While some audiologists have been conducting tinnitus management since the 1970s, organized clinical tinnitus treatment programs are a relatively new specialty with an evolving literature base. There are clinical guidelines for managing patients with tinnitus; however, there remains a lack of standardization in the field and varied approaches to management.

Last fall, the American Board of Audiology (ABA) began the development of a comprehensive, assessment-based tinnitus management certificate program for audiologists. The new certificate program reflects the current evidence and experience of a diverse group of experts in the field, providing audiologists with the foundational knowledge needed to assess and manage patients with tinnitus and/or decreased sound tolerance (DST). The first part of the program releases this fall, and part two will follow by spring 2018. Successful completion of both parts will lead to the designation of Certificate Holder–Tinnitus Management (CH–TM) by the ABA.

Program Need

The prevalence of tinnitus indicates a need for audiologists to have adequate training in tinnitus management. The 2007 National Health Interview Survey (NHIS) found that among an estimated (SE) 222.1 (3.4) million U.S. adults, 21.4 (3.4) million (9.6 percent [0.3 percent]) experienced tinnitus in the past 12 months. (Bhatt et al, 2016). An earlier analysis of NHANES 1999–2004 survey data found that 25.3 percent (approximately 50 million adults) had experienced some form of tinnitus, with 7.9 percent (approximately 16 million adults) experiencing frequent tinnitus within the past year (Shargorodsky et al, 2010). The prevalence of tinnitus among children and adolescents is somewhat unclear due to variations in study populations and methodologies. The Hearing Health Foundation estimates that about one in three young people have awareness of tinnitus, and about one in 12 experience significant challenges from tinnitus. This data suggests a demand for a significant number of health-care providers, notably audiologists, to have preparation in tinnitus management.

Anecdotal reports indicate that formal audiology education does not include sufficient content on tinnitus management to provide audiologists with the knowledge or confidence to include tinnitus management in their practices. Tinnitus sessions at the American Academy of Audiology’s annual conference have been well-attended, leading to their recording and inclusion in the Academy’s eAudiology library. In addition, an ABA needs assessment survey of 801 audiologists indicated a need for focused training in tinnitus management and a desire for a recognized certificate.

The subject-matter expert (SME) work group convened for the program identified that no other comprehensive and unbiased certificate training program exists in tinnitus management. This work group includes distinguished researchers and clinicians whose collective experience in tinnitus management is represented in the comprehensiveness of the program’s content. Contrary to other programs on the market, the CH–TM offers diversity of perspectives in the content and is an affordable option for audiologists seeking additional training in tinnitus management.

The Program

Delivered in a combination of video and interactive online learning through eAudiology, the CH–TM program consists of two parts.

Part One: Foundations of Tinnitus Management, launching this fall, provides an overview of tinnitus management and considerations for integrating tinnitus into an audiology practice. It includes three instructional modules. Part Two: Tinnitus Management Principles in Practice applies these foundational principles to practice. It will include four instructional modules. Completion of both parts earns the Certificate Holder–Tinnitus Management (CH–TM) credential. CEUs will be awarded upon completion of each part.

Part One: Foundations of Tinnitus Management

  • Module OneTinnitus Definitions and Theoretical Foundations: Identifies the different types and characteristics of tinnitus, its prevalence in the United States and globally, and different theories of its etiology.
  • Module Two—Management of the Patient with Tinnitus: Provides a snapshot of the experience of tinnitus, along with a broad synopsis of assessment approaches, intervention techniques, and practice management considerations.
  • Module Three—Business Management Considerations: Discusses the unique demands and business factors associated with integrating tinnitus and DST services into an audiology practice.

Part Two: Tinnitus Management Principles in Practice

  • Module Four—Audiological Evaluation of the Patient with Tinnitus: Teaches how to assess the results of a comprehensive audiological evaluation as a basis for clinical decision-making for a patient with tinnitus.
  • Module Five—Tinnitus Intervention Techniques: Reviews varied approaches that may be used as intervention for patients with tinnitus, including indications for use, benefits, and limitations of each technique.
  • Module Six—Management Plan for the Patient with Tinnitus: Teaches how to educate and collaborate with patients and other providers to develop a management plan for a patient with tinnitus.
  • Module Seven—Management of the Patient with Decreased Sound Tolerance: Summarizes the characteristics and prevalence of DST along with assessment approaches, treatment techniques, and practice management considerations for these patients.

Each module contains a toolbox with additional resources to enhance content and instruction. Sample toolbox contents may include:

  • Tinnitus questionnaires
  • Clinical practice guidelines
  • Quick reference checklists
  • Summaries of research findings
  • Case-study synopses

Visit ABA’s website for more information.

The Process

The ABA was able to establish a thorough development process, thanks to the program sponsorship support of Phonak Hearing Systems and the additional sponsorship by Plural Publishing. In December 2016, the ABA convened the SME group to draft an outline and the objectives for the critical content needed. Initially conceptualizing the program to include four modules, the ABA modified the program for more modules based on the recommendations of the SME group.

Following the SME group meeting, an instructional designer developed detailed content outlines built around the learning objectives laid out by the SME group. The detailed outlines for each module underwent review by both the SME group and an additional, independent validation panel of audiologists with experience in tinnitus management for finalization, and then were adapted into a storyboard by the instructional designer. The storyboard also undergoes review before translation into an online, interactive educational module. This full process engages multiple content experts and allows for infusion of diverse perspectives into the program.

Certificate Programs

The ABA has a history in developing comprehensive certificate training programs as the Certificate Holder–Audiology Preceptor (CH–AP) training program launched in 2016. CH–AP is the first standards-driven, certificate training program for audiology preceptors. CH–AP is a voluntary training certificate program with four modules, developed by audiology SMEs. The goal of the program is to create a new cohort of highly-skilled and technically-excellent preceptors who are the best possible coaches, teachers, role models, evaluators, and mentors who will create the best possible field placement experiences for audiology students.

In developing CH–AP, it was recognized how important it is that curriculum content reflects current and best practices in audiology. It is equally important that the modules presented are authentic to clinical settings and spark a clinician’s interest. The new tinnitus certificate program’s interactive component will ensure that audiologists are engaged and motivated in their e-learning experience. With quality content and interactive design, CH–TM will provide an effective learning experience for audiologists.


References

Bhatt J, Lin H, Bhattacharyya N. (2016) Prevalence, severity, exposures, and treatment patterns of tinnitus in the United States. JAMA Otolaryngol Head Neck Surg 142(10):959–965. 

Shargorodsky J, Curhan G, Farwell W. (2010) Prevalence and characteristics of tinnitus among US adults. Am J Med 123(8):711–718

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