How would you like to wake up one morning with a sound in your head that you have no control over and might never go away? Two publications recently highlighted the interference of tinnitus on a persons’ quality of life. Zeman, et al., studied more than 1,000 patients with varying degrees of tinnitus from the Tinnitus Research Initiative database from five different countries (Health Qual Life Outcomes. 2014;12:7 http://bit.ly/2DQBk5p). Tinnitus handicap was compared with the Beck Depression Inventory and domains of the World Health Organization Quality of Life questionnaire. The study found strong relationships between self-reported tinnitus burden, quality of life, and depression. It also highlighted that the problems associated with tinnitus can have a major impact on the patient's quality of life. Items such as “feeling confused from tinnitus, the trouble of falling asleep at night, the interference with job or household responsibilities, getting upset from tinnitus, and the feeling of being depressed“ were found to have the highest influence on quality of life and depression.
In a more recent web-based study, Durai, et al., investigated 154 subjects with tinnitus and 61 subjects without tinnitus but with hearing loss (J Am Acad Audiol. 2017;28:271 http://bit.ly/2DQg3Je). They found that tinnitus sufferers had higher levels of stress, lower social closeness, lower self-control, and higher alienation than those with hearing loss but without tinnitus.
CLINICAL MANAGEMENT IMPACT
These studies have important impact on the clinical management of tinnitus. First, we need to understand the problems caused by tinnitus to be sure that we can provide the appropriate counseling and sound therapy. Second, we need to convince health care insurance providers about the severity of the impact of tinnitus on peoples’ lives, deeming it appropriate to provide reimbursement for counseling and sound therapy.
Tyler, et al., discussed the psychological impact of tinnitus and noted four primary functions affected by this condition: (1) thoughts and emotions, (2) hearing, (3) sleep, and (4) concentration (ORL J Otorhinolaryngol Relat Spec. 2006;68:14 http://bit.ly/2DR9DcE). When one or more of these primary functions are affected, tinnitus sufferers can experience difficulties in secondary activities including socialization, work, and general quality of life. A progressive program that can be used to address these difficulties is the Tinnitus Activities Treatment (Tyler, ed. Thieme, 2005 http://bit.ly/2DSidbg). The Tinnitus Primary Functions Questionnaire can be used to determine which areas require treatment.
ISSUES IN COUNSELING
The audiologist is commonly the first health professional who sees a tinnitus patient, who usually also has a significant hearing loss that requires attention. Audiologists have been providing strategic counseling for years (e.g., Tyler and Erlandsson, eds. Taylor and Francis Group, 2003; Hearing Instruments. 1984;35:14; Henry & Wilson. Allyn & Bacon, 2001; J Rehab Research & Development. 2003;40:157; Mohr and Hedelund. In: Tyler, ed. Thieme, 2006).
The interest in evidence-based treatments has resulted in a focus on Cognitive Behavior Therapy (CBT) for tinnitus (Otolaryngol Head Neck Surg. 2014;151[2 Suppl]:S1 http://bit.ly/2fyhNut). The importance of CBT might be overemphasized considering that each person perceives tinnitus differently and requires individualized care. As such, it is important to consider where each patient is at—his or her beliefs, thoughts, and emotions—instead of offering a prescriptive formula (Hearing Journal. 2017;70:10 http://bit.ly/2DRD3Y8).
Notably, counseling is reimbursed when provided by a variety of health care workers (social workers, physicians, psychologists) for smoking cessation and weight management. These are often referred to as “smoking and tobacco use cessation counseling” and “dietary counseling and surveillance.” But why can't hearing professionals be reimbursed for tinnitus counseling?
Reimbursement for health care is complex, but these questions remain: How can audiologists get reimbursed for counseling services? And what can professional associations do? It has been argued that audiologists should develop their own reimbursement codes that define procedures and value to health care payers (ASHA Leader. 2011;16:26). Perhaps audiology professional organizations could take the first step and develop these reimbursement codes (note that Current Procedural Terminology codes are copyrighted by the American Medical Association). For example, audiologists can use the code “TinCo 20” for 20 minutes of tinnitus counseling. Reimbursing companies may not initially understand this, but we need to start somewhere.
Understanding the dramatic impact of tinnitus on a person's quality of life underscores the importance of counseling in tinnitus treatment and the need to advance the reimbursement of hearing health care providers for tinnitus counseling services.
Journal Club Highlight
The Personality Profile of Tinnitus Sufferers and a Nontinnitus Control Group.
Durai M, O'Keeffe MG, Searchfield GD1. J Am Acad Audiol. 2017;28(4):271http://bit.ly/2DQg3Je.
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