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Counseling the Tinnitus Patient: Often It’s What We Say That Counts

Remember the day your child first said the most important word in the world to you? “Mommy (or Daddy).” You rejoiced because it was music to your ears.
Well visualize this. You are on the phone, and you are engaged in an important conversation. During your conversation you begin to hear your child’s voice (ever so softly) as she tries to get your attention.
“Mommy…Mommy…Mommy…Mommy…Mommy…Mommy…Mommy...Mommy…Mommy…” At some point (after trying to ignore this soft, sweet voice in the background) you firmly cover the receiver with your hand and say, “I’m on the phone. Wait one minute – PLEASE!”
Why is it so difficult to continue with the conversation on the phone? Because the repetition of the signal (Mommy) is distracting and becomes annoying, to say the least. It is difficult to pay attention to any task when there is a continuous, repetitive signal present that does not stop. Tinnitus patients do not have the same luxury of asking the tinnitus to “wait one minute,” and for the most part, there is no compromising with tinnitus. Intrusive tinnitus never ceases, and the harder those afflicted try to ignore it, the louder and the stronger it sounds. That’s alarming!
A Typical Case

The following scenario is one that you may have experienced. A patient walks into your office and reports “ringing” in her ears. You gather information by taking a thorough history followed by an otoscopic evaluation and comprehensive audiological evaluation, including an audiogram, typmanometry, and tinnitus matching. If no tolerance problems exist you consider acoustic reflex threshold testing, acoustic reflex decay testing, and ABR (auditory brainstem response) testing.
The findings may well indicate that the tinnitus patient also has hearing loss that can be addressed with amplification. She is interested in addressing the tinnitus but not the hearing loss. Nevertheless, the patient is fitted with amplification to help address the hearing loss—and hopefully the tinnitus.
Ultimately the patient returns the hearing aids because they are not doing what she would like them to do. You evaluate the hearing aids and their performance, and you are perplexed. The hearing aids have significantly improved the patient’s hearing and helped address communication issues, yet she is not satisfied. However, in the mind of the patient, since her tinnitus has not been successfully masked or significantly alleviated, the hearing aid approach is a complete failure.
At this point, you may say to yourself, “Well, I have done everything I know to address the tinnitus. There are no other alternatives for this patient.” So essentially, you are about to tell her, “You will have to learn to live with it.” This comment represents a severe blow to the tinnitus patient. You have, in effect, turned “some ringing in the ears” into “a disease for which there is no cure.”
A Need for Compassion

I frequently hear patients with tinnitus complain about the lack of information, understanding, and compassion that they receive from their hearing healthcare professionals. Often that is because of what was said more than what was done. Their frustration is not always with the hearing healthcare professionals but with themselves, because they feel like failures. They are having difficulty concentrating at work or at home, their personal and professional relationships are becoming strained, and they feel persecuted.
Tinnitus patients typically develop a heightened sense of awareness of everything about themselves and their bodies. As a result, every word uttered by their audiologists or their physicians takes on increased significance. For many patients, the phrase “there is nothing we can do for your tinnitus” can greatly distort their sense of reality and their peace of mind. It is imperative, therefore, that we choose our words and the overall message we wish to convey with precision . . . and with care.
Negative comments, such as “learn to cope with it,” can sound just as loud and intrusive as any tinnitus signal! Moreover, a failed attempt at learning to cope with it is most commonly what leads the tinnitus patient to your doorstep in the first place. Hearing a negative message from you leaves tinnitus patients with even more questions and less hope. Such a message results in unnecessary suffering and may send the patient into an emotional abyss.
How Should We Respond?

As hearing healthcare professionals, we can greatly impact the tinnitus patients’ perspective for the better—if we make a concerted effort to offer proper education and unwavering compassion and understanding.
There is a significant difference between experiencing mild tinnitus (my ears ring every once in a while, but it doesn’t bother me) and being plagued by intrusive tinnitus (my ears are screaming, and I can’t get it to stop). Patients with mild tinnitus are not bothered by it and usually do not seek any medical or audiological assistance. However, for those who are plagued by their tinnitus, the experience is, in many cases, life altering.
Please understand that managing tinnitus is not a question of “mind over matter” or a question of one’s ability or strength. The experience of tinnitus is so unique and so real to tinnitus patients that it can begin to consume them in every way possible. Our positive and informed words can provide and maintain a level of trust, desperately needed at the first meeting and at every meeting thereafter with the tinnitus patients and their families. Only then does the healing process begin.
Simply said, misinformation, misrepresentation, or miscommunication can send a patient with tinnitus into complete despair. I am not recommending that tinnitus patients be deceived or be given false hope. We must become educated so we can become educators, so we can offer justifiable optimism. All too often patients will ask me, “Why didn’t the audiologist or physician back home mention any of this to me?” I am left to explain the inexplicable.
Be an Advocate

You do not have to have tinnitus to be an advocate for tinnitus patients and to demonstrate compassion and understanding. Information about tinnitus is plentiful and is easily accessible through audiology journals, books, conferences, and the Internet.
If you do not currently offer a comprehensive tinnitus program, tell your tinnitus patients, “There are effective options available. Your needs can be addressed. Unfortunately those options are not available at this facility, but here are some good places to start.” You can recommend that your tinnitus patients call the American Tinnitus Association for suggestions, or you can refer your patients directly to clinics specializing in tinnitus.
Be a wealth of good information and legitimate hope. Our words are among the most powerful tools of our profession.
The author gratefully acknowledges the assistance of the American Tinnitus Association in the preparation of this article.