Clinical management of tinnitus using a "progressive intervention" approach.
Chronic tinnitus is experienced by 10%-15% of the population, of which only about 20% require clinical intervention. People requiring intervention have different levels of need, ranging from the provision of basic information to long-term, individualized treatment. We address this clinical need by outlining a five-level "progressive intervention" approach to the management of tinnitus that would provide a systematic framework for treatment by audiologists. At each level, patients must be appropriately referred-usually to otolaryngology, psychology, and/or psychiatry. Level 1 is an interview method of screening for determining if the person requires clinical intervention (and addressing basic questions). Level 2 is the provision of structured group educational counseling. If the screening determines that care is urgently required or if further help is needed following the group session(s), a tinnitus intake assessment (Level 3) should be performed. The intake assessment, which includes educational counseling, can often meet a patient's needs. If not, then a program of continuing treatment (Level 4) would be indicated. If significant benefit were not achieved through consistent treatment over 1-2 years, longer-term treatment (Level 5) would be indicated, which could include alternate or multiple treatment modalities. At all levels, the goal is to minimize the impact of tinnitus on the patient's life as efficiently as possible.
Department of Veterans Affairs (VA) Rehabilitation Research and Development Service, National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, OR 97207, USA. james.henry@med.va.gov
James A
JA
Henry
Martin A
MA
Schechter
Carl L
CL
Loovis
Tara L
TL
Zaugg
Christine
C
Kaelin
Melissa
M
Montero
D002908:Chronic Disease; D000529:Complementary Therapies; D003376:Counseling; D019468:Disease Management; D004599:Electric Stimulation Therapy; D006310:Hearing Aids; D006801:Humans; D010353:Patient Education as Topic; D016032:Randomized Controlled Trials as Topic; D012017:Referral and Consultation; D012107:Research Design; D014012:Tinnitus / Q000453:epidemiology / Q000534:rehabilitation*; D014481:United States / Q000453:epidemiology; D014728:Veterans