^ McCombe A, Baguley D, Coles R, McKenna L, McKinney C, Windle-Taylor P (2001). "Guidelines for the grading of tinnitus severity: the results of a working group commissioned by the British Association of Otolaryngologists, Head and Neck Surgeons, 1999". Clinical Otolaryngology and Allied Sciences. 26 (5): 388–93. doi:10.1046/j.1365-2273.2001.00490.x. PMID 11678946. Archived (PDF) from the original on 2017-09-24.
An outer ear infection is sometimes called swimmer’s ear. That’s because it often starts as a result of water that remains in your ear after swimming or bathing. The moisture becomes a breeding ground for bacteria. If your outer ear is scratched or if you irritate the outer lining of your ear by putting your fingers or other objects in your ear, a bacterial infection can occur.

According to Ramirez et al, at a peripheral level TTTS appears to trigger a series of physiological reactions in and around the ear from tympanic membrane tension and alterations in middle ear ventilation. The tensor tympani muscle is innervated by the motor portion of the mandibular branch of the trigeminal nerve, and the authors consider that TTTS can lead to, and in an efferent pathway be caused by, an abnormal stimulation of the trigeminal nerve. This can lead to a chronic irritation of the trigeminal nerve, as well as other cranial and cervical sensory nerves of the ear and periauricular region. Central sensitisation can develop from the resultant chronic pain, leading to an expansion of the perceived peripheral pain and resulting in the typical symptoms of severe TMD.
Ramirez et al (14) aimed to explore the anatomical and physiological connections in TMD patients with secondary aural symptoms and the central and peripheral mechanisms involved. The authors carried out an extensive peer-reviewed literature search, using data from (12), 436 patients in 49 papers, to analyse aural symptoms (otalgia, tinnitus, vertigo, subjective hearing loss and aural fullness) exacerbated by dysfunctional mouth and jaw dynamics. They proposed a range of muscular, bone communication and neural scenarios to explain this relationship, placing emphasis on tensor tympani muscle involvement and trigeminal nerve dysfunction.

Deaf culture refers to a tight-knit cultural group of people whose primary language is signed, and who practice social and cultural norms which are distinct from those of the surrounding hearing community. This community does not automatically include all those who are clinically or legally deaf, nor does it exclude every hearing person. According to Baker and Padden, it includes any person or persons who "identifies him/herself as a member of the Deaf community, and other members accept that person as a part of the community,"[114] an example being children of deaf adults with normal hearing ability. It includes the set of social beliefs, behaviors, art, literary traditions, history, values, and shared institutions of communities that are influenced by deafness and which use sign languages as the main means of communication.[115][116] Members of the Deaf community tend to view deafness as a difference in human experience rather than a disability or disease.[117][118] When used as a cultural label especially within the culture, the word deaf is often written with a capital D and referred to as "big D Deaf" in speech and sign. When used as a label for the audiological condition, it is written with a lower case d.[115][116]
The potential severity and persistence of ASD symptoms have significant clinical and medico-legal implications. With the rapid growth of call centres around the world, professionals providing tinnitus and hyperacusis therapy, as well as general practitioners, ENT specialists, occupational physicians, TMD specialists, neurologists and trauma psychologists/psychiatrists, are increasingly likely to encounter some or all of the cluster of ASD symptoms in their clients.

Pain was the most frequent symptom, reported by 95%. Of these, 81% reported ear pain, 11% pain in the neck or jaw, and 7% facial pain. Tinnitus was reported by 50%, usually accompanied by other symptoms, but in 6% it was the only symptom. Loss of balance was reported by 48%. The most distressing and durable symptom tended to be hyperacusis, reported by 32%.
Since 1991, major manufacturers have incorporated an acoustic limiter in the electronics of their headsets to meet the requirements of the Department of Trade and Industry (DTI) specification 85/013. In the UK, this limiter ensures that any type of noise (eg conversation, short duration impulses) above 118 dB is not transmitted through the headset.
Depression is one of the leading causes of morbidity and mortality worldwide. In older adults, the suicide rate is higher than it is for younger adults, and more suicide cases are attributable to depression.[38] Different studies have been done to investigate potential risk factors that can give rise to depression in later life. Some chronic diseases are found to be significantly associated with risk of developing depression, such as coronary heart disease, pulmonary disease, vision loss and hearing loss.[39] Hearing loss can attribute to decrease in health-related quality of life, increase in social isolation and decline in social engagement, which are all risk factors for increased risk of developing depression symptoms.[40]
This is a meditation technique that is used frequently for pain management, and more recently for tinnitus. The idea is that we tend to resist unpleasant sensations (eg hearing tinnitus). If we stop resisting and allow the unpleasant sensation, this alters our awareness to include more sensations. We start to notice that sensations become less dominant once our attention moves away from them and focuses on a different part of the body. All of this can change in a moment, simply by changing our awareness. If we use mindfulness effectively, we can create some space from the tinnitus and in that space, we can decide how we’re going to respond to it. It’s a wonderful way of achieving ‘peace and quiet’.

Conductive hearing loss is sometimes temporary and can be treated with medication or minor surgery, if necessary. However, more major surgery may be required to fix the ear drum or hearing bones. If conventional hearing aids don't work, there are also some implantable devices for this type of hearing loss, such as a Bone Anchored Hearing Aids (BAHAs).
The first person to talk to is your GP. You may need to be referred to an Ear, Nose and Throat (ENT) Surgeon or an Audiovestibular Physician, who will rule out any medical factors, assess your hearing and probably give you some information about what tinnitus is and how best to manage it. Some hospitals have hearing therapists or specially trained audiologists who are available to offer more support if you need it.

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.


Noise-induced hearing loss (NIHL) typically manifests as elevated hearing thresholds (i.e. less sensitivity or muting). Noise exposure is the cause of approximately half of all cases of hearing loss, causing some degree of problems in 5% of the population globally.[50] The majority of hearing loss is not due to age, but due to noise exposure.[51] Various governmental, industry and standards organizations set noise standards.[52] Many people are unaware of the presence of environmental sound at damaging levels, or of the level at which sound becomes harmful. Common sources of damaging noise levels include car stereos, children's toys, motor vehicles, crowds, lawn and maintenance equipment, power tools, gun use, musical instruments, and even hair dryers. Noise damage is cumulative; all sources of damage must be considered to assess risk. In the US, 12.5% of children aged 6–19 years have permanent hearing damage from excessive noise exposure.[53] The World Health Organization estimates that half of those between 12 and 35 are at risk from using personal audio devices that are too loud.[11] Hearing loss in adolescents may be caused by loud noise from toys, music by headphones, and concerts or events.[54]
Recent research, reported in 2012 achieved growth of cochlear nerve cells resulting in hearing improvements in gerbils,[121] using stem cells. Also reported in 2013 was regrowth of hair cells in deaf adult mice using a drug intervention resulting in hearing improvement.[122] The Hearing Health Foundation in the US has embarked on a project called the Hearing Restoration Project.[123] Also Action on Hearing Loss in the UK is also aiming to restore hearing.[124]
If there is no obvious cause of hearing loss, your doctor can refer you for a hearing assessment with an audiologist or an ear nose and throat (ENT) specialist. They will look into your ears and test your hearing to see how well you can detect different levels of sound. This assessment will help find the cause of your hearing loss and what treatments would work best.
The research carried out by Ramirez et al (14) shows the aural symptoms associated with TMD and their neurophysiological consequences are at least partially a consequence of TTTS. These aural symptoms and the typical pattern with TMD of chronic, severe myofascial pain; numbness, tingling and burning in and around the ear; escalation and trigger point development in the neck, shoulder and arm and central pain sensitisation are identical to those observed in my clients with severe ASD, and support the proposal that TTTS is the neurophysiological mechanism of ASD. However, ASD clients do not generally have temporomandibular joint (TMJ) dysfunction, unless it is part of a secondary escalation pattern. A hypothesis is presented that TMD can develop when TTTS is caused by an ASD, albeit with a different aetiologic pathway and without TMJ dysfunction.
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]
The middle ear is connected to the back of your nose and upper part of your throat by a narrow channel called the auditory tube (eustachian tube). The tube opens and closes at the throat end to equalize the pressure in the middle ear with that of the environment and drain fluids. Equal pressure on both sides of the eardrum is important for normal vibration of the eardrum.
^ McCombe A, Baguley D, Coles R, McKenna L, McKinney C, Windle-Taylor P (2001). "Guidelines for the grading of tinnitus severity: the results of a working group commissioned by the British Association of Otolaryngologists, Head and Neck Surgeons, 1999". Clinical Otolaryngology and Allied Sciences. 26 (5): 388–93. doi:10.1046/j.1365-2273.2001.00490.x. PMID 11678946. Archived (PDF) from the original on 2017-09-24.

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.
Audiometry is a test used to measure how well you can hear different sounds. You will put on headphones that are attached to a machine. Sounds will be sent through the headphones. You will press a button or raise your hand when you hear the sounds. Each ear will be tested separately. Another device will be placed on the bone behind your ear. The device will test how well vibration moves through the bones. This is called bone conduction.
^ Langguth B, Goodey R, Azevedo A, et al. (2007). "Consensus for tinnitus patient assessment and treatment outcome measurement: Tinnitus Research Initiative meeting, Regensburg, July 2006". Tinnitus: Pathophysiology and Treatment. Progress in Brain Research. 166. pp. 525–36. doi:10.1016/S0079-6123(07)66050-6. ISBN 978-0444531674. PMC 4283806. PMID 17956816.
A really easy way to relax is to find somewhere peaceful and just slow your breathing down (feel free to have some sound on in the background). You can take a few slow deep breaths and pay full attention to the feeling of the breath entering your body, filling your lungs and leaving your body. When we use deep breathing to relax, we feel calmer and more able to manage the tinnitus, and often don’t notice it as much!
Audiologists recommend taking care of the conductive component first. There have been times when the addition of the conductive component made the person a better hearing aid candidate, by flattening out the audiogram for example, while the underlying sensorineural component presented a high-frequency loss. However, the emphasis would still be on treating medically what can be treated. Generally, you would expect positive results.

Speech perception is another aspect of hearing which involves the perceived clarity of a word rather than the intensity of sound made by the word. In humans, this is usually measured with speech discrimination tests, which measure not only the ability to detect sound, but also the ability to understand speech. There are very rare types of hearing loss that affect speech discrimination alone. One example is auditory neuropathy, a variety of hearing loss in which the outer hair cells of the cochlea are intact and functioning, but sound information is not faithfully transmitted by the auditory nerve to the brain.[22]
In addition to medications, hearing loss can also result from specific chemicals in the environment: metals, such as lead; solvents, such as toluene (found in crude oil, gasoline[67] and automobile exhaust,[67] for example); and asphyxiants.[68] Combined with noise, these ototoxic chemicals have an additive effect on a person's hearing loss.[68] Hearing loss due to chemicals starts in the high frequency range and is irreversible. It damages the cochlea with lesions and degrades central portions of the auditory system.[68] For some ototoxic chemical exposures, particularly styrene,[69] the risk of hearing loss can be higher than being exposed to noise alone. The effects is greatest when the combined exposure include impulse noise.[70][71] A 2018 informational bulletin by the US Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) introduces the issue, provides examples of ototoxic chemicals, lists the industries and occupations at risk and provides prevention information.[72]
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Noise-induced hearing loss (NIHL) typically manifests as elevated hearing thresholds (i.e. less sensitivity or muting). Noise exposure is the cause of approximately half of all cases of hearing loss, causing some degree of problems in 5% of the population globally.[50] The majority of hearing loss is not due to age, but due to noise exposure.[51] Various governmental, industry and standards organizations set noise standards.[52] Many people are unaware of the presence of environmental sound at damaging levels, or of the level at which sound becomes harmful. Common sources of damaging noise levels include car stereos, children's toys, motor vehicles, crowds, lawn and maintenance equipment, power tools, gun use, musical instruments, and even hair dryers. Noise damage is cumulative; all sources of damage must be considered to assess risk. In the US, 12.5% of children aged 6–19 years have permanent hearing damage from excessive noise exposure.[53] The World Health Organization estimates that half of those between 12 and 35 are at risk from using personal audio devices that are too loud.[11] Hearing loss in adolescents may be caused by loud noise from toys, music by headphones, and concerts or events.[54]
Recent research, reported in 2012 achieved growth of cochlear nerve cells resulting in hearing improvements in gerbils,[121] using stem cells. Also reported in 2013 was regrowth of hair cells in deaf adult mice using a drug intervention resulting in hearing improvement.[122] The Hearing Health Foundation in the US has embarked on a project called the Hearing Restoration Project.[123] Also Action on Hearing Loss in the UK is also aiming to restore hearing.[124]
Middle ear fluid or infection—The middle ear space normally contains air, but it can become inflamed and fluid filled (otitis media). An active infection in this area with fluid is called acute otitis media and is often painful and can cause fever. Serous otitis media is fluid in middle ear without active infection. Both conditions are common in children. Chronic otitis media is associated with lasting ear discharge and/or damage to the ear drum or middle ear bones (ossicles).
Inflammation of the middle and outer ear, otitis media and otitis externa respectively, are often due to infections or trauma. Infectious causes tend to present with additional symptoms like an ear discharge, which is usually purulent and often presenting with an offensive odor. When affected, the outer ear becomes red and swollen. Allergic causes, especially in cases of ear piercings and earrings made of certain metals, need to be excluded.
Assessment of psychological processes related to tinnitus involves measurement of tinnitus severity and distress (i.e., nature and extent of tinnitus-related problems), measured subjectively by validated self-report tinnitus questionnaires.[16] These questionnaires measure the degree of psychological distress and handicap associated with tinnitus, including effects on hearing, lifestyle, health and emotional functioning.[63][64][65] A broader assessment of general functioning, such as levels of anxiety, depression, stress, life stressors and sleep difficulties, is also important in the assessment of tinnitus due to higher risk of negative well-being across these areas, which may be affected by or exacerbate the tinnitus symptoms for the individual.[66] Overall, current assessment measures are aimed to identify individual levels of distress and interference, coping responses and perceptions of tinnitus in order to inform treatment and monitor progress. However, wide variability, inconsistencies and lack of consensus regarding assessment methodology are evidenced in the literature, limiting comparison of treatment effectiveness.[67] Developed to guide diagnosis or classify severity, most tinnitus questionnaires have been shown to be treatment-sensitive outcome measures.[68]
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