MANAGING TINNITUS& HYPERACUSIS

EFFECTIVELYMaria Harasymczuk

Psychologist

WHAT IS TINNITUS ?

• Physical condition

• Experienced as noises or ringing in the ears &/or head when there is no such external noise.

• Symptom of a faulty hearing system, not a disease.

WHAT IS HYPERACUSIS ?

• Physical condition.

• Experienced as a reduced tolerance & increased sensitivity to everyday sounds in the environment.

• Person experiences physical discomfort &/ or pain in their ears when exposed to sound (quiet, medium or loud in volume).

PRESENTATION

• Tinnitus & Hyperacusis

• Tinnitus

• Hyperacusis

Types of Therapy

1/ Tinnitus Retraining Therapy (TRT)

2/ Cognitive Behavioural Therapy (CBT)

Tinnitus Retraining TherapyTRT

• Developed by Dr Pawel Jastreboff

• Provides a model - explains how tinnitus & hyperacusis is processed by the brain

• AIM for Tinnitus: Habituation

• AIM for Hyperacusis: desensitize auditory pathways

TRT for Tinnitus

Tinnitus like a lion

Negative emotional association

Brain monitor threat - like a radar.

TRT for Tinnitus

Directive Counselling

Auditory Therapy

Directive Counselling

Reverse negative counselling / information about tinnitus.

Encourage acceptance of the tinnitus through neutral association.

See one of our Audiologists !

• Have a

hearing test

• Important -

provides information

for auditory therapy

AUDITORY THERAPY• Appropriate use of sound in environment.

• HEARING LOSS - Hearing aids +

sound machine / iPod, etc.

• NORMAL HEARING – WNG’s &/or

Sound Machine or iPod, etc.

IMPORTANT RULEof

Auditory Therapy

AVOID SILENCE

ANOTHER IMPORTANT RULE of

Auditory Therapy

DO NOT

MASK

CONSTANT NEUTRAL

SOUND BELOW TINNITUS

KEY to Auditory Therapy

Directive

Counselling

Auditory

Therapy

Acceptance of tinnitus.

Decreased tinnitus severity & awareness

TRT for Hyperacusis

Phonophobia

• Fear of noise

• Person avoids

noise exposure:

Physically avoid situation

Wears ear protection

TRT for Hyperacusis

• Directive Counselling

• Auditory Therapy

Directive Counselling

• Reversal of negative counselling about Hyperacusis.

• Addresses persons concerns.

• Encourages a neutral association to sounds that cause discomfort.

Overuse INCREASES

of Ear = Sensitivity

Protection to Noise

Auditory Therapy

• Appropriate use of sound in environment.

• Aim: Desensitise auditory pathways.

• Constant Neutral sound at comfortable level.

• Gradual exposure to sounds.

Cognitive Behavioural Therapy

A Event/Situation

B Thought / Beliefs

C Feelings/Behaviours

Negative Vs Constructive

Increase in Tinnitus Increase in Tinnitus

“My tinnitus is so loud. I can’t cope with this.

What if it gets louder. It is destroying my life. I am going to go mad. I can’t

go out tonight.”

“My tinnitus is loud at this time. I have coped

before. I am going to do my relaxation, as I know

this helps lower my tinnitus. I have had episodes of loud tinnitus & it has got better. I will go out tonight as I feel better

when I go out”.

Extremely AnxiousDepressed

Don’t go out

CalmAccepting

Go Out

Negative Vs ConstructiveAt Shopping Centre

Grocery Shopping

“This noise is so loud. I can’t do this. It is going

to damage my ears and make things worse.

I have to get out of here”.

“It appears to be loud, but I know it is not going to damage my ears. Other

people are here & they are not bothered by the noise.

The more I expose myself to this noise the less sensitive my hearing will be. I have

achieved this with other noises . I will finish my

shopping and then go home”.

Extremely AnxiousPuts in ear plugs

Abandons shopping trolley & Leaves supermarket.

Little bit stressed.Do Shopping

Go Home

At Shopping Centre

Grocery Shopping

Cognitive Behavioural Therapy

• Identify thinking style & beliefs about tinnitus & hyperacusis & their effect on feelings & behaviours

• Strategies to challenge negative thoughts & convert them to constructive thoughts

• Management of tinnitus & encourage acceptance of tinnitus

• Management of hyperacusis & encourage neutral association to sounds.

Helpful Points

• DON’T FOCUS ON TRIGGER OF TINNITUS OR HYPERACUSIS

• Feelings of Guilt, Anger, etc.

• Enhances Negative Emotional Association.

Live in the Present

PAST FUTUREGuilt WorryAnger

Reduce Anxiety &/or Depression

PRESENT

Lifestyle Changes

• Balanced Diet

• Regular Exercise

• Good night sleep

• Reduce stress

Interventions

• Hearing devices (hearing aids, sound machine, etc)

• Tinnitus Retraining Therapy

• Cognitive Behavioural Therapy

YOU CAN DO SOMETHING ABOUT TINNITUS & HYPERACUSIS!!!!

Thank

You

for

listening !!!!