Establishing a Comprehensive Tinnitus Care Pathway—Part 1: Essential Components

Lori Zitelli; Emma Alscher

doi:10.1055/s-0045-1804519

Seminars in Hearing, Table of Contents

Semin Hear 2024; 45(03/04): 284-295
DOI: 10.1055/s-0045-1804519

Review Article

Establishing a Comprehensive Tinnitus Care Pathway—Part 1: Essential Components

Lori Zitelli

¹UPMC Department of Otolaryngology, UPMC Eye & Ear Institute, Pittsburgh, Pennsylvania

²Department of Communication Sciences and Disorders, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania

,

Emma Alscher

¹UPMC Department of Otolaryngology, UPMC Eye & Ear Institute, Pittsburgh, Pennsylvania

²Department of Communication Sciences and Disorders, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania

› Author Affiliations

Abstract

This article is the first in a two-part series intended to provide guidance related to the essential components of establishing a tinnitus care pathway in your clinic. Please see Part 2: Implementation for Additional Details Related to Implementation of the Suggested Protocols.

Keywords

tinnitus - clinical - implementation - pathway

Full Text

References

References
1 Henry JA, Dennis KC, Schechter MA. General review of tinnitus: prevalence, mechanisms, effects, and management. J Speech Lang Hear Res 2005; 48 (05) 1204-1235
2 Bhatt JM, Lin HW, Bhattacharyya N. Prevalence, severity, exposures, and treatment patterns of Tinnitus in the United States. JAMA Otolaryngol Head Neck Surg 2016; 142 (10) 959-965
3 Jarach CM, Lugo A, Scala M. et al. Global prevalence and incidence of tinnitus: a systematic review and meta-analysis. JAMA Neurol 2022; 79 (09) 888-900
4 Newman CW, Jacobson GP, Spitzer JB. Development of the tinnitus handicap inventory. Arch Otolaryngol Head Neck Surg 1996; 122 (02) 143-148
5 Beukes EW, Ulep AJ, Andersson G, Manchaiah V. The effects of tinnitus on significant others. J Clin Med 2022; 11 (05) 1393
6 Mancini PC, Tyler RS, Perreau A, Batterton LF, Ji H. Considerations for partners of our tinnitus patients. Int Tinnitus J 2018; 22 (02) 113-122
7 Trochidis I, Lugo A, Borroni E. et al. Systematic review on healthcare and societal costs of tinnitus. Int J Environ Res Public Health 2021; 18 (13) 6881
8 Rademaker MM, Stegeman I, Hooiveld M, Stokroos RJ, Smit AL. Patients with tinnitus use more primary healthcare compared to people without tinnitus. Sci Rep 2021; 11 (01) 17299
9 Tziridis K, Friedrich J, Brüeggemann P, Mazurek B, Schulze H. Estimation of tinnitus-related socioeconomic costs in Germany. Int J Environ Res Public Health 2022; 19 (16) 10455
10 Coco L, Hooker ER, Gilbert TA. et al. The impact of tinnitus severity on work functioning among U.S. Military Veterans with tinnitus. Semin Hear 2023; 45 (01) 40-54
11 Daoud E, Caimino C, Akeroyd MA, Noreña AJ, Baguley DM. The utility of economic measures to quantify the burden of tinnitus in affected individuals: a scoping review. PharmacoEconom Open 2022; 6 (01) 21-32
12 Dawood F, Khan NB, Bagwandin V. Management of adult patients with tinnitus: Preparedness, perspectives and practices of audiologists. S Afr J Commun Disord 2019; 66 (01) e1-e10
13 Tyler RS, Haskell GB, Gogel SA, Gehringer AK. Establishing a tinnitus clinic in your practice. Am J Audiol 2008; 17 (01) 25-37
14 Piskosz M. How to Establish a Successful Tinnitus Clinic. Hear Rev. Published online 2013. Accessed February 6, 2025 at: https://hearingreview.com/practice-building/practice-management/how-to-establish-a-successful-tinnitus-clinic2
15 Husain FT, Gander PE, Jansen JN, Shen S. Expectations for tinnitus treatment and outcomes: a survey study of audiologists and patients. J Am Acad Audiol 2018; 29 (04) 313-336
16 Henry JA, Piskosz M, Norena A, Fournier P. Audiologists and tinnitus. Am J Audiol 2019; 28 (04) 1059-1064
17 Fox-Thomas L. Suicidal ideation among patients with chronic tinnitus. Hear J 2016; 69 (07) 10-11
18 Zitelli L, Palmer CV. Recognizing and reacting to risk signs for patient suicide. Semin Hear 2018; 39 (01) 83-90
19 Laird EC, Bryant CA, Barr CM, Bennett RJ. Psychologically informed practice in audiological rehabilitation: audiologist perceived barriers, facilitators, and preparedness. Ear Hear 2022; 43 (06) 1853-1865
20 Whicker JJ, Muñoz KF, Butcher GM, Schultz JC, Twohig M. Counseling training in AuD programs: a syllabi review. Hear J 2017; 70 (08) 36-37
21 O'Connor S, Glover L. Hospital staff experiences of their relationships with adults who self-harm: a meta-synthesis. Psychol Psychother 2017; 90 (03) 480-501
22 Stone L, Pellowski M. Factors affecting career choice among speech-language pathology and audiology students. Commun Disord Q 2016; 37 (02) 100-107
23 Hickman J, Schwartz J, Donai J. Vocational interests and personal preferences of audiologists, speech-language pathologists. Hear J 2019; 72 (09) 43-47
24 Carmody N, Hunter M, Eikelboom R. Help-seeker satisfaction with diagnosis and treatment of tinnitus. Int J Audiol 2024; 63 (12) 1019-1026
25 Carmody N, Eikelboom RH, Tegg-Quinn S. Seeking help for tinnitus and satisfaction with healthcare providers including diagnosis, clinical services, and treatment: a scoping review. Eval Health Prof 2023; 46 (02) 170-193
26 American Academy of Audiology. 2020 Audiology Certification Standards. Published 2020. Accessed February 6, 2025 at: http://www.asha.org/certification/2020-Audiology-Certification-Standards
27 Henry JA, Sonstroem A, Smith B, Grush L. Survey of audiology graduate programs: training students in tinnitus management. Am J Audiol 2021; 30 (01) 22-27
28 Bourez PH, Vallet GT, Fournier P. Improving audiology student training by clinical simulation of tinnitus: a glimpse of the lived experience of tinnitus. Brain Sci 2023; 13 (09) 1338
29 Packer B, Friedland E, Rahe F, Vento B, Walden T. Clinical education guidelines for audiology externships. Audiol Today 2006; 18 (02) 29-31
30 American Academy of Audiology. HEARCareers. Published 2024. Accessed February 6, 2025 at: https://hearcareers.audiology.org/
31 Audiology Clinical Education Network. ACEN Home Page for Externships in Audiology
32 Lewis J, Camera S, DeBacker J. Say the word “survey”: inspiring data-driven change for audiology externships. Audiol Today 2019;31(04):
33 Jamsek I, Romero D. Mixed methods analysis of student perspectives on the AuD externship. Audiol Today 2023;35(02):
34 Jastreboff Hearing Disorders Foundation. Training Courses. Published 2024. Accessed February 6, 2025 at: https://www.tinnitus-pjj.com/training/
35 American Academy of Audiology. CH-TM Program Information. Published 2024. Accessed February 6, 2025 at: https://eaudiology.audiology.org/tinnitus
36 AudiologyOnline. CEU Courses. Accessed February 6, 2025 at: https://www.audiologyonline.com
37 Tinnitus UK. Tinnitus Conference 2024
38 Tinnitus Research Initiative Conference. TRI 2024. Published 2024. Accessed February 6, 2025 at: https://www.tri2024.com/
39 The University of Iowa. International Conference on the Management of the Tinnitus and Hyperacusis Patient. Published 2024. Accessed February 6, 2025 at: https://medicine.uiowa.edu/oto/education/conferences-and-courses/international-conference-management-tinnitus-and-hyperacusis
40 Hashir International Institute. The 1st International Conference on Pharmacology & Gene Therapy for Tinnitus. Accessed February 6, 2025 at: https://hashirtinnitusclinic.com/event/the-1st-international-conference-on-pharmacology-gene-therapy-for-tinnitus/
41 American Academy of Audiology. Audiologic Guidelines for the Diagnosis and Management of Tinnitus Patients.; 2001. Accessed February 6, 2025 at: https://www.audiology.org/practice-guideline/audiologic-guidelines-for-the-diagnosis-and-management-of-tinnitus-patients/
42 Meijers S, Stegeman I, van der Leun JA, Assegaf SA, Smit AL. Analysis and comparison of clinical practice guidelines regarding treatment recommendations for chronic tinnitus in adults: a systematic review. BMJ Open 2023; 13 (09) e072754
43 MacDonald C, Caimino C, Burns-O'Connell G. et al. Tinnitus, suicide, and suicidal ideation: a scoping review of primary research. Brain Sci 2023; 13 (10) 1496
44 Aazh H, Moore BCJ. Thoughts about suicide and self-harm in patients with tinnitus and hyperacusis. J Am Acad Audiol 2018; 29 (03) 255-261
45 Suicide Prevention Resource Center. Training. Published 2022. Accessed February 6, 2025 at: https://sprc.org/training/
46 LivingWorks. ASIST. Published 2023. Accessed February 6, 2025 at: https://livingworks.net/training/livingworks-asist/
47 Henry JA. Directed attention and habituation: two concepts critical to tinnitus management. Am J Audiol 2023; 32 (02) 274-281
48 Cima RF, Maes IH, Joore MA. et al. Specialised treatment based on cognitive behaviour therapy versus usual care for tinnitus: a randomised controlled trial. Lancet 2012; 379 (9830): 1951-1959
49 Tunkel DE, Bauer CA, Sun GH. et al. Clinical practice guideline: tinnitus. Otolaryngol Head Neck Surg 2014; 151 (2, Suppl): S1-S40
50 Shi Y, Robb MJA, Michaelides EM. Medical management of tinnitus: role of the physician. J Am Acad Audiol 2014; 25 (01) 23-28
51 Durai M, Searchfield G. Anxiety and depression, personality traits relevant to tinnitus: a scoping review. Int J Audiol 2016; 55 (11) 605-615
52 Bhatt JM, Bhattacharyya N, Lin HW. Relationships between tinnitus and the prevalence of anxiety and depression. Laryngoscope 2017; 127 (02) 466-469
53 Cima RF, Andersson G, Schmidt CJ, Henry JA. Cognitive-behavioral treatments for tinnitus: a review of the literature. J Am Acad Audiol 2014; 25 (01) 29-61
54 Jun HJ, Park MK. Cognitive behavioral therapy for tinnitus: evidence and efficacy. Korean J Audiol 2013; 17 (03) 101-104
55 Gans J, O'Sullivan P, Bircheff V. Mindfulness based tinnitus stress reduction pilot study. Mindfulness (N Y) 2014; 5: 322-333
56 Aazh H, Danesh A. Internet-based cognitive behavioral therapy for tinnitus: insights from health care professionals. Hear J 2021; 74 (02) 20-22
57 Andersson G, Kaldo V. Internet-based cognitive behavioral therapy for tinnitus. J Clin Psychol 2004; 60 (02) 171-178
58 Manchaiah V, Vlaescu G, Varadaraj S. et al. Features, functionality, and acceptability of internet-based cognitive behavioral therapy for tinnitus in the United States. Am J Audiol 2020; 29 (03) 476-490
59 Gans JJ, Holst J, Holmes C, Hudock D. Healing from home: examination of an online mindfulness-based tinnitus stress reduction course during the 2020 COVID Pandemic. Am J Audiol 2023; 32 (01) 160-169
60 Pinchoff RJ, Burkard RF, Salvi RJ, Coad ML, Lockwood AH. Modulation of tinnitus by voluntary jaw movements. Am J Otol 1998; 19 (06) 785-789
61 Oostendorp RAB, Bakker I, Elvers H. et al. Cervicogenic somatosensory tinnitus: an indication for manual therapy? Part 1: Theoretical concept. Man Ther 2016; 23: 120-123
62 Michiels S, Ganz Sanchez T, Oron Y. et al. Diagnostic criteria for somatosensory tinnitus: a Delphi process and face-to-face meeting to establish consensus. Trends Hear 2018; 22: 23 31216518796403
63 Michiels S, Cardon E, Gilles A. et al. The rapid screening for somatosensory tinnitus tool: a data-driven decision tree based on specific diagnostic criteria. Ear Hear 2022; 43 (05) 1466-1471
64 Wójcicki M, Szkutnik J, Różyło-Kalinowska I. The role of the dentist in the treatment of patients with tinnitus. J Stomatol (Brux) 2019; 72 (02)
65 Ralli M, Greco A, Turchetta R, Altissimi G, de Vincentiis M, Cianfrone G. Somatosensory tinnitus: current evidence and future perspectives. J Int Med Res 2017; 45 (03) 933-947
66 Michiels S, Van de Heyning P, Truijen S, Hallemans A, De Hertogh W. Does multi-modal cervical physical therapy improve tinnitus in patients with cervicogenic somatic tinnitus?. Man Ther 2016; 26: 125-131
67 Michiels S, Naessens S, Van de Heyning P. et al. The effect of physical therapy treatment in patients with subjective tinnitus: a systematic review. Front Neurosci 2016; 10: 545
68 Michiels S, Van de Heyning P, Truijen S, Hallemans A, De Hertogh W. Prognostic indicators for decrease in tinnitus severity after cervical physical therapy in patients with cervicogenic somatic tinnitus. Musculoskelet Sci Pract 2017; 29: 33-37
69 Altay B, Çoban E, Yurttaş M, Arık Ö, Türkoğlu A. Dental patients' tinnitus profile: prevalence, types, and associated factors with oral and maxillofacial diseases. Acta Odontol Scand 2024; 83: 210-218
70 Asnis G, Majeed K, Henderson M, Sylvester C, Thomas M, De La Garza R. An examination of the relationship between insomnia and tinnitus: a review and recommendations. Clin Med Insights Psychiatry 2018; 9: 1-8
71 Folmer RL, Griest SE. Tinnitus and insomnia. Am J Otolaryngol 2000; 21 (05) 287-293
72 Miguel GS, Yaremchuk K, Roth T, Peterson E. The effect of insomnia on tinnitus. Ann Otol Rhinol Laryngol 2014; 123 (10) 696-700
73 Gao J, Tan P, Liu Y, Chen S, Liu J. Association between sleep apnea and tinnitus: a meta-analysis. Ear Nose Throat J 2024; 14 55613241226853
74 Langguth B, Hund V, Busch V. et al. Tinnitus and headache. BioMed Res Int 2015; 2015: 797416
75 Guichard E, Montagni I, Tzourio C, Kurth T. Association between headaches and tinnitus in young adults: cross-sectional study. Headache 2016; 56 (06) 987-994
76 Langguth B, Hund V, Landgrebe M, Schecklmann M. Tinnitus patients with comorbid headaches: the influence of headache type and laterality on tinnitus characteristics. Front Neurol 2017; 8: 440
77 Clarke NA, Henshaw H, Akeroyd MA, Adams B, Hoare DJ. Associations between subjective tinnitus and cognitive performance: systematic review and meta-analyses. Trends Hear 2020; 24: 23 31216520918416
78 Tavanai E, Mohammadkhani G. A different view on the link between tinnitus and cognition; is there a reciprocal link?. Int J Neurosci 2018; 128 (12) 1188-1198
79 Degeest S, Kestens K, Keppler H. Investigation of the relation between tinnitus, cognition, and the amount of listening effort. J Speech Lang Hear Res 2022; 65 (05) 1988-2002
80 Dalrymple SN, Lewis SH, Philman S. Tinnitus: diagnosis and management. Am Fam Physician 2021; 103 (11) 663-671
81 Ellis S, Wilson R, Dolan S. Tinnitus: systematic approach to primary care assessment and management. Br J Gen Pract 2022; 72 (717) 190-192
82 Taylor B, Tysoe R. Forming strategic alliances with primary care medicine: interventional audiology in practice: how to leverage peer-reviewed science to build a physician referral base. Hear Rev 2014; 21 (07) 22-27
83 El-Shunnar SK, Hoare DJ, Smith S. et al. Primary care for tinnitus: practice and opinion among GPs in England. J Eval Clin Pract 2011; 17 (04) 684-692
84 Martínez N, Connelly CD, Pérez A, Calero P. Self-care: a concept analysis. Int J Nurs Sci 2021; 8 (04) 418-425
85 Kalle S, Schlee W, Pryss RC. et al. Review of smart services for tinnitus self-help, diagnostics and treatments. Front Neurosci 2018; 12: 541
86 Nyenhuis N, Golm D, Kröner-Herwig B. A systematic review and meta-analysis on the efficacy of self-help interventions in tinnitus. Cogn Behav Ther 2013; 42 (02) 159-169
87 Mehdi M, Dode A, Pryss R, Schlee W, Reichert M, Hauck FJ. Contemporary review of smartphone apps for tinnitus management and treatment. Brain Sci 2020; 10 (11) 867
88 Baguley DM, Beynon GJ, Thornton F. A consideration of the effect of ear canal resonance and hearing loss upon white noise generators for tinnitus retraining therapy. J Laryngol Otol 1997; 111 (09) 810-813
89 Barozzi S, Del Bo L, Croceetti A. et al. A comparison of nature and technical sounds for tinnitus therapy. Acta Acust (Les Ulis) 2016; 102 (03) 540-546
90 Barozzi S, Ambrosetti U, Callaway SL, Behrens T, Passoni S, Bo LD. Effects of tinnitus retraining therapy with different colours of sound. Int Tinnitus J 2017; 21 (02) 139-143
91 Durai M, Searchfield GD. A mixed-methods trial of broad band noise and nature sounds for tinnitus therapy: group and individual responses modeled under the adaptation level theory of tinnitus. Front Aging Neurosci 2017; 9: 44
92 Reavis KM, Rothholtz VS, Tang Q, Carroll JA, Djalilian H, Zeng FG. Temporary suppression of tinnitus by modulated sounds. J Assoc Res Otolaryngol 2012; 13 (04) 561-571
93 Sweetow RW, Sabes JH. Effects of acoustical stimuli delivered through hearing aids on tinnitus. J Am Acad Audiol 2010; 21 (07) 461-473
94 Cederroth CR, Gallus S, Hall DA. et al. Editorial: towards an understanding of tinnitus heterogeneity. Front Aging Neurosci 2019; 11: 53
95 Henry JA, Zaugg TL, Myers PJ, Schechter MA. Using therapeutic sound with progressive audiologic tinnitus management. Trends Amplif 2008; 12 (03) 188-209
96 Gunjawate DR, Ravi R. Effect of yoga and meditation on tinnitus: a systematic review. J Laryngol Rhinol Otol 2021; 135 (04) 284-287
97 Tavakoli M, Marashi S, Hamid N, Beshlideh K. The effects of cognitive-behavioral training and muscle relaxation on the degree of tinnitus and the quality of sleep. Audit Vestib Res 2019; 28 (03) 183-189
98 Henry J, Zaugg T, Myers P, Schmidt C. How to Manage Your Tinnitus: A Step-by-Step Workbook.; 2022. Accessed February 6, 2025 at: https://www.ncrar.research.va.gov/Documents/HowToManageYourTinnitus-abbrev-web.pdf
99 Deshpande AK, Deshpande SB, O'Brien C. A study of social media utilization by individuals with tinnitus. Am J Audiol 2018; 27 (04) 559-569
100 Ni J, Bellon-Harn ML, Zhang J, Li Y, Manchaiah V. Twitter usage using common reference to tinnitus. Am J Audiol 2020; 29 (02) 206-217
101 Manchaiah V, Londero A, Deshpande AK. et al. Online discussions about tinnitus: What can we learn from natural language processing of reddit posts?. Am J Audiol 2022; 31 (3S): 993-1002
102 Manchaiah V, Ratinaud P, Andersson G. Representation of tinnitus in the US newspaper media and in facebook pages: cross-sectional analysis of secondary data. Interact J Med Res 2018; 7 (01) e9
103 Basch CH, Yin J, Kollia B. et al. Public online information about tinnitus: a cross-sectional study of YouTube videos. Noise Health 2018; 20 (92) 1-8
104 Ainscough E, Smith SN, Greenwell K, Hoare DJ. Findings and ethical considerations from a thematic analysis of threads within tinnitus online support groups. Am J Audiol 2018; 27 (3S): 503-512
105 Hébert S. Sleep quality of tinnitus patient: why, how you should care. Hear J 2021; 74 (12) 10-11
106 Hébert S. Sleep struggles are a wake-up call to seek guidance and make lifestyle changes. Tinnitus Today 2022; Summer: 4-6 . Accessed February 6, 2025 at: https://ata.org/wp-content/uploads/2022/09/2022-Summer-04-sleep-struggles.pdf?utm_source=BenchmarkEmail&utm_campaign=TINNLTR.1022&utm_medium=email
107 Jastreboff P. Tinnitus Retraining Therapy. In: Textbook of Tinnitus. 2011: 575-596
108 Jastreboff PJ, Jastreboff MM. Tinnitus retraining therapy: a different view on tinnitus. ORL J Otorhinolaryngol Relat Spec 2006; 68 (01) 23-29 , discussion 29–30
109 Jastreboff PJ, Gray WC, Gold SL. Neurophysiological approach to tinnitus patients. Am J Otol 1996; 17 (02) 236-240
110 Henry JA, Zaugg TL, Schechter MA. Clinical guide for audiologic tinnitus management I: assessment. Am J Audiol 2005; 14 (01) 21-48
111 Waechter S, Jönsson A. Hearing aids mitigate tinnitus, but does it matter if the patient receives amplification in accordance with their hearing impairment or not? A meta-analysis. Am J Audiol 2022; 31 (03) 789-818
112 Palmer C, Zitelli L, Jorgensen L. Errata: unleashing the power of test box and real-ear probe microphone measurement. Semin Hear 2024; 45 (02) e1
113 Jastreboff P, Jastreboff M. Treatments for decreased sound tolerance (hyperacusis and misophonia). Semin Hear 2014; 35 (02) 105-120
114 Tyler RS, Stocking C, Ji H, Witt S, Mancini PC. Tinnitus activities treatment with total and partial masking. J Am Acad Audiol 2021; 32 (08) 501-509
115 Tyler RS, Noble W, Coelho CB, Ji H. Tinnitus retraining therapy: mixing point and total masking are equally effective. Ear Hear 2012; 33 (05) 588-594
116 Henry JA, Schechter MA, Zaugg TL. et al. Outcomes of clinical trial: tinnitus masking versus tinnitus retraining therapy. J Am Acad Audiol 2006; 17 (02) 104-132
117 Jastreboff PJ, Jastreboff MM. Tinnitus retraining therapy (TRT) as a method for treatment of tinnitus and hyperacusis patients. J Am Acad Audiol 2000; 11 (03) 162-177
118 Langguth B. Non-invasive neuromodulation for tinnitus. J Audiol Otol 2020; 24 (03) 113-118
119 Riffle TL, Martel DT, Jones GR, Shore SE. Bimodal auditory electrical stimulation for the treatment of tinnitus: preclinical and clinical studies. Curr Top Behav Neurosci 2021; 51: 295-323
120 Conlon B, Langguth B, Hamilton C. et al. Bimodal neuromodulation combining sound and tongue stimulation reduces tinnitus symptoms in a large randomized clinical study. Sci Transl Med 2020; 12 (564) 1-15
121 Conlon B, Hamilton C, Meade E. et al. Different bimodal neuromodulation settings reduce tinnitus symptoms in a large randomized trial. Sci Rep 2022; 12 (01) 10845