May/June 2016
15
patients to pay less attention to their tinnitus. An effective manage-
ment program helps patients to understand and gain control over
their tinnitus, rather than allowing it to control them. The ultimate
goal is to reduce the
severity
of tinnitus. Clinicians should strive
to help patients progress to where tinnitus is no longer a nega-
tive factor in their lives.
Establishing tinnitus severity
Since only 20 percent of people who experience chronic tinnitus
consider the symptom to be a significant problem, these are the
patients most likely to seek treatment. If a patient is not bothered
by tinnitus and no active disease processes are detected, no treat-
ments are necessary. The clinician should reassure such patients
that tinnitus is a harmless perception of sound and does not usually
portend more serious medical conditions. What differentiates the
majority of people not bothered by tinnitus from the minority who
perceive it as a significant, even debilitating problem? Is it the
matched loudness, pitch, or other qualities of the sound(s) they
hear? Several studies have concluded that tinnitus severity is not
correlated with any of these psychoacoustic parameters. Tinnitus
severity can be defined and quantified several ways: by how much
or how often a patient is bothered by tinnitus; by how much or
how often tinnitus detracts from the patient’s enjoyment of life;
or by how disabling patients perceive their tinnitus to be. Patient-
administered questionnaires such as the Tinnitus Functional Index
can be used to assess tinnitus severity.
Tinnitus management strategies
Even though a true “cure” for most cases of chronic tinnitus
is not available, patients can obtain relief from the symptom
with assistance from clinicians who are familiar with tinnitus
management strategies. Materials for one effective program,
Progressive Tinnitus Management
2
, can be obtained for no cost
here:
TinnitusDocuments/Index.asp.
Once underlying conditions have been treated or ruled out, reas-
sure and counsel patients regarding factors that could exacerbate
or improve their condition. If patients understand their tinnitus
is nothing more than a perception of sound, they will be better
able to pay less attention to it. This process of patient education
and counseling helps to “demystify” the symptom of tinnitus and
encourages patients to view their tinnitus with a more realistic
perspective. As stated previously, the severity of tinnitus is often
associated with problems such as insomnia, anxiety, and depres-
sion. Such issues can form a vicious circle, with each one exac-
erbating the others.
5
Tinnitus is not always the starting point of this cycle—many patients
experienced depression, insomnia, or anxiety before tinnitus.
Medication or psychotherapy will often reduce the severity of
these symptoms and associated tinnitus.
As shown in the diagram below, many other factors can contribute
to the severity (and perceived importance) of tinnitus. In addition
to factors already discussed in this article, some patients experi-
ence “grief” for their loss of silence when tinnitus becomes chronic.
Tinnitus gains additional importance if the patient is involved in
litigation (due to a motor vehicle accident or work-related noise
exposure) associated with the onset of tinnitus. In these cases,
patients are likely to focus too much time and attention on tinnitus,
resulting in a disproportionate magnification of the symptom.
Identification of specific factors associated with tinnitus severity
is the first step in helping patients to develop a more rational
perspective about this benign symptom.
Because each patient has a unique medical, psychological, and
social history, tinnitus management programs should be individu-
alized. In fact, the most successful tinnitus management programs
employ multimodal strategies designed to address the specific
needs of each patient. Recommendations should be formulated
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