Tinnitus Patient Management - Massachusetts Academy of

115 Pages·2012·1.58 MB·English

Tinnitus Patient Management
Robert W. Sweetow, Ph.D.
University of California, San Francisco
San Francisco, California
[email protected]
Tinnitus Facts
• Approximately 15% of the world’s
population has tinnitus.
• More than 70% of hearing impaired
individuals have had tinnitus at some point
• 80-90% of tinnitus patients have some
evidence of hearing loss
• 10 - 20% of tinnitus sufferers seek medical
attention
Debilitating tinnitus
Population of
all people
who
experience
chronic
tinnitus
Progressively
more severe
tinnitus problems
Only education needed
Non-bothersome tinnitus
Dobie, 2004
Most common difficulties
attributed to tinnitus
• Sleep • Annoyance,
irritation, stress
• Persistence
• Speech • Concentration,
understanding confusion
• Despair,
• Drug
frustration,
dependence
depression
• Pain/headaches
Tyler and Baker, 1983
• Subjective tinnitus
idiopathic
sensory
neural
central
• Objective tinnitus
vascular
muscular
Some outer and middle ear

pathologies associated with tinnitus

cholesteotoma mastoiditis

otosclerosis otitis media
impacted cerumen allergies
palatal myoclonus head/ear trauma
patulous eustachian tube
glomus jugulare tumor
abnormal middle ear resonance
Some inner ear
pathologies associated with tinnitus
acoustic trauma presbycusis
noise exposure meniere’s disease
labyrinthitis acoustic neuroma
head/ear trauma ototoxicity
meningitis perilymph fistula
autoimmune inner ear disease
vestibular schwannoma
sudden hearing loss
Figure 2. Incidence of tinnitus by age group.

Kochkin et al, 2012
Tinnitus and Hearing Loss
Odds of Having Tinnitus
0 5 10 15 20 25 30
10-19 dB
20-29 dB
30-39 dB
40-49 dB
HL at 4k Hz
50-59 dB
60-69 dB
70-79 dB
> 80 dB
Correlation between tinnitus
severity and auditory threshold
Tinnitus symptom severity and best
hearing threshold
80

ta 70

d
lo 60
h
s
e x 50
r a
h m
t Q 40
g
n E
ir R 30
a F
e
h 20

t
s
e 10
B
0
0 20 40 60 80 100 120
Tinnitus Handicap Inventory Score
Tsai, Cheung, and
Sweetow, 2007