By Richard Tyler, Ph.D.
As a clinician and researcher, I see tinnitus patients weekly in our University of Iowa clinic. Many patients live far from Iowa City or are not able to travel easily, due to age or accessibility. Remote counseling by phone or video chat can be very helpful. Even before the current COVID-19 pandemic, our Tinnitus and Hyperacusis Clinic—which helps those who hear a sound without an external source, or experience sensitivity to sounds—had been seeing patients remotely for several years.
There are no documented cures for tinnitus, the perception of ringing in the ears, but there are treatments that can help manage the condition.
We’ve developed several tools to help the tinnitus patient, who is typically an older adult. We first ask them to complete the Tinnitus Primary Functions Questionnaire. These are 20 questions that my team and I developed and validated to help detail patient experiences. The questions cover four categories: Thoughts and Emotions, Hearing, Sleep, and Concentration.
Next—whether in person, over the phone, or on a video chat—we typically begin by asking the patient when their tinnitus started, what they think caused it, and how it has affected their life. It is important to connect with the patient and demonstrate that we care. We ask what they have tried or found helpful in coping with their tinnitus. Many say they use the internet to search for help and say they’ve found promising “cures.”
I tell them that it is reasonable to be upset and concerned and to have thoughts such as, “Why did this happen to me; it’s not fair!” We also note that typically the first three to nine months of their becoming aware of and affected by the tinnitus are the worst and repeat that their concerns are understandable.
One thing I am clear to point out is that there are no documented cures for tinnitus, but there are treatments that can help manage the condition. Our clinic uses Tinnitus Activities Treatment, also developed with my team. The focus remains the four categories above, and we have found that the picture-based approach, also accessible online, facilitates patient engagement and provides structured counseling. We also include homework and activities to show understanding and progress. During remote counseling, background noise is removed and counselors speak slowly and clearly. Significant others are welcome to join the session to help review directions.
Most tinnitus patients have a hearing loss and will benefit from hearing aids. We stress it is not about hearing per se, but about interacting with partners and friends and participating in life. Hearing aids can now be fit remotely, but an in-person follow-up visit is preferable. Many will also benefit from partial masking sound therapy, with a noise or music set to the lowest level that provides relief.
The questionnaire responses show that thoughts and emotions consistently rank highest among patient concerns. Our protocol is to address individual needs while considering the whole patient so we can help them cope with their tinnitus.
A 2012 Emerging Research Grants scientist, Richard S. Tyler, Ph.D., is a professor in the departments of otolaryngology–head and neck surgery and communication sciences and disorders at the University of Iowa. He oversees the Tinnitus and Hyperacusis Conference, held annually on campus and whose 28th edition will be June 17–18, 2021. This article originally appeared in the Fall 2020 issue of Hearing Health magazine. For references, see hhf.org/fall2020-references.
