Answers to frequently asked questions about tinnitus


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  • What is tinnitus?


    Tinnitus is the perception of noises in the ear which correspond to no acoustic signal in the environment. The buzzing, ringing, tinnitus is the perception by the individual of noises or sounds which do not come from the outside, but are produced by the patient himself/herself.

    Tinnitus corresponds to the buzzing or hissing sounds heard in one or two ears, or in the head, in the absence of any sound source in the surrounding environment.

    The sounds heard can be various natures: low tone pure sounds (buzzing), high-pitched (hissing), continuous or pulsatile, etc.... However, the sounds perceived by the subject are mostly complex and can be similar, for example, to the sound of a bell, hissing, a steam noise, an engine, a grating, a cicada/cricket sound.

    organe-auditif-enThe tinnitus is not strictly speaking an auditory hallucination (AH). It can be distinguished from AH by the rudimentary contents of the noises heard (pure sounds or more or less wide-band frequency noises devoid of sense or direction) and by the fact that the patient is aware that they originate from his/her own body.

    It results from the production of an abnormal neural signal at a particular level of the auditory pathways which, after being processed by such pathways, is interpreted as a noise when it reaches the auditory cortex.

    mal-oreilleGiven that there is no external source of noise, the sound received is an auditory hallucination created by a reorganization at the level of the cerebral cortex following the loss of auditory acuteness in the frequency of the tinnitus. That is why people who suffer from tinnitus avoid speaking about it too much for fear of being taken for hallucinating persons!

    The persons who suffer from it hear a ghost noise produced by the part of the brain which is not stimulated by the usual noises at frequencies which one does not hear any more, given the loss of auditory acuteness in the zone corresponding to the frequencies of the tinnitus.

    Regarding the origin of tinnitus, the theory that is most widely recognized is the existence of an external hair cell lesion. In particular, an alteration in the stereohairs attached to the external hair cells would induce the uncoupling of the tectorial membrane. This would lead to a hyperexcitability of the auditory nerve because of the excessive release of glutamate, which would be at the origin of the perceived sounds. A sound trauma can therefore lead to a lesion of the IHC which is visible with the use of electronic microscopy.

    irm-acoupheneMRI Scan showing TinnitusMRI (Magnetic resonance imaging) shows clearly this abnormality (see the illustration). Currently, it is well-established that chronic tinnitus is associated with an increase in the activity of the temporo-parietal cerebral cortex.

    There are two forms of tinnitus:
    1. Objective tinnitus refers to the few cases in which the noises heard result either from vascular abnormalities or from abnormal contractions of the muscles of the O.R.L . sphere, or from structural defects of the internal ear.
    2. Subjective tinnitus mostly originates from any level of the auditory pathways, from the external conduit of the ear up to the brain.




    FIGURES
    • Worldwide prevalence would be 10 to 17 % of the population which would be affected
    • 44 million Americans suffer from it among which 12 millions are severe cases;
    • Canadian Tinnitus Association considers more than 5 million cases;
    • One young person in five faces risks of deafness because of the noise and, because of the lack of large-scale epidemiological studies, it is difficult to quote figures. It is considered that 10 % and 20 % of them are hearing-impaired. But it would be necessary to add to these figures the young people suffering from tinnitus and from hyperacousis.



  • What causes tinnitus?


    There are many causes of tinnitus. In about half the cases, tinnitus is connected with hearing loss, but it is also caused by frequent or sudden exposure to loud noise, by some medications, by head injuries or frequently for no apparent reason.

    mecanisme-causes-acouphene-enSome of the causes are well known and some others unclear. It is about a symptom and not about a pathology with diverse sources. The causes can be associated with various affections: disorders of the external ear, of the middle ear and\or the internal ear, Meniere syndrome, acoustic neuroma, cranial trauma, high blood pressure, endocrine disorders, etc.

    Certain Known Causes:
    • Sudden Deafness
    • Auditory Trauma (concert, limps at night, firecracker, fireworks)
    • Hearing Loss
    • Cranial trauma (particularly after fractures)
    • Neurinome and tumor of the ponto-cerebellar angle
    • Medicines and drugs (aspirin, diuretics, aminoglycosides, quinine)
    • Cervical and mandibulary problems
    • Dental problems
    • Chronic Infections
    • Otosclerosis
    • Ménière Disease (or dizziness)
    • High Blood Pressure Hypertension
    • Severe Anaemia and Renal Insufficiency
    • Borréliose
    • Stress or depression



  • What are the origins of tinnitus?


    TINNITUS HAS DIVERSE ORIGINS

    AT THE LEVEL OF THE HEARING SYSTEM: the presence of earwax attached to the eardrum, presbyacousis, otospongiose, Meniere disease, acoustic neurinome, chroni otitis, cholesteatome, abrupt deafness, fracture of the rock;

    It appears essentially in the second part of life, after 60 years. Indeed, it often accompanies the hearing loss on high frequencies related to aging ( presbyacousis ), but also the hearing loss related to exposure to noise of professional origin (toleries, boilermaking, tailings(spinnings), orchestras) or during leisure activities (hunting, shooting (firing), concerts and orchestrate rock, mp3 players). The misuse of personal stereos and the non compliance with the legislation concerning the sound levels in theaters (cinemas, concert halls, discotheques) are at the origin of the development of a premature aging of the hearing system.

    AT THE VASCULAR LEVEL: vascular problems (reduced bloodflow, modified blood crase) are often incriminated as far as they can intervene at every level of the peripheral and\or central auditory pathway, without underestimating its implication on the nervous system in general.

    AT THE METABOLIC LEVEL: health problems such as diabetes, high blood pressure, high cholesterol level, high uric acid... oestrogen-progesterone hormonal disorders, thyroid disorders.

    Certain medications may cause tinnitus in certain individuals.
    Ototoxic medications: certain antibiotics (especially those of the class of aminosides administered intravenously for treatment of systematic or generalized infections), diuretics, anti-paludism medicines (against malaria), anti-cancerous medications and certain analgesics (salicylates such as aspirin) indicate in their product description the risk of toxicity for the ear as a side effect.

    Nutrition can also have an incidence on tinnitus, for instance: excessive consumption of caffeine, alcohol, drugs, spicy products, etc.

    We shall also note that the psychological factors(stress, anxiety, disturbing emotional event, depression) can influence, stress, or even reveal tinnitus. The disturbance caused by the tinnitus is not necessarily related to its intensity but rather to the perception felt by the individual towards this unwanted and sometimes so tenacious noise.

    Neuropsychology teaches us that stimulus sounds that are new or associated with a negative experience are treated as significant sounds and evoke an emotional response which prepares the body for a reaction of flight or confrontation. The repetition of these sounds is translated by an intensification of their perception and a resistance to their suppression by other stimuli.

    In contrast, the repetition of neutral signals is accompanied with the progressive fading of the induced responses, which corresponds to the phenomenon of habituation.

    The outcome of a tinnitus devoid of emotional meaning for the subject is thus the habituation.

    Balance Disorders
    One-sided or bilateral vestibular dysfunctions, Meniere disease, gentamicine-induced ototoxicity, vestibular neuronite or the labirynthitis are part of the causes of balance disorders.

    Balance disorder or what we call the "cerebellar syndrome" is so caused by a damage to the cerebellum or to parts that also contribute to the control of balance such as the internal ear. Several factors allow the detection of a balance disorder.


  • What is hyperacusis?


    Hyperacusis is defined as a collapsed tolerance to normal environmental sounds. It is a rare hearing disorder whereby a person becomes highly sensitive to noise. Sometimes people think they have hyperacusis because they are bothered by loud sounds like music, heavy equipment or sirens.

    Hyperacousis is a dysfunction of the hearing of the internal organ which perceives this sound. The individual has no finer hearing, but perceives noises much more hardly, which sometimes forces such patients to isolate themselves to avoid the noise.

    It is a rare affection. The affected persons have perfectly normal hearing, but their level of tolerance to sounds is reduced for certain sounds or sound levels which are not nevertheless recognized by the others as specially strong or unpleasant. The exposure to these sounds causes pain or tinnitusto the hyperacousic individuals, and they can be unbearable and last more or less for a long time. In contrast to a common thinking, if a hyperacousic person is forced to expose himself/herself to the sound that make him/her suffer, instead of protecting himself/herself from it, his/her hyperacousis aggravates. Some extreme cases exist.


  • What is Meniere's Disease?


    Meniere's is a very serious disease of the inner ear, resulting in extended vertigo attacks, major hearing loss, and frequent tinnitus


  • What does classic medicine propose?


    If you have already consulted a professional in regard to your tinnitus, you may have noticed that not all the symptoms are taken into account by the medical profession. The classic medicinal treatments limit themselves to vasodilators, peripheral oxygenators and to anxiolytics, all of which offer variable results and can offer precious help, in particular in the first months which follow the appearance of the first symptoms.


  • What is auditory prosthesis and TRT?


    Auditory Prosthesis - Sound Masking works on the generated noises, (specialists call white noise) the aim is to mask these noises which will ultimately stop tinnitus. The equipment called TRT (Trinitus Retraining Therapy) aims at inducing in the patient a signal to mask the tinnitus in an incomplete way. Its effectiveness is relative. In our approach, the signal which we propose is determined on the basis of a preliminary measure of the precise shape of the hearing loss of the subject.


  • Why use the behavioral therapies?


    The behavioral cognitive therapy (CBT) is a powerful tool of reprogramming the cerebral cortex. In 70 % of cases it decreases the annoyances experienced with tinnitus.


  • How do you choose the appropriate treatments?


    We study your audiogram and the acoustic profile of your tinnitus in detail. We elaborate the diverse acoustic signals and produce an acoustic image. These signals are transferred on to an IPod Nano. You will need to listen to the signals repeatedly for 2 to 3 hours a day for 10 weeks. This will reduce gradually the intensity of the tinnitus as its starts to diffuse and become less focused. We insist on the understanding that there is no cure for tinnitus or hyperacousis. The degree of relief varies among patients.


  • What if the noises persist after 10 weeks of treatment?


    This approach does not promise a guaranteed relief for all patients. At the post-treatment evaluation, solutions can be proposed.


  • Can the acoustic treatment aggravate my tinnitus?


    There is a great deal of factors which exacerbate tinnitus. A few examples include: coffee, alcohol, lack of sleep, noise, stress, there are no treatments without risk. We insist with all clients that they stop listening if they have the slightest escalation and call us. It is a risk that is worth taking given the lack of therapeutic alternatives.


  • What role does my attitude play in the treatment?


    It plays a major role. You have to approach the tinnitus treatment philosophically, stoically, patiently, knowing that it will disappear in the long run or at least, it will become so weak it will not disturb you any more. The paradox is that, the more you try diligently, the more you will hear it. It is what we have to keep in mind. In fact, it is better to keep nothing in mind at all, because it is exactly the opposite which will activate it.


  • Why do we say that it is necessary to manage one's stress?


    It is well known, stress is an aggravating factor - even causal - of cardiovascular or immunizing disorders. If we consider that tinnitus is symptomatic of a health problem, we understand the importance of a good management of stress as a precautionary measure. Given that arteriosclerosis and high blood pressure are often at the origin of tinnitus, it is certain that the regular practice of cardiovascular exercises will have a preventive effect.


  • What about prevention?


    Avoid exposing yourself to loud noises or above average volumes of noise. If necessary, use earplugs at work - when one works with certain noisy tools, etc., use earplugs on the plane, during a rock concert etc. It has been observed there was a certain correlation between the risk of contracting a mild tumor of the ear (in the vestibular region) and the increased use of cellular phones. This remains a controversy within the medical community. However, this type of tumor is a cause of tinnitus.




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