Tinnitus

How will I know if I suffer from tinnitus ?
Tinnitus can be defined as any sensation of sound(s) or noise(s) perceived by someone, within his/her ear(s) or head, in the absence of an external source. The tinnitus may be described as the following: a clicking sound, a vibration; a roar, a hum, a buzz; pounding, pulsating; engine noise; ocean roar or a static; bells, ringing, tone; water running; cricket, cicada; steam whistle; sizzling; high tension wire, etc. In many countries around the world, the prevalence of tinnitus lies between 10 and 18% of all men and women, including children, whether they are hearing or hearing impaired.

Can my tinnitus be assesed ?
The main purpose of the assessment is to help the client feel that his or her condition is understood. The tinnitus assessment associated with the presence of hypoacusis may help with the differential diagnosis, that is, trying to determine the etiology of these symptoms. The data also helps in predicting the technology's efficiency. To do so, the audiologist uses the audiometer and, if needed, a tinnitus synthesizer, noise generators, or even environmental tapes.

• 1. Type and frequency :
  The audiologist presents several times, in an alternating order, a variety of tones (puretones or warbled tones) or noises (white, speech, narrowbands) in order to determine which best resembles the type of tinnitus.
• 2. Intensity :
  It is measured in dBSL, that is, the number of decibels a signal is presented above the client's auditory threshold. The intensity of the tinnitus is usually measured at the matching frequency, but can also be measured in the region with the least amount of recruitment. According to some studies, 78-79% of tinnitus sufferers have a tinnitus with its intensity of 6dBSL or less.
  
• 3. Masking : 
  The audiologist determines if any more pleasant sound(s), tone(s), daily noise(s) may mask (decrease in the perception of) the tinnitus. This also allows one to confirm if the tinnitus is truly unilateral rather than asymmetrical and bilateral.
• 4. Residual inhibition :
  After listening the chosen masking noise (or a white noise) for one minute, the audiologist documents if the client reports a change in any of the characteristics of the tinnitus, either type/frequency, lateralization and especially, the intensity (worsening, no change, partial or complete decrease).

My philosophy while selecting the electroacoustic aids
If the client has a bilateral hearing loss and tinnitus, the technology should be worn in both ears. Wearing the technology only in one ear may increase the perception of the tinnitus intensity to the ear without the aid. Wearing the aids in both ears is usually necessary for masking a tinnitus which is perceived to be in the middle of the head.

The aid usually masks the tinnitus when it is generated by the cochlea, the inner ear.

The tinnitus appears to be most disturbing at the beginning, as we pay attention to it. The louder intensity in dBSL is not always equal to the most severe tinnitus or the most pathological. For example, it is possible to have a client with multiple tinnitus who claims that his 1dBSL tinnitus at a higher frequency, such as 12kHz, is more disturbing to him than his 3dBSL tinnitus centered at 2kHz, since the first type cannot benefit from masking given through the amplification.

The results of the tests of maskability and residual inhibition help to choose and predict the technology's efficiency (hearing aid with or without masker). It allows an estimation of the number of hours of usage and suggest which technique appears to be the best for this client: do we expect a minimal, partial or complete masking of the tinnitus. However, the absence of the inhibition does not exclude possible benefit from a masker.

In presence of psychological distress or psychiatric disorders, clients should be informed of their effects (stress, anxiety, depression, etc.) on the perception of the severity of the tinnitus. Following tinnitus counseling, it is easier for clients to understand the condition, the causal mechanisms, etc. of their tinnitus. The complete audiological evaluation, including that of the tinnitus, usually allows one to conclude that the tinnitus is a symptom which does not indicate a serious illness; this in turn reduces the fears associated with this symptom. Therefore, you should no longer hesitate to talk about it with your audiologist. He/she will most certainly be able to help you.