Tinnitus Week is February 5-11, and organizations from around the world are working to raise awareness of the condition. To help spread the word and tackle some of the misconceptions about tinnitus, the Ida Institute spoke with Sharon Sandridge, Ph.D. Sharon is the Director of Audiology Clinical Services at the Cleveland Clinic, and was a part of Ida’s Tinnitus Challenge in 2015. Below, she answers a few questions about how to treat and support patients with tinnitus and her role in developing our Tinnitus Thermometer.
What are the most immediate challenges of treating a patient with tinnitus?
Initially, it is important to provide the patient with a sense of hope that he or she will gain relief from the tinnitus. The patient needs to feel hope that the impact of the tinnitus will lessen, that quality of life will improve and he or she will return to pre-tinnitus functioning. Therefore, counseling – emotional and informational are critical elements in the early stages of management.
It is important to try to provide relief from the tinnitus sounds, initially through masking, if needed. There are so many sound apps now available for the patient to try and use to gain some degree of relief – especially if there is a wait to be seen by the professional. We particularly like the First Aid Kit by the Ida Institute to send patients to when they call and are in a desperate state. The message from the First Aid Kit is indeed hope! In addition, tinnitus is often associated with high stress periods – maybe brought on by stressful events. This may need professional intervention or at the least counseling on the relationship between stress and tinnitus and some recommendations to control the stress. It is important that this is discussed early on if professional counseling is warranted.
What are some basic things a clinician can do to support a tinnitus patient?
The primary action is, again, to provide hope through counseling. I can’t emphasize that enough. It is imperative that we truly listen to the patient without our own agenda interfering. We cannot assume we know what they are going through. We need to allow the patient to talk without interjecting our preconceived ideas. Read between the lines of what the patient is saying to understand that maybe the tinnitus is a symptom of something else. When the patient has finished talking – then we can do reflecting listening and restate what we heard the patient say. This helps in several ways. Firstly, it allows the patient to hear what we think we heard and maybe have an “Aha!” moment. Secondly, it allows for clarification of the patient’s point. The patient should feel like we listened and we understand and we care and not that he or she is just another patient on a busy clinic day.
Once you have listened then you need to begin offering suggestions and evaluate the patient’s reaction to those suggestions and their true willingness − determined by watching body language and listening to the undertones − to accept your suggestions and recommendations. This can be challenging because our solutions are not quick fixes and require effort and time. Many patients want a quick fix with a pill or want something that is free or low cost.
As part of the group that developed our Tinnitus Thermometer at an Ida seminar, why did you develop it as you did and what makes it useful?
We have a number of questionnaires we use to monitor how the patient is doing with their tinnitus over time; however they can be lengthy – 25-100 questions. As a group, we thought it would be nice to have a measure that was very quick – very relatable – and global. That is, the Tinnitus Handicap Inventory (THI) is a great pre-post tool but it looks at the impact on participation restriction specifically. We wanted a quick tool to assess the bothersome nature of the tinnitus – allowing “bothersome” to be defined by the patient. It also allows us to address patient expectations of the appointment more directly by asking what his or her expectations are. The Tinnitus Thermometer can be used as a pre-post tool to chart where they are with the tinnitus very quickly and very easily. The patients can add comments – a feature which is very helpful and not readily available on most self-assessment tools such as the THI or the Tinnitus Functional Index, to name just a few of the many options available.
What is one thing you would advise someone new to tinnitus to keep in mind about it?
For those new to the tinnitus arena, look at the literature and only recommend devices or programs that have the evidence to support their effectiveness. Question companies with new products to show you the research. Talk to your patients about avoiding programs and products that lack the scientific justification for effectiveness. Guide them to ask, “where is the proof?” Read the AAO-HNS Guidelines published in 2014 (Tunkel et al.). Be wary of new products on the market – too many new products and their companies fail. Remember that many products are designed for a specific type of tinnitus (e.g. tonal) and have limited application to your patients. As a clinician working with any patients, but especially patients who have tinnitus and who may be more desperate, it is imperative that we stay current with treatment options and the literature that supports those options. Be an informed professional.