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Tinnitus Management and Treatment

Dr. Ali Danesh

Serving Tinnitus Patients for the past 20 years.

Subjective Tinnitus is experienced by over 50 million Americans, ten million of whom have sought relief from medical or nonmedical intervention. Subjective Tinnitus is more prevalent and differs significantly from Objective Tinnitus. Objective Tinnitus can be heard by others and has a different genesis than does Subjective Tinnitus. Usually, Objective Tinnitus can be treated by appropriate medical or surgical methods.

Seldom is tinnitus an indication of some life threatening or debilitating disorder. However, it is imperative that specific clinical tests be administered to rule out the need for medical or surgical management.

By definition, subjective tinnitus is evidenced by an acoustic like sensation, usually located within the head, for which there is no external cause. It is defined in a variety of ways by those who suffer from it. Such statements as roaring, hissing, music, crickets, a cacophony of sounds, and static-like are only a few of the descriptions provided by our patients regarding this ongoing disorder.

Subjective tinnitus may be constant and unrelenting. It may be intermittent or change with respect to frequency and intensity. It may be in one or in both ears.

Two conclusions are evident. First of all, there is no general consensus as to etiology. Second, there is no general consensus of an absolute or effective treatment which cures the disorder. However, there is a need to provide treatment programs which assist the patient in coping with the problem, even though only the symptom (tinnitus) is being treated.

Tinnitus Retraining Therapy, also known as Habituation Therapy, is a relatively new approach to the management of tinnitus and of hyperacusis. It was developed by a world-renowned neurophysiologist, Doctor Pawell Jastreboff. In studies involving over 800 patients, he reports an 80+% success rate.

Tinnitus Retraining Therapy is based on strong neurophysiological evidence that any person can habituate to acoustic, or acoustic like, sensations in their environment.

With constant use of special sound generators coupled with careful counseling, habituation usually occurs within the first 18 months. This is not to suggest that the tinnitus disappears. Rather, it is no longer perceived at the conscious level of awareness. The sound generators are housed in a small, ear-level casing coupled with an open earmold. This configuration does not interfere with the patient's ability to hear.

We use a modification to this approach for hyperacusis. The modification allows retraining the lower parts of the brain and the inner ear to decrease their extreme sensitivity to moderate and loud sound.

Tinnitus and Cognitive Behavioral Therapy

Dr. Ali Danesh and Labyrinth Audiology are pleased to inform you that we now offer Cognitive Behavioral Therapy (CBT) for treating patients with persistent, bothersome tinnitus. By implementing CBT as a critical component of our tinnitus treatment, we utilize evidence-based treatment for tinnitus as described in the attached Clinical Practice Guideline: Tinnitus (Tunkel, David E., et.al. 2014). As stated in the Guideline: “…COGNITIVE BEHAVIORAL THERAPY: Clinicians should recommend CBT to patients with persistent, bothersome tinnitus.”

Patricia Wightman, M.Ed. , Ed.S, LMHC, a Certified Cognitive-Behavioral Therapist, is joining Labyrinth Audiology to offer CBT to all tinnitus patients. Patricia is a Licensed Mental Health Counselor (LMHC) with more than 25 years’ experience helping patients who experience chronic medical conditions which cause emotional distress and reduced quality of life. Patricia is also a tinnitus patient who has gone from “tinnitus sufferer” to “tinnitus survivor.” Along with CBT, Patricia will also provide education and counseling as recommended in the Guideline, which states: “Clinicians should educate patients with persistent, bothersome tinnitus about management strategies.” CBT adds to our multidisciplinary model which includes prior medical screening, audiology testing and diagnostics, sound therapy, and now, Cognitive Behavioral Therapy. Evidence-based therapies recommended in the Guideline are shown through research to reduce symptoms such as depression, anxiety and fear. CBT, delivered within a context of a caring, therapeutic relationship provided by a qualified counselor provides an effective basis for treatment. In addition to assisting patients, family members or significant others may receive counseling as an adjunct to patient treatment. Telemedicine (by phone or internet) will also be available to provide ongoing support and follow-up for patients needing “booster” sessions. We do not underestimate the distress and disturbance of normal life activities that tinnitus patients are experiencing. Intervention with these evidence-based therapies gives clinicians the ability to use evidence-based treatment upon diagnosis.

Enclosed Reference: Tunkel, David E., et al, Clinical Practice Guidelines: Tinnitus. Otolaryngology – Head and Neck Surgery, 2014, Vol. 151(25) S1-240.