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There are many factors that have been associated with an increased risk of developing tinnitus. Another hypothesis is that tinnitus develops because of changes in how the brain processes sound in response to altered input from the cochlea. Epidemiological research tracking the prevalence of hearing loss and tinnitus at all ages, and research on intervention approaches, can provide essential information about effectiveness and long-term trends. It is a common perception that tinnitus is an affliction of older individuals, which is to a significant extent true.
It must be acknowledged that prevention of tinnitus does not have the same urgency as that associated with tobacco use or passenger protection, which are examples that address risks affecting a substantial proportion of the population and if ignored can have catastrophic personal consequences. Individuals who regularly worked in loud sound situations or were frequently exposed to impulse noise were nearly three times more likely to have tinnitus than those who did not have regular, loud sound exposures [4].
However, many people have hearing loss without having tinnitus, and many people who have “normal” hearing according to their audiograms have tinnitus.
Picture 1: Hearing thresholds in individuals with and without tinnitus, matched for age above (right panel) or below 50 (left panel) years.
However, when the people in these tinnitus groups were compared to age-matched controls without tinnitus, both tinnitus groups had hearing thresholds that were elevated by approximately 11 dB compared to controls over the frequency regions corresponding to their tinnitus. Notwithstanding these lines of research pointing to a role for hearing loss in tinnitus, it is undeniable that there are individuals who have hearing loss but not tinnitus (see the older control group of picture 1). The good news is that nearly all noise-induced hearing loss (NIHL) and related tinnitus can be prevented. The Dangerous Decibels partnership began in 1999 and has been locally, regionally, nationally, and internationally active in hearing health promotion [48, 57]. An interactive, inquiry-based classroom program targeting kindergarten through 12th grade students covering the physics of sound, normal hearing function, the pathophysiology and functional consequences of noise exposure, and tinnitus and hearing loss protective strategies.
Tinnitus is one of the potential consequences, and information about the role of hearing loss in tinnitus is essential to prevention.
Noise-induced hearing loss and tinnitus prevention activities have historically been emphasized in, or perhaps even limited to, occupational and military settings with the assumption that those settings provided the highest risks.
Because tinnitus in most individuals is associated with hearing impairment, prevalence may be increasing among youthful populations owing to exposure to environmental and recreational sound. Although reported prevalence varies widely among studies, it has been estimated that between 8 and 20% of individuals over the age of 60 report a persisting tinnitus, and among these individuals approximately 25% describe their tinnitus “moderate” and another 6.6% as “severe” [1] implying an adverse effect on quality of life in the latter group, which translates into millions of Americans and many more around the globe.
However, the problem is compounded by the fact that while treatments exist that often can reduce the impact of chronic tinnitus on individual lives, elimination of the disturbing tinnitus sensation itself remains largely beyond the reach of medicine.
However, for millions of individuals severely affected, tinnitus is a debilitating and costly condition for which no simple effective medical treatments are currently available. Hearing thresholds are elevated between 2 and 8 kHz in tinnitus subjects compared to age-matched controls in both age groups, even though the audiograms for the younger tinnitus group were in the normal range up to 10 kHz. These findings suggest that tinnitus and hearing impairment are related and that the degree of impairment needed to increase the risk for tinnitus is not large [16].
However, recent epidemiologic evidence [59] indicates that cumulative hearing loss in the population has not declined over the past 30 years despite expected decreases in NIHL due to mandatory hearing conservation programs in occupational settings, suggesting that sound-related hearing loss may be resulting from exposures in non-occupational settings.
Coles RRA, AC Davis and MP Haggard (1981) Medical Research Council’s Institute of Hearing Research. Henry JA, KC Dennis and MA Schechter (2005) General review of tinnitus: prevalence, mechanisms, effects, and management. Axelsson A and T Jerson (1985) Noisy toys: a possible source of sensorineural hearing loss.
Roberts LE, G Moffat and DJ Bosnyak (2006) Residual inhibition functions in relation to tinnitus spectra and auditory threshold shift. Rosenhall U and A Axelsson (1995) Auditory brainstem response latencies in patients with tinnitus.
Norena AJ and JJ Eggermont (2003) Changes in spontaneous neural activity immediately after an acoustic trauma: implications for neural correlates of tinnitus. Ling LL, LF Hughes and DM Caspary (2005) Age-related loss of the GABA synthetic enzyme glutamic acid decarboxylase in rat primary auditory cortex.

Blair JC, D Hardegree and PV Benson (1996) Necessity and effectiveness of a hearing conservation program for elementary students. Lipscomb DM (1972) The increase in prevalence of high frequency hearing impairment among college students.
Meyer-Bisch C (1996) Epidemiological evaluation of hearing damage related to strongly amplified music (personal cassette players, discotheques, rock concerts)--high-definition audiometric survey on 1364 subjects. Plakke BL (1985) Hearing conservation in secondary industrial arts classes: a challenge for school audiologists. Roeser RJ (1980) Industrial hearing conservation programs in the high schools (Protect the Ear Before the 12th Year). Bess FH, J Dodd-Murphy and RA Parker (1998) Children with minimal sensorineural hearing loss: prevalence, educational performance, and functional status.
Kujawa SG and MC Liberman (2006) Acceleration of agerelated hearing loss by early noise exposure: evidence of a misspent youth. Griest SE, RL Folmer and WH Martin (2007) Effectiveness of “Dangerous Decibels,” a school-based hearing loss prevention program. Martin WH (2008) Dangerous Decibels®: partnership for preventing noise-induced hearing loss and tinnitus in children. However, it is well documented by national surveys [2] and confirmed by clinical experience that persisting tinnitus can occur at any age. It is especially worrisome that although tinnitus experienced by younger individuals after noise exposure often subsides, tinnitus may return later in life as changes in brain function related to ageing unmask a hidden vulnerability.
Tinnitus also shares in common with these examples evidence of a role for a causal and tractable factor that makes prevention of new cases of tinnitus a practical goal. Tests for off-frequency listening can indicate the presence of cochlear dead regions that may lead to the development of tinnitus. Briefly, hearing loss induced by experimental noise trauma in animals leads to a reorganization of tonotopic maps in the primary auditory cortex, as thalamocortical input to the affected region is impaired [24–26]. One factor that might distinguish between individuals with and without tinnitus despite the presence of hearing impairment is a difference in the prevalence of cochlear dead regions in the two groups. One study that evaluated the effectiveness of hearing conservation education in high school students found an average increase of 16% correct responses after participation in an educational program [45]. It is the most extensively developed, disseminated, and evaluated hearing loss and tinnitus prevention program in the world with materials in 46 US States and 17 different countries. Teaching individuals from an early age to cherish and protect the gift of hearing and equipping them to do so provides the highest likelihood of reducing the incidence of tinnitus.
Epidemiological research into the prevalence of hearing loss and tinnitus at all ages, and research on the effectiveness of intervention approaches, can provide essential information about the magnitude of the problem and long-term trends. Because in most individuals tinnitus is associated with hearing impairment, prevalence may be increasing among youthful populations owing to exposure to environmental and recreational sound in our electronic age. The prospect of a growing cohort in future years calls not only for intensified research into the causes of tinnitus and its treatment but also for programs aimed at its prevention. Epidemiological and neuroscience studies indicate that among the many benefits of preserving normal hearing is likely to be the prevention of tinnitus. The Oregon Tinnitus Data Registry reported that sound exposures represented the most commonly reported onset factor in a tinnitus clinic population of 2,503 individuals [6].
This reorganization likely occurs because when thalamocortical input is reduced, neurons in the hearing loss region begin to express the frequency tuning of their unaffected neighbors via horizontal connections in the tonotopic map. A second study presented an educational program on hearing conservation to elementary school children and found that their knowledge regarding NIHL improved by an average of 23% [46].
In addition to reducing the incidence of tinnitus, other benefits of hearing protection are reductions in health care costs and in disability claims as well as improved social and workplace communication.
Tinnitus has also been found to be an early indicator of permanent sensory neural hearing loss in work settings with prolonged loud sound exposure [7].
However, in the latter study, all 32 individuals with tinnitus had hearing thresholds exceeding 25 dB HL when measured above 8 kHz, underscoring the need for more thorough audiometric assessments. It has also been found that the spontaneous firing rate of the affected neurons is increased and that there is an increase in neural synchrony (temporally coupled neural activity, sometimes called temporal coherence) in the region of hearing impairment [24].

Age-related changes in intracortical inhibition [28, 29] may also play a role, with lags favoring normal tonotopic structure and conferring a benefit in preventing tinnitus.
Recent work using resources from the Dangerous Decibels program (see below) has shown that several interventions, including classroom programs, museum exhibits, and online interactives can improve knowledge, attitudes, and intended behaviors related to sound exposure and use of hearing protection strategies [ 47–49].
The results showed that the interventions were effective at changing knowledge, attitudes, and behaviors regarding exposure to loud sound and use of appropriate hearing protective strategies [47].
When measured within individuals, there is a close correspondence between the frequencies that are present in the tinnitus sensation and the sound frequencies at which hearing loss is present in the audiogram [8–11]. Evidence was found for circumscribed cochlear damage in the frequency ranges that were rated as being similar to the tinnitus percept. Evidence from physiological, psychoacoustic, and human brain imaging studies suggests that increased neural synchrony in the hearing loss region may underlie the tinnitus sound [27]. Some older individuals who have high-frequency hearing loss without tinnitus may eventually come to experience tinnitus, reducing the disparity between the two phenomena. Knowledge of potentially dangerous sounds, their consequences, and simple ways to protect oneself are all significant factors in prevention of NIHL and tinnitus.
The nature of this relation is that ratings of sound frequencies for their similarity to tinnitus increase incrementally at the audiometric edge and continue to increase with the depth of threshold shift up to about 12 kHz [10, 11]. Cochlear dead regions also appear to influence the shape of tinnitus spectra when band-limited noises differing in center frequency are used to measure these spectra, implying that individuals with tinnitus are listening off frequency to sounds in the stimulus where hearing thresholds are better preserved [11]. Nevertheless, what protects many elderly individuals with hearing loss from tinnitus is presently unknown.
Public education can promote hearing health and behavior to reduce noise-induced hearing loss, a fully preventable condition.
As expected, the older group exhibited threshold elevations commencing above about 2 kHz, but the younger group had normal hearing thresholds up to 10 kHz (see picture 1 below). Measurement of distortion product otoacoustic emissions (DPOAEs) is another approach to detecting changes in hearing. Surveys of junior high and high school students have identified large deficiencies in their knowledge about normal hearing as well as hearing loss, and that students know little about the damaging effects of noise exposure [41, 42]. No loud noise trauma had preceded the tinnitus, as it does for some sufferers — it was suddenly just there. Restoration of hearing is often associated with a decrease in tinnitus, provided that the tinnitus has not been present for too long.
It is commonly reported in the clinic and confirmed by systematic study [13] that many individuals with tinnitus experience a reduction of their symptoms when fitted with a hearing aid. He stopped going into work.That month, De Mong visited an ear doctor, who told him he had high frequency hearing loss in both ears. Another doctor at the Stanford Ear, Nose and Throat clinic confirmed it, and suggested hearing aids as a possibility.
They helped the hearing, but did nothing for the ringing.Meanwhile, he scoured the internet for cures. Of the 50 million Americans who experience tinnitus at some point in their lives and the 16 million who are bothered enough to seek help, 2 million have it to a degree so severe that it’s debilitating, according to the American Tinnitus Association.
Rauschecker believes that many understand tinnitus backwards, assuming a causal relationship between the tinnitus and the behavioral problems so common among patients with the condition, as if tinnitus was the cause, and the depression, anxiety and insomnia, the effect. Using state-of-the-art MRI scanners to peer deep inside the brains of tinnitus patients, Cheung and his team have managed to pinpoint an important source of the phantom noise. His team has developed a five-step program that includes audiology testing and evaluations, the use of external sounds to manage tinnitus, and cognitive behavioral therapy, which teaches coping techniques. She has since developed a mindfulness program for tinnitus, modeled after techniques used for chronic pain.

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