OUR TINNITUS TREATEMENTS.

The Audiologist role within a multi-disciplinary team.

(abstract)

I/ IMPORTANCE OF THE PROBLEM :

8% of people are disturbed by tinnitus. 2% can not put up with it. A collective taking charge by a multi-disciplinary team is essential.

II/ Role of E.N.T. doctor :

Tinnitus is a symptom and not an illness.

In France, after a GP consultation, the patient will have specific controls . After the analysis of the results of the functional explorations, the ENT doctor provides informations, counsels and relevant treatments. They are, mainly, medical, vascular, anti-depressive, anti-epileptic, etc., sometimes surgical.

Our experience shows that these results are rather disappointing or setbacks : " get on with it ", " no way against your agony" are often the conclusions ". In our presentation the role of the ENT doctor will not be developed, but his first intervention is compulsory.

III/ The TINNITOMETRIE^® .

III-1/ Target :

Within the frame of the " Tinnitometrie^® " technique, the target is to relieve the sufferer of tinnitus discomfort.

This one is estimated with an analogical display scale , from 0 (no tinnitus) to 10 (unbearable).

We consider that tinnitus is the result of the combination of several dysfunctions.

The target is to eliminate part or all of these dysfunctions. Amongst others, our hypothesis is based on an abnormal resonance start-up of the basement membrane, an abnormal oscillation.

Then, our technique is to recover the hearing function at supra introductory level with the basic hearing aids, but adaptations and adjustments will be different of the usual ones, because the main target is to protect the hearing system and to neutralize the resonance phenomenon, without to restart it.

On the same time, the patient will be entrusted with one or several practitioners ( osteopath, psychologist (sophrologue), physical therapist, optometrist, TMJ specialist...) to cure the others dysfunctions. As a matter of fact, we have noticed that with the technique of neutralization alone, about 75% of patients were relieved and more than 85% with the group therapy.

The main role of the audiologist is to make the situation less dramatic. As the tinnitus sufferers had to face some setbacks, they do not believe in a possible way to get relieved. With our complete, accurate and relevant explanations about our intervention and our targets, we obtain a relaxed climate good for our treatment and the patient’ self-implication.

III-2/ Tinnitus components :

They are physiological, biological and psychological mechanics. The components of tinnitus are similar of those of the pain.

3.2.1 Sensory components : treated by means of a specifically adapted hearing-aid

3.2.2 Behavioral components : treated with counsels, " sophrologie ", TMJ, osteopathy, postural therapy, optometry etc...

3.2.3 Affective and emotional components : treated by breathing control.

3.2.4 Awareness of life components : treated by " sophrologie " to dedramatize tinnitus, positive attitude of the therapists, and the family involvement. That is why the taking charge of the tinnitus sufferers must be a multi-disciplinary and " holistic " one. Every case is unique.

III-3/ Our hypothesis :

Internal ear resonance phenomenon + Action on limbic and reticular system + Perception

Þ Interpretation

Þ Reactions + Self maintenance or aggravation under lots of stress + Memorization

The others recognized treatments, as maskers, tinnitus retraining therapy with wide band noise generators, are not immediately performing and they are often disappointing.

III-4/ Interactions between differents systems (according to JASTREBOFF works)

 

Jastreboff realized works on the animal behavior. He extrapolated the results to the mankind and he imagined loop-reactions which explain, in part, the successive and interactive incidences of the differents systemes’actions.

Hence the importance of a multi-disciplinary team.

III-5/ Composition and working of a ‘Tinnitometric’ team.

 

Clic to enlarge

           
                                                   III-6/ Evidences of a " Tinnitometric residual inhibition ".

        Key :The levels of the subjective discomfort are expressed on an analogical scale, such : O/10 : no tinnitus. 10/10 : unbearable. A : Level before intervention, in silence. B : Level after intervention, in silence. C : Level after to pull out the equipment, in silence. Then, the estimated level of discomfort, every 30 seconds, in silence.

IV/ Examples of practice.

Three extreme cases highlight the possibilities of the " Tinnitometrie^® ".

IV-1/  Mr. H...37 years old. September 1995.

• Diving accident in1983, hyperbaric oxygen therapy, drips, vasodilators, etc.

• Constant tinnitus in 1983, discomfort estimated from 6/10 till 10/10 on the subjective discomfort scale.

• Auditive evoked potential is normal, dizzy spells.

• After the taking charge and the adjustment of a left hearing-aid, tinnitus is neutralized. After to pull out the equipment, the discomfort is back progressively , from 0/10 till 4/10 , instead of the initial 6/10.

IV-2/ Mrs. F...48 years old. May 1996.

• Tinnitus right and left, after the death of a parent. Then, the usual medical treatments : vasodilators, oxidizers...Then, psychological, relaxing, acupuncture, energy giving treatments etc... Mrs. F... received full functional explorations.
• Unbearable attempt with the white noise generators.
• Since 2 years, constant tinnitus ; the discomfort is estimated between 7 to 10/10 on the subjective scale. After the taking charge, a bilateral equipment is adjusted. The tinnitus are totally neutralized as well as the noise hypersensitivity. After to pull out the equipment, the discomfort is limited at 4/10, instead of the initial 8/10.

IV-3/ Mrs. P...70 years old. December 1997.

• Anamnesis :
  • right cophosis, left sub-cophosis.
• Medical history :
  • Many driving accidents. Cervical , lumbar, dorsal arthrosis. TMJ problems. Many treatments : penicillin and streptomycin for a flue in1991, vasodilators, oxidizers and fluorine.
  • Since 1984, tinnitus variable from 7 to 10/10 on the subjective discomfort scale, with a hard aggravation, in December 1997, at 10/10 continuously. Vertigo.
  • The level of discomfort decreases when the mind is occupied, e g , crosswords.
  • The level of discomfort decreases for 15 to 20 minutes after the getting up ; it increases in a calm atmosphere, tiredness , stress or a car journey.
  • Mrs. P... uses only labial perusal. She withdraws into herself.
  • After an heavy taking charge, a specific power hearing aid is adjusted : the tinnitus is down from 10/10 to 2/10, on the subjective discomfort scale, while the equipment is worn. The ‘Tinnitometric residual inhibition’ is weak , according to the level of hearing loss.

  

  

IV-4/ Conclusions about these 3 cases :

These patients have also benefited of a taking charge osteopathic, "sophrologique", optometric and sometimes psychological.

Then, very different and extreme audiological cases, with wide band of hearing loss, do not prevent the implementation of the "Tinnitometric technique".

V/ CONCLUSION.

After an ENT doctor consultation, the "Tinnitometrie^®" taking charge, including, anamnesis, specific full questionnaire, use of the analogical scale in order to estimate the subjective discomfort, can be undertaken. It gives assistance to the patient, with explanations, counsels, specific hearing-aid equipment, handling of the different dysfunctions, by a motivated multi-disciplinary team, within the framework of a dedicated relationship " patient-team ". The involvement of the family is highly recommended. There is no getting away from the patient’ self-involvement.