IHS Tinnitus Assessment and Management — Questions and Answers
Question 1: Tinnitus is MOST accurately defined as:
- A sudden drop in hearing threshold following noise exposure
- The perception of sound in the absence of an external acoustic source (Correct answer)
- Hypersensitivity to moderately loud sounds
- Fluid accumulation in the middle ear producing a rushing sound
Correct answer: The perception of sound in the absence of an external acoustic source
Tinnitus is defined as the perception of sound — such as ringing, buzzing, hissing, or roaring — that has no external source. It can be subjective (heard only by the patient) or, rarely, objective (audible to an examiner). It is not the same as hyperacusis (sound sensitivity) or hearing loss itself, though these often co-occur.
Question 2: The most common cause of chronic subjective tinnitus is:
- Otosclerosis
- Ménière's disease
- Sensorineural hearing loss from noise exposure or aging (Correct answer)
- Eustachian tube dysfunction
Correct answer: Sensorineural hearing loss from noise exposure or aging
The most prevalent cause of chronic subjective tinnitus is sensorineural hearing loss, particularly from noise-induced hearing loss (NIHL) or age-related hearing loss (presbycusis). Damage to cochlear hair cells disrupts normal auditory signals, which the brain may interpret as phantom sound. While otosclerosis and Ménière's can also cause tinnitus, they are far less common overall.
Question 3: During a tinnitus assessment, a specialist uses a procedure called tinnitus pitch matching. The purpose of this procedure is to:
- Measure the loudness of tinnitus in decibels SPL
- Determine the frequency or pitch the patient perceives for their tinnitus (Correct answer)
- Assess whether the tinnitus can be masked by white noise
- Evaluate the patient's psychological distress caused by tinnitus
Correct answer: Determine the frequency or pitch the patient perceives for their tinnitus
Tinnitus pitch matching involves presenting pure tones or narrowband noises to the patient and asking them to identify which frequency most closely matches their perceived tinnitus. This helps characterize the tinnitus and can guide sound therapy or masking choices. Loudness matching is a separate, complementary procedure.
Question 4: Sound therapy for tinnitus management works primarily by:
- Permanently eliminating the neural signals causing tinnitus
- Reducing the perceived contrast between the tinnitus and background sound environment (Correct answer)
- Increasing the patient's hearing thresholds to mask tinnitus
- Surgically redirecting auditory nerve pathways
Correct answer: Reducing the perceived contrast between the tinnitus and background sound environment
Sound therapy (including masking, sound enrichment, and neuromodulation approaches) works by reducing the contrast — or 'signal-to-noise ratio' — between the tinnitus signal and the auditory environment. By introducing background or therapeutic sound, the brain has less opportunity to focus on the tinnitus, reducing its perceived intrusiveness. It does not eliminate tinnitus at the neural level.
Question 5: Which hearing aid feature is specifically designed to provide tinnitus relief alongside amplification?
- Directional microphone arrays
- Built-in tinnitus sound generators (maskers) (Correct answer)
- Telecoil (T-coil) connectivity
- Feedback cancellation algorithms
Correct answer: Built-in tinnitus sound generators (maskers)
Many modern hearing aids include built-in tinnitus sound generators that deliver configurable sounds (white noise, pink noise, nature sounds, or fractal tones) directly into the ear canal. These are used alongside amplification to provide dual benefit: improving hearing and delivering tinnitus relief. Directional mics, telecoils, and feedback cancellation serve other purposes.
Question 6: Tinnitus Retraining Therapy (TRT) combines which two key components?
- Surgical intervention and audiological testing
- Directive counseling and sound therapy (Correct answer)
- Pharmaceutical treatment and hearing aid fitting
- Cognitive behavioral therapy and balance rehabilitation
Correct answer: Directive counseling and sound therapy
TRT, developed by Jastreboff and Hazell, is based on the neurophysiological model of tinnitus and combines: (1) directive counseling to demystify the tinnitus and reduce its emotional significance, and (2) sound therapy using low-level broadband noise to promote habituation. The goal is for the brain to reclassify the tinnitus signal as neutral and insignificant, reducing conscious awareness over time.
IHS Tinnitus Assessment and Management
Tinnitus is MOST accurately defined as: