Patient Education Discussion Points for Bothersome Tinnitus

Patient Education Discussion Points for Bothersome Tinnitus
Patient Education Discussion Points for Bothersome Tinnitus
Definition of tinnitus. Tinnitus is sound that is created in the ears or in the head. It is a symptom and
not a disease. People with chronic tinnitus usually hear it all or most of the time. For some people,
tinnitus is intermittent.
Distinguishing tinnitus from transient ear noise (brief spontaneous tinnitus). “Transient ear
noise” is a sudden whistling sound accompanied by the perception of hearing loss. The event is
unilateral and seems to occur completely at random without anything precipitating the sudden onset
of symptoms. Often the ear feels blocked during the episode. The symptoms generally dissipate
within a period of about a minute. Transient ear noise, sometimes also called brief spontaneous
tinnitus, is normal.
Assessment of tinnitus and associated hearing loss. Patients with tinnitus commonly attribute
hearing problems to tinnitus. The clinician should determine how much of a patient’s complaint is
due to a hearing problems and how much is due specifically to the tinnitus. Such assessment may
require an audiologic exam and appropriate questionnaires.
Tinnitus can be temporary. Exposure to loud noise can cause temporary threshold shift as well as
temporary tinnitus. Tinnitus induced in this fashion will likely resolve within a few days following
the insult. Repeated episodes of noise exposure increase the likelihood that the tinnitus will become
permanent.
Drugs and tinnitus. Tinnitus can be induced by a number of medications and drug interactions.
Such tinnitus is usually temporary (typically lasting 1 to 2 weeks post exposure), but can be
permanent—especially with the use of aminoglycoside antibiotics or the cancer chemotherapeutic
drug cisplatin. Aspirin is well known to cause temporary tinnitus, although the dosage generally has
to be rather high to induce tinnitus. Other medications that can cause temporary tinnitus include
NSAIDS, loop diuretics, and quinine. Drugs used to treat mental health and sleep conditions also
may trigger or exacerbate tinnitus.
No cure for primary tinnitus. A cure for primary tinnitus does not yet exist, and despite claims to
the contrary, no method has been proven to provide long-term suppression of tinnitus. We can help
patients by relieving the functional effects of tinnitus, such as sleep disturbance, difficulty
concentrating, problems with hearing, and difficulty relaxing. Patients need to be informed that
although tinnitus cannot be cured they can learn to manage their reactions to it, thereby improving
their QOL. Health care professionals should be compassionate regarding patient’s concerns and fears
about tinnitus. A brief overview of the evidence-based interventions discussed later in this
guideline can be presented.
Current theory on the pathophysiology of tinnitus. Research suggests that tinnitus results from the
compensatory adaptation of the central auditory system to hearing loss. Clinical observations
establish the near universal association of tinnitus with hearing loss. Hearing loss associated with
tinnitus can range in severity from minimal to profound, and most people with hearing loss do not
experience tinnitus. Changes in inhibitory and excitatory neurotransmitters occur throughout the
auditory pathway in association with tinnitus.
Current theory on the pathophysiology of tinnitus. Research suggests that tinnitus results from the
compensatory adaptation of the central auditory system to hearing loss. Clinical observations
establish the near universal association of tinnitus with hearing loss. Hearing loss associated with
tinnitus can range in severity from minimal to profound, and most people with hearing loss do not
experience tinnitus. Changes in inhibitory and excitatory neurotransmitters occur throughout the
auditory pathway in association with tinnitus.
SOURCE: Tunkel DE, Bauer CA, Sun GH, et al. Clinical Practice Guideline: Tinnitus. Otolaryngol Head Neck
Surg. 2014;151(S2):S1-S40.
About the AAO-HNS
The American Academy of Otolaryngology—Head and Neck Surgery (www.entnet.org), one of the oldest medical
associations in the nation, represents about 12,000 physicians and allied health professionals who specialize in the
diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck. The
Academy serves its members by facilitating the advancement of the science and art of medicine related to
otolaryngology and by representing the specialty in governmental and socioeconomic issues. The AAO-HNS
Foundation works to advance the art, science, and ethical practice of otolaryngology-head and neck surgery through
education, research, and lifelong learning. The organization's vision: "Empowering otolaryngologist-head and neck
surgeons to deliver the best patient care."
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