LM302 - The One Percent: Working with Complex Tinnitus Patients

Abstract: Millions of Americans experience chronic tinnitus,  seeking support from audiologists to assess and treat their tinnitus.  Many audiologists feel confident in addressing "run of the mill" or low needs tinnitus patients however are uncomfortable with those patients with significant degrees of anxiety/depression/distress, what we are referring to as the 1%.  This learning module will focus on higher level tinnitus treatment to those patients with the greatest difficulties with managing their tinnitus.  The difference between motivation and desperation will be discussed. Tools and techniques for working, establishing critical referral partnerships, and successfully working with this population of patients will be provided.

Summary: Many audiologists provide care to patients who present with tinnitus and sound tolerance disorders.  Some audiologists are comfortable with "run of the mill" or low needs tinnitus patients--those that present with a hearing loss and mild tinnitus perception or tinnitus related to noise exposure. However, many patients with chronic tinnitus present with concomitant issues that add a level of complexity in developing a treatment/management plan with them. These are often patients with high degrees of anxiety and depression,  have excessive stress that exacerbates the tinnitus perception, and may report suicidal ideations.  For this presentation, these patients are going to be considered "the1%".  Their tinnitus perception is severe or what may be classier as "catastrophic".  This patient population may seek audiologic care for their tinnitus after attempting a wide variety of at-home, OTC, and alternative and unconventional therapy methods, unsuccessfully. They often require considerable support from a collaborative multidisciplinary healthcare team in order to address these issues and provide direction. For many of these patients, other issues were precipitating factors in arriving in the audiologists office, however tinnitus was the tipping point.

One of the considerations with this 1%. population is motivation for treatment vs. desperation.  Integrating screening for anxiety and depression prior to initiating treatment is a critical step since treatment efficacy is based on realistic expectations on the part of the patient and the ability to follow through on treatment recommendations.  Additionally, the role of a support team, which may include physician, psychologist, psychiatist, must be considered. The audiologist may need to communicate with this team in order to move the patient forward on this journey.  Addressing suicidal ideation will be discussed since audiologists may have patients who discuss their extreme tinnitus distress and our role becomes a significant one in supporting patients with mental health needs.

Helping the patient frame realistic expectations regarding their tinnitus will be explored.  Many tinnitus patients will joke that they are looking for the "cure" but realize that reasonable expectations are to reduce tinnitus perception and make tinnitus a "non issue" in their lives.  For the 1%, rationally they understand that a cure is not the goal, however they are driven to pursue the "holy grail" of finding the treatment that takes their tinnitus away.  The role of the correct audiologist in helping the patient to focus on reasonable goals is critical. 

Tools for doing so will be discussed, including how to monitor progress and use of tools such as the Client Oriented Scale of Improvement for Tinnitus (COSIT).  Resources will be provided to explore audiology networking and partnerships in this process, including creating support teams among audiology peers and pursuing mental healthcare which supports the patient on the long run.