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Tinnitus Management

Tinnitus Management Process
How the process works
Undertaking tinnitus management is a process, and needs to be tailored to each individual's own needs.

The basic essentials of tinnitus treatment, however, are:

  • Understand the mechanism of tinnitus

  • Effectively manage autonomic responses

  • Prosthetic management (sound therapy including hearing aid amplification)

Understanding the Tinnitus Mechanism

An essential aspect of being able to manage intrusive tinnitus is gaining an understanding of what it is and why it behaves in the way it does

While it is true that there is still much to be learned of the intricacies of the neurophysiology and neuroscience of tinnitus i.e. precisely what is happening in highly complex brain physiology pertaining to the presence of the unwanted noise that we hear as tinnitus, it is also true to say that we understand enough of what happens to be able to learn to deal with it on a personal, individual level

Therefore, I ensure that everyone I work with understands the mechanism to the point at which it makes sense to them

Autonomic Response

The autonomic response is a main driver of tinnitus distress, therefore this too needs to be addressed. How it is addressed is entirely dependant upon each individual person because each of us 'operates' at our own level

It is this area of Tinnitus Management in particular where the knowledge and skills of clinicians vary enormously

Most audiologists should be able to help with the first aspect of Tinnitus Management (concerning the mechanism of tinnitus - see above) and at least to some extent, especially in terms of managing an aidable hearing loss through the use of hearing aid amplification, the third aspect (prosthetic management and sound therapy - see below). Some audiologists may also be able to help people to improve basic autonomic responses through teaching relaxation training
Prosthetic Management & Sound Therapy

Hearing Aids:

The use of hearing aids has been accepted as standard in the management of tinnitus since the 1950s. Where in addition to a troublesome tinnitus there is also an aidable hearing loss, appropriate hearing aids most commonly have a very positive effect and reduce tinnitus perception significantly

Sound Therapy

Sound enrichment is generally accepted to be helpful, and certainly many people find the use of recorded nature sounds e.g. sound waves helpful to aid sleep

White noise generators have been advocated as part of TRT (Tinnitus Retraining Therapy); however, more research is needed to give this a good evidence base

Further detail

I integrate two areas of knowledge and skills into this aspect of Tinnitus Management, and bring with me many years of experience doing so

The two areas are those of Hearing Therapy - a specialist area of Audiological Rehabilitation; and Psychotherapy - in particular Cognitive Therapy and Existential Psychotherapy. Through the integration of both sets of skills and experience, I am able to work very effectively with people who - in addition to distressing tinnitus - have anxiety, panic or depression, and very often all three plus tinnitus and hyperacusis (hearing hypersensitivity). Such debilitating symptoms require very careful management if a person is to return to anything resembling a "normal" life

No "basic course of Tinnitus Management" will alleviate tinnitus distress whilst anxiety, panic or depression are left unaddressed. By working with me, combining psychotherapeutic approaches most suited to the individual person I am working with, patients achieve major changes that of course impact on their lives generally as well as on tinnitus distress - problems that previously seemed to be insurmountable

This is complex work but extremely rewarding for me as a therapist - and for the patients I work with!

For people requiring a basic course of tinnitus management - for example where a THI score indicates mild-low moderate tinnitus distress - there is a self-managed on-line free to access basic course of tinnitus management that I made available in 2009 called the Tinnitus E-Programme, currently undergoing independent external evaluation by NHBRU

The majority of patients that I work with, however, need more than 'basic' Tinnitus Management. They are the relatively small percentage of the "15% of the 1 in 10" that don't habituate naturally to tinnitus and are extremely distressed by it. And even though these figures are relatively small in terms of population percentages, they equate to many hundreds of thousands of people

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More about Sound Therapy

Provision of hearing aids when there is an aidable hearing loss and tinnitus is and has been standard practice in the NHS since the 50s

My own personal experience as a clinician is the same as others in the field - hearing aids do have a very significant effect on tinnitus perception, often reducing it to being barely audible during hearing aid use

Although I have listed hearing aids separately above, they are part of "sound therapy" of course. However, many who have tinnitus do not have a hearing loss - at least not a hearing loss that can be measured using standard audiometers that measure hearing levels between 250 Hz and 8KHz. There may be some hearing loss at higher frequencies i.e. above 8KHz; indeed recent research
was able to demonstrate this:

Sereda, M., Hall, D.A., Bosnyak, D.J., Edmonson-Jones, M., Roberts, L.E., Adjamanian, P., Palmer, A.R. (2011) Re-examining the relationship between audiometric profile and tinnitus match, International Journal of Audiology 50 (5): 303-12)

It is still, however, the case that even if hearing loss is identified in the upper range of frequencies, current hearing aid specifications do not amplify beyond 9KHz maximum to the best of my knowledge; indeed most reach well below those high frequencies

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