Tinnitus and Decreased Sound Tolerance (TH)
Patricia Mazzullo, AuD
Clinical Audiologist
Walter Reed National Military Medical Center
Washington, District of Columbia
Disclosure(s): No financial or nonfinancial relationships to disclose.
Tinnitus is the most prevalent service-connected disability rating in the Veterans Administration. At Walter Reed National Military Medical Center, servicing active duty service members and veterans, we have a large number of tinnitus patients who require intervention. Mental health conditions such as anxiety and depression are often comorbid in chronic tinnitus suffers.
A series of case studies will highlight the benefits of tinnitus intervention, and barriers to consider, within this population. Due to the relationship between tinnitus and mental health conditions, it is important to be mindful of these co-existing conditions when treating tinnitus patients and assessing benefit.
Summary:
Tinnitus is the most prevalent service-connected disability rating in the Veterans Administration (VA). At Walter Reed National Military Medical Center, servicing active duty service members and veterans, we have a large number of tinnitus patients who require intervention. Mental health conditions such as anxiety and depression are often comorbid in chronic tinnitus suffers. A high prevalence of anxiety and/or depression has been reported amongst tinnitus suffers (Bhatt et.al, 2017; Hackenberg et. al, 2023). Intolerable and bothersome tinnitus may also lead to anxiety, depression, and insomnia. It may overall negatively impact a service member/veteran’s quality of life (Shute et al, 2023).
The tinnitus management offered by Walter Reed Audiology includes Progressive Tinnitus Management (PTM) and the use of hearing aids with tinnitus sound generators. PTM is a stepped clinical program for the evaluation and treatment of intrusive tinnitus involving coordinated care between both audiology and behavioral health, when available. Our PTM program incorporates a behavioral health provider.
A series of case studies will demonstrate the use of tinnitus management in patients with anxiety and/or other mental health conditions. Assessment measures include patient report, treatment goals, and subjective patient questionnaires. Patient questionnaires that are utilized include but are not limited to, the Tinnitus Functional Index (TFI), Tinnitus Reaction Questionnaire (TRQ), Hospital Anxiety and Depression Scale (HADS), and Generalized Anxiety Disorder 7 (GAD-7) questionnaire. Patients with a known diagnosis of anxiety, depression, post-traumatic stress disorder (PTSD), or other mental or behavioral health conditions are concurrently being treated by behavioral health.
These case studies will highlight the benefits of tinnitus intervention within this population. It will also emphasize barriers to consider. Due to the relationship between tinnitus and anxiety and other mental health conditions, it is important to be mindful of these co-existing conditions when treating tinnitus patients and assessing benefit.
References:
Bhatt, J. M., Bhattacharyya, N., & Lin, H. W. (2017). Relationships between tinnitus and the prevalence of anxiety and depression. The laryngoscope, 127(2), 466-469.
Hackenberg, B., Döge, J., O’Brien, K., Bohnert, A., Lackner, K. J., Beutel, M. E., ... & Bahr, K. (2023). Tinnitus and Its Relation to Depression, Anxiety, and Stress—A Population-Based Cohort Study. Journal of Clinical Medicine, 12(3), 1169.
Shute, R., Blacker, N., Dias, M., Frank, O., & Roughead, E. (2023). Changing the way we treat tinnitus. Journal of Military and Veterans Health, 31(1), 32-39.