A Deeper Look into Tinnitus: A Unique Case Study

Tinnitus is a concern for many people, and affects approximately 15 percent of the population. As hearing loss is increasingly identified and diagnosed, this trend is most likely to continue and grow. Many clinicians feel overwhelmed and uncertain about tinnitus and what can be done. During the 2013 AudiologyNOW! conference in Anaheim, California, ReSound’s Michael Piskosz, M.S., presented unique tinnitus case studies. Let’s take a look at one of his examples today.

First, there are two distinct tinnitus “camps” that patients can fall into:

• I have tinnitus. These patients want to be more informed about what tinnitus is and is not. They usually do not have any negative associations/reactions to tinnitus. Basic counseling with good information regarding their individual concerns should be addressed so the patient can feel comfortable and confident and can make smart, informed decisions in daily life.
• Tinnitus has ME! These patients are often misinformed of what tinnitus is and is not. They tend to have strong negative reactions and become extremely vigilant which can cause emotional, mental, motivational and behavioral distress. Regular directive counseling coupled with sound therapy is warranted. These patients are looking to regain their quality of life.

Case Study: Female, 73 years old in good health

Tinnitus History:

• Described as constant loud ringing; left ear worse than right; worse in quiet.
• TJMD but was not really told for certain by physician
• No reported history of noise exposure.
• White noise helps; possibly decrease in salt and caffeine also.
• Medications: Tekturna (high blood pressure), Singular, Nexium/Ativan PRN

Patient’s grades of severity:

• Tinnitus 9/10
• Hearing loss 6/10
• Hyperacusis 4/10
• Most troublesome tinnitus 9/10
• Influence on life (tinnitus) 9/10
• Influence on life (hyperacusis) 4/10
• Tinnitus Awareness/Annoyance 80% / 90%
• THQ = 50

3-month Follow-up Appointment: Patient is doing well with devices and hearing, especially at work. The patient wears the devices most of the day and uses a sound machine at night. She is sleeping approximately 6hrs/night and feels well-rested. At this appointment the neurological model was reviewed and THQ reduced to 43.

6- and 9-month Follow-up Appointments: Patient continues to do well. She notices a stark difference when devices are not in place. With devices out the tinnitus awareness is 50% and tinnitus annoyance is at 90%. THQ has been reduced to 20.

12-month Follow-up Appointment: At this appointment the patient also went through an annual audio evaluation. She continues to wear her devices most of the day, every day, and sleeps 6 hrs/night, feeling well-rested upon waking. Her audiogram was consistent from last year and the devices are in good working order. Her THQ is now 21 (20, 43 and initially 50). Follow up appointments going forward are necessary for maintenance of devices.