What is Tinnitus, is it serious, and can it be managed? Although an abundance of literature concerning tinnitus has been published in the last 25 years, there is a lack of uniformity with respect to all aspects of its clinical management.
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What is Tinnitus and is it serious?
Tinnitus poses a significant clinical problem for millions of people in the United States and by a definition, it is the perception of sound for which there is no acoustic source external to the head.
In other words, it occurs when we consciously hear a sound that does not come from any source outside the body. It is not a disease, but a symptom of an underlying problem. These transient auditory symptoms occur periodically and generally resolve within a few minutes.
Many people may experience transient “ear noises,” which are often described as whistling sounds, in association with sudden temporary hearing loss (Kiang, Moxon, & Levine, 1970).
Read More: Ringing In Ears >
A distinction is often made between subjective and objective tinnitus (A. R. Møller, 2003). Subjective tinnitus refers to an internal sound that is perceived only by the person suffering, whereas objective tinnitus is considered real noise that can be heard by the person suffering and the examiner (Ciocon, Amede, Lechtenberg, & Astor, 1995; Lockwood, Salvi, & Burkard, 2002; Perry & Gantz, 2000).
Regardless of the cause of tinnitus, the signal is eventually processed by the central auditory nervous system and consciously perceived in the auditory cortex.
Factors Associated with Tinnitus
It is often reported that the most common cause of tinnitus is noise exposure (Axelsson & Barrenas, 1992; Penner & Bilger, 1995), but many other factors are known to be associated with it. These factors are often considered “causes” of tinnitus when a connection between the two is established.
An event, such as unexpected impulse noise, may cause the onset of tinnitus. The mechanism responsible for sustained tinnitus, however, remains unknown even when the causal event is unequivocal.
Other factors associated with tinnitus include aging, head and neck injuries, vascular and cerebrovascular diseases, systemic disorders, infectious disease, autoimmune disorders, ear conditions, and TMJ (Temporomandibular Joint Disorders) disorders (Perry & Gantz, 2000; Vernon & Møller, 1995).
Changes, such as illness, retirement, loss of function, loss of spouse or friends, or reduced social activity may bring on changes in mood, depression, and anxiety.
Although tinnitus is commonly associated with hearing loss in older patients, other medical factors have become increasingly prevalent and must be considered as potential causes of tinnitus.
These factors include conditions such as vascular disease, middle-ear disease, diabetes, hypertension, autoimmune disorders, and degenerative neural disorders, with or without concomitant hearing loss (Perry & Gantz, 2000).
Oregon Research – Conditions associated with Tinnitus
Patients from the Oregon Tinnitus Clinic complete extensive questionnaires, including a description of what they believe has caused their tinnitus.
In a sample of 2,369 of these patients, 40% reported no known events associated with their tinnitus onset.
Patients who could identify a precipitating event revealed four general categories of tinnitus etiology: (a) noise-related, (b) head and neck trauma, (c) head and neck illness, and (d) other medical conditions.
The percentages by category of the associated condition (and subcategories of each condition) for the Oregon Tinnitus Clinic patient sample are shown in the table.
Best practices for treatment
Virtually all tinnitus treatment techniques seek ultimately to reduce the impact of tinnitus on a person’s life. In some cases, the tinnitus sound itself can be reduced, but there is no systematic method for accomplishing this in patients.
Practitioners either attempt a trial-and-error approach to find a treatment that works for the patient or they use a generic treatment method that is intended to work for all forms of tinnitus.
Is your Tinnitus serious? – Try these methods of treatment:
- Hearing Aids – The majority of audiologists do not possess specialized tinnitus expertise, but they are aware that hearing aids may have a beneficial effect on some patients with tinnitus.
- Counseling – There are a number of common counseling points that are appropriate for all tinnitus patients, such as (a) avoiding high-level noise exposure, (b) making lifestyle changes that would be conducive to minimizing tinnitus intensity (reducing stress, getting adequate sleep, limiting the intake of alcohol, caffeine, tobacco, etc.), (c) maintaining a constant background of sound.
- Psychological Treatments – Cognitive–behavioral therapy is a type of counseling that identifies negative behaviors, beliefs, and reactions and assists the patient in substituting appropriate and positive reactions. The method can, however, be administered by hearing specialists, including audiologists, because of its many similarities with aural rehabilitation (J. L. Henry & Wilson, 2001; Sweetow, 2000). Professionals who wish to learn this method require general training in cognitive-behavioral techniques, which they must adapt to the treatment of tinnitus.
- Pharmacological Approaches – Many medications have been proposed to relieve tinnitus. Antianxiety drugs, antipsychotics, sedatives, antidepressants, antihistamines, anticonvulsants, and even anesthetics have been reported to relieve tinnitus
for some people.
Impact on Workers’ Compensation
Many of us ask ourselves is Tinnitus serious, and what affects it. Workplace noise can be a significant hearing health hazard, not only in causing hearing loss but also in precipitating tinnitus. Severe tinnitus is frequently more disabling than hearing loss, but tinnitus has not typically been monitored in noise conservation programs (Gabriels et al., 1996).
Tinnitus that is associated with noise-induced hearing loss can severely affect or even end a person’s occupation. In spite of these realities, workers’ compensation boards are inconsistent in how they address tinnitus claims.
In some cases, compensation boards will not accept a claim for tinnitus by itself, rather, they assign impairment secondary to hearing loss.
Tinnitus is, however, becoming increasingly the primary or only complaint, and awards for tinnitus can greatly exceed those for hearing loss (Coles, 2000).
Workers’ compensation programs in 29 of the 50 United States compensate workers for tinnitus. In 13 of these states, tinnitus is compensated only if the hearing impairment is also present. In most states, statutes of limitations (which define the period within which legal action can be taken) range from 1 to 5 years. In some states, the statute of limitations is only 30–200 days.
Because tinnitus is by nature subjective, there is no objective measure to prove its existence or to verify the reported severity. Assessments, like pain assessment, depend on subjective scaling, self-report, and medical history.
Thus, any litigation involving tinnitus must rely on the reliability of tinnitus psychoacoustic measures, consistency of verbal responses and medical records, and sufficient duration of the tinnitus condition to establish permanency (minimum of 2 years duration).
Getting your Workers’ Compensation Claim
Since 1911, there have been over 2.5 million workers’ compensation claims filed. Hearing loss workers’ compensation claims now rank #3 in the number of occupational diseases claims filed.
Hearing loss workers’ compensation benefits are largely undiscovered benefits covering hearing health care, which is often uninsured. Many health insurance policies and programs like Medicare do not cover hearing aid purchases but workers’ compensation can.
It also pays for the disability of hearing loss just as it does for the loss of eyesight or other injuries.
Aging populations, advances in technology, and greater sensitivity to hearing loss are bringing more attention to financing hearing health care. For the most part, those who qualify for hearing loss workers’ compensation benefits are retired hearing-impaired workers who live on fixed incomes.
Always feel free to ask Johnson Law Offices about the process, the law, or an individual case. The legal, medical, and audio-metric questions that come into play in a hearing loss workers’ compensation claim can be complicated.
The claims require attention to detail mixed with an ability to work well with hearing-impaired retirees and their families, especially spouses, and their hearing health care professionals.