A brief guide to helping your tinnitus patients

By Dhyan Cassie
Go home and live with it is the advice all too often given to the tinnitus patient. Unfortunately, being told that there is no cure for tinnitus often creates feelings of helplessness and despair. Negative counseling that fails to offer hope can actually increase the patients perception of tinnitus as he or she feels it will go on forever, may get worse, and cannot be effectively treated. On the other hand, a sympathetic, caring, professional treatment plan often leads to a faster recovery. WHO IS A TINNITUS PATIENT? First, let us identify the tinnitus patient. The patient who simply mentions tinnitus when filling out a questionnaire is not a tinnitus patient and probably needs no more than directive counseling, including an explanation of the auditory system and the possible origins of tinnitus. Prescribing amplification devices in the case of hearing loss and ear protection in the presence of loud sound may be sufficient for such patients. The tinnitus patient, on the other hand, has come to you specifically because tinnitus is affecting his or her quality of life. Often a patient will report difficulty sleeping, concentrating, or enjoying social activities due to the severity of the tinnitus. We must be ready to help such patients. They are suffering real pain, and they need to have this acknowledged by a professional. HOW YOU CAN HELP There are several things you can do to promote the tinnitus patients feelings of hope and control. During your audiologic testing, measure pure-tone thresholds through 12,000 Hz. Although the patients hearing may be normal from 250 Hz to 8000 Hz, you may find auditory damage at the higher frequencies. This information will aid you in your counseling. Also, do tinnitus pitch and loudness level matching for counseling purposes. Measuring otoacoustic emissions (OAEs) can be a useful counseling tool when you explain outer hair cell damage and how it relates to tinnitus. Explain the auditory system, the damage that the outer hair cells may have suffered, and the pitch and loudness level that the patient has reported. An understanding by the patient of what is happening is fundamental for the demystification of tinnitus and allows habituation to occur. Advise the patient to avoid silence. Tinnitus is almost always worse in quiet, which is why most tinnitus patients feel their tinnitus is worse at night. Sound machines, which provide a broad-band, nonthreatening sound during quiet times, are available at many retail stores. Indoor waterfalls are effective. Fans, heaters, and the sound from fish tanks also provide a constant broad-band sound. If the patient has a hearing loss, the use of amplification with compression circuitry may be an option for introducing external sound into the auditory system. Again, the patient should be advised to avoid situations where there is no background sound since hearing aids are effective for tinnitus patients only when there is background sound to be amplified. The hearing instruments must have open venting and short-to-medium canal length. Completely-in-the-canal instruments are not recommended for the tinnitus patient, as the occlusion effect is likely to exacerbate the tinnitus. If it is obvious that the patient needs further counseling and follow-up, provide a list of clinics
January 2001 Vol. 54 No. 1

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Helping tinnitus patients

in your area that specialize in tinnitus evaluation and management. A list of audiologists who have been trained in Tinnitus Retraining Therapy can be obtained by accessing the TRT Association on Dr. Pawel Jastreboff s website, www.tinnitus-pjj.com, or by calling the Emory Clinic in Atlanta at 404/7783109. Names of physicians and audiologists who specialize in tinnitus are available from the American Tinnitus Association at 800/634-8978. If the patient has other factors causing stress, these must be dealt with before or during tinnitus treatment. It may be necessary for the patient to be referred for stress management or psychological counseling. The tinnitus specialist will be prepared to make this determination after reviewing a detailed questionnaire regarding the patients medical, audiologic, and environmental history. Patients should also be told about the American Tinnitus Association (ATA), the national association dedicated to helping tinnitus patients through information, tinnitus materials, research, support groups, and a hot line. Patients can join ATA and receive Tinnitus Today, a quarterly magazine whose goal is to promote relief, prevention and the eventual cure of tinnitus for the benefit of present and future generations. ATA can also put patients in touch with a professional who is prepared to listen and counsel. A list of tinnitus support groups in your area can be obtained by calling ATA. Although the patient may not require continued participation, often a support group will help the patient get through the most difficult times. Attend a support group yourself and learn more about tinnitus from the patients perspective than you ever will from a text book. Provide patients with a list of nutritionists, psychologists, and other healthrelated professionals in your area who have shown themselves to be understanding and knowledgeable about tin-

nitus. Often a support group facilitator will know of such professionals. Become a member of ATA so that you will have its materials available for your patients. Also, refer them to the associations website: www.ata.org. There they will find reliable information, which is much more helpful than the anecdotal information they may get from unknown sources. Schedule a follow-up appointment for the tinnitus patient to monitor the

persons progress. Let the patient know that he or she is not alone and you are available to provide on-going help. As hearing healthcare professionals, we can and should be prepared to provide valuable information, support, and treatment for our tinnitus patients.
Dhyan Cassie, MA, CCC-A, FAAA, is Coordinator of the Tinnitus/ Hyperacusis Management Center, Department of Language and Communication Sciences, College of New Jersey. Correspondence to the author at The College of New Jersey, Ewing, NJ 08618, telephone, 609/771-2322, or e-mail: Dhyan2@home.com.

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