Tinnitus and Hyperacusis
- Comprehensive hearing assessment (1.5 hours) which helps to identify changes in the auditory system that can lead to tinnitus. If a possible underlying medical cause is identified, our audiologist will make an appropriate referral to have it further investigated by an otolaryngologist. If specialized tinnitus services are recommended, you will be referred to one of our audiologists who are specially trained in tinnitus services.
- Initial Tinnitus Consultation (1.5 hours): consists of tinnitus screening an educational PowerPoint presentation, and an overview of current treatment approaches and management strategies.
- Tinnitus Retraining Therapy (TRT): TRT is an extensive treatment program carried out over a course of several sessions, and can be provided in conjunction with psychotherapy, cognitive behavioural therapy, and other stress reduction approaches. It consists of a comprehensive tinnitus evaluation, detailed educational counselling and in a process of shared decision making, treatment goals are established and appropriate techniques selected.
What is Tinnitus?
Tinnitus is an involuntary perception of sound, sometimes heard as ringing, popping, or buzzing that is not present in the environment yet can be heard in the ears or the head. Some people may report a steady sound while others experience fluctuations in the sound’s quality or perceived loudness. If you are experiencing tinnitus, know that you are not alone. Tinnitus is very common. According to a recent analysis of Canadian data from Statistics Canada Health Report1, 9.2 million adult Canadians (37% of the population) experienced tinnitus in the past year, of which 1.7 million (7% of the population) reported it as bothersome.
What Can Cause Tinnitus?
The most common causes of tinnitus are hearing loss and noise exposure. However, other risk factors can include:
- Wax in the ear(s)
- Middle and inner ear disorders
- Head, neck and jaw issues
- Whiplash injuries
- Muscle spasms
- Some medications
- Some medical conditions such as otosclerosis or a benign growth on the auditory nerve
What To Do If You Experience Tinnitus?
- Most people who experience tinnitus can easily habituate to it, which means that they learn to view it in the same neutral way as when they listen to a constant sound of a refrigerator or air conditioning in their home. Some, however, can find it bothersome and intrusive and will experience reduced enjoyment of life because of it.
- Audiologists are one of the best trained professionals to address tinnitus because of their extensive knowledge of the auditory system, auditory disorders, hearing loss treatment and hearing conservation.
- It is important to remember that tinnitus is a symptom, not a disease, therefore it does not require a cure; however, when it is perceived as bothersome by an individual it requires therapeutic intervention. There are several evidence-based approaches available to successfully manage tinnitus symptoms.
What Are Hyperacusis and Decreased Sound Tolerance?
Hyperacusis is a form of decreased sound tolerance. Hyperacusis occurs when everyday sounds that most people can tolerate comfortably or consider only as slightly loud are perceived to be uncomfortably loud and at times even painful.
Another form of decreased sound tolerance is misophonia. It is defined as a strong dislike of specific sounds (such as: the sound of someone chewing, copy machine, certain voices, running water etc.). Phonobia is a form of misophonia with fear as the dominant emotion. Intolerance for these sounds may develop when people view them as invasion of their personal space.
Currently, we do not offer treatment for misophonia or phonophobia; however, we can offer reliable referral sources, if needed.
What Can Cause Hyperacusis?
- Hearing loss and/or tinnitus
- Noise exposure (this can include a sudden noise or long-term noise exposure)
- Temporomandibular joint (TMJ) syndrome
- Viral infections that involve the inner ear such as Bell’s Palsy
- Head injury
- Associated with developmental disorders in children, such as William’s Syndrome and Autism Spectrum Disorder (ASD)
- Lyme disease
- Air bag deployment
- Psychological issues – for instance post-traumatic stress disorder (PTSD) or depression
- Chronic conditions such as migraine, fibromyalgia, fatigue
How to Manage Hyperacusis?
- A successful treatment involves counselling and sound therapy over a few months to a year.
- Sound-generating devices that produce a gentle white noise at a soft but comfortable level are encouraged for almost all waking hours.
- Entire therapy to improve sound tolerance requires patience and commitment.
- Thought adjustment therapies can help address maladaptive or negative thoughts.
- Use of appropriately attenuated noise reduction plugs should be discussed with an audiologist when noise exposure is present. Overuse of hearing protection is discouraged.
- No medications or surgical treatments exist to help with hyperacusis.
Components of Our Tinnitus and Decreased Sound Tolerance Program
- The first step to treatment is a comprehensive hearing assessment (1.5 hours) which helps to identify changes in the auditory system that can lead to tinnitus.
- If a possible underlying medical cause is identified, an audiologist will make an appropriate referral to have it further investigated by an otolaryngologist.
- The next step is the Initial Tinnitus Consultation (1.5 hours) where you will receive a tinnitus evaluation, an educational PowerPoint presentation, an overview of current treatment approaches and management strategies.
- If necessary, you may be referred for Tinnitus Retraining Therapy (TRT) which is a more extensive treatment program. TRT can be offered in conjunction with psychotherapy, cognitive behavioural therapy, and other stress reduction approaches. In a process of shared decision making, treatment goals are established and appropriate techniques selected. These may include sound therapy, thought adjustment therapy, stress reduction techniques and self-help strategies.
What is Tinnitus Retraining Therapy?
Tinnitus Retraining Therapy (TRT) is an approach to treating tinnitus based on the Neurophysiological Model of Tinnitus, developed by Dr. Pawel Jastreboff in the 1980s.
According to this model the exact causes of tinnitus are not important in its treatment. Once you start experiencing tinnitus, your brain activates a strong subconscious connection between an auditory system responsible for hearing and other brain areas, particularly the limbic system, responsible for an emotional response to sound, and the autonomic nervous system, which controls your body’s reaction to a perceived danger. These brain areas increase your attention to tinnitus, which in turn causes you to hear your tinnitus more, and can trigger strong reactions to it, such as annoyance or anxiety. This is known as a subconscious feedback loop and it explains why in some people tinnitus can be persistent and bothersome.
According to Dr. Jastreboff, tinnitus is a normal compensatory activity of our brain and as such “it is not a problem; it’s the reaction to the tinnitus that is a problem.” Because your reaction to tinnitus is a subconscious reflex, the only way to treat tinnitus is to break the feedback loop by reclassifying tinnitus to a neutral sound. When your brain no longer perceives tinnitus as threatening or annoying, it no longer gives it attention and importance, and even if you continue to hear it, it is no longer bothersome. This process is called habituation.
In order to reach habituation, audiologists provide a therapy based on a combination of extensive educational counselling and consistent use of sound enrichment. TRT supports the use of a partial masking sound that is pleasant to listen to, neutral enough as not to be too engaging, but able to provide relief from tinnitus.
Outline of TRT treatment:
- Initial consultation, medical history, questionnaires
- Prior medical consultation with an otolaryngologist is required
- Audiologic evaluation and tinnitus evaluation
- Extensive tinnitus counselling
- Ongoing sound therapy
- Goal setting and progress assessment
TRT is appropriate for all types of tinnitus regardless of its causes. It has been used by many clinicians as a complete method or its elements can be utilized in combination with other approaches. In majority of cases, TRT successfully diminishes the distress caused by tinnitus and provides quality of life improvement. While there are no negative side effects, there is no guarantee that this treatment will work for every person. Treatment usually reaches clinical effectiveness after at least 9 months of therapy. Full treatment is typically achieved in 18-24 months. The success of this treatment will depend on your commitment to prescribed protocol, consistent use of sound therapy and adherence to the required timeline.
- Ramage-Morin, P. et al. (2019, March). Tinnitus in Canada. Statistics Canada. Catalogue no.82-003-X. Health Reports. Vol.30. no.3. pp. 3-11. doi: https://www.doi.org/10.25318/82-003-x201900300001-eng
- Han BI, Lee HW, Kim TY, Lim JS, Shin KS. Tinnitus: Characteristics, causes, mechanisms, and treatments. Journal of Clinical Neurology2009; 5(1):11-19.
- Westcott, M. Middle Ear Myoclonus and Tensor Tympani Syndrome. DWM Audiology. Retrieved from: www.dwmaudiology.com.au.
- Jastreboff, P. & Jastreboff, M. (2002). Decreased sound tolerance and tinnitus retraining therapy. Australian and New Zealand Journal of Audiology. 24. No.2. pp. 74-84.
Best On-Line Resources
Hyperacusis Research: www.hyperacusisresearch.org
Canadian Academy of Audiology: https://caatinnitus.weebly.com/
British Tinnitus Association: https://www.tinnitus.org.uk/
American Tinnitus Association: www.ata.org
Ida Institute Tinnitus First Aid kit: www.tinnituskit.com