A Patient’s Guide to Tinnitus

A Patient’s Guide to Tinnitus

Robert L. Folmer, Ph.D.

What is Tinnitus?

Tinnitus, often described as ringing, buzzing or hissing sounds in the ears, is a symptom that can be related to almost every known hearing problem. Tinnitus can be temporary (acute) or permanent (chronic). It can also be constant or intermittent. Temporary tinnitus can be caused by exposure to loud sounds, middle or inner ear infections, and even wax on the eardrum. Because tinnitus can sometimes be treated medically, all patients who develop the symptom should first consult with an ear, nose and throat physician (otolaryngologist).

Elements of an Effective Tinnitus Management Program

It is preferable for the program to have a Tinnitus Management Team rather than just one clinician. Depending on the clinical expertise required to help a particular patient, a Tinnitus Management Team could be composed of an otolaryngologist, an audiologist, a neurologist, a psychologist, a psychiatrist, and sleep or pain specialists.

The Tinnitus Management Team members should be willing and able to spend a substantial amount of time with each patient. As much information as possible should be gathered about each patient’s medical, hearing, tinnitus, and psychosocial histories and conditions. Because each tinnitus patient is unique, therapeutic interventions should be individualized.

The most successful treatment programs employ multimodal strategies that are designed to address the specific needs of each patient. Patients should meet with Tinnitus Management Team members for an in-depth interview and review of their histories and conditions. Patients should receive education about possible causes of tinnitus as well as reassurance and counseling regarding factors that could exacerbate or improve their condition.

Thorough Otolaryngological and Neurological Examinations

Comprehensive audiological evaluations: Tinnitus evaluations that include matching tinnitus to sounds played through headphones.

Evaluations of acoustic therapies: based on the patient’s audiological evaluations, various devices should be described and demonstrated. These could include hearing aids, in-the-ear sound generators, tinnitus instruments (combinations of hearing aids and sound generators), tabletop sound generation machines, Sound Pillows, tapes or CDs. For patients with significant hearing loss, hearing aids will not only improve their hearing ability, the devices will also reduce their perception of tinnitus. For patients with normal hearing, in-the-ear sound generators usually provide relief from tinnitus.

The Tinnitus Management Team should review the results of evaluations and explain them to the patient. Recommendations can then be formulated and explained to the patient.

Referral and contact information regarding physical or psychiatric evaluations, psychological counseling, and other recommended services or products should be provided.

Follow-up: patients should be encouraged contact the clinic anytime if they have questions and also to inform clinicians of their progress Some tinnitus patients also experience insomnia, anxiety or depression.

Symptoms Can Form a Vicious Circle and Exacerbate Each Other

Tinnitus does not always start this cycle. Some patients experienced depression, insomnia, or anxiety before their tinnitus began. Tinnitus can, however, make each of these problems seem worse. Also, patients who continue to experience depression, insomnia, or anxiety report that these factors can cause their tinnitus to seem more severe. In these cases, effective treatment of depression, insomnia, and anxiety is necessary. A combination of medication and/or psychotherapy should reduce the severity of all of these conditions including tinnitus.

Things to Avoid

Harmful Sounds
Wear ear plugs or ear muffs as protection against loud sounds such as gunfire, gas lawn mowers, leaf blowers, chain saws, circular saws, other power tools and heavy machinery. Exposure to loud sounds can make tinnitus worse and can also cause additional hearing loss.

Excessive use of Alcohol, Caffeine, or Aspirin
However, moderate use of these products is usually O.K.

False Claims about Tinnitus “Cures” or Herbal “Remedies”
These do not exist for most cases of chronic tinnitus. Even though a true “cure” for most cases of chronic tinnitus is not yet available, patients can obtain relief from the symptom now with assistance from qualified and experienced clinicians.

REFERENCES

1. Seidman MD, Jacobson GP. Update on tinnitus. Otolaryngol Clin North Am 1996 Jun;29(3):455-465.

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8743344&dopt=Abstract

2. Duckro PN, Pollard CA, Bray HD, Scheiter L. Comprehensive behavioral management of complex tinnitus: a case illustration. Biofeedback Self Regul 1984 Dec;9(4):459-469.

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6399462&dopt=Abstract

3. Folmer RL, Griest SE, Martin WH. Chronic tinnitus as phantom auditory pain. Otolaryngol Head Neck Surg 2001 Apr;124(4):394-400.

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11283496&dopt=Abstract

4. Folmer RL, Griest SE. Tinnitus and insomnia. Am J Otolaryngol 2000 Sept-Oct;21(5):287-93.

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11032291&dopt=Abstract

5. Folmer RL, Griest SE, Meikle MB, Martin WH. Tinnitus severity, loudness, and depression. Otolaryngol Head Neck Surg 1999 Jul;121(1):48-51.

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&ist_uids=10388877&dopt=Abstract

FOR MORE INFORMATION

American Tinnitus Association
P.O. Box 5
Portland, OR 97207-0005
telephone: (800) 634-8978
email: tinnitus@ata.org
http://www.ata.org

OHSU Tinnitus Clinic
Mail Code NRC04
Oregon Health & Science University
3181 SW Sam Jackson Park Road
Portland, OR 97201-3098
telephone: (503) 494-7954
email: ohrc@ohsu.edu
http://www.ohsu.edu/ohrc/tinnitusclinic