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Prepare to Help Tinnitus Patients with New Recommendations

Tyler, Richard S. PhD

doi: 10.1097/01.HJ.0000461183.36240.bc
Editorial

Dr. Tyler is professor of otolaryngology–head and neck surgery and of communication sciences and disorders at the University of Iowa.

Hearing healthcare professionals should carefully view the new clinical practice guideline for tinnitus, which was recommended by an American Academy of Otolaryngology–Head and Neck Surgery Foundation-sponsored committee on which I served ( Otolaryngol Head Neck Surg 2014;151[suppl 2]:S1-S40 http://oto.sagepub.com/content/151/2_suppl/S1.full).

The guideline highlights important responsibilities and opportunities for hearing healthcare professionals. For example, it recommends prompt audiologic examination for people with tinnitus that is unilateral, persistent, or associated with hearing difficulties, and routine audiologic examination as an appropriate option for any patient with tinnitus.

In addition, the guideline recommends the consideration of hearing aids, provision of brochures ( Audiological Med 2008;6[1]:85-91 http://informahealthcare.com/doi/abs/10.1080/16513860801912281), and suggestion of self-help books for people with problematic tinnitus. Clinicians also may recommend sound therapy devices as an option, the guideline notes.

Opportunities for all these types of interventions arise in part because there are no medical treatments or dietary supplements recommended for tinnitus.

There were a few areas of disagreement among guideline development group members. For example, some thought that acupuncture could be recommended, but others did not. Ultimately, no recommendation on acupuncture was made.

Also, I sometimes found the terminology confusing. In the discussion of sound therapies, a distinction was made between tinnitus masking therapy and tinnitus retraining therapy. I have always understood tinnitus retraining therapy to be a masking therapy; it just uses a high level of partial masking.

The guideline recommended cognitive behavioral therapy (CBT), which was first introduced into the tinnitus realm by Robert Sweetow, PhD, and outlined an eight-week program.

Of course, now there are many tinnitus counseling protocols. Our Tinnitus Activities Treatment, for instance, combines cognitive behavioral therapy strategies with acceptance and refocusing techniques based on the primary functions affected by tinnitus: thoughts and emotions, hearing, sleep, and concentration.

This individualized application of CBT requires only two treatment sessions for some patients and up to five weeks of therapy for others, depending on the primary functions affected. (Tyler RS, Gehringer AK, Noble W, Dunn CC, Witt SA, Bardia A. Tinnitus Activities Treatment. In: Tyler RS, ed. Tinnitus Treatment: Clinical Protocols. New York, NY: Thieme; 2005:116-132.)

There also is a new questionnaire that focuses both on highlighting areas likely to benefit from treatment and measuring the effectiveness of therapies evaluated in clinical trials ( Am J Audiol 2014;23[3]:260-272 http://aja.pubs.asha.org/article.aspx?articleid=1871415). For more details about the questionnaire, please see page 34.

It is hoped that the new clinical practice guideline will substantially increase referrals to hearing healthcare professionals and motivate our profession to prepare for providing comprehensive tinnitus care.

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