Tinnitus is the presence of sounds heard in the ear or head, in the absence of any exterior sound. Tinnitus may be heard in many different forms. People have reported hearing ringing sounds, tonal sounds at one particular frequency (more often high), cricket sounds, clickings, engine sounds and even musical sounds and singing. There are so many variations heard that it would be impossible to talk about them all. People may hear tinnitus occasionally or all the time or any variation in between. It is more usual for people to hear tinnitus at quiet times. Most people who have tinnitus have some degree of hearing loss but some people have normal hearing when tested, however, there may be undetected minor changes in hearing that are causing the tinnitus. The majority of people respond well to Tinnitus Retraining Therapy. All Patients attending for a tinnitus appointment must bring a recent audiogram with them. The audiogram must include pure tone audiometry and uncomfortable loudness levels, and be performed by an accredited professional.

ASSESSMENT

All patients are assessed using standardised routine assessment sheets and questionnaires including the Tinnitus Handicap Inventory.

Patients’ history will relate to tinnitus, hearing and balance problems, lifestyle, social situations and employment.

Questionnaires are used to evaluate the difficulties people are experiencing that might have an impact on their tinnitus. Questionnaires may also be used to monitor progress thus offering proof of change to patients.

If psychological difficulties are being experienced further questionnaires may be completed. The Hearing Therapist will recognise professional boundaries and refer on to other professionals if appropriate.

INTERVENTION

Initially the patient will have their hearing test explained to them so as to give a good understanding of what it means. The hearing mechanism and the generation of tinnitus will be explained according to the Jastreboff/Hazell model using a model ear, diagrams and illustrations to enhance the patients’ understanding of their tinnitus. The explanation will be tailor-made according to each person’s individual needs and previous knowledge.

Treatment options will be discussed with the patient as appropriate. This may include one or all of the following:

1. Ambient sound enrichment

2. Distraction techniques

3. Relaxation and/or stress management

4. Sleep hygiene

5. Looking at lifestyle

6. Advice on diet

7. Alternative therapies e.g. Aroma therapy

8. The possibility of wearing a hearing aids and visiting an audiologist.

9. White noise generators

Written information is always provided to support verbal information.

Letters are sent to referrers or GPs in instances where the appointment is a self-referral.

In this service the current treatment of tinnitus emphasises that tinnitus is NOT TO BE MASKED. The patient is encouraged to listen to exterior sound at just below the mixing point of their tinnitus to encourage the tinnitus volume to lower.

White noise generators (formerly called “makers”) are used at just below mixing point of tinnitus.

THE AIM

The aim is “habituation”. Habituation is a ‘normalising’ of the sound to the point when the tinnitus is no longer bothersome. This may take a short time or a long time depending on the individual and their response to Tinnitus Retraining Therapy. Habituation may be likened to the process whereby a new appliance in the home may sound intrusive when first heard but in time the brain learns to ignore the sound because it knows that the sound is harmless.

HYPERACUSIS

Hyperacusis is over sensitivity to sound or hearing certain sounds as abnormally loud. This condition is also treated in this service using a very gradual exposure to sounds that are causing sensitivity. Again a clear understanding of the hyperacusis is essential to the habituation of this condition.

THE AIM

The aim is to decrease the over sensitivity to the point when there is no longer any bothersome discomfort.

APPOINTMENTS

A first appointment is always one and a half hours. Further appointments will usually be half an hour to one hour in duration. Frequency of appointments is very individual, Some people only need one appointment, others need a few frequent appointments and then further appointments becoming less and less frequent.