Tinnitus
What is tinnitus?
Tinnitus is the term used to describe hearing any sounds which are not present externally. It is most commonly heard as ringing, hissing, buzzing or clicking, and can be a single sound or a number of different sounds.
Research has shown that almost everyone develops temporary tinnitus in an abnormally quiet environment (such as a sound proof booth) and instructed to pay attention to any sound they may hear.
An increased awareness of tinnitus usually occurs because it changes in some way and becomes louder or more frequently present. This can be associated with the development of a hearing loss, a range of disorders affecting the auditory system, and periods of high stress and fatigue.
Tinnitus can become significant if attention is drawn to the ringing; it becomes perceived as intrusive, irritating or distressing; and there is an increase in active tinnitus monitoring.
Audiologist
Audiologists' scope of practice appropriately includes tinnitus management for a number of reasons (J. A. Henry, 2004a). Audiologists are knowledgeable about auditory disorders and auditory system functioning. They understand acoustics and psychoacoustics, which are important components of many forms of tinnitus assessment and therapy. Audiologists are skilled in using clinical audiometers to assess hearing function, and these devices can also be used to perform tinnitus psychoacoustic assessment. Audiologists are expert in the use of hearing aids, which have long been used to ameliorate the effects of tinnitus through the use of auditory stimulation (Sheldrake & Jastreboff, 2004). They have working relationships with otolaryngologists, who are needed for the medical evaluation and management of tinnitus (Wackym & Friedland, 2004). Finally, audiologists generally possess good counseling skills, which are essential for any form of tinnitus management (Hall & Ruth, 1999; Sweetow, 1986, 2000).
Pharmacological Intervention
One question that often arises is whether drugs can be useful in treating tinnitus. Many controlled studies have been conducted to evaluate different drugs for this purpose, but none of them have shown conclusively that any drug results in benefit consistently more often than placebo (Dobie, 1999). A patient who suffers from depression, anxiety, or sleep disorder should be considered for appro- priate drug treatment from a physician (Dobie, 2004a). If these disorders can be resolved through pharmacological treatment, it is likely that the tinnitus will also become less of a problem. It is important to bear in mind that some antidepressants can cause or exacerbate tinnitus as a side effect or as a withdrawal symptom (Robinson, Viirre, & Stein, 2004). Further information about drugs used to treat tinnitus can be found in recent reviews (Dobie, 2004a; Robinson et al., 2004).
Tinnitus habituation
Most people will spontaneously habituate or adapt to their tinnitus over time, so that while it may be heard, attention is rarely given to it and emotional acceptance of it is achieved. This process involves a gradual increase in the periods of time where the tinnitus is not noticed, as well as a gradual reduction in any annoyance or distress it may cause.
Sometimes people can become stuck in this process and are unable to habituate to their tinnitus as fully as they would like. Some people can find their tinnitus distressing; their reaction to it overwhelming; and do not know how to control the way it affects them.
Credible therapeutic approaches to tinnitus management aim for tinnitus habituation to be achieved.
Our Tinnitus Program
We address any fears you may have of your tinnitus by providing you with an understanding of it, an analysis of your emotional reaction to it and reassurance with regard to your ability to habituate to it.
Our program involves:
- an evaluation of the tinnitus and its impact on you individually,
- taking a thorough history of your tinnitus and associated issues,
- a hearing assessment,
- providing detailed information about your tinnitus: including an opinion about the possible cause; some of the factors that affect tinnitus fluctuation or make you more aware of it; an opinion as to why you may not have been able to habituate to it.
- a detailed and personalised explanation of the peripheral and central auditory system, your hearing test results and the neurophysiological basis of tinnitus-related distress and annoyance.
- a therapy program for managing your tinnitus.
Therapy
Practical self-management strategies known to lead to tinnitus habituation, personalised to suit your individual coping style, will be developed with you. This may involve the use of hearing aids; sound enrichment strategies including the use of sound generators; counselling in cognitive management strategies and training in stress management and relaxation.
Specific techniques to cope with periods of heightened awareness and/or increased volume of your tinnitus will be given.
For many people, the information and guidance provided in one appointment may be sufficient to move towards tinnitus habituation. For this reason, our initial appointment time is approximately 30 minutes. However, the time involved in a program will vary, depending on the level of your reaction to your tinnitus and the on-going guidance and support you may require.
Tinnitus and hearing loss
People with a hearing loss often blame their tinnitus for their hearing problems, particularly when communicating in groups and in background noise. The tinnitus is a symptom of the hearing loss, not the cause. If you have a hearing loss, then hearing aids will be effective in both the management of your hearing loss and your tinnitus. Hearing aids, by amplifying external sounds around you, will result in your internal noise, or tinnitus, becoming less noticeable.
The efforts of straining to hear a conversation and the resultant communication difficulties frequently lead to frustration, fatigue and stress. These are all major aggravating factors in tinnitus awareness and annoyance. Once you have adapted to the amplification provided by your hearing aids, you can expect a significant reduction in stress and fatigue.
