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The complete evaluation of the tinnitus patient should be approached
from a dual perspective. The patient with tinnitus, regardless of
location, type, or severity, must first have a thorough otologic and
audiologic examination. If there are accompanying symptoms, a complete
neurological examination may be appropriate. The patient with an
isolated symptom of a persistent, yet unexplained, tinnitus should
receive follow-up examinations at definite intervals when initial
medical, otologic, and neurological studies reveal no evidence of
disease. Tinnitus may be the first symptom of disorder, appearing long
before any other symptom, including hearing loss. When medical and
otologic examination fail to disclose a remediable cause for the
tinnitus, or when a diagnosis is ascertained for which no known medical
therapy is presently available at present, the tinnitus patient should
undergo further evaluation to determine the most appropriate nonmedical
avenue for rehabilitation.
When a specific otologic cause for the tinnitus is
identified, otologic management is indicated. When a lesion or disease
process is not identifiable, however, then tinnitus management is more
difficult. Given no underlying otologic disease, there is at present no
effective surgery or medical therapy for the treatment of tinnitus.
Research on the effectiveness of pharmacological
therapy for tinnitus, although certainly encouraging, involve
medications, such as carbamazepine, lidocaine, and intravenous
barbiturates, whose potentially serious side effects limit their
usefulness. There is some suggestion that relatively low doses may prove
effective in tinnitus management.
Masking
The use of masking as a management tool in the treatment of the tinnitus
patient has met with mixed success over the years. The audiologist
should remain cognizant of factors such as the patient's perception of
the pitch and loudness and the overall spectral intensity of the masking
signal. The referring neurologist should be aware of these issues as
well.
Tinnitus maskers are designed to provide relief to
the tinnitus sufferer by introducing an external masking sound into the
effected ear or ears, thereby minimizing or eliminating the perception
of the tinnitus. Although the use of tinnitus maskers has not proved
universally successful, masking is still a feasible technique that
cannot be ignored. The actual efficacy of tinnitus maskers in the
average tinnitus patient is probably less than 30%. The use of a hearing
aid may be more beneficial by addressing the primary hearing problem.
Biofeedback
Experience with tinnitus patients reveals that many have relatively high
levels of anxiety, tension, or other symptoms of chronic stress. There
is a significant correlation between tinnitus and tension. Biofeedback
as a treatment in the management of tinnitus was first reported in the
literature in the mid-1970s. These early studies reported the use of
biofeedback as effective in the relief of tinnitus or the associated
annoyance produced by it. Biofeedback is quite effective for enhancing
relaxation, as are traditional relaxation procedures. When used
together, muscle tension and general life stresses are reported to be
reduced.
Counseling
The need for effective counseling is one important aspect of tinnitus
management regardless of the management approaches taken with a given
patient. Many patients are frightened by the presence of tinnitus and
need a careful and clear explanation of the disorder, coupled with firm
reassurance from both the neurologist and the audiologist. In light of
the various effects tinnitus may have on a given patient counseling must
be directed toward all of the patient's difficulties, not this specific
problem in isolation.
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