Progressive Audiologic Tinnitus Management
We have described audiologic tinnitus management previously . The ATM method provided specific guidelines for audiologists to implement a well-defined program of tinnitus management. Our subsequent tinnitus clinical research pointed to the need to provide tinnitus clinical services in a hierarchical manner, that is, to provide services only to the degree necessary to meet patients’ individual needs. In addition, we saw a need to make numerous changes to the ATM assessment and intervention methodologies to improve the effectiveness and efficiency of the clinical protocol. ATM therefore was completely revamped, resulting in a five-level hierarchical program of tinnitus management that we refer to as progressive audiologic tinnitus management .
The primary objectives of PATM are to provide the following services to patients who complain of tinnitus: education to facilitate the acquisition of tinnitus self-management skills a progressive program of assessment and intervention that addresses each patient’s individual needs and ensuring that patients are referred appropriately for medical and mental health services if needed. The management program is goal-oriented with a focus on individualized management, patient and family education, counseling, and support.
Figure 1. Tinnitus Pyramid.
Figure 2. Progressive Audiologic Tinnitus Management hierarchical levels.
Causes Of Hearing Loss After Head Injury
There are two primary ways that hearing problems can arise after a head injury or concussion: neurological damage or mechanical damage.
For example, if an injury affects the mechanical process of hearing, the ear will not transmit sound to the brain at all. This is the most common cause of hearing loss after head injury.
On the other hand, if the parts of the brain that process hearing become damaged or disrupted, the brain can no longer process sound. Therefore, even if the ear itself functions properly, a patient can still experience hearing problems.
Most Common Types Of Disabilities Caused By Tbi
Traumatic Brain Injury can cause a range of disabilities.
Almost 50 percent of victims of TBI experience post-concussion syndrome within a few days of the injury. The condition may last weeks up to several months depending on severity. Symptoms are wide ranging and they include: dizziness, memory problems, difficulty concentrating, headache, sleep disturbance, anxiety, agitation, sadness and apathy. While the condition is temporary it is severe enough that patients cannot work or carry out normal activities until the symptoms are managed. Typical treatment is threefold: medication, occupational therapy and psychotherapy.
Cognitive problems related to TBI happen because of one serious injury or a succession of mild injuries such as those experienced by football players. The main issue facing victims is memory loss specifically, losing the ability to remember certain past events and difficulty remembering new things. Other symptoms commonly experienced for six months or longer after the injury are foggy brain and the inability to organize schedules, make appropriate judgments, reason logically or solve problems.
Victims may also experience other disabilities relating to the senses including:
- Ringing or roaring in the ears, for others their
- Only tasting bitterness
- Non-stop itching, tingling or hurting skin
Unfortunately, there are no known remedies for these irritating symptoms.
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Types Of Disabilities Caused By Traumatic Brain Injury
Traumatic Brain Injury can result in many types of disabilities. The most common involve thinking, the five senses, communication skills and mental health. Damage to these brain functions can affect every aspect of our lives, which is why TBI can be so devastating.
Almost half of TBI patients will develop Postconcussion Syndrome within a few days of the injury. The syndrome involves various symptoms like headache, dizziness, memory problems, difficulty concentrating, sleep disturbance, agitation, anxiety, sadness and apathy. Doctors treat PCS with medication, occupational therapy and psychotherapy to help patients learn to manage symptoms. Until symptoms subside, many patients will be unable to work or perform normal daily duties.
Cognitive problems can result from severe brain injury, or a succession of mild injuries .The patient may have trouble thinking clearly, remembering events and facts, or reasoning logically. Memory loss is the most common cognitive disability, usually showing an inability to remember certain past events and trouble remembering new things. Patients may be unable to organize schedules, solve problems, reason, or make appropriate judgments for six months or more following the injury.
Types Of Hearing Loss
Hearing loss comes in many forms. It can range from a mild loss, in which a person misses certain high-pitched sounds, such as the voices of women and children, to a total loss of hearing.
There are two general categories of hearing loss:
- Sensorineural hearing loss occurs when there is damage to the inner ear or the auditory nerve. This type of hearing loss is usually permanent.
- Conductive hearing loss occurs when sound waves cannot reach the inner ear. The cause may be earwax buildup, fluid, or a punctured eardrum. Medical treatment or surgery can usually restore conductive hearing loss.
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Making The Right Diagnosis
It is recommended that anyone suffering from head trauma be evaluated medically. Since many hearing problems cannot be detected by the patient, diagnostic evaluations may include neuroimaging, neuropsychological tests, and comprehensive audiologic evaluation including vestibular balance assessment with videonystagmography and posturography.
NOTE: It is strongly recommended on all audiology case history assessments that each patient is asked, not only have they ever suffered a concussion, but have they ever hit their head or been in a concussive event.
Currently, the Balance Error Scoring System is used to assess balance deficits indicating concussion. In addition to BESS, a paper test such as the Standardized Assessment of Concussion is commonly used. The Acute Concussion Evaluation was developed to provide physicians with an evidence based protocol to conduct an initial evaluation and diagnosis of patients (bot children and adults with known or suspected MTBI.
How Common Are They
The CDC estimates that 1.6 million traumatic brain injuries each year result from contact sports, car collisions, and recreational activities. Of those injuries, up to 50% involve hearing loss or sudden-onset tinnitus. TBIs are especially common among football players, with up to 10% of all college players and 20% of all high school players sustaining TBIs during any given year. In the elderly, falls are the leading cause of TBIs, which can be especially serious when blood-thinning medications are in use.
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What Is The Outlook For People With Ear Injuries
The outlook varies depending on the type and severity of the injury. Many ruptured eardrums and minor ear injuries heal without treatment. In severe cases, ear and head trauma can lead to serious problems, including:
- Cerebrospinal fluid leak, which can result from fractures in the head and the base of the skull. This can sometimes lead to meningitis, an infection of the lining of the brain.
- Long-term problems with balance and vertigo .
- Paralysis of the face .
- Permanent hearing loss.
- Recurring ear infections, which can happen when bacteria enter the inner ear through a torn eardrum.
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Location And Severity Of Injury
Generally, but not always, the trauma is to the vicinity of the ear. Slaps to the ear, blunt objects hitting the around the bone of the ear are particularly common. In the author’s experience, loss of consciousness is less common than retained consciousness. Falls with head contact to an unyielding surface, such as from a ladder to the floor, are more likely to be injurious than, for example, boxes falling on the head. Generally, although not always, in cases with post-traumatic dizziness or hearing loss there is signs of head injury — a skull fracture being the most obvious, but also bruises, swelling, abrasions are seen in head injuries that are associated with hearing loss or tinnitus. A perforation of the ear drum is an unequivocal sign of a significant middle ear trauma. However, most of the time, the ear drum is not perforated .
Impact Of Age And Exposure To Noise On Hearing
The most common causes of hearing loss are age and over-exposure to noise. This can happen if you work in a loud environment. If you experience hearing loss due to a brain injury, this could worsen over time as you age or if your workplace is loud.
Make sure to wear proper ear protection in loud environments, and work with your audiologist as you age. While it may not be possible to stop age-related hearing loss, a hearing aid could be used to help with deficits.
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What Causes Ear Injuries
There are several causes of ear injury and trauma, including:
- Accidents and injuries: Trauma from a fall, car accident or contact sports can cause serious ear injuries.
- Changes in pressure: Scuba diving and flying on an airplane can lead to a perforated eardrum.
- Foreign objects: Inserting a pen or another object into your ear canal can damage the bones, cartilage and tissue.
- Loud noises: Eardrums can also tear due to loud noises, such as gunshots, explosions and loud music concerts. Long-term exposure to loud noise can cause permanent hearing loss.
Can Head Injury Cause Hearing Loss
Hearing loss is one of the most common, chronic health conditions that people experience. Nearly 1 in 8 people have some degree of impaired hearing in the U.S. which impacts over 40 million people. Hearing loss can be caused by a variety of factors including: aging, existing medical conditions , environmental exposure to loud noise, and genetic history.
In addition to these, an often-overlooked cause of hearing loss is head injuries. Head injuries are common injuries that millions of people experience every year. Resulting from contact sports, car and/or bike accidents, or falling head injuries can lead to significant damage including hearing loss.
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Signs And Symptoms Related To Traumatic Brain Injury
- Loss of new skills, such as toilet training
- Sensitivity to light and/or noise
- Unsteady walking, loss of balance
In cases of abusive head trauma such as shaken baby syndrome, sometimes there are no apparent external physical signs to indicate a TBI. Attention to behavioral symptoms such as those listed above is critical .
For infants and toddlers, acute deficits following TBI tend to be in skill areas that are developing at the time of injury. Lack of overt deficits in these very young children just after TBI does not mean that they will not require services later. For skills that are not fully developed at the time of injury, later-onset symptoms can arise, including memory and attention deficits, language delay or deficits, and behavioral problems. These younger children are also more likely to have difficulties academically compared with children who were injured at later ages . The full extent of deficits may become evident only as the child’s brain matures and expected skills fail to develop or emerge more slowly .
See the Assessment and Treatment sections for more information about young children with TBI.
Causes of pediatric TBI are varied and appear to differ by age. The Centers for Disease Control and Prevention identified the following leading causes of TBI in children and adolescents ages 0 to 14:
Hearing Loss After Head Injury: Causes Diagnosis And Treatments
Hearing loss after a head injury can occur after damage to certain parts of the brain, particularly the temporal or parietal lobes. It can also be a result of problems with the ears mechanisms itself.
To help you navigate the various hearing problems that can occur after brain injury, this article will cover everything from diagnosing hearing loss to treating it.
Use the following links to jump to a relevant section:
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Roles And Responsibilities Of The Slp
Speech-language pathologists do not diagnose TBI however, they play a key role in the screening, assessment, and treatment of children and adolescents with TBI. The professional roles and activities in speech-language pathology include clinical services , prevention, and advocacy, as well as education, administration, and research. See ASHA’s Scope of Practice in Speech-Language Pathology .
Appropriate roles for SLPs include the following:
As indicated in the Code of Ethics , SLPs who serve this population should be specifically educated and appropriately trained to do so.
How Is Hearing Loss Related To Tbis Treated
If you notice symptoms after any kind of head trauma, be sure to have your hearing checked as part of your workup.
Treatment will depend on the symptom and its cause. A ruptured eardrum, for example, can recover on its own in about a month. Damaged ossicular bones can be repaired or replaced surgically. Dizziness from Menieres syndrome can be treated with medications, but you will not be able to reverse hearing loss. A hearing aid will help.
Key message: Be sure to get an auditory evaluation after any incident that might have injured your brain and mention your history when you speak to a doctor about any current hearing or balance issues.
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The Link Between Concussions And Hearing Loss
Contact sports, car crashes and falls are the leading causes of concussions in Thousand Oaks, California. A concussion is a type of traumatic brain injury caused by a sudden acceleration or deceleration to the head. Headaches, dizziness, temporary loss of consciousness, confusion, fatigue and vomiting are common symptoms of this brain injury.
While hearing loss is also a common side effect of brain injuries, it is often left off the list of symptoms. The force required to cause a concussion can also cause damage to the tiny bones in the middle ear or fracture bones in the inner ear and cochlea. It can also cause an injury to specific parts of the brain that are responsible for processing sound.
After a concussion, immediate medical attention is required. The following tests are typically performed:
- Neurological evaluations, which are used to measure your sensory and motor responses. This includes your vision, hearing, balance and coordination.
- Cognitive tests, which are used to evaluate your ability to think.
- Imaging tests, such as cranial computerized tomography or a magnetic resonance imaging , which are used to confirm if the concussion caused any physical injuries or bleeding inside the skull.
An observation is also ordered for at least 24 hours after the event. This may be performed in a hospital setting or in your own home. The observation is important to make sure your symptoms do not get any worse.
Some Facts About Concussions
-A concussion is a mild form of traumatic brain injury caused by a bump, blow, or jolt to the head. A concussion can also be caused by violent movement or jarring of the head or neck, or as a result of a sound blast, in which the pressure of the noise is so loud that it causes brain damage.
-The primary injury in a mild concussion is a contusion of the brain. But in moderate to severe cases, hemorrhaging of the brain can also occur.
-The most common causes of concussions are sports injuries, bicycle and car accidents, and falls.
-People who have already sustained one concussion tend to be more susceptible to having another.
-Although a concussion is not a life-threatening injury and people generally recover quickly, it can cause serious symptoms, including hearing loss.
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How Traumatic Brain Injury Affects Hearing
TBI is short for traumatic brain injury and it can cause hearing problems. The reason is that the inner ear has a direct connection to the central nervous system. Hearing loss and ringing in the ears are two most common side effects of the traumatic brain injury. However, there are other problems that may cause when a person suffers from brain injuries. For example, hyperacusis in which the patient finds normal sounds very loud. Moreover, the patient may find it difficult to differ background sounds from other sounds. Another hearing problem is known as auditory agnosia where the patient fails to recognize certain sounds.
After a traumatic brain injury, hearing problems may occur due to a number of reasons. There are two types of hearing problems namely neurological and mechanical. These problems occur especially when the temporal lobes and/or the inner ear receives damages. External bleeding in the canal of the ear, middle ear damage or temporal lobe damage may result in auditory dysfunction. Serious hearing problems may occur if the brain injury is of serious nature.
Children who are suffering from traumatic brain injury may face other problems associated with a communication area, such as obtaining new information, task completion, spatial orientation, social conversation and impulse control. According to research studies, kids, for the most part, face these additional problems.
Hearing Loss: A Common Problem For Older Adults
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Hearing loss is a common problem caused by noise, aging, disease, and heredity. People with hearing loss may find it hard to have conversations with friends and family. They may also have trouble understanding a doctors advice, responding to warnings, and hearing doorbells and alarms.
Approximately one in three people between the ages of 65 and 74 has hearing loss, and nearly half of those older than 75 has difficulty hearing. But, some people may not want to admit they have trouble hearing.
Older people who cant hear well may become depressed, or they may withdraw from others because they feel frustrated or embarrassed about not understanding what is being said. Sometimes, older people are mistakenly thought to be confused, unresponsive, or uncooperative because they dont hear well.
Hearing problems that are ignored or untreated can get worse. If you have a hearing problem, see your doctor. Hearing aids, special training, certain medicines, and surgery are some of the treatments that can help.
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