tinnitus and balance
tinnitus and related conditions
Tinnitus may be caused by disease, such as Ménière’s Disease or in some rare cases, a growth on the auditory nerve. As a symptom associated with disease, it’s important to have an investigation by an Ear, Nose and Throat Specialist to rule out such problems. Tinnitus that sounds like a grating noise can be associated with the function of the jaw and should be investigated by a Dentist with an understanding of Tempero-Mandibular Joint (TMJ) function.
In many cases, however, the presence of tinnitus is the indication of wear of the auditory system (probably the auditory nerve) and is inevitably present, as a person gets older.
The presence of tinnitus can be perceived in a healthy ear, when the person is in very quiet conditions, but as the auditory system ages and hearing loss develops, the internal noise can become louder – this is not necessarily a sign of disease, but that a developing hearing loss does not cover up the internal sound generated from the auditory system, as it had done, when the hearing was normal.
Other related conditions include hyperacusis and misophonia. Hyperacusis (decreased sound tolerance) and misophonia (fear of sound) are both conditions that can range from mild to severe to extreme and have the potential to escalate so that an increasing range of sounds become intolerable.
Read more about these conditions here: Dineen Westcott Moore Audiology
Tinnitus Retraining Therapy (TRT)
Successful tinnitus management is the result of retraining the auditory system to learn to not be disturbed by the auditory sensation of tinnitus. This is based on the premise that tinnitus is a neutral sound that has had meaning subconsciously attached to it and that process has allowed the auditory system to perceive the noise at a disturbing level, especially after illness or if stress levels are increased.
Sound therapy is used to achieve the retraining of the auditory system and can involve the use of ambient noise, a hearing aid or a sound generator. Previous attempts at tinnitus management have been through the “masking” procedure when a sound generator was used to generate white noise at a level that would cover the tinnitus.
TRT takes an alternate approach, by presenting the white noise at a level below that of the tinnitus and allowing the brain to learn to listen to the external noise, not the internal tinnitus. Similarly, the use of a hearing aid will give sufficient external sound to reduce the difference between random background activity and the tinnitus and enable the process of retraining to work.
Directive counselling is part of the process to ‘demystify’ the tinnitus and how it has developed: strongly held beliefs about the noise need to be changed and a discussion of the auditory system and how the internal sound develops through conditioning of the brain processes helps to reduce the problem. Relaxation therapies are also encouraged to help manage stress.
This whole process is slow and can take 18 months or more, depending on the severity of the tinnitus. This will involve the initial appointment when assessment of hearing and tinnitus is undertaken and recommendation of further management is made: if a sound generator or hearing aid is prescribed, a fitting and several follow up appointments follow at 2, 3, 6 and 12 weeks, then at 6 monthly intervals.
The Vestibular (Balance) System is a series of three semi-circular canals, that are fluid filled. The correct performance of the vestibular system needs input from visual sensations and movement from throughout the body, as well as a functioning vestibular system.
If the fluid within these structures is displaced or incorrect signals coming from the visual system or peripheral movement sensory inputs are faulty, a feeling of imbalance can occur. There is also a connection between migraine and vestibular disturbance.
These conditions may be caused by a number of medical reasons, including head injury or disease and should always be investigated. This should be done, with an initial hearing test as well as functional tests as head positioning tests. In general, with pervasive conditions, further investigations will be undertaken by an Ear, Nose and Throat Specialist and specialised tests can be performed to determine the actual cause of the imbalance.
. Electronystagmography (ENG): a test that examines spontaneous eye movement, generated by the vestibular system.
. Rotational Chair Testing: in mainland clinics, this sophisticated form of testing assesses the activity in the vestibular system.
. Caloric Tests: a test using warm and cold air or water, that can trigger a specific reaction in the vestibular system, showing the differing activity from the left
and right sided vestibular organs. Specific recording of the visual reactions gives important information about where the damage to the vestibular system might be sited.
. Vestibular Evoked Potentials: recording electrical impulses from either the neck or eyes, that occurs as a reflex, also gives information about vestibular system defects.
. Head Impulse Test: a relatively new procedure, using particular head movements with recordings by goggles to track eye movements, devised by a Sydney Vestibular researcher, Prof. Ian Curthoys. This is a quick test that can be retested within minutes, without discomfort, unlike some of the other tests described.
Treatment for balance problems are often specific physical exercises, recommended by a physiotherapist specialising in balance conditions, or in some cases, medication and dietary changes are prescribed. In rare cases, surgery may be required, for instance, if the problem is a growth on the vestibular nerve.
In all circumstances of unusual or sudden onset of poor balance symptoms, your G.P. should investigate the possibility of the vestibular system being affected.