Tinnitus

What is Tinnitus:

Tinnitus is defined as the perception of noise or sounds in the head or ears in the absence of an actual stimulus. Tinnitus is associated with many different medical pathologies, including hearing loss, acoustic trauma, closed head injury, disease processes, etc.

What Treatments Do We Offer

You will be provided with the most applicable treatment options for your situation at the time of the evaluation. The two more popular treatment methods in the world today include Tinnitus Retraining Therapy (using ear-level sound equipment of various types) and Neuromonics Oasis Retraining Program (using neural stimuli mixed with filtered music tones). Other potential approaches include Environmental Sound Sculpting, Widex Zen Tinnitus Hearing Aids, Siemen’s Micon Tinnitus Hearing Aids, and maskers. We also adapt iPods, iPads, and iPhones to help stream sound therapy into ear-level units. Finally we provide a full line of sleep aids from SleepPhones, a patented soft and flexible headband that creates an ideal sleeping or relaxing environment. Some of the treatments are covered by insurance, others are not and must be paid out of pocket. We also provide the services of our onsite CBT counselor, Ms. Anita Vinson, M.Ed., LPC, who is available to work with you in the clinic.

What to Expect from a Evaluation

Goal: Audiologist Dr. Marsha Johnson will evaluate your medical history, symptoms both subjective and objective, the degree of distress associated with the tinnitus, and perform a complete tinnitus evaluation in the sound booth and with other assessment equipment to determine the state of the auditory system including hearing, middle ear function, and more. Generally initial evaluations require 60-90 minutes, depending on the severity of the case and contributing factors.

What to Bring

Please bring current insurance information including all contacts and phone numbers for medical providers, vocational rehabilitation case workers, worker’s compensation agents, or insurance agents and claim numbers for accidents. Many people find it helpful to type up a list of current medications and bring this to the appointment for review; drugs can add to or create tinnitus. Also please obtain and bring any previous hearing tests or auditory test results performed in the previous five years. You can obtain these copies by contacting your providers and asking for copies to be sent to your home. We only need the audiograms or other hearing tests.

Testing/Assessment

You will be asked to complete a sound-treated booth evaluation including auditory thresholds, tinnitus matching evaluation for pitch and volume, LDL (loudness discomfort test), and possibly other tests. You will be tested using tympanometry to assess middle ear function and eardrum health. You may be tested using Otoacoustic Emissions equipment to check the cochlear cell function. We may also include other tests as deemed necessary to assess the function of the outer, middle, and inner auditory systems. The tinnitus will be masked using narrowband noise to determine its tractability and potential value in particular treatment program options. The testing is comfortable and pain free, no one should worry about the testing prior to the visit, we are highly trained in acquiring very good results with a minimum of discomfort and we will take very good care of you in our clinic.

Who to Bring

It is often good to bring a friend or family member to the appointments, who can help with listening and remembering what is discussed. Tinnitus patients are often sleep deprived, anxious, and overwhelmed and memory can be impaired.

Results/Reports

You will be presented with the results of the assessment and interview, and provided with clear explanations as to the most likely origin of the tinnitus, if possible, and how a particular treatment might work to improve your situation. Depending on your situation, a brief report or an extensive one will be created to meet your needs (medical, legal or personal). If requested, we will provide these reports to your medical providers, attorneys, insurance agents or counselors.

History of Tinnitus

Elizabeth Willingham, M.D., July 22, 2004

The first written account of medical treatment of tinnitus is all the way back to the Egyptians. For the bewitched ear and humming in the ears, they would infuse oil, frankincense, tree sap, herbs, and soil; and they would administer it via a reed stalk that they put in the external ear. The Mesopotamians documented on clay tilework their rituals and chants, and they used to chant to get rid of the whispering or singing in the ears. These are two of the chants. “Whoever thou may be, may E restrain me.” This is E depicted in the figure. He was the god of water. The other incantation was, “It hath flown against me. It hath attacked me. O seven heavens, seven earths, seven winds, seven fires, by heaven be ye exorcised.” I do not think they worked.

Early Greco-Roman medicine defined the treatment of tinnitus based on the cause of the disease, so they were the first to really try to relate the two. If it stemmed from a cold, then the ear should be cleaned and the breath held until some humor froths out from it. If the tinnitus stems from the head, then exercise, rubbing, and gargling should be carried out, as well as dieting and placing radish, cucumber juice, honey, and vinegar in the ear. Later, the works of Hippocrates and Aristotle really were the first to introduce the idea of masking. They were fond of saying, “Why is it that buzzing in the ear ceases if one makes a sound. Is it because a greater sound drives out the less?”

In the Middle Ages, they continued with this pouring of things into the ear, and a Welsh treatment recommended to take a loaf of hot bread, divide it in two, and put it in each ear as hot as you could take it and thus perspire and by the help of God you would be cured. That sounds like it is from the Middle Ages, but here is a picture of ear candling, which is still done in alternative medicine. A burning candle is put in the ear to try to draw out wax and other debris. But, in addition, some proponents of candling say it is good for tinnitus and sinus problems.

In the Renaissance, we saw the introduction of surgery into the treatment of tinnitus. The thought was that wind would become entrapped in the ear and circle around and around inside it, and so they would trephinate the mastoid to allow the wind to escape.

In the 19th century, the work of Frenchman, Jean Marie Gaspard Itard advanced the study of tinnitus with some progressive ideas that we still adhere to today. Most tinnitus is associated with hearing loss. He gave the earliest descriptions of objective versus subjective tinnitus, and he recognized that the treatment often failed but, meanwhile, the physician was to make the tinnitus less unbearable. Usually he did this with masking. Finally, in the 19th century, we saw advances in technology and in the germ theory and anesthesia. Electrical stimulation evolved as a treatment, and germ-free surgery allowed more attempts at surgical therapy, including ligation of offending blood vessels as well as incudectomy.

Types of Tinnitus : Diagnosis & Evaluations

Definition:

Diagnostic/Types:

Objective Tinnitus:

can be heard by other people.
Possible Causes of Objective Tinnitus:

muscular abnormalities, spastic activities of the palatal muscles, spastic activities of the stapedius muscle in the middle ear, abnormally open eustachian tubes, abnormalities in the large blood vessels near the ears, tumors of the middle ear space or nearby areas, temporal bone fractures, misconnection between adjoining arteries and veins, narrowing of the carotid artery walls, high blood pressure, hyper or hypo thyroidism.

Subjective Tinnitus:

can only be heard by the person affected.
Possible Causes of Subjective Tinnitus:

noise induced hearing loss, age related hearing loss, ear infection, wax build-up, otosclerosis (disease where the middle ear space fills with spongy bony growth), problems with the eardrum, adverse drug reactions, auto-immune disorders, brain chemistry disruptions or disorders, substance abuse, poisoning, metabolic disorders, closed head injuries, toxic reactions to ingested or inhaled substances, multiple sclerosis, meningitis, encephalitis, acoustic schwannoma (tumor on the nerve from the ear to the brain), brain disease or disorder.

Associated emotional/social conditions:

Anxiety, anger, depression, irritation, insomnia, sadness, frenzy, panic, despair, fear, isolation, rejection, distrust of medical community, avoidance, rationalization of negative behaviors, poor social interactions, loss of sense of humor and feeling that the conditions will worsen.

Medical/Audiologic Evaluation/Exams Should Include:

Complete case history including tinnitus and hyperacusis, overall health
Investigation into whether vertigo or imbalance is present.
History of head trauma, other illnesses or conditions.
History of medication use, abuse, previous and present.
Physical exam of head, neck, throat, ears, chest, etc. etc.
Blood pressure, pulse, listening to heart and lungs.
Possible blood testing recommended for Lyme disease, thyroid, etc.
MRI or CAT scans as indicated by presence of objective tinnitus.
Complete audiologic evaluation including tinnitus/hyperacusis.
Possibly an Auditory Brainstem Response if problem is one sided and test results demonstrate the need.

(Realistically, this sort of examination requires a longer session than the typical 10 minute office visit. When you schedule an examination with an ear specialist for a tinnitus evaluation, you may wish to express a desire for a more involved consultation. According to my two favorite local otologists, this is a perfectly acceptable way to ensure a little more time with them but needs special approval prior to the visit. Also be sure that your primary care physician has completed a referral if your insurance company requires one).

Drugs with Tinnitus Side Effects

The following is a list of drugs which potentially can have tinnitus as a side-effect as indicated in the 1995 Physicians Desk Reference and distributed by the American Tinnitus Association.

Your physician should always be consulted about questions before any changes are made in your medication. Also, it should be abundantly clear that just because tinnitus develops while you are on one of the drugs, it does not mean that the tinnitus is actually due to the drug. Similarly, if you do have tinnitus, and one of these drugs is indicated for treatment of an unrelated disorder, your tinnitus may not necessarily get worse. Bring the situation to the attention of your physician, and make a mutual decision in your best interest.

The absence of incidence data [ * ] means there was none given, and/or it is unknown.

Accutane [less than 1%]
Acromycin V
Actifed with Codiene Cough Syrup
Adalat CC [less than 1%]
Alferon N [one patient]
Altace [less than 1%]
Ambien [infrequent]
Amicar [occasional]
Anatranil [4-5%]
Anaprox and Anaprox DS [3-9%]
Anestacon [among most common]
Ansaid [1-3%]
Aralen Hydrochloride [one Patient]
Arithritis Strength BC Powder
Asacol
Ascriptin A/D
Ascriptin
Asendin [less than 1%]
Aspirin [among most frequent]
Atretol
Atrofen
Atrohist Plus
Azactam [less than 1%]
Azo Gantanol
Azo Gantrisin
Azulfidine [rare]

BC Powder
Bactrim DS
Bactrim I.V.
Bactrim
Blocadren [less than 1%]
Buprenex [less than 1%]
BuSpar [frequent]

Cama
Capastat Sulfate
Carbocaine Hydrochloride
Cardene [rare]
Cardioquin
Cardizem [less than 1%] ” CD [less than 1%] ” SR [less than 1%]
Cardura [1%]
Cartrol [less common]
Cataflam [1-3%]
Childrens Advil [less than 3%]
Cibalith-S
Cinobac [less than 1 in 100]
Cipro [less than 1%]
Claritin [2% or less]
Clinoril [greater than 1%]
Cognex
Corgard [1-5 of 1000 patients]
Corzide [ ” ]
Cuprimine [greater than 1%]
Cytotec [infrequent]

Dalgan [less than 1%]
Dapsone USP
Daypro [greater than 1% less than 3%]
Dasprin
Deconamine
Demadex
Depen Titratable
Desferal Vials
Desyrel & Desyrel Dividose [1.4%]
Diamox
Dilacor XR
Dipentum [rare]
Diprivan [less than 1%]
Disalcid
Dolobid [greater than 1% in 100]
Duranest
Dyphenhydramine [Nytol, Benydrl, etc]
Dyclone
Dasprin
Dynabac

Easprin
Ecotrin
Edecrin
Effexor [2%]
Elavil
Eldepryl
Emcyt
Emla cream
Empirin with Codiene
Erythromycin
Engerix-B
Equagesic
Esgic-plus [infrequent]
Eskalith
Ethmozine [less than 2%]
Etrafon

Fansidar
Feidene [1-3%]
Fioricat with Codeine [infrequent]
Flexeril [less than 1%]
Floxin [less than 1%]
Foscavir [1-5%]
Fungijzone

Ganite
Gantanol
Gantrisin
Garamycin
Glauctabs

HIVID [less than 1%]
Halcion [rare]
Hyperstat
Hytrin [at least 1%]

Ibuprofen [less than 3%] [Advil, etc.]
Ilosone
Imdur [less than or equal to 5%]
Indocin [greater than 1%]
Intron A [up to 4%]

Kerione [less than 2%]

Lariam [among most frequent]
Lasix
Legatrin
Lncocin [occasional]
Lioresal
Lithane
Lithium Carbonate
Lithobid
Lithonate
Lodine [greater than 1% less than 3%]
Lopressor Ampuis
Lopressor DCT [1 in 100]
Lopressor
Loreico
Lotensin HCT [0.3-1%]
Ludiomil [rare]

Magnevist [less than 1%]
Marinol (Dronabinol) [less than 1%]
Marcaine Hydrochloride
Marcaine Spinal
Maxaquin [less than 1%]
Mazicon [less than 1%]
Meclomen [greater than 1%]
Marcaine Hydrochloride
Marcaine Spinal
Maxaquin [less than 1%]
Mazicon [less than 1%]
Meclomen [greater than 1%]
Methergine [rare]
Methotrexate [less common]
Mexitil [1.9% to 2.4%]
Midamor [less than or equel to 1%]
Minipress [less than 1%]
Minizide [rare]
Mintezol
Moduretic
Mono-Cesac
Monopril [0.2-1%]
Monopril [0.2-1%]
Motrin [less than 3%]
Mustargen [infrequent]
Mykrox [less than 2%]
MZM [among most frequent]

Nalfon [4.5%]
Naprosyn [3-9%]
Nebcin
Neptazane
Nescaine
Netromycin
Neurontin [infrequent]
Nicorette
Nipent [less than 3%]
Nipride
Noroxin
Norpramin
Norvasc [0.1-1%]

Omniscan [less than 1%]
Ornade
Orthoclone OKT3
Orudis [greater than 1%]
Oruvail [greater than 1%]

P-A-C Analgesic
PBZ
Pamelor
Parnate
Paxil [infrequent]
Pedia-Profen [greater than 1% less than 3%]
Pediazole
Penetrex [less than 1%]
Pepcid [infrequent]
Pepto-Bismol
Periactin
Permax [infrequent]
Phenergan
Phrenilin [infrequent]
Piroxicam [1-3%]
Plaquenil
Platinol
Plendil [0.5% or greater]
Pontocaine Hydrochloride
Prilosec [less than 1%]
Primaxin [less than 2%]
Prinvil [0.3-1%]
Prinzide [0.3-1%]
Procardia [1% or less]
ProSam [infrequent]
Proventil [2%]
Prozac [infrequent]

Questran
Quinaglute
Quinamm
Quinidex
Q-vel Muscle Relaxant Pain Reliever

Recombivax HB [less than 1%]
Relafen [3-9%]
Rheumatrex Methotrexate [less common]
Rifater
Risperdal [rare]
Romazicon [less than 1%]
Ru-Tuss
Rythmol

Salflex
Sandimmune [2% or less]
Sedapap [infrequent]
Sensorcaine
Septra
Sinequan [occasional]
Soma Compound
Sporanox [less than 1%]
Stadol [3-9%]
Streptomycin Sulfate
Sulfadiazine
Surmontil

Talacen [rare]
Talwin [rare]
Tambocor [1% or less than 3%]
Tavist and Tavist-D
Tegretol
Temaril
Tenex [3% or less]
Thera-Besic
Thiosulfil Forte
Ticlid [0.5-1%]
Timolide
Timoptic
Tobramycin
Tofranil
Tolectin [1-3%]
Tonocard [0.4-1.5%]
Toprol XL
Toradol [1% or less]
Torecan
Trexan
Triaminic
Triavil
Trilisate [less than 20%]
Trinalin Repetabs
Tympagesic Ear Drops

Ursinus

Vancocin HCI [rare]
Vantin [less than 1%]
Vascor [up to 6.52%]
Vaseretic [0.5-2%]
Vasotec [0.5-1%]
Vivactil
Voltqaren [1-3%]

Wellbutrin

Xanax [6.6%] – – Also can be very helpful
Xylocaine [among most common]

Zestril [0.3-1%]
Zestoretic [0.3-1%]
Ziac
Zoleft [1.4%]
Zosyn [less than 1%]
Zyloprim [less than 1%]

Your physician should always be consulted about questions before any changes are made in your medication. Also, it should be abundantly clear that just because tinnitus develops while you are on one of the drugs, it does not mean that the tinnitus is actually due to the drug. Similarly, if you do have tinnitus, and one of these drugs is indicated for treatment of an unrelated disorder, your tinnitus may not necessarily get worse. Bring the situation to the attention of your physician, and make a mutual decision in your best interest.

Levo Otoharmonics

We are adding the Levo Otoharmonics system to our clinical equipment for the management of tinnitus and hyperacusis. This device came from the research world into the therapy world some years ago and has been undergoing clinical evaluation with positive results. The US Veterans Administration has added the system to its approved devices for tinnitus as well. We are interested to offer this targeted therapy to those suffering from the negative impact of constant unwanted auditory perception at our clinic here in Oregon. Each patient will receive a thorough evaluation and then ongoing monitoring and re-evaluations for a 12 month period. There is a 30 day trial period for each patient who enters the clinic and chooses this targeted sound therapy.

Please check out this website link, and then call for an appointment to be evaluated for the Otoharmonics Levo System.

Thank you!

https://otoharmonics.com/patients/

We are proud to provide this wonderful effective therapy for tinnitus (and hyperacusis) from the Australian Company, Neuromonics. Dr. Paul Davis developed this equipment and its significant program for reducing and managing tinnitus. Our clinic began to provide this device in 2003 and we have many hundreds of satisfied and improved patients. This device was included in the US Veterans Administration auditory rehabilitation prosthetic devices many years ago. It has been thoroughly evaluated at multiple clinics around the globe and Dr. Johnson presented a research project at the International Tinnitus Convention in Gothenberg Sweden in 2008.

Please contact us to schedule an appointment to evaluate if you are a good candidate for this program. Even patients with hearing loss can benefit from this wonderful therapy. There is no trial period for this device in our clinic, as the initial conditioning use requires 3 months, followed by 9 months of therapeutic active use.

Please follow this link to learn more about the Neuromoics Program.

http://neuromonics.com/tinnitus-treatment-oasis/

Dr. Marsha Johnson, AuD