Tinnitus in 10: What Every Audiologist Should Know to Provide Research-Based Care

By Candice Manning

This article is a part of the May/June 2019, Volume 31, Number 3,  Audiology Today issue.

Tinnitus is an invisible condition affecting 10 percent to 15 percent of adults (Hoffman and Reed, 2004). Chronic tinnitus is defined as the persistent perception of sound when there is no external source (Jastreboff, 1990). It generally is accepted that tinnitus is manageable and not bothersome for about 80 percent of those who experience it (Davis and Refaie, 2000; Hoffman and Reed, 2004; Jastreboff and Hazell, 1998). That is, most people who experience tinnitus tend to ignore it and are not interested in receiving specialized clinical services. For the remaining 20 percent, however, tinnitus disturbs sleep, impairs concentration, and/or causes negative emotional reactions—all to different degrees. These 20 percent are the ones in greatest need of clinical services (Figure 1). People with tinnitus most likely have had noise exposure that caused peripheral auditory damage, resulting in both tinnitus and hearing loss (Axelsson and Barrenas, 1992). And that is where we, the audiologists, come in.

The Role of the Audiologist

Audiologists across the nation are inundated with the number of patients seeking help for tinnitus complaints. Tinnitus care should include evaluation, management, and follow-up of patients’ symptoms; however, we may not have been trained adequately in our graduate programs to know how to treat a tinnitus patient and may be unaware of clinical resources that are available. In addition, we’re bombarded with a plethora of new products, devices, and “cures” that will fit every tinnitus patient type. Although many therapies for tinnitus are available, most do not have the support of rigorous scientific research. There is no cure for tinnitus, and, despite claims that are ubiquitous on the Internet, no method has been shown to permanently suppress the perception of tinnitus. To help patients, it is therefore necessary to mitigate the functional effects of tinnitus (Davis and Refaie, 2000). Where do we get this information, though?

As audiologists, it is emphasized that we are to provide clinical care based on scientific evidence. But what does this really mean? And how do we differentiate “strong” from “weak” evidence? Figure 2 shows the different levels of evidence—the bottom step indicating the weakest and the top step being the strongest level (Liddle et al, 1996). Anecdotal evidence is labeled weak evidence, but that’s not to say it is not valuable information, especially with respect to tinnitus. We rely heavily on our patients to tell us how they react to their tinnitus, which suggests how to design their best management options. This type of evidence is especially important when providing patient-centered care.