The Medical/Audiologic Approach

1. Goals:

2. Plan - Completion Medical Audiologic Tinnitus Patient Protocol

A. Initial Visit:

B. Recommendations: Extensive tests of the nerve of the ear and brain for hearing and balance to attempt to clinically identify the type of tinnitus and any underlying condition(s) which may influence the tinnitus.

C. Follow-Up Consultation Plan of Treatment/Control Tinnitus Medical/Audiologic Conference with Patient

Realties 2006:

Both the professional and the patient must face some realities about tinnitus in 2006.

Protocols of Diagnosis and Treatment

TESTS:

Audiologic Examination:

Electrophysiologic Testing of Hearing (Cochlear) and Balance (Vestibular) Function:

  1. Quantitative Electroencephalography (qEEG): Quantitative EEG analysis is a computerized digital measure of brain wave activity at the scalp. It measures brain function. Statistical analysis of brain wave patterns are compared to a normative database. Quantitative Electroencephalography (qEEG) has been introduced into the Medical Audiologic Tinnitus Patient Protocol: 1. in an attempt to improve the accuracy of the tinnitus diagnosis by the identification of an electrophysiologic correlate(s); 2. to provide a basis for a biofeedback treatment method influencing brain rhythms called neurofeedback therapy; and 3. as a method to monitor the efficacy of modalities of therapy attempting tinnitus relief.
  1. Additional Procedures: Other tests are advised on an individual basis and may include laboratory examinations (like blood work), X-rays, CAT Scan, MRI of the Brain and Temporal Bones, and Single Photon Emission Tomography (SPECT). SPECT scanning of the brain is a functional imaging technique which our Center introduced for the identification of abnormalities of regional blood flow in patients with severe and disabling central tinnitus. SPECT has also shown us an area of hyperexcitability in the brain identical to that identified for epilepsy. This has a practical application for selected tinnitus patients. For example, we can narrow down the selection of drugs to a specific group of drugs, i.e. anti-seizure drugs, to increase the effectiveness of treatment. SPECT has also provided objective support for the speculation that in some patients tinnitus is a sign of central nervous system disease with associated complaints of anxiety, depression, and fear.
  1. Management Plan - Tinnitus Targeted Therapy: After completing the MATPP, our patients have a follow-up visit with the neurotologist and the audiologist during which an individualized plan of treatment, or Tinnitus Targeted Therapy, is recommended. Current tinnitus treatments include instrumentation (amplification with hearing aids, masking, habituation with Tinnitus Retraining Therapy, and electrical stimulation, Ultra Quit device), surgery (e.g. intratympanic drug infusion), drug therapy including Receptor Targeted Therapy, neurofeedback therapy, counseling, and cognitive therapy. Individualized patient plans usually combine medication and instrumentation. During follow up visits, patients and their significant others have the opportunity to ask questions about the test results and the plan of therapy.

Instrumentation:

Medical Criteria

In our experience, the following medical criteria usually suggests a patient's suitability for instrumentation.

When an identified medical condition is treated, the chance of success with instrumentation is improved.

Audiologic criteria for selection of instrumentation:

Medications:

The introduction and application of new drug therapies have increased the success of our Tinnitus Targeted Therapy since 1997. These medications include calcium channel blockers, free radical scavengers, corticosteroids, glutamate antagonists, and anti-seizure drugs. Surgical insertion of a new microcatheter can deliver drugs through the eardrum to the round window of the inner ear. This procedure increases the possibility of tinnitus relief for cochlear-type tinnitus.

This audiologic/medical approach lets us individualize and target the therapy for tinnitus. Approximately 80-85% of our tinnitus patient population (more than 8,000 patients) has achieved some degree of tinnitus control: 30-35% with medication and 60-65% with instrumentation. Approximately 10-15% have persistent problems. The percentage of problems that persist reflects the complexity of the tinnitus in the patients who visit our practice.

Our goal and the goal of the Martha Entenmann Tinnitus Research Center is to improve the accuracy of tinnitus diagnosis and the modalities of tinnitus control therapy. We also support educational programs both for the professional and the patient. The ultimate goal of our Center is to achieve a cure for all clinical types of tinnitus