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As printed in Hearing Health, volume 19:1,
Spring 2003
Deciding on a course of action in tinnitus treatment
is a challenge. Knowing as much as possible about the
people seeking relief makes the likelihood for success
much greater. Dr. Jack Vernon offers a sampling of a
screening tool that clarifies an individual’s
experience with tinnitus. Combining subjective information
with results of objective diagnostic tests puts the
treatment team of patient and therapist on the best
possible footing. These questions and explanatory comments
are a good example to follow.
1. How much of a problem is
your tinnitus on a scale of 1 to 10, with 1 being “little
or no problem” and 10 being “an extremely
bad problem?”
Self-ratings help indicate the urgency of the need for
treatment. If rating is 4 or below, treatment may not
be necessary but there would be benefit from information
and counseling. If 8 or above, the patient is in urgent
need of treatment and the clinician should give immediate
attention to providing help.
2. What are the most disturbing
effects of your tinnitus?
Responses concerning: sleep problems call for treatment
involving sleeping medications, bedside maskers and/or
training in relaxation techniques that promote sleep;
difficulties concentrating may be eased with tinnitus
masking or Tinnitus Retraining Therapy (TRT), with more
delayed effects.
3. Can you hear your tinnitus
when you are in the shower or running a faucet?
If no, wearable tinnitus maskers, bedside maskers or
other non-wearable sound-making devices may produce
reduction or elimination of the tinnitus.
4. For how long have you had
tinnitus? Did it start suddenly or develop gradually?
Sudden onset is often much more unsettling and intrusive
than gradually increasing tinnitus. Tinnitus of short
duration may fade away. The condition is considered
permanent if it has remained essentially unchanged for
18 months or more.
5. Where does your tinnitus
appear to be located?
Localization is important for adequate acoustic therapy;
bilateral devices are often needed if tinnitus is bilateral
or “in the head.” Improvement may occur
unevenly; people with tinnitus in more than one location
may report that treatment has caused it to disappear
or diminish in one location but not in others.
6. Do you have hearing loss?
In one ear or both? How severe?
Normally hearing tinnitus patients, although in the
minority, are often those who are most severely affected
by it. Hearing loss, particularly in the high frequencies,
may limit the ability to hear and benefit from acoustic
therapy but individuals with high frequency losses can
benefit from wearable tinnitus instruments that combine
a masker and a hearing aid. Slightly more than 10 percent
of patients will experience reduction of their tinnitus
from use of hearing aids alone in the presence of ambient
sound.
7. Have you been or are you
now exposed to loud sound levels?
Tinnitus is frequently caused by exposure to damaging
levels of loud sound. To avoid making the condition
worse, it is important for people with tinnitus to avoid
exposure to excessive noise (e.g., leaf blowers, chainsaws,
vacuum cleaners, motorcycles, tractors, loud sporting
events and concerts, etc.).
8. Does your tinnitus have a
pulsating or pounding quality?
If in phase with the heartbeat, it is called objective
tinnitus and might be correctable by a physician specializing
in treatment of vascular noises. This type can usually
be heard by others.
9. What treatments have you
tried, if any?
Previous treatment attempts may have been inappropriate
or done incorrectly. For example, Tinnitus Masking,
either with wearable devices or with bedside devices,
aids thousands to achieve relief while using the devices
and some obtain long-term relief. If earlier treatment
with masking was not effective, it may not have been
done correctly. The most common errors are providing
only one wearable device even for bilateral tinnitus,
not introducing a combination device for hearing loss
in addition to tinnitus, or using a masker that contains
insufficient high frequency sound.
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