Tinnitus Report

Present Symptoms The patient reports experiencing a constant, high-pitched ringing in both ears, which they describe as 'very bothersome.' The tinnitus started approximately six months ago, following a period of increased stress. They report that the tinnitus is worse in quiet environments and seems to be exacerbated by caffeine and lack of sleep. The patient denies any significant hearing loss, but reports a history of occasional ear fullness. They have no other reported issues related or unrelated to tinnitus. Medical history The patient has a history of mild hypertension, well-controlled with medication. They deny any history of head trauma, ear infections, or other relevant medical conditions. Current Medications * Lisinopril 10mg daily Audiological testing results: "Pure tone audiometry is a hearing test used to determine the presence or absence of hearing loss. Pure tone air and bone conduction results reveal" Pure tone audiometry revealed normal hearing thresholds bilaterally across all frequencies tested. Air conduction thresholds were within normal limits at 0-20 dB HL, and bone conduction thresholds were also within normal limits, indicating no conductive component to the patient's hearing. "Word recognition scores in quiet were" * Right ear: 100% at 40 dB HL * Left ear: 100% at 40 dB HL "Speech in noise testing (Quick SIN- a stress test to see how the brain addresses the challenges of processing speech in the presence of noise) shows" QuickSIN testing revealed normal speech understanding in noise bilaterally. "This loss is consistent with" This loss is consistent with the patient's reported history and age. "Tinnitus pitch matching and loudness matching" * Right ear: 8000 Hz at 10 dB SL * Left ear: 8000 Hz at 10 dB SL "Impedance testing was completed today to determine the status of the tympanic membrane and the middle ear status. Results reveal Type [A] tympanogram. These results indicate" Normal middle ear pressure and mobility. "Contralateral and ipsilateral acoustic reflex testing is performed to evaluate the acoustic reflex pathways, inclusive of the VII and VIII cranial nerves and the auditory brainstem. These findings show" Acoustic reflexes were present bilaterally at normal sensation levels. "Distortion Product Otoacoustic Emission testing (DPOAE) was performed. Otoacoustic emissions are sounds that the ear emits and can be detected by microphones placed in the ear that can indicate the health of the auditory receptors. This test is performed when there is a need to perform baseline cochlear monitoring, cochlear ototoxicity baseline testing, cochlear mapping, to verify cochlear versus non-cochlear functions, and to verify functional hearing loss. DPOAE results reveal" DPOAEs were present bilaterally, indicating healthy outer hair cell function. "These findings are consistent with cochlear outer hair cell loss." Education on Tinnitus The patient was counseled on hearing test results, informed on how the auditory system functions, and how cochlear decline relates to tinnitus. [She] was educated on the anatomy and physiology of the ear, the known origins and/or causes of tinnitus, as well as the negative feedback loop that can occur with bothersome tinnitus and the limbic system. Tinnitus causes, medications that can exacerbate tinnitus, tinnitus triggers, and management methods were discussed at length. Tinnitus is a complex phenomenon. It is estimated that 44 million Americans experience tinnitus. Of those, about 8 million find tinnitus to be a significant problem with 2 million finding tinnitus to be debilitating. There are more than 550 prescription and non-prescription medications and chemicals documented that are associated with tinnitus, however, individual’s side effects will depend on many factors such as body chemistry, sensitivity to drugs, dosages, pre-existing otologic factors, and length of time the drugs are taken. Tinnitus can exist because of cochlear decline and be exacerbated by medications. Problematic tinnitus is a combination of otologic origins compounded with the negative reactions from the limbic system. Regardless of the origin of tinnitus the treatment objective would be - to habituate the tinnitus so that the patient 'experiences tinnitus but it is not a problem.' Patients with bothersome tinnitus have involvement of the limbic system with negative emotions and reactions associated with the tinnitus. The patient was counseled about the multiple treatment approaches to managing tinnitus, such as TRT (Tinnitus Retraining Therapy), Lenire Tinnitus Treatment device, Sound Enrichment using sound generators, hearing devices/combo devices, and CBT (Cognitive Behavior Therapy). Tinnitus management apps can be helpful, as well as use of tabletop sound generators for use at night with or without pillow speakers. We discussed how and why on-ear hearing devices are useful in treating tinnitus. When sleep is an issue a sleep study could be helpful. Diet and exercise can have in impact of tinnitus loudness and ability to fall asleep. Lenire Assessment The patient reported a current tinnitus loudness rating of 6/10 and an annoyance rating of 7/10. They have tried using white noise and relaxation techniques, with limited success. "The patient was provided with a glass of water prior to the examination and mouth was confirmed to be free from food and gum. Visual examination of the upper and lower lips, buccal mucosa underneath the upper and lower lips, as well as tongue, palate was conducted. No ulcerations, cold sores, lesions, inflammation, evidence or oral surgery, piercings or other abnormalities of the mouth were noted. The patient denied impaired sensitivity of the tongue, teeth or gums." Recommendations 1. Utilize strategies for coping with and habituating to tinnitus (avoid silence, wear hearing protection when in loud environments etc) 2. Use of sound generator and/or tinnitus relief app 3. Behavior modifications, including relaxation, meditation, breathing exercises, stretching, yoga. 4. Lenire Tinnitus Treatment Device 5. Tinnitus Retraining Therapy 6. Oto CBT for Tinnitus program 7. Referral to Sleep Clinic 8. Cognitive Behavioral Therapy with mental health care provider 9. Prescription hearing aids/combo devices 10. Follow up at 6 months to assess progress and adjust treatment plan as needed.