Tinnitus Assessment Battery Flashcards by Jenna Skare

What will the initial tinnitus assessment do?

Rule out or confirm disease or pathology underlying the tinnitus
Document health conditions and factors influencing tinnitus perception
Evaluate auditory function to identify peripheral or central auditory dysfunction associated with the mechanisms of tinnitus
Describe and quantify the severity of the patient’s tinnitus
Define the impact of tinnitus on quality of life
Contribute to decisions regarding an effective management plan

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What are the steps of assessing a new tinnitus patient?

Screening questionnaire
Case history
Hearing assessment

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How do you assessment the majority of patients?

Basic case history
Audiologic assessment
Tinnitus screening questionnaires
Tinnitus classification
Brief counseling
Hearing aids if needed

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How do you assess patients with severe symptoms?

Comprehensive case history
Tinnitus impact inventories
Psychoacoustic evaluation (loudness matching and level)
Mental health screening

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What are the tinnitus questionnaires?

Validated questionnaires
Used to assess the impact of tinnitus on a patient (reaction to tinnitus, distress, severity, functions affected)

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What is the purpose of questionnaires?

Help clinicians to choose an appropriate intervention, identify areas that need to be addressed, and document changes
Quantify impact on quality of life
Delineate patient reactions and psychosocial consequences
Identify potential psychological distress (depression, anxiety)
Provide metrics for referral decisions
Guide selection of appropriate management options

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What is the tinnitus function index?

Questionnaire developed in 2015
25 questions used to assess the severity of tinnitus and its negative impact on daily functioning
8 subscales (intrusiveness, sense of control, cognition, sleep, auditory, relaxation, quality of life, and emotional)

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What is the tinnitus handicap inventory?

Questionnaire developed in 1996
25 questions
Grades severity of tinnitus (from 0 to 100)
0 - slight
100 - catastrophic

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What is the tinnitus reaction questionnaire (TRQ)?

Questionnaire developed in 1991
26 questions
Graded scale

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What is the tinnitus and hearing survey?

Questionnaire developed in 2015
3 subsections (tinnitus, hearing, and sound tolerance)
About 5 questions per section

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What mental health screenings can you do for tinnitus patients?

Patient health questionnaire (PHQ-9)
Generalized anxiety screener (GAD-7)

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What is the difference between suicidal ideation and suicidal intent?

People with suicidal ideation do not have a plan for ending their life
For ideation, refer to mental health
For intent, it is a medical emergency

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What are some important things to discuss as you’re collecting case history?

History of tinnitus
Tinnitus severity
Factors related to tinnitus onset
Behavioral, social, interpersonal, and emotional consequences of tinnitus
Descriptive characteristics of tinnitus
Factors that exacerbate or reduce tinnitus
Risk factors for tinnitus
Co-morbidities

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What is the importance of a thorough initial case history?

To understand patient’s tinnitus-related problems
Identify areas to address in counseling sessions
Distinguish bothersome form non-bothersome tinnitus
Educate patient on probable causes and consequences

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What are the elements of a comprehensive case history?

Referral concerns
Management history
Medical/surgical history
Perceptual features
Factors that change tinnitus perception
Psychosocial and functional impacts

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What questions are important to ask about a patients referral and management history?

Who referred the patient?
Why is the patient seeking care?
What previous professional care, if any, has the patient received for his/her tinnitus)?
What were the recommendations?
Were they followed? Did they help?
What treatments/management strategies, if any, has the patient pursued on his/her own?
Did they help?

What are some medical issues that may cause tinnitus?

Neurosurgery, particularly if it affects the auditory cortex
Brain tumors, including acoustic neuromas
Brain injuries, concussion, and head trauma
Cardiovascular diseases
Stroke and transient ischemic attacks
Tempo-Mandibular Joint Dysfunction
Otologic diseases, including disorders of the middle ear
Autoimmune diseases
Metabolic diseases, including abnormal thyroid function

What are some medical issues that may impact how a patient experiences their tinnitus?

Mental health disorders such as: anxiety, depression, post-traumatic stress disorder (PTSD), and schizophrenia
Brain injuries which affect learning and memory may impact tinnitus treatment
Cognitive disorders
Chronic pain

What are some medications that may lead to temporary tinnitus?

NSAIDs, (Aspirin is high risk, naproxen is lower risk)
Loop diuretics (furosemide, bumetanide)
Quinine derivatives

What are some medications that may lead to permanent tinnitus?

Ototoxic chemotherapy meds (platinumbased, nitrogen mustard, Vincristine)
Aminoglycoside antibiotics (erythromycin, vancomycin, amikacin, streptomycin, polymixin B)
Some antidepressants (Buproprion, possibly others)
Opioids/narcotics

What questions should you ask about the perceptual features of the tinnitus?

What is the location of the tinnitus (left, right, bilateral, can’t locate)?
What does it sound like (e.g., hissing, ringing, pulsing, etc.)?
How loud is it (eg, 1-10 scale)?
How annoying is it in an average day (eg, 1-10 scale)?
Does the pitch, loudness, and/or quality change?

Can patients have psychosocial or function impacts from tinnitus?

Yes
Sleep disturbance
Concentration difficulty
Interference with speech understanding
Interference/avoidance of social situations
Increased mental/emotional stress
Effects on family/friends/co-workers
Depression/suicidal ideation

What are some things to include in a hearing assessment with a tinnitus patient?

Otoscopy
Tympanometry
Acoustic reflexes
PT thresholds (0.25-8 kHz)
SRTs
WRS
LDL
Tinnitus evaluation
DPOAEs
EHF audiometry
Reflex decay
QuickSIN

Why would you do DPOAEs on a tinnitus patient?

Confirm cochlear origin by identifying absent or below-normal amplitudes in patients with SNHL
Often a correlation between the patients perceived tinnitus pitch and test frequencies yielding abnormally reduced DPOAE amplitudes
Identify cochlear dysfunction in patients with normal hearing sensitivity
Provide evidence on the laterality of tinnitus
Validates auditory basis, especially with normal audiograms

What is the goal of screening?

Describe and quantify the severity of the patients tinnitus Define the impact of tinnitus on quality of life Contribute to decisions regarding an effective management plan

What is the goal of case history?

Document health conditions and factors influencing tinnitus perception Rule out or confirm disease or pathology underlying tinnitus Contribute to decisions regarding an effective management plan

What is the goal of a hearing assessment?

Rule out or confirm disease or pathology underlying tinnitus Evaluate auditory function to identify peripheral or central auditory dysfunction Describe and quantify severity of tinnitus Contribute to decisions regarding an effective management plan

What symptoms indicate a referral to ENT?

Unilateral tinnitus Secondary tinnitus (somatosounds) Pulsatile tinnitus that pulses with heartbeat Ear pain, drainage, or malodor Vestibular symptoms *Tinnitus and any of the others

What would indicate a referral to emergency care or ENT?

Physical trauma - facial palsy Sudden unexplained hearing loss *tinnitus and these

What would indicate referral to mental health or emergency care?

Suicidal ideation Obvious mental health problems *with tinnitus

Do many patients have a profile that is consistent with tinnitus of sensorineural origin?

Yes History of noise exposure and concurrent or subsequent onset of tinnitus Tinnitus that is symmetrical, stable, and nonpulsatile Tinnitus of long duration An audiogram consistent with a diagnosis of symmetrical sensorineural hearing loss *Suggests further diagnostic testing not necessary (otologic evaluation advised to rule out physical causes of tinnitus)

For some patients, is the primary purpose of a tinnitus assessment to receive a legal claim for compensation?

Yes Clinicians must have the skills to conduct this assessment and to make qualified judgments as to the legitimacy of such claims

What are the components of the legal tinnitus assessment?

Presence of tinnitus: determine whether tinnitus is present and if it can be classified as pathological Severity of tinnitus: determine the impact and extent of the issues related to a patient's tinnitus Etiology of tinnitus: identify potential causes Permanency of tinnitus: based on durations of symptoms

What are legal assessments focused on?

The reliability of psychoacoustic measures The consistency of patient responses Tinnitus duration to ascertain its permanency Clinicians need to be vigilant about possible exaggeration in self-reports, aiming to confirm the consistency, plausibility, and credibility of responses

What is the 2 dB rule?

Developed by Vernon in 1996 Loudness matching should be performed five or six times within a test session with other testing interspersed between the repeated tests Each loudness match is obtained to the nearest 1 dB the presence of tinnitus is indicated if the repeated results within a session agree to within 2 dB *recently the validity of this rule was challenged

Are loudness matching, pitch matching, MML, and RI used to validate their responses?

Yes The goal is to establish whether the patient's responses are consistent, plausible, and credible across all assessment components