Final Exam, Case #2 Flashcards
What recommendations should be made to the patient to manage his tinnitus and his hearing loss and why?
With these management strategies in mind, it was recommended to the patient that he pursue hearing aids to help with his co-morbid tinnitus and hearing loss. Hearing aids can help improve his quality of life by treating both his hearing loss and his tinnitus (Tunkel, et al. 2014). Hearing aids are helpful because they increase the level of neuronal activity and amplify speech and ambient sounds, which may reduce tinnitus audibility and awareness. Amplification also improves ease of communication, which can reduce stress. Current research does not definitively state that hearing aids are the only viable treatment option for tinnitus and hearing loss (Hoare, et al., 2014). However, research does indicate that patients can experience a significant change in the perception of their tinnitus by pursuing amplification (Searchfield, Kaur, and Martin, 2010). Lastly, it was suggested to the patient that he utilize noise protection while hunting and using guns. He should not wear hearing instruments while participating in these recreational activities.
How is tinnitus management expected to help the patient with concentration during the day?
In addition to amplification, strategies were discussed to reduce the patient’s reaction to the tinnitus so he can concentrate in his quiet office environment. Tinnitus is always exacerbated by stress. It was recommended to the patient that he attempt to minimize the stress in his office space to create a calm and relaxing environment. Additionally, tinnitus can become more pronounced in quiet environments, sometimes causing the patient to attend to their tinnitus. It was suggested to the patient that he add a source of background noise, such as a white noise machine or a fan. This type of sound source can create a distraction from the patient’s perceived tinnitus, facilitating improved concentration in the work place.
Describe different methods of tinnitus management with respect to the underlying philosophy.
Consequently, the different tinnitus therapy options were reviewed with the patient. The three primary modalities for treating and managing tinnitus are the Auditory, Limbic, and Auditory-Limbic Modalities. First the auditory modality focuses on altering the audibility and awareness of tinnitus. This goal is achieved by using hearing aids and/or sound generators to either habituation or mask the tinnitus. Habituation sets the generated sound below the tinnitus, whereas masking can partially or completely cover the tinnitus. Hearing aids are helpful because they increase neuronal activity and amplify speech and ambient sounds, which can reduce the volume of the patient’s tinnitus and/or change the awareness of the tinnitus.
The second modality is the limbic modality, which focuses on altering the patient’s reaction to the tinnitus. This can be achieved through various methods. Cognitive-Behavioral Therapy (CBT) is a form of psycho-social therapy that operates under the premise that there is faulty thinking that is leading to maladaptive behavior. This therapy can include role-playing to address fear or anxiety related to the tinnitus. Then, Mindfulness-Based Stress Reduction (MBSR) focuses on having the patient be aware and mindful of their tinnitus moment by moment. This goal is achieved through an 8-week program that focuses on yoga, meditation, deep breathing, and relaxation. Tinnitus is highly affected by stress. Teaching the patient to reduce stress will allow them to reduce the effects of tinnitus on their quality of life. Acceptance and Conditioning Training (ACT) is considered a “kinder” version of CBT. There is no current evidence-based research to support this strategy.
The final modality, the auditory-limbic modality, focuses on reducing the perception of the tinnitus and altering the patient’s reaction to the tinnitus. This goal can be achieved through four different methods. First, Tinnitus Retraining Therapy (TRT) is a habituation method that focuses on removing the tinnitus from the patient’s conscious perception. Second, Tinnitus Activities Treatment (TAT) focuses on the patient’s overall well-being, including sleep, concentration, and mood. This is achieved through one-on-one informational counseling, where the professional provides appropriate coping mechanisms in conjunction with sound generators or hearing aids. Third, Progressive Tinnitus Management (PTM) is a patient-centered, hierarchical therapy method that focuses on an individualized therapy plan to best meet patient needs. There are five levels in this hierarchy, but each patient does not have to go through each level; they move through the program based on their medical, audiological, and mental health needs. Lastly, Integrated Tinnitus Therapy (ITT) has different components that focus on relaxation, amplification, and behavioral therapy.
