Final Exam, Case #5 Flashcards
What recommendations should be made to the patient to manage his tinnitus and his hearing loss, and why?
With these modalities in mind, it was recommended to the patient that he pursue amplification to treat his co-morbid hearing loss and tinnitus. While current literature does not definitively state that hearing aids are the only viable treatment method to treat hearing loss and tinnitus, patients may experience a change in the perception of their tinnitus (Hoare, et al., 2014 and Searchfield, Kaur, and Martin, 2010). Hearing aids can increase neuronal activity, which may reduce the tinnitus audibility and awareness. By treating the hearing loss, hearing instruments can improve the patient’s ease of listening, which in turn reduces stress. A reduction in stress can lead to an improvement in the perception of tinnitus. Then, the patient was appropriately counseled on reasonable expectations for the hearing aids and his tinnitus (Tunkel, et al., 2014). Lastly, it was recommended to the patient that pursue optoacoustic emission testing to monitor the effects of cisplatin on his hearing. Distortion Product Otoacoustic Emission (DPOAE) findings alone can indicate whether or not hearing thresholds have changed, especially in the high frequencies (Reavis et al., 2010)
How is tinnitus management expected to help the patient’s sleep?
By changing the patient’s perception and reaction of the tinnitus, he should notice improvements in his sleep. Tinnitus management can improve the quality and duration of sleep, without the patient waking up in the middle of the night. Typically, the perception of tinnitus does not make the tinnitus problematic. Rather, it is the emotional response from the limbic and autonomic nervous systems that can make create a negative reaction to the tinnitus (Klapp and Haas, 2005). The patient was also educated about appropriate sleep hygiene, which includes not using electronic devices before sleeping, not working in the bedroom, and creating a stress-free and relaxing environment (Tunkel, et al., 2014). By incorporating good sleep hygiene and altering the reaction to his tinnitus, the patient should be able to ignore the tinnitus and improve his quality of sleep.
Describe tinnitus therapies with respect to modality and give examples of the therapy options available within each modality. Describe how each example works to minimize the effects of tinnitus.
The results from today’s testing were reviewed with the patient and was provided information on tinnitus and tinnitus management. The patient was informed that tinnitus is a perception of a sound that occurs without an external sound source. It is not clear what causes tinnitus, but it is most often associated with outer hair cell damage, which can also be related to hearing loss. It was stressed to the patient that tinnitus is not a dangerous disease. He was further informed that there is no cure for tinnitus, but there are strategies that can be utilized to alter his perception and reaction to his tinnitus (Tunkel, et al., 2014).
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.
