Combined psychological and prosthetic management of tinnitus: a cross-sectional study of patients with severe tinnitus.
A consecutive clinical sample of 154 highly selected patients with severe problems due to tinnitus have been treated within a programme combining psychological and prosthetic approaches. The therapy works within the framework of existential psychology. The programme was evaluated by a postal questionnaire. Pre- and post-intervention comparisons of self-rated tinnitus loudness, major problems in getting to sleep and concentration showed significant improvement in all three domains. The patients greatly appreciated the programme and benefited from information on coping strategies, use of natural masking sounds and from reassurance about lack of serious pathology and prognosis. After intervention the patients were more active in sharing information about tinnitus with key persons, although the consequence in terms of greater empathy was discouraging. Two-thirds of the patients fitted with instruments as part of the programme still had their devices at follow-up. The intervention package has been evaluated as a whole, and therefore it is not possible to separate which part of the intervention each patient benefited from most. It is concluded that improvements in the lives of patients with severe problems due to tinnitus can be achieved within a management programme of this kind. The patients were divided into three severity groups according to pre-intervention impact of tinnitus upon life. Post-intervention evaluation showed that the two more afflicted groups had significantly greater benefit from the intervention in terms of self-rated tinnitus loudness and major problems in getting to sleep compared to the less afflicted group. A small subgroup of younger male political refugees was found less suitable for this type of programme. Both clinically and in the research area it is essential to specify the severity of tinnitus, and there is an urgent need to reach international consensus concerning this issue.
Vesterager
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Department of Audiology, Bispebjerg Hospital, Copenhagen, Denmark.
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010470:Perceptual Masking; D019736:Prostheses and Implants; D011613:Psychotherapy; D012803:Sick Role; D014012:Tinnitus / Q000523:psychology / Q000628:therapy*