Tinnitus also called tinnitus or "tinnitus" is a symptom, not a disease, defined as a sensation of sound perceived in one or both ears or, more generally, inside the head, not supported by external sound sources and caused from activities of the auditory system or from alteration of the sound processing mechanisms.
In the presence of tinnitus it is essential to carry out a specialist visit in order to obtain a correct diagnostic framework and consequent therapy. The specialist examination, at the exclusive judgment of the doctor, may be followed by a series of clinical and instrumental analyzes necessary for a correct classification of the symptom. The diagnostic process can be completed by radiological investigations (e.g. CT and MRI) aimed at completing the diagnosis and excluding related pathologies.
A systematic review of the epidemiological data reports that tinnitus affects about 10% of the general population, rare in children, with a greater representation in the age range between 40 and 70 and a greater frequency in the male sex than in the female one (3 /2). Although most of the affected subjects tend to "live" with the symptom and not to seek medical help, about 1-2% of the subjects affected have a certain impact on the quality of life, manifesting debilitating disorders such as insomnia, lack of concentration, tension and, in the most extreme cases, anxiety and depression.
In general, tinnitus can arise due to damage to the peripheral, central or mixed auditory system. It seems that the lesion should be sought at the level of the auditory periphery (cochlea), particularly affecting the hair cells. More rarely, the lesion affects the central auditory pathways.
Research has shown that no etiological factor is recognized in nearly 40% of cases. Tinnitus does not represent a disease in itself, but rather the symptom of underlying pathologies affecting the cochlea and / or one or more areas of the acoustic pathways. The diagnosis that is most associated with tinnitus is technoacusis or excessive exposure to noise followed by presbycusis (age-related hearing loss), otosclerosis and Ménière's disease. Head injuries, metabolic diseases (e.g. diabetes), ototoxic drugs, acoustic neuroma and all inflammatory forms affecting the ear (otitis) and upper respiratory tract (rhinosinusitis) can cause tinnitus.
Although a somatic factor can rarely cause tinnitus, it is more common for the various somatic components to combine with other causes, such as hearing impairment, acting as triggers or modulators. From the union of the different elements, tinnitus can arise with large fluctuations in volume, variability of location (often changes the location), present mainly during the day or on waking, without any hearing loss but head or neck problems. In addition, stronger tinnitus on waking suggest that somatic factors (bruxism - position of the neck and head) act at night.
It is now recognized that pathologies of the temporomandibular joint or dental malocclusion can cause tinnitus. Usually these types of tinnitus are called objectives because they can be listened to by an external examiner (eg doctor). Tinnitus can also arise in those who grind or grind their teeth (bruxism).
The drugs currently on the market, when used on prescription and at the indicated doses, are relatively safe. Hearing damage from drugs if treated promptly, for example by discontinuing use, can be reversible. Recovery usually takes place within a month up to a maximum of three to six months from the event. Often the general condition of the subject, the concomitant use of other drugs or an already present hearing impairment (even if only minor) can compromise the resolution of the problem. Ototoxicity is expressed by using high-dose drugs and for long periods of time. However, an individual predisposition to the establishment of possible hearing impairment and the onset of tinnitus is recognized.
The presence of ear wax in the ear canal is a natural phenomenon with a protective function towards the ear. In fact, earwax serves to keep the surface of the ear canal soft and, thanks to its acidity and the presence of some enzymes, it has a mild antibacterial action. Under normal conditions, ear wax is slowly expelled naturally towards the outside. For external maneuvers e.g. use of cleaning sticks (cotton swab) ear wax can accumulate forming the common "cap". The occlusion of the duct can cause the perception of sounds (e.g. heartbeat, mandibular and muscle noises) that disappear once the cap is removed.
Each person defines tinnitus in a personal way (whistle, hissing, buzzing etc.) even if, at times, tinnitus are very similar to each other. The problem is not the type of sound perceived, but the meaning of the sounds received. The same sound, for example a song, listened to by different people can arouse indifference, emotion, annoyance, detachment, emotion, or a wide range of emotional-emotional coloring. The same goes for tinnitus. The exact same tinnitus can elicit completely different reactions between the different people who perceive it. Therefore, the problem is not the intensity of tinnitus, but how each individual reacts to his perception.
Although tinnitus can occur in some members of the same family, at the moment there is no scientific evidence that is transmitted by the action of one or more mutated genes that come from the gene pool of one of the two parents. In reality there may be a hereditary predisposition to develop a hearing impairment which can, in some cases, be associated with a tinnitus.
Tinnitus is a symptom and not a disease. In the presence of tinnitus, a specialist visit is always mandatory. The symptom takes on characteristics of gravity when its perception over time alters the quality of life of those who perceive it. The process of attention towards tinnitus involves a depletion of personal resources which manifests itself with the appearance of psycho-physical stress until, in the most extreme and substantially few cases, the onset of anxious and depressive signs.
The effects of tinnitus on the individual can be manifold, ranging from total inattention towards the symptom to complete emotional involvement. In the most extreme forms (20-30% of those who perceive them) tinnitus assume real "invalidating" characteristics with repercussions on the quality of life: altering or limiting participation in normal social activities, sleep mechanisms, work potential, the family balance, the ability to concentrate and the general ability of the subject. In reality, this intrusiveness is not linked to the severity of tinnitus but to the subjective characteristics of those who perceive it.
In some cases, hyperacusis is associated with tinnitus. Hyperacusis is defined as an abnormal increase in hearing sensitivity, which does not mean hearing better but, rather, a feeling of annoyance, even extreme, in hearing certain types of sound regardless of their volume. Hyperacusis is due to an alteration of the sound processing system at the cortical level, while the ear is often not damaged in any way. People who complain of hyperacusis can also suffer from phonophobia or fear of exposing themselves to particular sounds.
It is intolerance towards specific sounds that causes feelings of anxiety, stress and anger, regardless of the volume of the sound itself.
Tinnitus therapy is extremely complex and for this reason a correct diagnosis must be made from which personalized treatment derives (there is no single therapy for all patients with tinnitus). Once the cause has been discovered, if it can be done, the therapy will be consequential. In cases of chronic tinnitus (> 6 months) the therapies are manifold and often involve several specialists. Generally the strategies used make use of the "sound therapy" (which has undergone numerous changes in recent years) and counseling. Sound therapy is the enrichment of the sound world of the person suffering from tinnitus, aimed at blocking the perception of the symptom. The goal is to avoid silence. Counseling consists of a series of meetings to be carried out with the specialist in order to check tinnitus and its impact on everyday life. Over the years, therapeutic strategies and new knowledge on tinnitus have given birth to the birth of new technologies - with conflicting results - (such as biostimulation lasers, sound generators for night rest, sound pillows, etc.), to the experimentation of new drugs. and to therapeutic treatments that use relaxation and hypnosis techniques. Strictly low-sodium diuretics and diuretics aimed at the treatment of tinnitus following or with alleged genesis from endolymphatic dropsy. Last born among therapies, it is the strategy that combines sound therapy and counseling in an app (Tinnibrain®) customized according to tinnitometry. This type of therapy, applicable only to people with normal hearing, originates from Conditional Acoustic Neuromodulation, a new therapeutic technique born from the most recent research of neurophysiology and brain plasticity.
It is a therapeutic strategy that uses sounds, used for the treatment of tinnitus or other disorders with a psychosomatic component.
It is a cushion with one or two small speakers inside connected to an external plug necessary to be connected to any device that delivers sounds (mp3, Iphone, smartphone, radio, Ipad, CD player, etc.). The sound pillow is useful in tinnitus therapy to listen to relaxing sounds and to promote night's rest.
Before carrying out any therapy, it is essential to undergo a specialist visit. Generally people with hyperacusis are rehabilitated differently depending on the co-presence of tinnitus and hearing impairment. In hyperacusic patients without or with tinnitus, "sound therapy" has the task of gradually desensitizing the auditory system, starting with the delivery of low intensity sounds, very close to the patient's hearing threshold, and then gradually increasing according to the type of hyperacusis and the response of the patient himself. In the case of hyperacusis and simultaneous reduction of hearing capacity, hearing aids are applied. Initially, the amplification delivered must be minimal and then gradually increase, in close collaboration with the patient's liking and adaptability. In some cases, sound therapy must be associated with sound therapy.
Vertigo is one of the most common symptoms in daily clinical practice. Sometimes defined as a feeling of imbalance or "dizziness", vertigo is an incorrect sensation of movement of the body or of the surrounding environment, determined by a peripheral or central alteration of one or both hemispheres assigned to maintaining posture. In some cases, tinnitus is associated with dizziness (eg Ménière's disease). The symptoms associated with vertigo, very often, aggravate the symptoms. Among these we will distinguish the neurovegetative (nausea, vomiting, sweating) and auditory (tinnitus, hearing loss and feeling of full ear) phenomena.
Tinnitometry is an instrumental method that allows you to determine the subjective intensity of tinnitus (loudness) and the tonal range (frequency or pitch).
In past years, masking tinnitus was one of the most widely used therapies. The treatment involved listening to an external broadband sound (e.g. rustling, white noise) delivered at a volume that would "cover" the tinnitus. In his classic studies on masking, Feldman (1969) also notes that in a substantial number of people the perception of tinnitus is reduced or canceled for a certain period of time, immediately after the end of the masking sound. These two phenomena, which respectively take the name of masking and residual inhibition, have been used for therapeutic purposes for many years. The inability to maintain stable levels of masking and residual inhibition, as well as the search for tinnitus suppression has directed studies towards new ways of delivering sound. Precisely in the face of these problems, masking has been questioned and, in part, abandoned.
In the 90s the first works were born that use sounds not to mask but to confuse the perception of tinnitus with other sounds. Preventing the perception of tinnitus would not favor the natural habituation process, a fundamental prerequisite for clinical improvement. On the contrary, partial masking reduces the loudness of tinnitus without canceling perception by facilitating habituation processes (Jastreboff et Al.). The sound delivered must not mask tinnitus but must be adjusted to the mixing point: i.e. the point where tinnitus and external sound have the same intensity. This phenomenon determines the birth of a third sound which facilitates the habituation phenomenon. The total and partial masking techniques therefore have completely different purposes (Henry et Al. 2002) since the former constitutes a symptomatic therapy while the latter is an adjuvant treatment for perceptual adaptation to the disorder and is therefore configured as a rehabilitation treatment (“sound therapy ").
Tinnitus is a symptom - in some cases extremely annoying - and not a disease, therefore it can never generate deafness, it is not the cause of a possible presence of deafness and, consequently, it can never aggravate a deafness. Not understanding the words, not hearing some sounds is not caused by the volume of tinnitus, but by the decrease in hearing sensitivity (hearing loss) caused by damage to the auditory structures. The reduction of auditory sensitivity over time, can give the false belief that tinnitus has increased or that it is the cause of deafness. In reality, the progressive drop in hearing over time leads to a reduction in the perception of external sounds necessary to "mask" tinnitus.
In silence or during the night, external sounds and noises are reduced (e.g. work activity and city traffic are reduced) therefore there are much less sounds that can hinder the perception of tinnitus. In the evening our attention to something that is different from tinnitus is also considerably reduced (eg a job we are doing) this means that there are fewer "competitive" activities with tinnitus and, consequently, a false feeling of increase of the volume.
If the causes that led to tinnitus can be treated pharmacologically, surgically or with conventional therapeutic approaches, tinnitus can disappear. It is essential to undergo a specialist examination (Audiologist / Otolaryngologist) in order to define the diagnosis from which a personalized treatment derives. In fact, there is no single therapy for all people who perceive tinnitus. Over the years, therapeutic interventions have sought various pharmacological, surgical and instrumental solutions and a whole series of approaches, often of dubious efficacy. In recent years, the progress of medicine and the greater knowledge of the auditory system and its connections has made it possible to implement extremely valid therapeutic strategies.
Since, to date, there are no drugs of proven efficacy in attenuating or abolishing tinnitus, in a significant number of cases and in light of recent neurophysiological research, symptom treatments - for which it has been excluded, through a specialist visit instrumental and radiological investigations, the presence of pathological situations of pharmacological and / or surgical relevance - can generally be divided into two main categories: the first includes those aimed at directly reducing the intensity of tinnitus and the second those aimed at alleviating the nuisance associated with tinnitus. Pharmacotherapy, electrical suppression through transcutaneous magnetic stimulation, osteopathy and chiropractic therapy belong to the first group, where there is postural failure. Part in itself, given the importance now recognized by all, is given to sound therapy in all its forms and means of administration. In cases of disturbing chronic tinnitus in the absence of a response to drug therapy and / or other type of treatment, the intervention is aimed at understanding the symptom and strategies to reduce the related discomfort (counseling); enrichment of the patient's sound world or correction of a possible hearing impairment (sound therapy); control of the perception of the symptom and modification of the emotional response (cognitive-behavioral therapy and techniques for controlling the emotional state). Prevention focuses on a work of information on hearing damage from noise, metabolic diseases and on improving lifestyle.
It is now recognized that in the face of a reduction in hearing ability (hearing loss) with associated tinnitus, there are all indications to proceed with the use of hearing aids, subject to diagnosis and medical prescription. Any harmful event that is at the basis of hearing loss, if not promptly corrected, can increase the imbalance of the nerve pathways at the base of the generation of tinnitus and increase, as a consequence, perception. The rationale for the use of hearing aids lies in the by now acquired certainty that in addition to correcting hearing loss, these devices increase the amount of external sounds with a "masking" effect against tinnitus and inhibit selective attention towards the symptom .
On the subject of "sound therapy", the new knowledge on the "plastic capacities" of the central nervous system have made it possible to develop therapeutic courses according to the model of the Auditory Brain Training (acoustic brain training). Cerebral plasticity represents the brain's potential to modify its structure and functions following external stimuli or pathological or traumatic events. The ability to act on brain plasticity, through external sound stimuli, for therapeutic purposes is the foundation of this new therapeutic strategy which makes use of daily sound exercises which are associated with sound melodies (sounds of nature) built "to measure" by the user . The consequent evolutionary processes, according to the principles of Conditional Acoustic Neuromodulation, are the result of the most recent research in neurophysiology and brain plasticity.
Conditional Acoustic Neuromodulation, structured through the Tinnibrain® app to support the person with tinnitus, is an innovative sound therapy based on the latest knowledge of brain plasticity and conditioned listening. The goal of Conditional Acoustic Neuromodulation is to train the brain through external acoustic signals for therapeutic purposes. Daily sound training (Auditory Brain Training) exploits cortical plasticity in order to reduce the impact of tinnitus and neural activity related to the auditory system and from the auditory system to the limbic and autonomic systems. Consequently, the strength of tinnitus and the related symptoms decrease.
It is an innovative path of daily sound exercises to support tinnitus, which allow the user who listens to them to divert attention from the symptom and develop selective attention towards other sounds. The APP is inspired by Conditional Acoustic Neuromodulation (CAN), an innovative form of sound therapy based on the latest knowledge of brain plasticity and conditioned listening. The goal of CAN is to train the brain against external acoustic signals for therapeutic purposes. If the frequency of these signals is similar, but not superimposable to that of tinnitus, the trained cerebral cortex competes with the areas stimulated by the constant presence of tinnitus, subtracting the pathological synaptic substrate from it.
Before using Tinnibrain®, a specialist visit must be carried out to identify the cause of the onset of tinnitus. If the symptom cannot be treated through drugs, surgery or anything else (e.g. use of hearing aids or cochlear implant) then Tinnibrain® can be used. It is indispensable not to have hearing impairments for which the use of hearing aids is required. Since Tinnibrain® is a personalized course, it is mandatory to perform a tinnitometry (indicates the frequency of your tinnitus) before accessing the app.
The 160-day support program includes: daily active listening exercises specially prepared based on the frequency of the tinnitus, lasting about 15 minutes and sound melodies lasting 60 minutes, which include sounds of nature reworked with the ability to interfere with tinnitus, produce inhibitory effects, promote relaxation and night rest. Last but not least, 160 sentences complete the app - one a day - which summarize definitions, concepts, opinions, beliefs, references, explanations, clarifications and descriptions of the tinnitus universe. The act is necessary for the purpose of a better understanding of the symptom, of the causes that can cause it, of the effects related to it.
The sound exercises lasting 15 minutes can be carried out at any time of the day preferably with headphones and at a comfortable audible volume. The sounds of nature lasting 60 minutes delivered through Tinnibrain® can be heard at any time of the day, even several times, and at night without masking the tinnitus. It is advisable to listen to the sound melodies especially in the quietest moments of the day or when the tinnitus is annoying. They can be heard on headphones or through any device. During the night the "sound" pillow can be used. A simple cushion inside which there are two small speakers equipped with a plug for connection to a sound source (for example smartphone) with the choice of the sound of nature at one's discretion.
The sound exercises must be carried out with a volume that is not high but such as to perceive the sounds and in comfortable audibility (the volume must not cause discomfort!). It is expressly indicated to listen to the sound tracks at the minimum volume useful for hearing the sounds.
Along with specific sound exercises, the APP also provides the delivery of nature sounds (eg rain, sea waves, wind, stream, etc.). These sounds with "relaxing" characteristics must be used to regain calm, rest, reinforce the process of "inattention" to tinnitus. Listening to the sounds of nature must take place with a volume adjusted to the "mixing point", that is, of the same intensity as your tinnitus or just below. Sounds must not mask tinnitus! It is expressly recommended to listen to sounds in comfortable audibility.
Conditional Acoustic Neuromodulation specifies that sounds and music, to be effective on the symptom, must be created "tailor-made" for the individual person. These sounds have precise and subjective physioacoustic characteristics. That is why the supporting sound exercises are arranged on the basis of tinnitus. According to the CAN, the plasticity process is not, however, lasting over time, so much so that it can decrease after an interval of between 6 months and a year from the interruption of the exercise. For this reason, it is advisable to listen to the sound melodies (sounds of nature), if the tinnitus persists, even after the end of the 160-day training.
Numerous studies have highlighted the double psychotherapeutic effect of music on a physical and psychic level. The sounds of nature have relaxing, soothing and distracting characteristics and help to reinforce the process of "inattention" to tinnitus, carried out through sound exercises. The sound of the waves of the sea, of the wind in the trees, that of a stream, the song of birds in the woods determines mental calm and predisposes the body to a state of rest and relaxation.
Sleep disturbance, attributable in most cases to the difficulty of falling asleep due to the sound sensation and associated anxiety, constitutes one of the most frequent findings in the person with tinnitus. This effect is determined by the night silence that makes the perception of tinnitus more intrusive. In these cases, listening to the sounds of nature interferes with the perception of tinnitus and facilitates falling asleep. The sound delivered should not mask tinnitus but be of equal volume or slightly below.