Tinnitus in the GP’s practice
This useful list of 8 Top Tinnitus Tips is aimed at informing GPs of helpful ways to advise tinnitus patients
The list, written by two tinnitus specialists, provides helpful information order to support a tinnitus patient when they first consult you in your general practice.
1) Tinnitus is more common in people with hearing loss
Tinnitus prevalence is greater among people with hearing impairment but the severity of the tinnitus correlates poorly with the degree of hearing loss. It is also quite possible to have tinnitus with a completely normal pure tone audiogram.
2) Giving a negative prognosis is actively harmful
It is all too common to hear that patients have been told nothing can be done about tinnitus. Such negative statements are not only unhelpful but also tend to focus the patient’s attention on their tinnitus and exacerbate the distress. A positive attitude is generally helpful and there are many constructive statements that can be made about tinnitus, such as most tinnitus is mild; tinnitus is not a precursor of hearing loss.
3) Hearing aids are helpful
Straining to listen causes increased central auditory gain and this increased sensitivity can allow tinnitus to emerge or, if already present, to worsen. Correcting any associated hearing loss reduces this central auditory gain and thereby reduces the level of the tinnitus. Hearing aids are useful even if the hearing loss is relatively mild and an aid would not normally be considered. Recent Department of Health guidelines have emphasised the value of audiometry in a tinnitus consultation, and this is the definitive basis for decisions about hearing aid candidacy. If in doubt, refer for an audiological opinion. In our view, all people who describe tinnitus deserve an audiological assessment. Decisions on when to start using a hearing aid and what sort to use are up to the individual patient and audiologist. Some hearing aids are more suited to managing tinnitus than others.
4) Underlying pathology is rare, but be vigilant
In many cases tinnitus is due to heightened awareness of spontaneous electrical activity in the auditory system that is normally not perceived. It can however be a symptom of treatable and significant otological pathology, such as a vestibular schwannoma or otosclerosis. One should be especially vigilant if the tinnitus is unilateral, or if it has a pulsatile quality.
5) Tinnitus can be associated with a blocked sensation
For reasons that are not clear tinnitus and sensorineural hearing loss can give rise to a blocked feeling in the ears despite normal middle ear pressure and eardrum mobility. Otoscopy and, if available, tympanometry can exclude Eustachian tube dysfunction. Decongestants and antibiotics are rarely helpful.
6) At any point in time around 10% of the population experience tinnitus
Both sexes are equally affected and although tinnitus is more common in the elderly it can occur at any age, including childhood. The perceived sound can have virtually any quality – ringing, whistling and buzzing are common – but more complex sounds can also be described.
7) Most tinnitus is mild
In fact it is relatively rare for it to develop into a chronic problem of life-altering severity. The natural history of tinnitus in most patients is of an acute phase of distress when the problem begins, followed by improvement over time. But for a minority of patients the distress is ongoing and very significant, and they will require specialist support.
8) There is no direct role for drugs
Although they can be used to treat associated symptoms such as vertigo, insomnia, anxiety or depression. There is also no conventional or complementary medication that has been shown to have specific tinnitus ameliorating qualities and there is anecdotal suggestion that repeatedly trying unsuccessful therapies worsens tinnitus.
Written by: Dr David Baguley PhD, Head of Audiology, Addenbrooke’s Hospital, Cambridge and Mr Don McFerran, Consultant ENT Surgeon, Essex County Hospital, Colchester.
David and Don are members of the British Tinnitus Association’s Professional Advisers’ Committee (PAC).
David and Don are co-authors, with Laurence McKenna, of the self-help book Living with tinnitus and hyperacusis (Sheldon Press, 2010). It can be purchased from the British Tinnitus Association at www.tinnitus.org.uk