A&E Audiology, Inc. is now offering the Neuromonics Tinnitus Treatment. If you are bothered by tinnitus you do not have to "live with it". With our comprehensive tinnitus services, we will do a thorough evaluation, determine if you are a candidate for treatment and then find ways to help you manage it. For more information on the Neuromonics Tinnitus Treatment visit their website at www.neuromonics.com!!! What is Tinnitus Tinnitus is the perception of sound described as: ringing, buzzing, humming, hissing or roaring when external noise is not present. It can also sound like chirping, clicking or crickets. Tinnitus can be constant or intermittent. Sometimes tinnitus can be very stressful for some people to the point of affecting their sleep and quality of life. Tinnitus may be mild or severe, and may vary from a low roaring sensation to a high-pitched type of sound. It may or may not be associated with a hearing loss. It is also classified further into subjective tinnitus (a noise perceived by the patient alone) or objective (a noise perceived by the patient as well as by another listener). Subjective tinnitus is common; however, objective tinnitus is relatively uncommon. The location of tinnitus may be in the ear(s) and/or in the head. Tinnitus is a symptom much like a headache, pain, temperature, hearing loss or vertigo. With tinnitus, the reported distress is usually subjective and difficult to record and appreciate by others. The quality of the tinnitus refers to the patient�s description of it. It may be a ringing, buzzing, cricket, ocean, etc., type of sound. The quality may be multiple sounds or a singular sound. Tinnitus may be produced in one or more locations, referred to as its site of lesion. The cause of tinnitus may be singular or multiple. A peripheral (i.e., auditory nerve or cochlea) site of lesion includes dysfunction established within the auditory system that extends up to but not involving the brainstem. A central site of lesion refers to involvement of the central auditory pathways beginning at the brainstem and involving other portions of the central nervous system. Tinnitus is, therefore, a symptom of neurotologic disease. It may occur with a hearing loss, vertigo or pressure symptoms in the ear or it may occur alone. Tinnitus must always be thought of as a symptom and not a disease, just as pain in the arm or leg is a symptom and not a disease. Because the function of the auditory (hearing) nerve is to carry sound, when it is irritated from any cause it produces head noise. This phenomenon is similar to the sensation nerves elsewhere. If one pinches the skin, it hurts because the nerves stimulated carry pain sensation. A complete cochleovestibular evaluation is necessary in all patients with severe disabling tinnitus. The test battery is used to attempt to establish the site of lesion and to rule out any significant pathology that may require further treatment. There are many causes just related to the ear that would result in tinnitus. Such things as simple earwax in the ear canal to other middle ear abnormalities may result in tinnitus. Otosclerosis (fixation of the stapes bone in the middle ear) can cause tinnitus as well as fluid in the middle ear. There are many other ear abnormalities that may cause tinnitus. A more common example would be Meniere's disease. Sudden trauma to the inner ear such as exposure to excessively loud sounds may result in tinnitus. Tumors on the hearing nerve or other problems in the brainstem or central nervous system may also cause tinnitus. In addition, other vascular abnormalities in the skull or base of the skull may result in tinnitus. Measurement of Tinnitus Since tinnitus often has high pitch, frequency judgments in this region normally are poor. Frequency discrimination up to approximately 16,000 Hz (which is the upper limit of hearing) is far less exacting than the middle frequency region. In addition, patients suffering from high-pitched tinnitus often have a high frequency hearing loss that may impair their frequency discrimination. Therefore, test-retest reliability in matching the frequencies of audiometer tones to the pitch of tinnitus may be poor. An attempt is occasionally made, however, to do pitch matching and loudness-matching. In addition, an attempt may be made to determine the mask ability of the tinnitus (which is unrelated to its loudness) and a determination of residual inhibition can be made (i.e. when tinnitus is temporarily reduced after a masking sound has been turned off; the reduction is termed "residual inhibition.") How Many People Have Tinnitus? According to the American Tinnitus Association over 50 million Americans are affected to some degree. Of these, about 12 million have tinnitus which is severe enough to seek medical attention. Of those, about two million patients are so seriously debilitated by their tinnitus, they cannot function on a "normal," day-to-day basis. What Causes Tinnitus? Tinnitus is often a symptom of hearing loss. Certain types and sites of lesions may also cause tinnitus. Tinnitus and Hearing Loss Chronic tinnitus is usually associated with some degree of hearing loss. 90% of the patients who come to our Tinnitus Clinic have at least some hearing loss. Below are questions commonly asked by tinnitus patients: Q: Does tinnitus cause hearing loss? A: No. In fact, the reverse is true: whatever caused a person to have hearing loss (including noise exposure, infections, aging or genetic factors) is also responsible for the generation of tinnitus. Q: Does tinnitus interfere with hearing? A: No, tinnitus does not interfere with hearing, although it may affect one?s attention span and concentration. On the other hand, tinnitus might seem louder if hearing loss increases (or if you wear ear plugs or ear muffs) because outside sounds will no longer reduce the perception of tinnitus. Q: Does cutting the hearing nerve cure tinnitus? A: Unfortunately, cutting the nerve does not relieve tinnitus often enough to recommend it as a treatment. However, it does produce total deafness in the operated ear, may cause balance problems, and in some cases can make tinnitus worse. Folmer, Robert L. Ph.D. A Patient's Guide to Tinnitus. Tinnitus Management and Treatment Generally, most patients will not need any medical treatment for their tinnitus. Patients who have hearing loss and tinnitus often find that their tinnitus is less bothersome or even gone completely when they wear hearing aids. The hearing aids provide an additional sound input that often in effect works to mask the tinnitus. Therefore, the hearing aids effectively can serve two functions- to help the patient hear well and to help relieve the patient of his/her tinnituts. For patients who are greatly bothered by tinnitus, they may use some masking techniques such as listening to a fan or radio that would mask some of their tinnitus. In addition, other sound source generators can be obtained and be adjusted to sound-like environmental sounds and this is also effective in masking tinnitus. This generally is more advantageous if one is attempting to go to sleep. A tinnitus masker is utilized in some patients. It is a small electronic instrument built into a hearing aid case. It generates a noise that prevents the wearer from hearing his own head noise. It is based on the principle that most individuals with tinnitus can better tolerate outside noise than they can their own inner head noise. Biofeedback training is effective in reducing the tinnitus in some patients. It consists of exercises in which the patient learns to control the various parts of the body and relax the muscles. When a patient is able to accomplish this type of relaxation, tinnitus generally subsides. Most patients have expressed that the biofeedback offers them better coping skills. Other measures to control tinnitus include making every attempt to avoid anxiety, as this will increase your tinnitus. You should make every attempt to obtain adequate rest and avoid over fatigue because generally patients who are tired seem to notice their tinnitus more. The use of nerve stimulants is to be avoided. Therefore, excessive amounts of coffee and smoking should be avoided. Tinnitus will not cause you to go deaf and statistically, 50 percent of patients may express that their tinnitus with time decreases or is hardly perceptible. There are other medications that have been utilized to suppress tinnitus. Some patients benefit with these drugs and others do not. Each patient has an individual response to medication, and what may work for one patient may not work for another. Some of these medications have been proven, however, to decrease the intensity of the tinnitus and make it much less noticeable to the patient. There is, however, no drug anywhere that will remove tinnitus completely and forever. There are some drugs that will also cause tinnitus. If you have tinnitus and are on medication, you should discuss the symptom of tinnitus with your physician. In many instances, once the drug is discontinued the tinnitus will no longer be present. Visit the American Tinnitus Association website for more information, ideas and strategies at www.ata.org Things to Avoid 1) Harmful Sounds -- Wear ear plugs or ear muffs as protection against loud sounds such as gunfire, gas lawn mowers, leaf blowers, chain saws, circular saws, other power tools and heavy machinery. Exposure to loud sounds can make tinnitus worse and can also cause additional hearing loss. 2) Excessive use of alcohol, caffeine, or aspirin -- However, moderate use of these products is usually O.K. 3) False claims about tinnitus "cures" or herbal "remedies." These do not exist for most cases of chronic tinnitus. Even though a true "cure" for most cases of chronic tinnitus is not yet available, patients can obtain relief from the symptom now with assistance from qualified and experienced clinicians. Folmer, Robert L. Ph.D. A Patient's Guide to Tinnitus. Please see the links below for related informational articles about tinnitus. The American Tinnitus Association: A Resource for Enhancing Tinnitus Patient Services Cheryl McGinnis, MBA, Executive Director of the American Tinnitus Association. There IS something you can do about tinnitus! Robert E. Sandlin, Ph. D., Adjunct Professor of Audiology, Private Practice, San Diego, CA & Robert J. Olsson, M. A. A Patient's Guide to Tinnitus Robert L. Folmer, Ph.D. Managing Chronic Tinnitus As Phantom Auditory Pain Robert L. Folmer, Ph. D., Assistant Professor of Otolaryngology, Oregon Health Sciences University, Portland, OR Tinnitus: It Has a Certain Ring to It Robert E. Sandlin, Ph. D., Adjunct Professor of Audiology, Private Practice, San Diego, CA & Robert J. Olsson, M. A.	A&E Audiology, Inc. Lititz 1555 Highlands Dr. Suite 101 Lititz, Pa 17543 Phone: 717.627.HEAR (4327) Fax: 717.627.2690 A&E Audiology, Inc. Willow Street 226 Willow Valley Lakes Dr. Suite D Willow Street, PA 17584 Phone: 717.464.2144 Fax: 717.464.4255
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