Tinnitus
Ringing in the ears and
what to do about it
Ringing in the ears and
what to do about it
Teletherapy and Digital Health
In light of the current situation, we are pleased to offer Telehealth services for mental or neurological disorders. We offer an online physical and cognitive rehabilitation program as an alternative treatment option to meet the individual needs of our clients.
Tinnitus
Recognized across Canada for the last 15 years The Montreal Tinnitus Clinic uses methods derived from the most recent research to achieve durable improvement for subjective noise, hyperacousis and vestibular disorders.
Initial Evaluation
Audiologic Assessment
Immitance Audiometry High Frequency Audiometry (at least up to 16 kHz)
Loudness Discomfort Level
Psychoacoustic Measures of Tinnitus
Loudness match
Pitch match
Minimum Masking Level
Residual Inhibition
Questionnaires
Tinnitus evaluation questionnaires: Tinnitus severity (STSS), Handicap (THQ), Reaction (TRQ), Evaluation of tinnitus severity with the tinnitus handicap questionnaire (THI), which is the most widely used internationally.
Beck Depression Inventory (BDI)
State-Trait-Anxiety-Inventory (STAI)
Evaluation of results
Following the evaluation, results will be explain to the patient and a personalise treatment plan will be proposed.
Our Expertise
Acoustic Stimulation (AS)
Tinnitus Desensitisation Therapy™
Neurofeedback – Biofeedback
Dizziness and Balance Disorder
Transcranial Magnetic Stimulation
Hearing Loss
Cognitive behavioral therapy
Intensive Treatment
Biofeedback / Neurofeedback
The most popular form of neurofeedback is also known as brain biofeedback, EEG biofeedback, or more simply — brain training. It’s based on the scientific finding that we can all learn to change our brain’s functioning through feedback about brain wave activity. Brain waves are generated by the building blocks of your brain — the individual cells called neurons. Neurons communicate with each other by electrical changes.We can actually see these electrical changes in the form of brain waves as shown in an EEG (electroencephalogram).
Brain waves are measured in cycles per second (Hertz; Hz is the short form). We also talk about the “frequency” of brain wave activity.
The lower the number of Hz, the slower the brain activity or the slower the frequency of the activity.
Researchers in the 1930’s and 40’s identified several different types of brain waves.
Traditionally, these fall into 4 types::
- Delta waves (below 4 hz) occur during sleep
- Theta waves (4-7 hz) are associated with sleep, deep relaxation (like hypnotic relaxation), and visualization
- Alpha waves (8-13 hz) occur when we are relaxed and calm
- Beta waves (13-38 hz) when we are actively thinking, problem-solving, etc.
Since these original studies, other types of brainwaves have been identified and the traditional 4 have been subdivided.
Some interesting brainwave additions:
1. The Sensory motor rhythm (or SMR; around 14 hz) was originally discovered to prevent seizure activity in cats. SMR activity seems to link brain and body functions.
2. Gamma brain waves (39-100 hz) are involved in higher mental activity and consolidation of information. An interesting study has shown that advanced Tibetan meditators produce higher levels of gamma than non-meditators both before and during meditation.
Our Biofeedback clinicians work with tinnitus patient for a period of 2 to 3 months,one 45 minutes session a week.
Transcranial Magnetic Stimulation (TMS)
Transcranial Magnetic Stimulation (TMS) a medical technique finalized in the year 1985s. Used in the diagnosis of the neurological diseases, as tool of scientific investigation in neurosciences and as clinical treatment in certain psychiatric affections.
Following fMRI mapping (functional Magnetic Resonance Imaging), it consists in applying a magnetic impulse to the brain through the skull in a painless way by placing a coil on the surface of the head. We create a variable magnetic field by passing a well-controlled alternative electric current through a coil in an insulating girdle. When we place it near the head, the field triggers an electric activity in the cerebral cortex. The low frequency currents (< 1 Hz) reduce the activity and the high frequency currents increase it. Thanks to the passage of an electric current in a “coil” placed on the scalp, we create a perpendicularly oriented directed magnetic field; This magnetic field leads in turn in the neighboring tissues a parallel electric current – but of opposite direction- to the current of stimulation. In other words the SMT is an electric stimulation, but obtained without electrodes and having no major unwanted side effects.
MAGNETIC STIMULATOR
These magnetic fields lead to an electric field which thus modifies the activity of neurones situated in the magnetic field of the TMS. The current use of the TMS is the repetitive stimulation (rTMS ) which consists in giving a series of impulses during an interval of time so as to modify appreciably the activity of the targeted region.
We can control the intensity of the stimulation, the cerebral region to be stimulated, the frequency of the trains of delivered impulses. A frequency lower than 1 Hz is supposed to have an inhibitive effect on the targeted neurons. If superior to 3 Hz, it would be excitatory.
At present it is well established that chronic tinnitus is associated with an increase in the activity of the temporo-parietal cerebral cortex. The modulation of this aberrant activity by magnetic rTMS can contribute to the treatment of tinnitus which resist to classic treatments. Since 2003, European researchers proved the therapeutic potential of the TMS in the treatment of the chronic tinnitus. The researches in this field continue actively to ‘ to increase the efficiency of the therapeutic protocols. The rTMS used at low frequency on the left primary auditory cortex allows to treat this disorderof hyperexcitability and to reduce or to relieve the buzzing in ears. Two treatments a day during five days are needed at least to feel the beneficial effects of the treatment. The treatment of the tinnitus is extremely targeted. The patients have to wear a swim cap on which the sites to be stimulated are marked.
Cognitive Behavioral Therapy
Tinnitus patients complain about the impact of this symptom on their everyday life: sleep, intellectual activity, social relationships. The anxiety and the depression are often associated with the tinnitus.
The modern medical techniques, such as positron emission tomography, allowed to show that certain zones of the brain in connection with the treatment of emotions and the memorization (hypothalamo-limbic system) are activated when the patients hear their tinnitus.
Cognitive behavioral therapy (CBT) facilitates the work on the improvement of the perception of the tinnitus and the handicap which is related to it. CBT leans on the theories of the learning, the behavior and the conditioning. These therapies, called “cognitive”, are interested in the progressive modification of the mental plans of interpretation of the reality, to eliminate the disorders, annoyance and the unsuitable behavior (example of the behavior of fold to avoid the exposure to the tinnitus.
Our psychologists trained in these clinical approaches offer individual meetings and groups.
The group work contributes to help the patient to put in perspective its perception of the tinnitus and to be inspired by initiatives of others as other many potential alternatives.
Tinnitus Desensitisation Therapy™
This therapy provides a range of options that are selected to meet your personal processing requirements.
Given your tinnitus sound profile that was identified during the initial assessment, and your very personal experience of tinnitus Desensitization Therapy uses a number of different therapeutic techniques such as hearing aids combined with integrated tinnitus management program.
These are used to control your awareness of Tinnitus with the long term objective to encourage the brain to filter perceptions tinnitus of your consciousness. This filtering process is known as “habituation”. Desensitization helps you take control of the impact tinnitus has on your life.
The therapy aims to redirect the attention of your brain away from the tinnitus signal and help the natural habituation process to occur so that, over time, you become progressively less aware of your symptoms of tinnitus.
Our Audioprothésiste offer from a range of suppliers the device that suits you.
We will give you a 60 day satisfaction guarantee!
Dizziness and Balance Disorder
Dizziness is a very common reason for consultation.
They can result from a stroke central but often reflect a dysfunction of the inner ear. Various conditions may be responsible for these symptoms: viral labyrinthitis sequelae, vertigo, positional secondary to impact the head, cervical injury, brain concussion, a Meniere’s disease.
The Balance
In case of severe dizziness, possible causes are;
- Vertigo Benin paroxysmal positional (BPPV)
- Labyrinthitis
- Vestibular neuritis
- Meniere’s Disease
- Neuroma
- Perilymphatic fistula
- Traumatic brain injury
- Central or idiopathic Parkinson’s disease or other impairments of the motor and sensory control.
Balance is achieved through three types of sensory information from the vestibular system, vision and proprioception (muscles, tendons, joints). This information converge on the central nervous system after integration of these signals sent to muscles information capable of keeping the body in balance.
The peripheral vestibular system is made at each ear of five different types of sensors : the semicircular canals in number three ( horizontal channel , vertical anterior and posterior ) and the otolith organs two in number ( utricle and saccule )
Proprioception is provided by the mechanical sensors of the trunk and lower limbs is located within tendons or ligaments or joints.
It is their stretching which will inform the brain about the position of the body by means of the sensory nerves.
The aim of vestibular rehabilitation is :
- Allow the patient to regain some stability;
- Decrease the frequency, duration and intensity of his dizziness ;
- Decrease the associated symptoms (such as nausea , vomiting, headaches , etc.);
- Improve patient autonomy in activities of daily living.
Physiotherapy
We offer a therapy based on intensive exercises that focus on neuro-rehabilitation principles using neuro plasticity. The goal of treatment in physiotherapy is to restore, maintain and maximize physical strength. Our physiotherapists prescribe, to that end, customized therapeutic exercises.
Neurological Physiotherapy focuses on the evaluation and treatment of neurological disorders using methods that apply the principles and foundations of both the NDT (Neuro-Developmental Treatment) and Bobath approach.
Both approaches use techniques specifically adapted by our physiotherapists to improve participation and physical functions of adults and children with specific neurological disorders. Neurological rehabilitation applies therapeutic manipulation to influence how the neurological system responds to sensory stimuli and thereby improves the quality of patient movement. This technique can be used to enhance the desired movements and / or prevent bad posture or movement disorders with emphasis on balance, strength and flexibility.
Neurological disorders can affect each person in different ways, which is why our plans and treatment goals are tailored to the specific needs of each individual and in his current capacity.
To maximize fitness all meetings with our physiotherapists are personalized and usually last 90 minutes.
Hearing Loss
Hearing Aid
Clinical evidence shows that the use of hearing aids in tinnitus patients provides two benefits:
- it makes the patient less aware of the tinnitus
- it improves communication by reducing the annoying sensation that sounds and voices are masked by the tinnitus.
Hearing is good! Understand is even better!
Our Audioprothésist offers digital hearing solutions with latest and cutting edge technology for speech understanding in noisy places.They are available in all the different models and styles. In Quebec, the RAMQ, the CNESST, Veterans and others, are organizations who pay for hearing aids according to criteria of eligibility which audiologist, audioprothesist, ENT physician who can inform you.
* Mandatory Prescription
Our hearing aids allow you to rediscover the pleasure to get together with friends and family, you feel more confident at work, and enjoy movies, music and television.
Hearing loss reduces stimulation from external sounds resulting in increased awareness of tinnitus and deprivation of input may change the function of structures of the auditory pathways. Tinnitus is often caused by expression of neural plasticity evoked by deprivation of auditory input. With hearing aid amplification, external sounds can provide sufficient activation of the auditory nervous system to reduce the tinnitus perception and it may elicit expression of neural plasticity that can reprogram the auditory nervous system and thereby have a long-term beneficial effect on tinnitus by restoring neural function.
To obtain the best results, hearing aids should be fitted to both ears, use an open ear aid with the widest amplification band, and disabled noise reducing controls. In some cases a combination device would be preferable. The conditions required in order to obtain good results include not only the use of devices, but above all, their adaptation to the needs of the single patient, by counseling and customization. Wearing the hearing aid must become second nature to the patient even though it is only one element of the therapy.
A New Technology
Luckily, tinnitus is rarely emergent of more than 10 dB with regard to the hearing threshold and a noise of some supplementary decibels in the zone of the tinnitus allows an effective masking. The amplification depends moreover on the intensity of the sound environment of the patient. The more the met intensity will be weak and the more the amplification of the zone of the tinnitus will have to be important, without leading however to a subjective annoyance. The amplification must be able to exercise a masking of the tinnitus in a quiet environment, what sometimes leads) to an amplification more important than for a classic equipment. Our Intensive Treatment
Multimodal Tinnitus Therapy.
Since 2012, We propose a new concept called Multimodal Tinnitus Therapy.
This program was designed for our patients coming from out of town,Canada,USA, Latin countries and Europe.
The goal is to achieve in the shortest time optimal targeted activation of the brain.
We know through brain imaging that tinnitus and hyperacusis are linked to hyperactivity and other abnormal brain patterns throughout the central auditory system.
fMRI studies show neural activity in two key regions along the auditory pathway: the inferior colliculus (IC), a major subcortical auditory center located in the midbrain, and the auditory cortex (AC), a region associated with sound perception.
Our program targets these regions using paired stimulation of auditory and somatosensory pathways.
Assessment using The QEEG/LORETA
An Electrophysiology noninvasive imaging of electrical activity of brain function. The Qeeg in is a tool which demonstrates electrophysiologic data of brain wave activity i.e. oscillation, in multiple regions of interest, reflective of multiple brain functions in the presence of the tinnitus signal. The application of the QEEG for tinnitus is recommended to be called, the Electroencephalotinnitogram (TCG).
Clinically, the stage of the QEEG clinical application in 2014 for tinnitus is considered analogous to the EKG for cardiology in the 1930s.
The EEG Functional brain imaging with the spectral analysis 3-D source localization of Low resolution provides:
- An objective measure and quantification of multiple brain wave electrical frequencies of activity;
- Clinical translation for an increased accuracy of the tinnitus diagnosis;
- A choice for treatment of a particular central type tinnitus;
- The identification of correlate for a predominantly central type tinnitus.
Individualized Treatment Based On Your Brain Mapping
1- Repetitive TMS (rTMS) induces alterations of neuronal activity that outlast the actual stimulation period for a considerable amount of time rTMS treatment strategy for tinnitus patients that consists of a combination of high-frequency prefrontal and low-frequency temporal rTMS.
30 sessions are included in the program.
2- Research (N Weisz, K Dohrmann, W Schlee, T Hartmann, T Elbert) has shown relationships between tinnitus and enhanced slow wave and concomitant reduced alpha wave activity over temporal and frontal areas.
Modification of this pattern via EEG-neurofeedback can significantly reduce the matched tinnitus intensity.
15 sessions are included in the program.
3- Acoustic Therapy periphery strategy consists of desensitizing the auditory cortex by a directed training of the auditory cortex. Tinnitus is produced by the brain itself and not by an external source. The principle behind this is based on the plasticity theory of the brain that shows neurons.
re-organise themselves to succeed and accomplish neurological tasks after a loss of functionality, like an auditory loss that prevents the brain to be normally stimulated by external sounds.
This treatment will be done during and after the intensive for a period of 6 months.
The Program
This program requires daily visits at the clinic from Monday to Friday.
• Intensive Treatment Program includes:
- QEEG (quantitative Electroencephalogram)
- High frequency audiometry to 16 kHz & Comprehensive Assessment of tinnitus
- Programming for acoustic stimulation
- 30 sessions of Neurofeedback
- 30 Session of rTMS (transcranial magnetic stimulation)
- Monitoring 3 months
The costs could be covered by private insurance spending under audiology
Schedule An Appointment
Free Conference Call With A Senior Team Member
