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Hearing Conditions

Tinnitus Patients

How Tinnitus Treatment Works

Tinnitus is very common and affects millions of people around the world. Tinnitus is a phantom auditory perception and this auditory sensation is not related to an external sound.

Although there is no cure for tinnitus, patients can successfully learn to manage their tinnitus thus limiting emotional effects.

Because each person’s hearing thresholds and tinnitus characteristics are different, they require a tinnitus assessment and hearing test to help in the identification of the auditory, limbic and neural pathways which may contribute to the problems with their tinnitus.

After assessment the most appropriate tinnitus treatment strategy and management is recommended and if the patient agrees to proceed, the treatment techniques used are designed to interact, interrupt and desensitise their tinnitus and give long term relief.

The clinical goal is to have the patient feel more relaxed and reduce the impact of tinnitus on their lives.

 

Tinnitus Treatment and Management:

  • Targets the neurological, audiological and psychological aspects of the patient’s tinnitus.
  • Management is customised to the patients individual tinnitus and hearing profile.
  • Treatment is comprehensive and non–invasive.
  • Treatment is aimed at retraining or reversing the connections between
  • the auditory, limbic and autonomic nervous system to achieve change.
  • Management is monitored by Attune specialist audiologists.

Even when tinnitus is no longer an issue for a patient, they will generally report being aware of tinnitus a small percentage of the time. However, they will also report that tinnitus is no longer a major disturbance in their life.

 

Possible Causes for Tinnitus

There are many potential causes of tinnitus making each individual case unique. An undiagnosed medical problem exposure to loud noise, ear problems, viral infections, some drugs and hearing loss may contribute to the patient’s tinnitus.

While tinnitus typically begins with a hearing loss (59 to 86% of tinnitus sufferers also experience some form of hearing loss (Jastreboff 2004), it is not exclusively an auditory problem. As tinnitus is a cycle of audiological, neurological and psychological factors, a multifaceted approach is required to manage and treat tinnitus awareness and disturbance. The Attune program targets all aspects of the patient’s tinnitus and the impact on their quality of life.

 

If your patient has one or more of the following, they may be suitable for Tinnitus Treatment:

  • Tinnitus with or without associated hearing loss.
  • Experiencing sleep disturbance due to tinnitus. ƒ Finding it hard to relax due to tinnitus.
  • They feel their tinnitus is out of control.
  • They feel their tinnitus is interfering with their ability to hear. ƒ Sensitive to moderate or loud sounds.
  • Tinnitus is still disturbing after hearing aid fitting.

 

What are the treatment steps?

Step 1. Tinnitus and hearing assessment by Attune specialist audiologist.

Step 2. Explanation of the auditory and neurological pathways relevant in understanding tinnitus.

Step 3. Appropriate Tinnitus Management model recommended.

 

Recruitment? Hyperacusis? Phonophoba?

Should your patient at any time report the following a diagnostic hearing test (PTA) should be performed.

At times the following are associated with tinnitus. Pure Tone Audiometry (PTA) is recommended.

Recruitment is when a patient with a hearing loss perceives sounds as “getting too loud too fast” or being louder than they really are to the point of discomfort. Recruitment is always a consequence of a sensorineural hearing loss.

Hyperacusis is the super-sensitivity to normal sounds and may be associated with a hearing loss. Often found in children.

Phonophobia is the fear of normal sounds resulting in super-sensitivity to them.

  • Tinnitus is common.
  • Tinnitus affects 20% of the general population.
  • Over the age of 55 the incidence of tinnitus increases to over 30%. ƒ 1 -2 % of people are severely affected.

 

Allow your patient to take control of their tinnitus today.

Attune Hearing audiologists will help your patient choose the most appropriate treatment management for your tinnitus. Contact us today.

 

Help for Dizzy Patients

Vertigo Assessment and Investigation Guide

Vertigo, the subjective sensation of movement, is a symptom that patients are usually quite poor at describing. Dizziness, imbalance, spinning and vertigo are common complaints and assessing who should be investigated and in what manner is determined predominantly by history. Balance homeostasis is co-ordinated by the brain with major inputs from the ears, eyes and lesser input from, particularly cervical, proprioception. Upsets in any of these areas can result in balance symptoms.

The history should include questions regarding the frequency, duration, severity, aggravating factors, relieving factors and nature of the balance symptoms and also questioning regarding accompanying symptoms. Associated symptoms that should be enquired about include headache, cardiac symptoms, visual symptoms, major neurological symptoms, neck symptoms and otological symptoms. Past medical history, particularly cardiovascular risk factors, headache and travel sickness history and family history of cardiovascular and migraine should be included. Current drug history is obviously important. Past ototoxic history may be important.

The major aim is to identify rapidly patients who have vertigo due to brain hypo-perfusion, be it due to cardiac problems or ischaemicevents. A delay in diagnosing a vestibular cause of vertigo is usually of little consequence, while a delay in diagnosing a cardiac or neurological cause can result in a catastrophic event. Posterior fossa ischaemia can be difficult to detect and relatively clinically silent.

The common ENT diagnoses are labyrinthitis and benign paroxysmal positional. Meniere’s disease is less common and often the more common vestibular migraine is misdiagnosed as Meniere’s disease.

Neuro-otological examination should include assessment of cerebellar function, ocular movements and vestibular function. It should include head impulse tests, Rhomberg’s tests, Unterberger’s tests and Dix Hallpike tests. Full cranial nerve and long tract assessments should be done.

Tests of hearing and balance can be performed by Attune to aid in diagnosis when needed. An audiogram is a good screen for cochlear disease. Electronystagmography (ENG) including video-oculography (VNG) and calorics can give information on central and peripheral causes of vertigo. ECoG is only occasionally useful in Meniere’s patients. Imaging should be ordered in patients who historically are at risk of posterior fossa ischaemia. Non-contrasted CT scans of the head can miss posterior circulation problems.

 

When to refer a dizzy patient

Vertigo – hearing loss, fullness, tinnitus, drop attacks, nausea, vomiting

Lightheaded – Patient reports feeling like they’re about to pass out

Unsteadiness – Patient reports constant dizzy feeling

If your patient is exhibiting these symptoms frequently, we recommend an assessment by an Attune hearing audiologist.

 

Children with Speech, Hearing or Learning Difficulties

When to refer for a Paediatric Hearing Test

  • Speaks loudly or whispers.
  • Speech development stops or slows.
  • Little or no babbling.
  • Appears inattentive, restless or expresses some behavioural problems. ƒ Doesn’t respond to speech from behind or soft speech.
  • Learning difficulties.
  • Pulls at their ears (may be a sign of ear infection).

 

What test to refer

Hearing Test for infants (birth to 13 months) or Hearing Test for young children (13 months to 4 years).

 

Management

Attune recommends intervention for children over 3 months with middle ear problems that persist. This can be determined by clinical assessment. Attune will repeat the audiometry if required.

If there is a possible sensorineural hearing loss (permanent) referral to Attune for diagnostic audiometry and to ENT for medical investigation is recommended.

 

When to refer for a (Central) Auditory Processing Disorder (C)APD

  • Has trouble paying attention and remembering information presented orally.
  • Has low academic performance particularly in reading and spelling.
  • Has difficulties understanding speech in the presence of any background noise.
  • Has problems carrying out multi-step directions.
  • Seems to hear but not understand what people say.
  • Needs more time to process information.
  • Has difficulty with sound direction and localisation.

 

Central Auditory Processing Disorder (C)APD Assessment

The (C)APD assessment will assess the various auditory skills in the (C)APD system including:

  • Auditory closure skills.
  • Auditory integration skills.
  • Auditory separation skills.
  • Temporal aspects of processing information.
  • Auditory interaction skills.

 

Management

Ideally the management of (C)APD involves a team of professionals (eg. audiologists, speech pathologists, educational psychologists, learning support teachers, paediatricians, occupational therapists), with the amount of each member’s involvement dependent on the specific needs of the child. The management of the (C)APD focuses largely on the implementation of various strategies to maximise existing listening skills, and to encourage the development of new skills.

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