What’s the Buzz About?

imagestinnitusAn estimated 37 million Americans suffer from ringing, buzzing, humming or hissing in the ear known as tinnitus. Tinnitus, by definition is the conscious perception of sound in the absence of an externally generated sound source. Tinnitus can be a combination of sounds and for many people may vary in tone, character and loudness. It may remain consistent and persist or may subside or at times seem to disappear. For some, stress and diet exacerbate it. Others have difficulty determining what makes it better or worse.

And while tinnitus is perceived in the ear, and may, in some cases be generated in the middle ear space, most scientists will agree that in most cases, the sound perceived in the ear is occurring in the brain. Yes, that’s right, tinnitus is perceived in the ear, but occurs in the brain. This explains why many patients with severed auditory nerves will lose all ability to hear from the severed nerve ear, but will still experience tinnitus.

Scientists disagree over the causes, origins and models for how tinnitus originates and becomes weaved into the neural pattern, but what they do agree about is the fact that many different types of tinnitus exist. A popular theory suggests that damage to the peripheral auditory structures send disrupted, abnormal neural signals to the brain which subsequently causes persistent abnormal activity in the central auditory pathway (Nageris, et al., 2010; Jastreboff & Hazell, 1993).

While tinnitus can occur for individuals with normal hearing, 85% of those with tinnitus do have some degree of hearing loss. (Simpson & Davies, 2000). This makes sense when we think about how damage to the ear can result in disrupted and abnormal signals to the brain.

For many patients, simply acknowledging the presence of the tinnitus and understanding that it is a result of damage to the auditory mechanism is enough for them to accept the noise intrusion. Others find their tinnitus more debilitating and seek other avenues for help.

For many tinnitus sufferers with hearing loss, a properly fit hearing aid will help to reduce the perception of tinnitus in over 60% of cases. Some find that use of amplification can suppress tinnitus. But for most, decreased awareness of tinnitus is either a result of a complete or partial masking of the sounds or a reduced contrast between silence and the tinnitus, or because of a more structured neural pattern, among other possible occurrences that contribute to diminished awareness of the presence of tinnitus.

For others, amplification alone will be insufficient to help deal with the effects of tinnitus. Stress management and counseling or cognitive behavioral therapy is often extremely useful when used alone or in conjunction with amplification therapies.

Certainly, one with tinnitus should know that there is help. An appointment with an audiologist can help identify whether there is hearing loss, need for medical referral and design an approach for dealing with tinnitus.

Hears to Healthy Living!

Stefanie Wolf, Au.D.

Doctor of Audiology
Audiology of Nassau County
165 North Village Avenue
Suite #114
Rockville Centre, NY 11570
(516) 764-2094
www.audiologyofnassau.com

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Sources

Jastreboff, P., & Hazell, J. (1993). A neurophysiological approach to tinnitus:
clinical implications. British Journal of Audiology, 27, 7-l7.

Nageris, B., Attias, J., & Raveh, E. (2010). Test-retest tinnitus characteristics in patients with noise-induced hearing loss. American Journal of Otolaryngology–Head and Neck Medicine and Surgery, 31, 181-184.

Simpson, J., & Davies, E. (2000) A review of evidence in support of a role for 5-HT in theperception of tinnitus. Hearing Research, 145, 1-7.

I Can Hear but I Can’t Understand

images (1)The auditory mechanism is an astoundingly complex and brilliant design. It is truly amazing how sound waves or vibrations in the air, initiate a chain reaction that starts with vibrations to the eardrum and concludes with a neural signal to the cortex. Our physiological reaction, this delicate chain of vibration, pulsation, displacement, conduction, that occurs in response to sound is what allows us to communicate, participate and enjoy music, and the sounds of the world that surrounds us. This design is so fascinating, and so intricate that a slight interruption along this pathway, either occurring at the peripheral or central level, can result in tremendous difficulty with hearing, understanding, or both.
Hearing and understanding are not always codependent. One must be able to hear to capture a spoken message, but hearing alone does not necessitate that the message was understood. The ability to understand an auditory signal ultimately depends on the brain’s capacity to receive and interpret a complete and synchronously fired neural message.

For many older adults who suffer from sensorineural hearing loss, damage to the peripheral auditory system passes incomplete messages to the brain. More than 50% of adults over age 65 have some degree of presbycusis or hearing loss in the higher frequencies. These adults often have difficulty hearing certain higher pitch sounds such as a bird chirpings , certain phones ringing and particular letters of the English alphabet. Because our alphabet is comprised of a combination of vowels, which are lower in frequency, and consonants which are higher in frequency, an individual with high frequency hearing loss, might remark that they can hear, (because they can indeed hear ) but they didn’t understand because they didn’t quite receive all of the information due to the brain’s inability to receive a complete message. In English, consonants envelop vowels to give meaning to speech and hearing only vowels and limited consonant sounds offer opportunities for misunderstanding. “Fifty” and “sixty” sound somewhat alike for someone with presbycusis, especially in noise.

Hearing aids offer tremendous help for most individuals with hearing loss by bringing the inaudible sounds into the range of audibility and offering the brain complete messages. Yet, there are individuals who have difficulty understanding, despite being able to hear. For some, damage to the auditory nerve results in its inability to fire synchronously, delivering an unclear signal to the brain. Some listeners with auditory nerve damage may have normal hearing (when it comes to detecting tones) but cannot interpret speech because the signal sounds distorted or unclear. For many who suffer from a lack of clarity, assistive listening devices in conjunction with aural rehabilitation often result in tremendous improvements in listening.
If you or a loved one has difficulty hearing OR understanding , a hearing evaluation is a first step. There is help for most hearing loss. No one should suffer in silence. Schedule an appointment at an audiologist today.

Stefanie Wolf, Au.D.
 
Doctor of Audiology
Audiology of Nassau County
165 North Village Avenue
Suite #114
Rockville Centre, NY 11570
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