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Conductive hearing loss is caused by any condition or disease that blocks or impedes the conveyance of sound through the outer or middle ear.
Some examples of causes of sensorineural hearing loss are Meniere’s disease, noise exposure, aging (presbycusis), trauma, ototoxic medication, acoustic neuroma, congenital (birth) and hereditary.
Hearing loss can be caused by something as simple as excessive ear wax or as complex as a congenital disorder, medical problem or disease.
Sudden onset hearing loss occurs across the entire age spectrum with equal prevalence in men and women, but most patients are between 50–60 years of age.
Infection-related hearing loss occurs when fluid from the infection builds up behind the eardrum. Hearing loss related to birth defects or genetics—Genetic sensorineural hearing loss (SNHL) includes a broad range of disorders that affect infants, children, and adults. Ototoxic hearing loss occurs when someone takes or is given a drug that causes hearing loss as one of its side effects.
An Audiologist is a healthcare professional who specializes in identifying, diagnosing, treating and monitoring disorders of the auditory and vestibular system portions of the ear. Hearing care professionals need to be able to recognize which tools in their tinnitus toolbox to utilize on a patient-by-patient basis, and be aware of research to help make navigation of this an easier process for both the clinician and the patient.
Since the inception of audiology in the 1950s, treatment and assessment have slowly become cornerstones of tinnitus patient care. Part I of the “Tinnitus Toolbox” is a comprehensive guide for hearing care professionals to successfully navigate a best practices assessment protocol for their patients presenting with tinnitus.
While the assessment portion of patient care is an imperative part of quantifying and documenting a diagnosis of tinnitus, it is just as important to be able to provide well-rounded, scientifically based patient care post assessment. However, outside of assessment, there is limited insurance reimbursement for many additional aspects of tinnitus care.
A thorough case history and auditory pathway assessment should be completed prior to beginning a comprehensive tinnitus evaluation.
For the hearing evaluation component, it is often useful to obtain high frequency audiometry with inter-octaves and an increased resolution around the area of the suspected tinnitus (Figure 1). In addition to the audiogram, middle-ear status should be verified by performing tympanometry and high frequency Otoacoustic Emissions (OAEs), preferably including frequencies above 8,000 Hz. Questionnaires can garner important information from the patient about their current tinnitus management, if any, as well as facilitate discussion by giving the provider a framework in which to begin counseling.
Hearing care professionals are naturally inclined to focus on the hearing aspect of tinnitus symptoms.
After performing the comprehensive audiological assessment and obtaining the appropriate questionnaire results, the final piece of a tinnitus evaluation is quantifying the tinnitus through measures such as Pitch Matching, Loudness Matching, and Residual Inhibition. Figure 3 shows a preview of the tinnitus tab for the MADSEN® Astera2 by Otometrics, which has all of the necessary components for a tinnitus evaluation built into the software.  In this example, since only the right ear has been assessed, a-52 modifier to the CPT code would be needed if no further testing was performed. After leaving the defined harbor of a tinnitus evaluation, navigating the sea of tinnitus treatment options can be overwhelming. While there are promises of medical and minimally invasive approaches, currently the hearing care professional needs to be able to recognize which tools in their tinnitus toolbox to utilize on a patient-by-patient basis, and be aware of current and upcoming research to help make navigation of this an easier process for both the clinician and the patient. Discover what all of your possible tinnitus treatment options are, and which ones might be best suited for your particular case of tinnitus. Tinnitus retraining therapy, also known as TRT, is one of the most popular and effective methods of treating tinnitus.
There are certain neck exercises which can be done in order to reduce the ringing or buzzing sounds which have become a problem due to tinnitus, it might be a good idea to start looking into some of the different neck exercises you can do. There are many different things which tinnitus sufferers can do to mask the sounds they are forced to hear, including wearing headphones.


Those who have jobs that expose them to very loud noises on a regular basis will want to make sure to avoid developing tinnitus or worsening this problem if they already have it. Although tinnitus which is classified as an inner ear disorder can be difficult to treat, there are certain over-the-counter medications which have proven to be helpful for some with this condition. Although there have been many different types of treatment targeted at tinnitus sufferers, low level laser therapy or LLT is one of the up and coming contenders. Notched music therapy could offer hope to millions of people around the world with subjective tinnitus. There are certain risk factors which are important to be aware of, especially if you think there might be a chance of developing this problem.
Pink noise treatments can be very effective for those who have tinnitus and other inner-ear disorders. Heartburn sufferers shouldn't be too quick to reach for, Heartburn sufferers shouldn't be too quick to reach for the antacids; heartburn medications do more harm than good. Copyright © 2012 Autos Weblog, All trademarks are the property of the respective trademark owners.
In addition to some irreversible hearing loss caused by an inner ear or auditory nerve disorder, there is also a dysfunction of the outer or middle ear mechanism, making hearing worse than the sensorineural loss alone.
Prolonged noise exposure damages the hair cells in the cochlea and results in permanent hearing loss.
Affected individuals may have unilateral or bilateral hearing loss ranging from mild to profound. Audiologists are trained in anatomy and physiology, hearing aids, cochlear implants, electrophysiology, acoustics, neurology, counseling and sign language. Tinnitus management has been a major topic in audiology, especially in the past several years. For example, long-term treatment does not have a designated code; therefore, more comprehensive tinnitus management strategies, such as Tinnitus Retraining Therapy (TRT) and Cognitive Behavioral Therapy (CBT), may not be reimbursed by insurers.
For example, you may test 1,500, 3,000 and 6,000 Hz and determine threshold utilizing 2 dB steps instead of 5 dB. Excerpt from the Tinnitus Functional Index questionnaire in the MADSEN Astera2 Tinnitus Module. These two questionnaires not only give a variety of easy-to-score and comprehensive questions, but they have been validated in numerous studies as effective measures of tinnitus quantification.3 Both are brief, containing only 25 questions each, and when utilized in a baseline assessment, can be used as benchmarks for patient success post tinnitus management. However, it’s imperative to take a more universal approach to these patients and consider concomitant medical issues. Characterizing the subjective symptoms improves communication between the clinician and the patient and provides a documented basis for treatment.
Each patient has unique experiences, comorbidities, and even perceptions of their tinnitus that can further complicate the therapy process, even for the most skilled clinician. Monitoring and predicting ototoxic damage using distortion-product otoacoustic emissions: pediatric case study. Psychometric adequacy of the tinnitus handicap inventory (THI) for evaluating treatment outcome. The tinnitus functional index: Development of a new clinical measure for chronic, intrusive tinnitus. Noise-cancellation headphones are available to those who are suffering from tinnitus and need relief, especially when they go to bed at night.
Despite what many people think, urine is not simply a waste product that is produced by our body. Whether or not a certain medication works depends on a few different factors, including which type of tinnitus the person has.


Unlike other types of sound therapy, notched music therapy is custom-designed for the person who is undergoing it. Those who have this inner ear disorder will want to look into getting an ear massage to help with their ringing as it has been proven to help some people with tinnitus.
Generally, the cause of conductive hearing loss can be identified and treated, resulting in a complete or partial improvement in hearing.
The conductive component may improve with medical treatment and reversal of the associated hearing loss, but the sensorineural component will most likely be permanent. The process begins after age 20, but it is not until around ages 55 to 65 that high frequencies in the speech range begin to be affected.
An estimated 4,000 people will develop sudden sensorineural hearing loss each year in the United States.
Assessment, evaluation, and counseling tools are now available for hearing care professionals who would like to add tinnitus care to their practice. Medical referrals also need to be considered, especially if the patient exhibits any of the red flags of tinnitus, such as pulsatile tinnitus, auditory hallucinations, or depression, etc (Table 1).9,13 As with any patient, always utilize clinical judgment for referrals if any concerns arise regarding the patient’s well-being.
This can be useful particularly for patients who have normal or symmetrical audiological pure-tone results between 250-8,000 Hz.
For example, of all tinnitus patients, it is estimated that “approximately 35% have anxiety, 13-28% have depression, and 25% exhibit psychiatric disorder, all of which can contribute to the negative feedback loop, or vicious cycle,” that tinnitus can foster.13,17 So, while planning a thorough tinnitus evaluation, other types of validated, psychoanalytical questionnaires can be useful in determining if a referral needs to be made to a mental health professional. A tinnitus evaluation is typically associated with tests such as pitch matching and minimum masking levels, and those measures are needed for reimbursement as noted above. It is the result of blood filtration and the medical term for it is “plasma ultrafiltrate”.
As with conductive hearing loss, this type of loss also reduces the intensity of sound, but it might also result in a lack of clarity even when sounds, particularly speech, are loud enough.
Hearing aids can be beneficial for persons with a mixed hearing loss, but caution must be exercised by the hearing care professional and patient if the conductive component is due to an active ear infection. Hearing loss can also occur as a result of an acoustic trauma due to a single exposure or few exposures to very loud sound. There are numerous causes for this type of loss, ranging from autoimmune inner ear disease and viral infections to traumatic insult (skull fracture, puncture of the eardrum, sudden changes in air pressure). People with hearing loss need to be especially aware of the potential for ototoxic effects, as an ototoxic drug can make an existing hearing loss worse. Hearing instrument manufacturers have addressed this need by adding tinnitus-specific features into their hearing instruments and even introduced new and innovative ways to treat tinnitus via smart phone applications.1 Tinnitus treatment options are abundant and online resources are increasingly available for people who would like to learn about their condition. Obtaining Most Comfortable Levels (MCLs) and Uncomfortable Loudness Level (UCLs) for pure-tones gives an indication of the patient’s residual dynamic range or an indication of hyperacusis. These can include the Beck Depression Survey, the Spuelberger State-Trait Anxiety Inventory, and the Primary Care PTSD survey. While these measures are useful in understanding and documenting a patient’s tinnitus, a thorough hearing assessment and tinnitus questionnaires provide important additional information that can assist in a differential diagnosis. Following the completion of medical treatment, hearing aids are effective in correcting the remaining hearing loss.
Ototoxic drugs include some antibiotics, chemotherapy drugs and anti-inflammatory medications, including some over-the-counter drugs.
Some examples of causes of conductive hearing loss are: impacted cerumen, atresia (closed ear canal), perforated eardrum, otitis media (fluid in the middle ear), otosclerosis and ear trauma.



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