Chances are your healthcare providers know very little about tinnitus, its causes, or how to treat it.
Even if they went to a prestigious school or work hard to stay up to date on new treatments. Why? Well, in part because researchers don’t claim to know that much about tinnitus. But we know a lot more today than ever before and there are many evidence based treatments available. Unfortunately, despite the fact tinnitus effects 15% of the population, most medical schools aren’t teaching enough about the ear/brain system. And, what they do teach, is usually out of date. Even many doctors of audiology like myself, are still telling their patients unfounded information about tinnitus.
Where does this leave patients and their healthcare providers looking for answers? Sadly, two very unhelpful places:
- The idea that “nothing can really be done for tinnitus.” It’s true, there is no singular cure, but that is far from “nothing can be done”.
- Gimmicks and over the counter concoctions that either do nothing or actually exacerbate tinnitus. Worse still, detracting them for viable treatments for long periods of time.
Let’s start with what tinnitus is exactly:
Tinnitus – The perception of a sound when no external sound is present. Often individuals experience ringing, buzzing, wooshing, or hissing but sometimes people hear birds or music. It can be constant or come and go. For some, it has a pulsing quality (like a heartbeat or clicking) and we call this pulsatile tinnitus.
In order to effectively treat tinnitus, we need to rule out some causes first. Namely, the more dangerous causes (like a tumor) and the ones that can be treated easily (like ear wax). To do this, providers need to know:
- Is the tinnitus is pulsatile or not?
- Is it in one ear or both?
- Was the onset was sudden or gradual?
- Was it associated with any trauma or event (like a car accident or an infection) or any hearing loss, dizziness or facial paralysis?
- They also need to examine if there is an ear wax build up or signs of middle ear fluid or trauma.
In my clinical practice over the past 6 years, I’ve seen how often this triaging of tinnitus is not done. Further examination of the jaw and the patients emotional state are also rarely looked in to, despite their potential role in the symptom. This is not to say that primary care physicians should know everything about the ear. That is not their job and they already have a great deal on their list of responsibilities in caring for people. But, they do need to know and communicate when they don’t know something. They also need to know when and where to send their patients to get answers they don’t have.
Here is a great example:
A patient reports tinnitus following a car accident or trauma to the head. They are treated for their injuries. They even go to physical therapy or a chiropractor to make sure everything is taken care of. But their ringing persists. Every provider they see says, “You will hopefully get used to it, but their really isn’t anything that can be done if you don’t.” The patient tries to get used to it, they search the internet, they take supplements that claim to get rid of tinnitus. Nothing works. Maybe they even try acupuncture because a friend recommended it. Maybe over time it has gotten a little better but it persists, effecting their sleep and ability to concentrate at work.
All of their providers demonstrate that they don’t understand a few things. First, even in the case of a car accident, 90% of tinnitus is caused (at least in part) by an underlying hearing loss. A hearing loss could potentially be treated and/or prevented from getting worse (like noise induced hearing loss). Second, they may not know specific methods for addressing trauma to the head and neck that are often especially effective for tinnitus. Third, many other therapies have shown to improve tinnitus, like cognitive behavioral therapy. This tinnitus patient likely has a very different causal pathway (and thus treatment plan) compared to someone who acquired tinnitus very gradually over time.
You see, tinnitus is similar to pain in many ways – it doesn’t make sense it would have a one-dimensional cause or etiology.
Another common case:
A tinnitus patient has been prescribed a variety of medications or supplements over the years with no improvement. They have finally come to believe there really is nothing that can be done for this awful hissing sound, permeating life. They come in to my office for something unrelated, like ear wax (which they don’t have), and I test their hearing. I find a moderate to severe hearing loss in both ears (that they had no idea they had or thought was “normal aging”).
I recommend hearing aids for the hearing loss and for the tinnitus. In about 60-70% of cases, tinnitus is significantly improved with use of hearing aids. Furthermore, they can now engage much more effectively in their relationships and social activities because they can understand people better. Hearing aids, fit properly, can be life-changing. Knowing when to refer patients for a simple hearing test (by a quality hearing professional), covered by insurance, can be life-changing. But many healthcare providers simply aren’t aware of what treatments to try or what is the most efficacious order of operations. And there is so much more they can do within their specialty.
On that note, did I also mention this patient has significant issues with anxiety?
Coupling effective treatments for anxiety (in the context of understanding how it impacts tinnitus in that particular patient) with addressing their hearing loss, turns out to be the best treatment plan. It took a team of informed pros to get them there.
Good providers do not want dead-end outcomes or unnecessarily prolonged experiments for their patients.
The sad thing is, I don’t believe most providers have any idea they are letting this happen to their patients. Most providers would much rather have an answer, a way to help; that is where they get a great deal of fulfillment from their work. They try all sorts of things to help because there really isn’t a lot of accessible and reliable information out there on tinnitus. So, to help providers help their patients better, I made an online continuing education course on tinnitus. I cover how to manage it within their specific scope of practice (whether they are an acupuncturist, physician, chiropractor, or psychologist). Next we review protocol for when they should refer to other professionals and a quick PDF referral tool.
Or let us know if you’d like to schedule a live presentation.