Tinnitus

Tinnitus

I Made Nudi Arthana

Literatur Review

Definition of Tinnitus

Tinnitus is perception sound heard​ patient without the presence of external stimuli . Symptoms that arise can be bilateral or unilateral. Sound it Can resemble buzzing , humming , whistle , chirping , ring , hiss , ringing And sound click accompanied by with or without disturbance hearing . It is not disease , It is symptoms that are similar with pain , sore head , or fever , can varies in level severity and can influence life patient in various levels . (JB Ballenger. 2006) 

Tinnitus is symptoms that can associated with various causes and factors trigger . It Can impact negative in quality life causes insomnia, difficulty understand talk , disturbance concentration , depression , and difficulty emotional on the spot Work or at home . ( Flint.P , 2014)

Picture 1 Tinnitus

2.1.2 Epidemiology

Throughout​ population obtained 6% - 17% of population the experience ongoing not enough from 5 minutes . Estimated 10% -15% of population in the United States experience complaint tinnitus chronic And around 0.5% - 1% from population the with severe  that affects​ life sufferers . The incidence rate increase along with increase age And existence disturbance hearing And especially consequence exposed voice noisy . increasing around double on all​​ group age , with history exposed voice noisy . (JT Jhonson . 2006)

Prevalence  in adults with problem hearing high (59 to 86%), and is estimated that appears in 50% of patients with disturbance hearing suddenly , 70% with presbyacusis , and 50 to 90% with disturbance hearing consequence noise . Most of the patient report experience problem including : disturbance sleep (42%), problems concentration (47%), and sensitivity to voice (33%). A study of 1,100 children conducted in Italy showed that 34% suffer  and 6.5% complained  . Tinnitus is also experienced by those who have normal hearing ; 18% of patients  reported own normal hearing . Pregnancy has proven in a way significant increase possibility it . The severity of it is associated with severity anxiety and depression and it seems influence ability cognitive patient . (Flood, LM 2017)

There are various causes and sometimes it is difficult to know for sure. Here are some conditions that can cause someone to experience this condition: Damage to the inner ear. Normally, sound that enters the ear will be sent to the brain by the auditory nerves after passing through the cochlea. However, if there is damage to the cochlea, the signal sending process will stop and the brain will continue to search for signals from the remaining cochlea. Hearing loss due to aging. The sensitivity of the auditory nerve will decrease with age so that the quality of our hearing will decrease. Loud sounds or noises, for example listening to music that is too loud through earphones, factory workers handling heavy machinery, or hearing loud explosions. Buildup of wax in the ear. This will block hearing and can trigger irritation of the eardrum. Infection in the middle ear. Abnormal growth of the ear bones. Meniere's disease. Head or neck injury. Side effects of certain medications. Hyperthyroidism. Earthquake. Acoustic neuroma. Cardiovascular disorders, such as hypertension or atherosclerosis.

Some other sounds that may occur in people with tinnitus are:
Rumbling, Clicking, Hissing, Humming, Subjective tinnitus, only the sufferer can hear is the most common.
This ringing sound can range in pitch from a low roar to a high-pitched scream, and you may hear it in one or both ears.

In some cases, the sound can be so loud that it interferes with your ability to concentrate or hear external sounds. Symptoms may be present all the time, or they may come and go.
In rare cases, it can occur as a rhythmic pulsing or whooshing sound, often in conjunction with a heartbeat.

2.1.3 Classification

Tinnitus can also classified in a way qualitative as pulsatile ( often objective ) and nonpulsatile  ( usually subjective ). Nonpulsatile subjective is the most common and only heard by the sufferer , while  pulsatile objective sometimes can heard by observer And due to by vibration or noise internal body . (Sanchez TG, 2005) Tinnitus can also shared into primary and secondary . Primary is not own causes that can identified and possibly related or No related with sensorineural deafness or sensorineural hearing loss (SNHL). In contrast , secondary own underlying cause​ or condition related ( outside of SNHL) ( Flint.P , 2014). Tinnitus is also divided become tinnitus I that is not enough from 3 months and tinnitus chronic more from 3 months . (Kreuzer, PM, 2013)

Tinnitus objective rare : even in the center reference , that only represents 1.5% of all complaint. Nonpulsatile tinnitus subjective so far This is type the most common tinnitus , representing about 90% of all tinnitus . ( Flint.P , 2014)

Classification according to Klockhoff and Lindblom tinnitus shared into 4 namely in accordance with table under This :

2.1.3.1 Degree Tinnitus ( Klockhoff and Lindblom., 1967)

2.1.4 Pathophysiology

Tinnitus has connected with various factor risks , including infection in 10% of cases , injury head or neck in 17% of cases , exposure long-lasting noise in 22% of cases . Theory latest to put forward that system nerve center is source tinnitus . Based on inspection functional magnetic resonance imaging (fMRI) and Positron emission tomography (PET), indicate loss of cochlear input to neurons in the system auditory central as it happens in case of damage cell hair or lesion on the nerve vestibulocochlear cause abnormal neuronal activity in the cortex auditory . (Tyler, RS, 2009) . Persistent tinnitus ( lasting more than 6 months ), unilateral, or relate with difficulty hearing . ( Flint.P , 2014)

Theory damage or dysfunction that​ make existence signal tinnitus mention that signal generated at the level nucleus dorsal cochlea because activation that is not balance that comes from from cell hair outside and inside . In special , when cells hair outside No functioning in the area certain from basilar membrane and some cells hair in the same area​ Still functioning with Well , disinhibition in the dorsal cochlear nucleus occurs and may produce formation signal tinnitus . (Flood, LM 2017)

2.1. 5 Manifestation

Tinnitus classified based on assessment that includes 3 factors that is :

1)         Factors psychology

2)         Factors physiology and

3)         Adjustment psychoacoustic

Ability identify factor physiology in a way objective and very helpful in classify Tinnitus .  a way substantial consequence exposed voice noise and NIHL ( noise induced hearing loss ). Damage cochlea caused by noise​ possibility associated with the emergence tinnitus . Deafness from NIHL is cochlear and general sensorineural deafness happened on both ear . (Westcott, M. 2009.)

List of complaints related to reported by patients with tinnitus includes : 1) problems emotional , such as , anxiety , and depression ; 2) problems hearing like difficulty understand conversation ; and 3) problems somatic like Sick head , pain neck , and pain jaw . (Flood, LM 2017)

2.1.6 Diagnosis 

2.1.6.1 Anamnesis

Patient with complaint tinnitus must asked regarding , onset ( gradual or suddenly ) and nature sound ( quality , location ), effects  in life everyday ( the effect to quality sleep , work , concentration , atmosphere heart , and activities social ), duration tinnitus and symptoms related , including difficulty hear . Medical history previously . ( Atik , A. 2014.)

2.1.6.2 Inspection Physical and Supporting

Evaluation comprehensive audiology​ must performed on patients with tinnitus accompanied by difficulty hearing , or MRI or computed tomography or CT Scan from temporal bone ) is indicated . (Magnusson, JE 2009.)

2.1.7 Therapy

Until moment This therapy For proven tinnitus​ effective Not yet found . It is can due to Because tinnitus Alone is symptom from various condition pathological with various mechanism different basis . (Liang J. 2021 )

Therapy varies from the simplest to the complex and requiring approach multidisciplinary from aspect physical and psychological tinnitus That alone . (C. Jerram. 2009.)

In patients with persistent and more severe tinnitus disturbing , can given other therapies such as use of sound generators ; tinnitus retraining therapy (TRT); and psychotherapy . (Thorne, PR 2009.)

In Table 1 it can be seen seen various therapy that can given for patient . (M. Martin. 2002.)

2.1.7.1 Therapy For Tinnitus Chronic

Tinnitus retraining therapy (TRT) is the intended technique For reduce impact auditory , emotional , and autonomous from tinnitus noise and with thus reduce response stress to tinnitus stimulus . After a history of tinnitus detailed , disturbance from tinnitus achieved with noise broadband delivered​ through device tinnitus ( noise generator ) used as tool help Listen and counsel non- standard psychology . Although No There is proof For intervention term short , TRT can under consideration For used as intervention term long .

2. 2 Music As Therapy ( Therapy Acoustic )

In general , humans from various eras, cultures , groups age , and community own the universal ability to can enjoy music . Music can become a medium for man For express teak himself . Besides That music can also own different roles​ in accordance condition psychological listeners , among other things, provide happiness and comfort , regulate emotions , as well as help relieve stress. (Plein, CT, 2015.)

2.2.2 Types Therapy Acoustic On Tinnitus

2.2.2.1 Hearing Aids

Patient with tinnitus accompanied by disturbance hearing should recommended For installation tool help hear (ABD). The use of ABD is intended For increase noisy environment so that can cover sound tinnitus and strengthening sound at a disturbed frequency . ( Ceranic B. 2008.)

2.2.2. 2 AIDS​ hear combination with noise generator

The presence a constant sound in the ear at a certain level certain will give effect therapeutic . The presence of noise generator will make tinnitus become No be noticed Again . ( Jastreboff , P.J. 2009.)

2.2.2.3             Personal listening devices

Devices This means all devices used by sufferers​ tinnitus in nature easy brought and can used in all condition environment . ( Särkämö T. 2018)

2.2.2.4 Tabletop sound generating devices .

Tabletop sound generating devices is device acoustics placed in place​ or room certain . Type voice like a waterfall or fan wind is type frequent sound​ used . (Wang S. 2018)

2.3 Stages Making from the beginning Tinnitus Application . (Lely Rahayu , 2022), (Lely Rahayu , 2023)

2.3.1    Creation Tinnitus Song

At the beginning study look for all over characteristics patient willing​ follow in study Good factor risk , amplitude , frequency , audiometry and others . Examination This covering measurement amplitude and frequency from tinnitus participants , then match repeat whether in accordance with each participant . The amplitude and frequency according to participant in accordance We use as a basic tone from making Tinnitus Song .

2.3.2 Customizing Tinnitus Songs according to with frequency and amplitude tinnitus patient

The song de Tinnitus that has been made Then We do checking what is the average frequency Already similar with frequency every sufferer with using the program and we also play song the using speakers and measuring frequency song through the speaker with application .

2.3.3 Merging Tinnitus Songs with sound generator so that become Music de Tinnitus

The song de Tinnitus that has been in accordance the frequency when measured with each​ sufferer so We merge with a sound generator that has frequency 15,000 Hz to 20,000 Hz and frequency below 250 Hz as addition Then tested repeat for average frequency so that obtained the appropriate average frequency with each​ sufferers . The song de Tinnitus that has been merged with sound generator This called Music de Tinnitus. Music de Tinnitus 's tested repeat with method like on For ensure same frequency​ with each participant .

2.3.4 Creation Tinnitus Application

This Tinnitus Music made application For player songs on Android using android studio application so Can installed on every Android cellphone that will be . In the application the added A little code for application running at the appropriate amplitude with each participant . The application has been So Then played use the speaker and be seen frequency and amplitude from music the when Already in accordance with frequency and amplitude patient so application the Already Ready given to participant research . Application This We call Tinnitus Application .

2.4 Assessment Tinnitus

Evaluation tinnitus using 3 ratings effectivewith Tinnitus Handicap Inventory (THI) and Questionnaire Tinnitus Primary Function Questionnaire 12-item (TPFQ) whereas in a way subjective with Visual Analog Scale (VASE)

2.4.1 Tinnitus Handicap Inventory (THI)

Evaluation For tinnitus used with Tinnitus Handicap Inventory (THI). Which contains scoring like under this : ( Priyanto , Agus , 2017)

Name :… ……………………………..         Date :… ……….

Age :… ……………………………..

Instructions : Purpose questionnaire This is For identify , measure , and evaluate difficulties you may experience​ Because tinnitus . Please Don't to miss question whatever . When you have answer all question , add up your total score , based on mark For every response .

Table 2.4.1.1 THI ( Priyanto , Agus , 2017)

Total THI Score: ( sum ' Yes ' response x 4) + ( total response ' Sometimes ' x 2) = ................

Determine existence disturbance tinnitus is felt based on total THI score . Table 2.4.1.2 

THI Score

2.4.2 Tinnitus Primary Function Questionnaire 12-item (TPFQ)

Please mention your consent to every statement under This from value 0 ( completely No agree ) to 100 ( completely agree ) with multiples of 5.

Table 2.4.2.1 TPFQ ( Xin, Y et all , 2023)

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