitus (eg Wallhausser- Franke et al, 2012.)
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Arousal and Distress Intervention effects depression scores as well as tinnitus scores Much less known about ‘lower level’ distress (annoyance, irritability, unease….)
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Selective attention & monitoring
Some studies show differences in attention paid to tones/ tinnitus- like sounds ‘Inability to ignore’ tinnitus linked to greater annoyance (Hiller and Goebel, 2007) TVAQ (Cima et al, 2011) will investigate further….
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Safety Behaviour Some evidence of link between avoidance behaviour and tinnitus distress (Kleinstauber et al, 2013.) Beware! Well- intentioned advice may be counter- productive.
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Beliefs Control beliefs may influence tinnitus distress(Sirois et al, 2006.) These may apply more widely than just to tinnitus.
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Distorted perception Hard to demonstrate- what’s the ‘actual loudness’ of tinnitus? In several studies, tinnitus matched to low intensity tones (10dB)
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What can we do about it? Take out the lynchpin! Negative thinking
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How can we change our thoughts?
“Try not to think about it??” Cognitive Behavioural Therapy Mindfulness Sometimes, information Review of CBT studies shows effectiveness for tinnitus distress (Martinez- Devesa et al, 2010.)
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What can you do? Refer to tinnitus clinic Give information
Offer amplification Sound therapy
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Referring to a tinnitus clinic
Mostly NHS- based Access usually via ENT BTA has a list Not only most desperate Talk to us!
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Giving information False beliefs? Sources of information? Listen
Acknowledge distress Reassure
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Self- help recommendations
BTA- Book: Living with Tinnitus & Hyperacusis (Baguley, McKenna, McFerran) An online course:
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Amplification Usually helpful:
Davies et al, THQ scores reduced in pts fitted with NHS hg aids compared to controls (not randomised) Byrom & Thyer, large reductions (~40) in TFI scores post HA fitting in mild hg loss (not controlled) Larger mild hg loss study planned (NHBRU)
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How do hearing aids help?
Increased environmental sound Less ‘straining to hear’ Reduced stress?
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“I have found that when I wear my hearing aid I can almost forget the tinnitus.”
but “If I am offered a noticeable hearing aid I will probably have to turn it down and continue suffering”
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Hearing aid considerations
Consider in mild hg loss if bothersome tinnitus Avoid occlusion May be especially helpful in situations not involving communication
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Sound therapy Ear- worn sound generators show little benefit over counselling (McKenna and Irwin, review) Can become safety behaviour More benefit in hyperacusis? Night- time sound therapy may be beneficial (Handscomb, 2006) Many apps available
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Want to know more? Masterclass: Tinnitus and Hyperacusis in Adults and Children UCL Ear Institute, London 20th- 22nd January, 2015
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