Understanding Tinnitus | Symptoms to Solutions Expert Tips by Dr. (Major) Rajesh Bhardwaj #tinnitus

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TINNITUS MANAGEMENT PROTOCOL
• ENT Examination
• Audiogram
• Tinnitus matching and masking
• THI

TRT
• TRT is a method based on the neurophysiological model of Tinnitus and decreased sound tolerance, aimed at inducing and sustaining habituation of reactions and perceptions to intrusive Tinnitus and/or to external sounds- Jasterboff
Tinnitus retraining therapy is the use of a combination of low-level, broadband noise, and counseling for the patient to get habituated to Tinnitus. The overall objective is to divert their mind off Tinnitus. It involves training the nervous system to enhance the sound outside, making Tinnitus noise to be perceived as background noise, which
diminishes the jarring effect. It is also known as Acclimatization
therapy.

TRT
• The attempt in TRT is not to eliminate Tinnitus but to create ‘habituation of perception’, which is the weakening/ disappearance of functional connections between the auditory pathways and the limbic/ autonomic nervous system.
• Tinnitus will still be perceived but the patient is not bothered by it

MASKING DEVICES FOR TINNITUS
• Like Fighting Fire with Fire
• Being used as an effective treatment strategy since 1970
• Tinnitus is maskable in up to 95% of patients – (Tinnitus Clinic, Oregon)

TYPES OF WEARABLE TINNITUS MASKERS
• Hearing Aids – Mask by amplifying ambient noise causing inhibition of the Tinnitus
• Tinnitus maskers – generate white noise. They may have an adjustable frequency range which the patient can use to achieve maximum relief
• Tinnitus instruments are a combination of hearing aids and Tinnitus maskers within the same case. Each must have a different volume control for optimal adjustment of a patient’s Tinnitus as well as achieve maximum benefit in hearing.

The frequency range of patients’ hearing loss determines the choice of Masking device
• High-frequency hearing loss is the most common configuration
• Most Tinnitus is high-pitched- whistling, pressure cooker sound, etc.
• Many patients with pitched Tinnitus require high-frequency noise to mask their Tinnitus – this is usually at a range higher than what the usual hearing aid can provide

Tinnitus Masking
• It is possible to achieve Tinnitus masking at low levels of sound
• Patients with CI who continue to have troublesome Tinnitus may
benefit from masking via narrow band noises given selectively
• Pulsatile Tinnitus may be better masked by using headphones

SOUND ENRICHMENT
– Sound Enrichment is helpful if there is relief in Tinnitus by the audiologist
‘Never allow yourself to stay in a perfectly quiet room with nothing but your Tinnitus to listen to’.

SOUND ENRICHMENT
• relaxing, neutral sound—like ocean waves crashing, rain falling, white
noise or instrumental music—and playing it as background noise
throughout the day
• “The key is to not set volume levels so high that it drowns out the tinnitus sound. You really don’t want to mask it. The goal is to retrain the brain so you need to hear the tinnitus along with the sound that you’re playing in order to help the brain make that connection,”
• During the night as well

TRANSTYMPANIC MANAGEMENT OF TINNITUS
Largely two indications
• Tinnitus associated with Meniere’s Disease where Gentamycin is
injected
• Tinnitus associated with Sudden SNHL where an Intratympanic
Steroids would be injected
Cochlear Implantation for Tinnitus
Management
• Patients who experience preoperative tinnitus can benefit from either
unilateral or bilateral cochlear implantation.
• Improvements in the tinnitus perception score by more than 50%
• The meta-analysis revealed significant decreases in THI scores after
cochlear implantation in patients with different types of hearing loss
and at different lengths of follow-up
• There is a small risk of worsening Tinnitus after Implantation

CBT
• Cognitive-behavioral therapy (CBT) is a well-established psychotherapy based on the identification of maladaptive behaviors and their modification using therapist-mediated cognitive restructuring. The technique has been successfully applied to tinnitus for many years and forms the basis of another type of habituation therapy for tinnitus

CAM
Acupuncture,
Acupressure,
Homeopathy,
Naturopathy,
Temporomandibular joint (TMJ) manipulation
Nutritional programs,
Hypnosis, etc.
The results of these studies have been equivocal.
Herbal remedies – Ginkgo Biloba etc

TINNITUS MANAGEMENT- THE ESCALATION MATRIX
• Explanation and Reassurance. Education
• Medical Management
• TRT
• Sound Enrichment
• Tinnitus Masker
• IntraTympanic Injection
• Cochlear Implantation
• CBT
• CAM

Contact Us:
📍 Location: MedFirst ENT Centre, South Delhi
📞 Phone: +91 98711 50032, +91 92055 85295
📧 Email: entdelhi@gmail.com
🌐 Website: entdelhi.com
🕒 Timings: Monday – Saturday: 9 AM – 6:30 PM

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