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Your First Tinnitus Appointment

What is tinnitus and why is it relevant for hearing care professionals?

Tinnitus is defined as the auditory perception of sounds when no external sound is present.  Tinnitus is a perception of sound generated somewhere in the auditory pathways (Jastreboff, 2008).  It is described in many terms, for example, ringing, buzzing, or hissing.  Tinnitus is often described as intermittent or chronic.  Most individuals have experienced intermittent tinnitus at some point in their lives.  Chronic tinnitus is defined as constant or frequently occurring, lasting longer than six months.

Globally, 10-15% of adults experience chronic tinnitus, compared to 10% of adults experiencing hearing loss (Beck, 2012).  80% of individuals with hearing loss have tinnitus and 80% of individuals with tinnitus have hearing loss.  This significant overlap is the main reason that doctors of Audiology should learn more about tinnitus and are uniquely qualified to work with this population.  While there is no known cure, there are many treatment options that patients can use to manage their tinnitus.

1) Your First Appointment:

Case History:  Patients will be asked to fill out a Tinnitus history questionnaire that will help identify the causes and severity of their tinnitus.  The questionnaires help our doctors measure tinnitus perception and experience before, during, and after treatment.  Hearing & Balance Associates has patients complete the Tinnitus Handicap Inventory (THI) questionnaire (Newman, Sandridge & Spitzer, 1996).  Medically treatable causes of tinnitus such as ear wax and TMJ disorder will be identified and medical treatment can be recommended.   

Audiological Evaluation: the conventional audiological evaluation is the cornerstone of the consultation.  This includes otoscopy, tympanometry and bone conduction testing for pure-tones and speech.  The audiometric results influence the direction of sound treatment and counseling.  The need for amplification is determined here as well.

Tinnitus pitch and loudness matching:

Our doctors will identify the frequency (pitch) of each individual's tinnitus.  Most patients have high pitch tinnitus and our equipment is designed to identify pitches well above conventional pure-tone audiometry.  Our doctors will also identify the loudness of each patient's tinnitus with our audiometer.

Minimum masking levels:      

The minimum sound level needed to mask each patient's tinnitus will be identified during their first visit as well. 

Treatment and Sound Therapy Hearing devices:

Our doctors will devise a treatment plan based on the results of your first appointment.  Hearing & Balance Associates utilizes several hearing aid manufacturers that have sound therapy built right into their devices.  The purpose of sound therapy is to reduce the perception of tinnitus loudness and the patient's reaction to the tinnitus using sound.  Sound can include something as simple as turning on background music in a quiet room.  

If patients have hearing loss they will be exposed to the sound they are missing out on by using hearing devices.  This is because the additional sound (provided by the hearing devices) can help move mental focus away from the internally created tinnitus sound.  In fact, 80% of patients experience significant and sufficient relief from their tinnitus simply by wearing hearing devices that amplify the frequencies (pitches) where the tinnitus is coming from.  Today's hearing devices including Oticon's Opns amplify way out into the high frequencies where tinnitus often occurs.    

Often tinnitus patients are resistant to the use of hearing devises because they consider their tinnitus to be a greater problem than their hearing loss and they do not associate hearing devices with tinnitus treatment.  If appropriately programmed hearing devices by themselves do not adequately help alleviate the patient's tinnitus, sounds will be introduced through the hearing devices.  Each sound treatment plan is different for each patient.  Our doctors will help the patient identify sounds that are pleasurable to the patient and introduce those sounds into the hearing devices.  The type and loudness of the sounds varies from patient to patient but over time patients will focus on the more pleasureable sounds, the loudness perception of the tinnitus will decrease, and ultimately their brains will be focused away from the tinnitus.