Tinnitus Patient Management Robert W. Sweetow, Ph.D. University of California, San Francisco San Francisco, California [email protected] Tinnitus Facts • Approximately 15% of the world’s population has tinnitus. • More than 70% of hearing impaired individuals have had tinnitus at some point • 80-90% of tinnitus patients have some evidence of hearing loss • 10 - 20% of tinnitus sufferers seek medical attention Debilitating tinnitus Population of all people who experience chronic tinnitus Progressively more severe tinnitus problems Only education needed Non-bothersome tinnitus Dobie, 2004 Most common difficulties attributed to tinnitus • Sleep • Annoyance, irritation, stress • Persistence • Speech • Concentration, understanding confusion • Despair, • Drug frustration, dependence depression • Pain/headaches Tyler and Baker, 1983 • Subjective tinnitus idiopathic sensory neural central • Objective tinnitus vascular muscular Some outer and middle ear pathologies associated with tinnitus cholesteotoma mastoiditis otosclerosis otitis media impacted cerumen allergies palatal myoclonus head/ear trauma patulous eustachian tube glomus jugulare tumor abnormal middle ear resonance Some inner ear pathologies associated with tinnitus acoustic trauma presbycusis noise exposure meniere’s disease labyrinthitis acoustic neuroma head/ear trauma ototoxicity meningitis perilymph fistula autoimmune inner ear disease vestibular schwannoma sudden hearing loss Figure 2. Incidence of tinnitus by age group. Kochkin et al, 2012 Tinnitus and Hearing Loss Odds of Having Tinnitus 0 5 10 15 20 25 30 10-19 dB 20-29 dB 30-39 dB 40-49 dB HL at 4k Hz 50-59 dB 60-69 dB 70-79 dB > 80 dB Correlation between tinnitus severity and auditory threshold Tinnitus symptom severity and best hearing threshold 80 ta 70 d lo 60 h s e x 50 r a h m t Q 40 g n E ir R 30 a F e h 20 t s e 10 B 0 0 20 40 60 80 100 120 Tinnitus Handicap Inventory Score Tsai, Cheung, and Sweetow, 2007