KNOW HOW | Practice Differentiation Through Tinnitus Management: An Overview for Beginners

By Caitlin Turriff

This article is a part of the May/June 2017, Volume 29, Number 3, Audiology Today issue.

With the changing landscape of hearing health care, many audiologists are seeking ways to distinguish themselves and their practices from other dispensing offices and big-box stores. One aspect of patient care that can help differentiate one’s practice from the competition is tinnitus management.

Tinnitus, which is defined as a perceived sound that lacks an outside source, affects about 15–20 percent of the global population (Swain et al, 2016). Despite the large number of individuals who experience tinnitus, only about a quarter of those who report tinnitus feel it negatively impacts daily life and actively seek out management options (Woelver et al, 2015). Upon first glance, tinnitus management may seem fairly straightforward—a typical visit could include a case history, audiological evaluation, tinnitus evaluation, and counseling. In actuality, there are diverse ways that tinnitus affects individuals resulting in the need for more comprehensive tinnitus evaluations and management options. This article will describe the different aspects of tinnitus evaluation, provide examples of tinnitus management, and examine ways to incorporate both into your practice.

Initial Evaluation

The first step of a tinnitus evaluation should include a detailed case history. To date, there is no definitive cause of tinnitus; however, it is commonly associated with hearing loss, noise exposure, head trauma, and infections/diseases of the ear (Swain et al, 2016). Because there is no universal cause, a thorough case history interview should educate the audiologist on the patient’s perceived hearing ability, a description of the tinnitus, vestibular symptoms, current medications, and personal and family medical history. The information collected will help guide the hearing assessment and provide clues as to what, if any, medical referrals are necessary.

In addition to the case history, it is important to consider the impact the tinnitus has on the patient’s life and mental well-being. Using a screening tool may provide a more efficient and effective way of determining that impact. The Tinnitus and Hearing Survey (THS) is a ten-item questionnaire that helps determine whether the patient's complaints stem more from tinnitus or hearing loss (Henry et al, 2015a). Henry and colleagues (2015a) have divided the THS into two sections: statements relating to tinnitus and how it affects the patient's life (i.e. difficulty concentrating, difficulty sleeping, etc) and statements evaluating how hearing loss affects communication and listening (i.e. difficulty understanding the television, difficulty understanding in groups, etc). The patient's responses for each statement are rated on a scale of 0 (not a problem) to 4 (very big problem) and whichever section receives the higher score suggests it is the main contributor to the patient's complaints (Henry et al, 2015a). While no cutoff score is used to determine the direction of treatment, it allows the audiologist and the patient to discuss the root of the problem, how the tinnitus or hearing loss can be addressed, and enables the patient to make an informed decision regarding management. The THS can be used prior to other tinnitus questionnaires if the patient chooses to pursue tinnitus management (Henry et al, 2015a).