Many tinnitus patients believe that they must have a terrible undiagnosed condition because their symptoms are so bizarre and distressing. When medical professionals cannot help and family and friends grow weary of supporting a condition they don't understand, the patient can easily begin a long journey down an emotionally hopeless path.

According to the American Tinnitus Association, more than 50 million Americans have some degree of tinnitus; of these, 12 million need medical attention and 2 million cannot maintain normal lives. In almost all cases, the tinnitus is subjective, meaning that only the patient can hear noises that have been described as ringing, hissing, static, crickets, screeching, whooshing, roaring, pulsing, ocean waves, buzzing, or dial tones. Some even hear music.¹

Unfortunately, many patients say their doctors have told them, "You just have to learn to live with it." Far from being helpful, this phrase increases the isolation and frustration they already feel. Patients are looking for something that will stop the noise, or at least help them better manage it. But in many instances, they also are looking for hope and answers.¹

Because of ongoing research, today we can provide both, and we also can make significant improvements in the lives of our tinnitus patients. There is no cure for tinnitus, but it can be managed by a variety of treatments. Each tinnitus patient is unique, and a treatment that works for one person may not be successful for another. However, audiologists who have specialized in treating tinnitus and worked with hundreds of patients can see similarities in many of their cases.

We begin our series of tinnitus case studies with a patient that might be described as a "typical tinnitus patient."

When first seen at The New England Tinnitus and Hyperacusis Center, the patient was a 66-year-old retired, married male who had been suffering with debilitating tinnitus for approximately 1 year. He described the tinnitus as a buzzing/cricket noise. The onset of the tinnitus had coincided with a very stressful family event. Over the past year, the tinnitus became audible 100 percent of the time.

The patient sought the help of numerous medical professionals who further strengthened the response of the emotional limbic system by telling him, "Learn to live with it." At the time of his tinnitus evaluation, he was clinically depressed, irritable and anxiety-ridden. He lacked motivation and would lay on the couch all day in a quiet, darkened room just listening to his tinnitus. He scored "severe" on the Tinnitus Handicap Inventory (THI) and said he felt that his life was over. He believed that he would suffer this way for the rest of his life. He also was being seen by a psychiatrist who prescribed anti-depressant/anxiety medications, which he stated were not helping him.

An audiological evaluation revealed a bilateral, severe, precipitously-sloping, high-frequency, sensorineural hearing loss for the 3000 to 8000Hz region. Approximately 15 years prior, he had worked in a very noisy factory setting, which had most likely caused his hearing loss. An MRI previously had been performed, ruling out a retro-cochlear site of lesion.

The patient was immediately fit with binaural behind-the-ear broad band noise devices for tinnitus retraining therapy. A very important part of his tinnitus rehabilitation process was a cognitive part of the retraining. He was seen for cognitive and educational counseling every 3 months to help him to deflect his negative thoughts about tinnitus.

Within 8 to 12 months of treatment, a more relaxed and engaging individual appeared before me. We were slowly able to change the patient's destructive behaviors, such as spending most of his day in a quiet darkened room. He became more moti-

vated and started to do projects around the house, and he also began an exercise program. At the year-and-a-half point, he scored "mild" on the THI and stated that, although audible, the tinnitus was much softer and not as much of a priority in his life.

It is now 4 years since the patient's extensive 2-year treatment.

He is seen annually for maintenance and audiological testing. At present, he reports that the tinnitus is only audible when he listens for it in a quiet environment. The tinnitus is no longer a disabling condition, and his wife is so grateful to have her real husband back.

References

1. American Tinnitus Association. Accessed online at www.ata.org.

Janice Howard, MA, CCC-A, is on staff at the New England Tinnitus and Hyperacusis Center in Hamden, CT. She is a certified member of the Tinnitus Practitioners Association, www.tinnitus_practitioners.com.