I first became interested in working with
tinnitus patients way back, many, many years ago, when I began my graduate studies in audiology.
I always found tinnitus to be fascinating, and I found that people who have tinnitus
certainly have needs that aren't being addressed in a proper manner. So I've been doing this
clinically for 30 years now, almost on a daily basis, where I’ve been seeing tinnitus patients
and working with them, and recognizing that a tinnitus patient needs counselling, and
needs other therapeutic intervention in a variety of ways, and that the important thing
is that we be very flexible, and that we treat each person as an individual. There are a lot of challenges with tinnitus
treatment, and part of the reason why there are so many challenges is that there are so
many things that can cause tinnitus, number one, and number two, every individual reacts
to having tinnitus in a different way, just as every individual would react to having
pain in a different way. Some people have high pain thresholds, others have low pain
thresholds. Many people that have tinnitus can completely ignore it, other people are
tremendously bothered by it.
So I think one of the biggest challenges is realising that
you have to treat people as individuals, realising that tinnitus is a symptom that triggers a
lot of emotions, a lot of fear. And so recognizing that you are going to have to address the
person, not only in terms of their physical needs, but also in terms of their emotional
needs, and giving people space to allow themselves to grieve about having lost their hearing,
about having tinnitus, about having lost some of the capacity to sit around and relax in
You have to let the patient experience that,
but then we have to make sure that our patients realise that they are not doomed, this is
not something that there is no help for, or that there is no hope for. Even if we can’t
cure tinnitus, we can do things to help our patients realise how they can allow their
brain to suppress their tinnitus. And we have to, in doing that, address their emotional
concerns, allow them to realise that they're not crazy, they’re not weak, they have something
going on that’s abnormal, and that they are reacting in a manner that may be contributing
to some of the problems they are having.
So it's our job, as professionals, to provide
them with education and to give them the kind of information they need to allow their brain
to function in a normal manner and to suppress this very, very annoying signal that they
are receiving. So if we're going to work with the patient
and provide them with a pretty comprehensive tinnitus management programme, we have to
recognize that it is going to entail both very extensive counselling, and by counselling
I mean educational counselling, so they understand what is going on in their auditory system,
and that in most cases, the reason that they have tinnitus is related to the fact that
they have a hearing loss.
And so we need to educate them about that, we need to educate
them about what their brain is doing that is making it lock in or focus in on the tinnitus.
So education becomes a very important component, but then another very important component
of tinnitus management is some kind of sound or acoustic therapy. Because we want to provide
the patient with some kind of background stimulus that will mingle or mix with their tinnitus,
so that it allows their brain to not focus directly on the tinnitus. We're not necessarily
trying to distract a patient away from their tinnitus, but we are trying to provide the
brain with multiple stimuli, so that the brain can turn down its contrast between silence
and the tinnitus that a person perceives.
This sound therapy can come in the form of
hearing aids, noise generators, music, home background signals such as a fan, a television,
a radio. So there's a variety of means of delivering sound therapy, but sound therapy
can be very important in assisting, in going along with the counselling that we are providing,
so that we are working both on the brain and the ears at the same time, and providing the
patient with a more comprehensive solution to allow them to cope with this tinnitus. I think there are a lot of hearing health
care professionals that become afraid when they have a patient sitting in front of them
that is upset about their tinnitus. I think that there is this mystical aspect to tinnitus
that makes some hearing health care professionals think that they are not qualified to deal
with these patients. I don't agree with that. I think that there are some who feel that
‘Unless I take extensive course work in tinnitus, I'm not qualified to help the patient’.
I think that all hearing health care professionals understand the basics of tinnitus. I think
that there is some training, some basic training, that should be involved, so that you can understand
the relationship between hearing loss, tinnitus, stress, emotions, things like that.
understanding is there, then I think, as a hearing health care professional, you have
an ethical obligation to try to at least begin the process of helping a person to cope with
their tinnitus – recognizing that the majority of people who have tinnitus are able to cope
with their tinnitus fairly easily. So I think that the professional needs to understand,
let me understand the basics, let me know what the tools are out there that are available,
and very importantly, the professional does need to understand that if I'm not making
progress with the patient, who should I refer the patient to? Does the patient need further
medical care, do they need a psychologist, a psychiatrist? What kind of help should they
be getting? Are they in need of medication? The hearing health care professional may not
know the answer to that, but there are other professionals who do.
So if you can be honest
with yourself as a professional and recognize that none of us knows everything, and that
if you can recognize when the patient needs to be seen by another professional, you are
going to be serving that professional in a positive manner. So understanding the basics, having tools
to offer to the patient, and recognizing your limitations, and also, knowing how to assess
progress, are very important and should allow really any hearing professional to be able
to start with the tinnitus patient..