Tinnitus needs assessment – for use by clinicians

We believe that the tinnitus treatment must be holistic and personalized to the needs of the individual. To assist the client to drive the treatment plan and map needs to solutions, we recommend assessment across 3 axis (I psychological, II audiological / medical, III psychophysical). You can use this structure to help determine the individual’s needs and priorities.

To help compile the patient’s case history you may wish to download the Tinnitus questions for use by a clinician. At this stage you may wish to refer the client to another specialist for further medical assessment or treatment to check if there are any underlying medical causes for the tinnitus. From an outcome perspective, if that underlying cause can be treated the tinnitus may well also be resolved.

Another tool that can be very helpful in understanding the individual, their goals, and involving them in the decision making process is an open-ended questionnaire the Client Orientated Scale of Improvement in Tinnitus (COSIT). Many audiologists will already be familiar with the Dillons COSI tool as used in hearing aid fitting, this download is a modified version of that tool. It helps in determining a treatment plan based on needs and realistic goals, and is also a means to measure the degree of treatment success.

The clinician and patient identify specific situations in which tinnitus is bothersome, e.g. Tinnitus affects my ability to concentrate at work, and means of reducing tinnitus in these situations, e.g. Amplify sound to reduce tinnitus audibility. This helps to identify the current effects of tinnitus, what interventions may target the problems and how realistic the goals are (e.g “cure tinnitus” is unspecific and unrealistic).

At stages throughout the tinnitus rehabilitation process the problems identified using the COSIT are re-examined and improvement in tinnitus in each situation is determined. If improvement is not shown appropriate steps are undertaken to address the problem until realistic goals are achieved. The groundwork for counselling can been laid through the discussion and exploring of the patient’s problems. This may be the first time the patient has expressed the underlying problems with tinnitus.

The patient’s needs may be addressed through variations and combinations of counselling, sound therapy and possibly referral to another specialist.

Tinnitus therapy matrix

The patient's needs may be addressed through variations and combinations of counselling, sound therapy, supply of specialist devices and possibly referral to another specialist.

That means that clients with high and low needs can me managed appropriately, so individuals with high emotional needs are provided with more in depth counselling, while those with greater complexity of auditory injury may require more complex technological solutions. Simply pick which combination of counselling, sound therapy type and device that best matches your needs.

Counselling

Counselling interventions can range from providing handouts to psycho-education through to psychological referral. 

The content also includes audio pod casts from a range of other universities that assist with visualisation, breathing exercises and progressive relaxation.

Sound therapy

Our Tinnitus Tunes library consists of a series of sounds and listening exercises that can be used to treat tinnitus in different ways. There are no hard or fast rules as to which sounds are best, but our sound therapy approach is based on “detection control” (partial masking), “relaxation”, “attention refocus” and “adaptation”. This includes the special Brain Training sound therapy that takes advantage of brain plasticity to "rewire" the patient's brain so attention is switched way from their tinnitus.

Patients typically like the fact they can manage this aspect of their treatment 24 x 7 and work through the stages and techniques at their own pace. It is an important aspect of helping the patient take personal control over their tinnitus.

The sound and audio pod cast library includes a large sample of nature based sounds that have been recorded using special 3 dimensional sound recording techniques to provide a full surround effect.

Devices 

Desktop or “bedside” sound generating devices produce a variety of different sounds (for example, ocean waves, rain, running water) these have been found useful to reduce tinnitus effects at night and can be combined with pillow speakers or speakers embedded within soft headbands for convenient use in bed.

Personal music players such as MP3 players or smartphones are an easy way of providing sound therapy. Sounds can be downloaded from the Tinnitus Tunes sound library or other internet sources. Use of pre-recorded sounds is an easy way of obtaining treatment sounds that clients find comfortable and easy to listen to. These should be used in combination with quality headphones. When a hearing loss is present headphones with independent volume controls can help reduce some of the asymmetry between ears.

Because many hearing aids now are available with Bluetooth wireless connections sounds from smartphones can be streamed directly to the ears, with the hearing aids compensating for the hearing loss. Tinnitus hearing aids are small ear-level devices that produce sound stimuli of variable intensity and frequency along with improved hearing to reduce tinnitus.