tinnitus

Tumour of Opportunity: Brittany's Story

joanne — Mon, 30 Aug 2021 21:28:20 +0000

Tumour of Opportunity: Brittany's Story joanne Mon, 08/30/2021 - 17:28

Brittany Blanchard was only 25-years-old when she was diagnosed with an AN. She used her experience to her advantage and is now a Hearing Instrument Specialist.

Brittany Blanchard

In early 2017, I had never heard of an acoustic neuroma, nor considered that one day I would be having brain surgery. By the end of 2017, I was living a totally different life! This is the story of how a tumour, which almost stole my life, instead ended up illuminating my path to success.

In January 2017, while watching TV, I suddenly realized, I think I’m losing the hearing in my left ear. With that ear on a pillow, I was able to hear well; however, with my right ear on the pillow, I was unable to hear any sound on the TV. Concerned, I spoke to the only person I knew who wore hearing aids. She told me about a nearby clinic where I could have my hearing tested . . . I was only 25-years-old!

A few weeks later, I started having tinnitus in the left ear, so I scheduled a hearing assessment at the clinic. It was almost two months since I first noticed my hearing loss, and three weeks since the unilateral tinnitus first began. Upon filling out the case history form, I came across a question about vertigo, something I had developed about five years prior, but never looked into as it was so mild. Seeing it on a form for a hearing test, I found both intriguing and disconcerting.

The results revealed normal hearing in my right ear, with a mild loss in the high frequencies, and a mild hearing loss in the left ear, with a severe loss in the high frequencies. I was then referred to an ENT, who retested my hearing. As there was further decline, the ENT ordered an MRI. During the MRI, they pulled me out and said they had to inject me with dye so they could see more information in my brain. This is when I knew something was really wrong.

Three days after my MRI, I learned that I had a very large acoustic neuroma and required brain surgery. The ENT referred me to Dr. Izukawa, a neurosurgeon in Mississauga, and to Dr. Joseph Chen, ENT surgeon. I had my first appointment with Dr. Izukawa in August 2017. He showed me and my parents the MRI images revealing my 4.5 cm tumour, which was crushing my brain, bending my brainstem, and pressing on my optic nerves. He told us that although this tumour is benign in nature, its sheer size was threatening to snap my brainstem. To put into perspective just how large this tumour was, it was about a quarter of the size of my brain.

I met Dr. Chen for the first time ten days before the surgery, in October 2017. Having lived with the knowledge of my tumour for a few months, I had had a chance to tell my family and friends about it. Naturally, they wanted to discuss it extensively and the word “tumour” became a source of panic in itself. As a result, I decided to give it the least threatening name I could think of, Winnifred!

Dr. Chen informed my mother and I that he would be severing my 8th nerve on the left side, and I would become permanently 100% deaf in that ear. Due to the size of my tumour, there was also an extremely high chance that he would have to sacrifice my 7th nerve, which would result in the left half of my face being paralyzed. As a now 26-year-old woman, I was devastated, terrified, and lost. Although I was surrounded by love, I felt alone and isolated. I had had reconstructive knee surgery a year prior and comforted myself by thinking, “at least it’s not brain surgery!”. And then it was.

The morning of the surgery, I woke up feeling an almost unsettling sense of calm, likely because, for about three months, I was afraid to sleep because I did not know if I would wake up or not. My dad picked me and my boyfriend up at 6 a.m. to drive us to the hospital where we met my mom and grandmother. Walking to the operating table was surreal. As I climbed onto it, I couldn’t help but think, “this is brain surgery . . . I might not leave this table alive.” My wonderful little support team patiently waited 12 hours while I had the tumour removed.

Although I was dizzy, no longer had hearing in my left ear, the left side of my face was paralyzed and my vision was impacted, I was grateful for the surgeons and the nurses who took care of me.

About six months post-op, I was fitted with a CROS system, and my life changed again. I fell so deeply in love with my hearing aids that, within a few weeks of wearing them, I registered for college to become a Hearing Instrument Specialist. I knew that I had to help other people. Just ten months after surgery, I was sitting in a classroom. Still experiencing dizziness, and having to undergo surgery to correct vision complications, I had the feeling that I may have rushed myself. Nevertheless, I knew I had made the right decision because helping people has always been a passion of mine, but I had not been able to decide on a career . . . until now.

I graduated in April 2020, completed my internship and passed the International Licensing Exam in 2021. I am now a certified Hearing Instrument Specialist, on top of being an acoustic neuroma survivor. My next goal is to support other young individuals diagnosed with this tumour and ensure that they never feel they have to face this diagnosis alone.

My acoustic neuroma threatened my life but, with the help of my family, friends, and phenomenal surgeons, I overcame it and have now been tumour-free for four years! It is extremely easy to feel alone when you have an acoustic neuroma, so it is fantastic that there is an entire community for support within ANAC!

facial paralysis

hearing

tinnitus

How Can Tinnitus Retraining Therapy Facilitate Habituation to a Problematic Tinnitus

admin — Tue, 09 Apr 2019 20:51:49 +0000

How Can Tinnitus Retraining Therapy Facilitate Habituation to a Problematic Tinnitus admin Tue, 04/09/2019 - 16:51

Tinnitus is defined as the perception of sound(s) in the ears or head when no external sound is present. While it is often referred to as “ringing in the ears,” tinnitus can present as different sounds, including buzzing, hissing, whistling, swooshing, and clicking. Tinnitus is also described as a “phantom sound” or “phantom auditory sensation” that shares many similarities with chronic pain disorders.

There are two types of tinnitus: subjective and objective tinnitus.

Subjective tinnitus is generated by the brain (auditory cortex) in response to disturbances within the auditory system. Subjective tinnitus is only audible to the patient. Objective tinnitus is rare and is defined as the perception of sound(s) generated by sound sources in the body that are transmitted to the ear such as a blood vessel adjacent to the middle ear (pulsatile tinnitus). Objective tinnitus can be audible to others such as in the case of rapid muscle spasms of the soft palate (myoclonus).

Tinnitus is not considered a disease but rather a condition resulting from a wide range of health issues. Tinnitus is most commonly caused by noise exposure, age-related changes, whiplash and head injury, acoustic neuroma, side-effect of some prescription medications (e.g., high dose of aspirin, some antibiotics, antidepressants and chemotherapy agents), Ménière’s disease, otosclerosis, ear infection, severe cold and flu, Eustachian tube dysfunction and aerotitis, temporomandibular joint dysfunction, diabetes, high blood pressure, hyperthyroidism, arthritis, stress, anxiety and depression.

Tinnitus is almost always accompanied by hearing loss. It is estimated that 90% of tinnitus patients present with some degree of hearing loss. Patients with tinnitus may also experience decreased sound tolerance. The most common form of decreased sound tolerance is hyperacusis which is characterized by the experience of discomfort and sometimes ear pain with everyday sounds such as dishes clanking, babies crying, dogs barking, cars honking and sirens of emergency vehicles. It is estimated that 40% of tinnitus patients present with hyperacusis.

Tinnitus is a prevalent condition. It is estimated that 15% to 20% of the general population experiences tinnitus at some point in their lives. The condition interferes with daily activity in about 3% to 5% of the affected population.

Tinnitus becomes a problem when it affects quality of life. The impact of a problematic tinnitus ranges from a mild annoyance to a completely debilitating condition with significant social and economic consequences. The most common tinnitus-related complaints are:

difficulty understanding speech and television, poor appreciation of music, and trouble using the phone;
interference with work duties, social activities, and family responsibilities;
effects on general health including sleep disturbances, fatigue, headaches and ear pain;
emotional and cognitive problems including annoyance, irritation, inability to relax, anxiety, depression, suicide ideation and difficulty concentrating.

A problematic tinnitus has both auditory and non-auditory (emotional) components. The auditory component involves the perception of the sound of tinnitus generated by the brain (auditory cortex) in response to disturbances within the auditory system. When hearing loss is present, the brain receives reduced information from the ears. The brain adapts to this change by compensating for the lack of information. In an effort to fill in the blanks, the auditory cortex augments its processing activity. The tinnitus or phantom sound heard is essentially the perception of this increased activity.

Even with normal hearing ears, the brain can receive incomplete information. Scientists have observed abnormalities with the delicate structures of the cochlea (inner ear) such as the outer hair cells and auditory nerve fibres that don’t always show up on a clinical audiogram. This phenomenon is referred to as hidden hearing loss or cochlear synaptopathy.

The non-auditory component involves the emotional reaction to the sound of tinnitus. The annoyance experienced with tinnitus is the result of negative thoughts, fears, and worries associated with the experience of tinnitus. Is my tinnitus going to get worse? Will I be able to go back to work? Will I be able to enjoy silence again? What if I lose all hearing in my good ear? An emotional response is triggered when the brain starts focusing a significant amount of attention onto the tinnitus. The negative thoughts associated with tinnitus lead to distress, which increases attention and monitoring of tinnitus resulting ultimately in a more noticeable and intrusive tinnitus. This is what is referred to as the vicious cycle of problematic tinnitus. The brain temporarily loses its ability to filter out the harmless sound of tinnitus before it reaches consciousness. Tinnitus becomes problematic when natural habituation mechanisms are held back by the negative experience and fears associated with tinnitus.

Habituation is a simple form of learning in which we progressively stop paying attention to annoying sensory information. Habituation happens all the time. For example, the loud ticking of a grandfather clock in a quiet room doesn’t seem as resounding after a while and starts fading in the background. We forget about the humming noise coming from the ventilation system until it stops working. Habituation is also why some people can live near a train station, the highway or an airport. In time, the brain ceases to respond to these sounds as they are perceived as non- threatening, familiar and meaningless.

The good news is that there are evidence-based treatments designed to assist habituation of a problematic tinnitus. It is possible to retrain the brain to no longer react to tinnitus and bothersome environmental sounds.

Most tinnitus patients seen in today’s audiology clinic present with a subjective tinnitus, some form of decreased sound tolerance and hearing loss. There are comprehensive management programs currently dispensed by audiologists specialized in these hearing-related disorders that facilitate tinnitus habituation and desensitization of the auditory system to bothersome environmental sound(s). The most commonly used are Tinnitus Retraining Therapy, Progressive Tinnitus Management, and Cognitive Behavioral Therapy.

As an audiologist at the Canadian Hearing Society providing services to patients with tinnitus and decreased sound tolerance, I am often asked what methods of treatment I use in my practice. I am a firm believer in the Tinnitus Retraining Therapy (TRT) approach. Most of the counselling material and assessment and management protocols I use come from TRT. More specifically, TRT is based upon the idea that structures in the brain other than the auditory system are involved in the development of a problematic tinnitus. The limbic and autonomic nervous systems are believed to be the primary and dominant non-auditory brain systems responsible for tinnitus annoyance and distress while the auditory system plays a secondary role.

TRT was developed by Dr. Pawel Jastreboff (Research Neuroscientist), Dr. Jonathan Hazell (ENT Specialist) and Jacqui Sheldrake (Clinical Audiologist) in the 1990s. TRT combines the use of directive counselling sessions and fitting of sound therapy devices such as ear-level sound generators and hearing aids. The counselling component aims at demystifying tinnitus/ hyperacusis and creating a new frame of reference for thinking about the troublesome condition. The sound therapy component is designed to provide enrichment of the auditory background noise, reduce the audibility of tinnitus and improved audibility of sounds difficult to hear for patients with hearing loss.

A comprehensive audiological assessment is essential for the success of TRT. The assessment includes a detailed case history designed to investigate causes, characteristics and progression of tinnitus and general physical and emotional health. A thorough hearing examination is also performed to assess patient’s hearing health and associated hearing loss and decreased sound tolerance. It is crucial to consider the entire person as many internal and external factors can not only cause tinnitus but also aggravate its perception and experience.

If you are struggling with a problematic tinnitus, inquire about comprehensive management programs offered by your community Audiology and Psychology clinics. Let a professional help you live a life free of tinnitus burden.

Dany Pineault

Dany Pineault completed his Doctor of Audiology (Au.D.) at A.T. Still University. He has been an audiologist for 25 years and has extensive clinical experience in the assessment and management of problematic tinnitus and decreased sound tolerance. He currently practices as a clinical audiologist at the Canadian Hearing Society, the largest non-profit hearing healthcare organization of its kind in North America and is also a research advisor for Statistics Canada. He recently co-authored the Tinnitus in Canada paper (Ramage-Morin P, Banks R, Pineault D and Atrach M, 2019).

Dany is an assistant adjunct professor at A.T. Still University. He teaches the Tinnitus and Hyperacusis course to students enrolled in the Post-Professional Doctor of Audiology program and is an off-campus preceptor supporting Canadian University Audiology Programs (e.g.: University of British Columbia, Western University, Dalhousie University and l’Université d’Ottawa).

tinnitus

therapy

Managing Tinnitus: What's All The Noise in My Head?

admin — Tue, 24 Oct 2017 22:13:39 +0000

Managing Tinnitus: What's All The Noise in My Head? admin Tue, 10/24/2017 - 18:13

Most people would be surprised to learn that there is an internal alarm system located within their brain that is constantly monitoring the world around them. Basically, our central nervous system is idling in a state of readiness to respond to any type of "red alert" it may encounter. This idling causes "brain noise" that runs in the background. The majority of us are completely unaware of this brain noise until something triggers it to cross a threshold to become audible to some in the form of what’s called tinnitus.

Tinnitus is an auditory perception of a sound in the in the ear that can only be heard by the person experiencing it. Each person who has tinnitus describes it in their own way. Many people report that it sounds like a ringing, buzzing, humming, clicking, whistling or roaring. It can be loud or soft, constant or intermittent, can change in pitch, and be heard in one or both ears. About 15% of the population experiences tinnitus with 5% reporting severely intrusive tinnitus that affects their day-to-day activities.

It’s important to understand tinnitus itself is not a disease, but a symptom. It’s your body’s internal alarm system going off and telling you that something is not quite right. Tinnitus can be caused by a number of health conditions including high blood pressure, head trauma, dental problems, certain types of tumours, hearing loss and much more. Your ears are always working but relax when they find a soothing background sound to listen to. They are geared to naturally want to listen to sound and are always scanning the environment for it. For people with hearing loss, the amount of environmental sound they are exposed to is reduced. This causes their ears to strain to hear what’s around them and all of this straining increases their sensitivity to their internal brain noise which manifests as tinnitus.

So if you do have tinnitus, you should avoid silence as it only intensifies your sensitivity to your internal brain noise. For this reason, hearing aids are often recommended as a front line defence against tinnitus because hearing aids expose people with hearing loss to sound. For those who experience tinnitus but don't have hearing loss, custom ear sound generators may be recommended. In a nutshell, external sound decreases your sensitivity to internal sound.

Tinnitus can also be managed with the implementation of Tinnitus Retraining Therapy (TRT). Developed in 1990 by neurologist Dr Pawel Jastreboff, and audiologist Jonathan Hazell, TRT is the gold standard for tinnitus treatment. For those individuals whose tinnitus has become a significant annoyance, a systematic approach to "habituate" to their condition can be delivered through TRT. To understand how TRT works, it is important to understand tinnitus in greater detail. Tinnitus can be divided into two components.

The first component is the auditory component, or the perception of the tinnitus (arises from the inner ear and auditory centres in the brain).

The second component is the non-auditory component, and this refers to the ‘bothersome’ nature of tinnitus. This non-auditory component arises from the limbic system (the emotional centre of the brain) and the autonomic nervous system (the brain’s ‘alert system’ designed to give the message to the individual of ‘fight’ or ‘flee’ from a dangerous situation). When the limbic system is activated by the tinnitus, the person may feel a sense of extreme discomfort or panic.

TRT can help a person ‘habituate’ to their tinnitus. To ‘habituate’ to something means to grow accustomed to it. To habituate to tinnitus means to reach a state of mind where there is no longer a negative emotional response to the tinnitus. Tinnitus Retraining Therapy is delivered by Audiologists, who have received specialised training in this therapeutic model. TRT includes:

Directive Counselling: Intensive client education about the auditory mechanism and the role of the brain plays in tinnitus perception. With education, the tinnitus will be demystified. This will help reduce distress and anxiety about the tinnitus.

Sound Therapy: Use of ear level or table-top sound generators and/or hearing aids to provide continuous stimulation of the auditory system to interfere with the perception of tinnitus. This would also include the use of environmental sounds. This will also help reduce distress and anxiety about the tinnitus.

Time: It takes time for the brain to habituate to the perception of tinnitus. Most clients report a noticeable improvement is as little as 6-8 weeks. The duration of the TRT program can last between 16 – 24 months.

Regardless of the cause of the tinnitus, with or without hearings loss, the success rate of TRT is 80%. This is the highest success rate of any treatment or therapy currently available. The effects of TRT are long lasting, and there are no side effects.

If you have difficulty understanding speech or following a conversation in background noise if sounds seem muffled or you are suffering from tinnitus – you are probably experiencing hearing loss. Make an appointment with an audiologist to get your hearing checked and get advice on how to manage your hearing loss and how to prevent more from occurring. Whether you need a hearing aid, assistive listening device, tinnitus therapy or strategies for communication, an audiologist can help you get reconnected to the world around you.

Rex Banks

Rex Banks, Au.D., has been an audiologist since 1989 and is the Director of Audiology at the Canadian Hearing Society. In addition to being registered with the College of Audiologists and Speech Language Pathologists of Ontario (CASLPO), Rex is also a certified member of the American Speech Language Hearing Association (ASHA) and holds the Certificate of Clinical Competency in Audiology (CCC-A) designation.

tinnitus

hearing

diagnosis

Managing Tinnitus: What’s All The Noise in My Head?

joanne — Mon, 07 Nov 2016 16:53:31 +0000

Managing Tinnitus: What’s All The Noise in My Head? joanne Mon, 11/07/2016 - 11:53

Dr. Rex Banks, Doctor of Audiology, Chief Audiologist and Director of Audiology, Canadian Hearing Society

Rex Banks, Au.D

The first component is the auditory component, or the perception of the tinnitus (arises from the inner ear and auditory centres in the brain).

1. Directive Counselling
Intensive client education about the auditory mechanism and the role of the brain plays in tinnitus perception. With education, the tinnitus will be demystified. This will help reduce distress and anxiety about the tinnitus.

2. Sound Therapy
Use of ear level or table-top sound generators and/or hearing aids to provide continuous stimulation of the auditory system to interfere with the perception of tinnitus. This would also include the use of environmental sounds. This will also help reduce distress and anxiety about the tinnitus.

3. Time
It takes time for the brain to habituate to the perception of tinnitus. Most clients report a noticeable improvement is as little as 6-8 weeks. The duration of the TRT program can last between 16 – 24 months.