Tinnitus Assessment & Management Flashcards

What is minimum masking level (MML) in tinnitus assessment?

Answer: The lowest level of broadband noise required to just mask the patient's tinnitus, measured in dB SL above the patient's hearing threshold

Minimum masking level (MML) is determined by increasing broadband noise until the patient reports their tinnitus is just covered, expressed as dB SL above the hearing threshold—it quantifies tinnitus loudness and guides sound therapy levels.

What is residual inhibition in tinnitus and why is it clinically relevant?

Answer: A temporary reduction or complete suppression of tinnitus following the cessation of a masking sound, lasting seconds to minutes

Residual inhibition (RI) is the temporary reduction or disappearance of tinnitus after a masking stimulus is turned off—it demonstrates that tinnitus can be temporarily suppressed, which is encouraging for patients and informs the neurophysiological understanding of tinnitus.

Cognitive Behavioral Therapy (CBT) is considered a first-line treatment for which tinnitus presentations?

Answer: Tinnitus associated with significant psychological distress, anxiety, insomnia, or depression—CBT is the most evidence-based treatment for tinnitus-related psychological disability

CBT has the strongest evidence base for reducing tinnitus-related psychological distress, depression, anxiety, and sleep disturbance, even though it does not reduce the tinnitus sound itself; it changes the patient's emotional and cognitive response to tinnitus.

What is the relationship between stress and tinnitus severity?

Answer: Stress activates the limbic and autonomic nervous systems, which amplify the emotional impact of tinnitus and may increase perceived tinnitus loudness and annoyance through descending auditory pathway modulation

Psychological and physiological stress activates the limbic system and autonomic nervous system, which have bidirectional connections with the auditory system; this can amplify the perceived annoyance and loudness of tinnitus and create a reinforcing distress cycle.

What audiological finding most commonly predicts poor benefit from hearing aids for tinnitus?

Answer: Normal audiogram (tinnitus without significant hearing loss), where hearing aids provide no amplification benefit and therefore limited masking effect

Patients with tinnitus but normal or near-normal audiograms cannot benefit from amplification-based tinnitus relief, since hearing aids are not indicated for normal hearing and provide minimal acoustic masking benefit without amplifying environmental sound.

What is notched music therapy (NMT) for tinnitus and on what principle is it based?

Answer: Music processed to remove frequencies around the patient's tinnitus pitch, hypothesized to reduce neural activity at that frequency through lateral inhibition in the auditory cortex

Notched music therapy removes a frequency band centered on the patient's tinnitus pitch from music, which is hypothesized to reduce cortical tonotopic map reorganization and decrease neural hyperactivity at the tinnitus frequency via lateral inhibition.