If your doctor cannot find any medical condition responsible for your tinnitus, you may be referred to an otolaryngologist (commonly called an ear, nose, and throat doctor, or an ENT). The ENT will physically examine your head, neck, and ears and test your hearing to determine whether you have any hearing loss along with the tinnitus. You might also be referred to an audiologist who can also measure your hearing and evaluate your tinnitus.
Call centre staff using a telephone headset are vulnerable to ASD because of the increased likelihood of exposure, close to their ear(s), of sudden unexpected loud sounds randomly transmitted via the telephone line. In the early 1990s, co-inciding with the rapid growth of call centres in Australia, increasing numbers of employees were reporting ASD symptoms. A similar pattern was being noticed overseas. As a result, a number of audiologists, scientists and occupational health experts began to research ASD.

Having information about tinnitus can be very helpful. A lot of people start off looking online and while there is some fantastic information available on the internet, there is also a lot of very unhelpful information. An easy way to ensure what you are reading is appropriately written and produced is to check that the Information Standard has been adhered to - all our information complies with the Information Standard.
About half of hearing loss globally is preventable through public health measures.[2] Such practices include immunization, proper care around pregnancy, avoiding loud noise, and avoiding certain medications.[2] The World Health Organization recommends that young people limit exposure to loud sounds and the use of personal audio players to an hour a day in an effort to limit exposure to noise.[11] Early identification and support are particularly important in children.[2] For many, hearing aids, sign language, cochlear implants and subtitles are useful.[2] Lip reading is another useful skill some develop.[2] Access to hearing aids, however, is limited in many areas of the world.[2]
Depending on the cause of your deafness, your doctor may suggest you have a cochlear implant. This device turns sounds into electrical signals and uses them to directly stimulate your auditory nerve, allowing you to hear. One part of the device is put behind your ear on the outside of your head. The other part is surgically implanted in a bone (called the mastoid bone) behind your ear. It will take time and help from a therapist to get used to using a cochlear implant.
Vertigo is the subjective sensation of the surroundings moving or spinning. It is a symptom of inner ear disease (peripheral) or disorders associated with the brain (central). The cause of many cases of vertigo are unknown (idiopathic) although peripheral vertigo may be related to infection, trauma or chemical irritation of the semicircular canals. Central vertigo may be seen in conditions like multiple sclerosis or strokes.
Most hearing loss, that resulting from age and noise, is progressive and irreversible, and there are currently no approved or recommended treatments. A few specific kinds of hearing loss are amenable to surgical treatment. In other cases, treatment is addressed to underlying pathologies, but any hearing loss incurred may be permanent. Some management options include hearing aids, cochlear implants, assistive technology, and closed captioning.[9] This choice depends on the level of hearing loss, type of hearing loss, and personal preference. Hearing aid applications are one of the options for hearing loss management.[82] For people with bilateral hearing loss, it is not clear if bilateral hearing aids (hearing aids in both ears) are better than a unilateral hearing aid (hearing aid in one ear).[9]
Rapid referral for a comprehensive audiological assessment provides reassurance, and can help control an escalation of symptoms and limit the development of hyperacusis. History taking should document immediate and persistent symptoms since the acoustic incident exposure; prior acoustic incident exposures; and prior otological and psychological history. Significant malingering is rare in ASD clients, in my experience. Most clients are bewildered, frightened or angered by their symptoms and desperate to recover.
Acoustic shock is a recently recognised clinical entity: following an abrupt, intense and unanticipated acoustic stimulus, usually delivered by a telephone handset or headset, some individuals report a symptom cluster that includes otalgia, altered hearing, aural fullness, imbalance, tinnitus, dislike or even fear of loud noises, and anxiety and/or depression. Symptoms start shortly after the triggering acoustic incident and can be short-lived or can last for a considerable time. If persistent, the condition can lead to significant disability. Proposed mechanisms include involvement of the tensor tympani muscle, hyperexcitability of central auditory pathways, and a precursive state of raised anxiety or arousal. A formal treatment programme has not yet been proposed, but the potential utility of modern therapeutic techniques for tinnitus and hyperacusis are considered. Given the large number of UK residents working in telephone call centres, this condition is of considerable clinical importance.

Tinnitus also could be the result of neural circuits thrown out of balance when damage in the inner ear changes signaling activity in the auditory cortex, the part of the brain that processes sound. Or it could be the result of abnormal interactions between neural circuits. The neural circuits involved in hearing aren’t solely dedicated to processing sound. They also communicate with other parts of the brain, such as the limbic region, which regulates mood and emotion.
Tinnitus retraining therapy is a form of treatment that tries to retrain the nerve pathways associated with hearing that may allow the brain to get used to the abnormal sounds. Habituation allows the brain to ignore the tinnitus noise signal, and it allows the person to become unaware that it is present unless they specifically concentrate on the noise. This treatment involves counseling and wearing a sound generator. Audiologists and otolaryngologists often work together in offering this treatment.
Call centre staff are therefore particularly vulnerable: the workplaces are often large, open plan environments with high levels of ambient noise, requiring the operator to turn up the volume of their headset, increasing vulnerability to acoustic incident exposure. Additionally, the workplace environment is potentially stressful: the job requirements are often competitive, monitored and repetitive, with the calls made frequently unwelcome
Besides research studies seeking to improve hearing, such as the ones listed above, research studies on the deaf have also been carried out in order to understand more about audition. Pijil and Shwarz (2005) conducted their study on the deaf who lost their hearing later in life and, hence, used cochlear implants to hear. They discovered further evidence for rate coding of pitch, a system that codes for information for frequencies by the rate that neurons fire in the auditory system, especially for lower frequencies as they are coded by the frequencies that neurons fire from the basilar membrane in a synchronous manner. Their results showed that the subjects could identify different pitches that were proportional to the frequency stimulated by a single electrode. The lower frequencies were detected when the basilar membrane was stimulated, providing even further evidence for rate coding.[130]
While the American College of Physicians indicated that there is not enough evidence to determine the utility of screening in adults over 50 years old who do not have any symptoms,[99] the American Language, Speech Pathology and Hearing Association recommends that adults should be screened at least every decade through age 50 and at 3-year intervals thereafter, to minimize the detrimental effects of the untreated condition on quality of life.[100] For the same reason, the US Office of Disease Prevention and Health Promotion included as one of Healthy People 2020 objectives: to increase the proportion of persons who have had a hearing examination.[101]

Hyperacusis is an increased sensitivity to sound. If you find that everyday or ordinary sounds are uncomfortable, you may have hyperacusis. Whilst it might seem natural to want to block out as much sound as possible, avoiding sound can actually make hyperacusis worse. Talk to your GP about this and ask for a referral to either an ENT Surgeon or Audiovestibular Physician who will be able to suggest management options – often, using sound (in a very controlled way) can improve hyperacusis.
Pulsatile tinnitus is a rare type of tinnitus that sounds like a rhythmic pulsing in the ear, usually in time with your heartbeat. A doctor may be able to hear it by pressing a stethoscope against your neck or by placing a tiny microphone inside the ear canal. This kind of tinnitus is most often caused by problems with blood flow in the head or neck. Pulsatile tinnitus also may be caused by brain tumors or abnormalities in brain structure.
If you are experiencing hearing loss, you should see an ENT (ear, nose, and throat) specialist, or otolaryngologist, who can make a specific diagnosis for you, and talk to you about treatment options, including surgical procedures. A critical part of the evaluation will be a hearing test (audiogram) performed by an audiologist (a professional who tests hearing function) to determine the severity of your loss as well as determine if the hearing loss is conductive, sensorineural, or a mix of both.

People often say that they are aware of noises in the ears when they have a cold, an ear infection or wax blocking the ear. Sometimes people become aware of tinnitus following a really stressful event and once they’re aware of it, seem to notice it more and more, but this usually fades once these things have passed. However, some people continue to notice the tinnitus, for example after an infection has cleared up.
When the sound waves reach the inner ear, they travel through the fluids of the cochlea. The cochlea is a snail-shaped structure in the inner ear. In the cochlea, there are nerve cells with thousands of miniature hairs attached to them. These hairs help convert the sound wave vibrations into electrical signals that then travel to your brain. Your brain interprets these electrical signals as sound. Different sound vibrations create different reactions in these tiny hairs, signaling different sounds to your brain.
You must consult with a qualified physician or hearing healthcare clinician to find the proper treatment for hyperacusis. All content, text, graphics, and information is for general informational purposes and is not intended for use as a diagnosis or treatment of a health problem or as a substitute for consulting a licensed medical professional. The Hyperacusis Network is a free network and accepts no advertising. Any information received is kept confidential and shared with no one.
If your hearing loss is caused by a bacterial infection of the outer ear canal, your doctor may prescribe antibiotic drops. Antibiotics taken by mouth are usually prescribed only for very severe middle ear infections. Ask your pharmacist for advice on your medicine, and always read the patient information leaflet that comes with it. If you keep getting ear infections, your doctor may refer you to a specialist.
Sensorineural causes of hearing loss involve the inner ear or brain and are usually, but not always, permanent. Implants and more invasive procedures may help to restore hearing. Birth defects (prenatal infection, injury during childbirth, and genetic disorders), infections particularly in childhood and age-related degeneration (presbycusis / presbyacusis) are more frequent causes of this type of hearing loss. Sudden, unilateral hearing loss may be related to conditions like a stroke.
Hearing loss is defined as diminished acuity to sounds which would otherwise be heard normally.[15] The terms hearing impaired or hard of hearing are usually reserved for people who have relative inability to hear sound in the speech frequencies. The severity of hearing loss is categorized according to the increase in intensity of sound above the usual level required for the listener to detect it.
ASD is beginning to be recognised as a legitimate and discreet disorder, and can be readily misdiagnosed as TMD stemming from TMJ dysfunction. From a differential diagnosis perspective, TMJ dysfunction can lead to TTTS symptoms and escalate to TMD. While central pain sensitisation is common with TMD caused by TMJ dysfunction, the aural symptoms do not tend to escalate and hyperacusis is not usually present.
Hyperacusis escalation is common with ASD so that an increasing range of sounds become intolerable, with a corresponding escalation in TTTS symptoms, potentially leading to TMD. For this reason, a detailed history is essential in tracking the order of development and escalation of symptoms, and their relationship to acoustic incidents/headset use, prior to making a responsible and considered diagnosis of ASD.
Acoustic shock is an involuntary response to a sound perceived as traumatic (acoustic incident), which causes a specific and consistent pattern of neurophysiological and psychological symptoms (1).  The degree of trauma is influenced by the psychological context of the workplace and/or environment where the acoustic incident exposure occurred. Acoustic shock symptoms are usually temporary, but for some the symptoms can be persistent, escalate and result in a permanent disability. The term acoustic shock disorder (ASD) is used to identify this persistent symptom cluster.

Outer ear infection: otitis externa – usually affects adults aged 45 to 75. It affects the ear canal and is often caused by bacterial infection of the skin of the canal, or a fungus or a yeast. It can also be caused by an irritation such as wearing earplugs or a hearing aid. It is common in people who suffer from skin problems such as eczema, psoriasis or dermatitis but also in people who are keen swimmers.
Fluid accumulation is the most common cause of conductive hearing loss in the middle ear, especially in children.[2] Major causes are ear infections or conditions that block the eustachian tube, such as allergies or tumors.[2] Blocking of the eustachian tube leads to decreased pressure in the middle ear relative to the external ear, and this causes decreased motion of both the ossicles and the tympanic membrane.[3]
A study of ASD symptoms in 103 call centre operators exposed to 123 acoustic incidents is reviewed. The proposed neurophysiological mechanism of ASD is discussed, in particular tonic tensor tympani syndrome (TTTS) and temporomandibular disorder (TMD). An understanding of TTTS provides insight into the neurophysiological basis of tinnitus and hyperacusis escalation, in association with high levels of emotional trauma and anxiety. Audiological assessment, diagnosis, rehabilitation and workplace management of ASD is discussed.
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Hearing loss is defined as diminished acuity to sounds which would otherwise be heard normally.[15] The terms hearing impaired or hard of hearing are usually reserved for people who have relative inability to hear sound in the speech frequencies. The severity of hearing loss is categorized according to the increase in intensity of sound above the usual level required for the listener to detect it.

Tinnitus is the perception of sound when no corresponding external sound is present.[1] While often described as a ringing, it may also sound like a clicking, buzzing, hiss, or roaring.[2] The sound may be soft or loud, low or high pitched, and appear to be coming from one or both ears.[2] In some people, the sound may interfere with concentration or increase feelings of anxiety or depression.[2] Tinnitus may be associated with some degree of hearing loss and with decreased understanding in noise.[2]
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