Hi Audiology folk!
Here’s hoping that as of this writing you are all safe and continuing to social distance as the beautiful Minnesota winter descends upon us! If you remember, our last letter to the public discussed the basics of what tinnitus is, how to say it, etc. If you don’t remember – see below!
Here is a part one of four part series on Tinnitus. For this publication, we’re going to dive a little deeper, and discuss how tinnitus is assessed, or measured.
Tinnitus is a highly individualized and subjective disorder – every person experiences their tinnitus in a different way. Some people hear whistling, some hear “crickets”, this audiologist hears a high-pitched ringing (a classic) pretty much all the time. Every person will describe the sensation in a way that is specific to them – so how do we quantify the tinnitus? How do we establish how much of an issue any one person is having with it?
The initial evaluation will look very similar to the initial evaluation for a hearing loss. The reason for this is simple – 90% of people who have tinnitus also have an underlying sensorineural hearing loss. So the first steps are going to look the same.
First up is a thorough intake form, and complete case history. The intake form may include a screening questionnaire to determine your perception of your tinnitus and/or hearing loss – in order to begin assessing the tinnitus and guide a course for treating it, first we have to know where to start, and questionnaires help us along that path. A tinnitus case history should include how long the tinnitus has been present, how often it occurs, if it is in both ears or just one, if you have a history of noise exposure, and how much you feel the tinnitus is impacting your day-to-day life.
Next up is a diagnostic audiologic evaluation, which sounds scary, but is actually pretty straightforward. It includes otoscopy (your friendly neighborhood audiologist is going to look in your ears), a hearing test (to determine if there is any underlying hearing loss accompanying the tinnitus) that includes pure-tone air conduction (under headphones), bone conduction (using a bone oscillator), and word understanding testing (repeat after us!). If indicated, your audiologist may also test the movement of your eardrums with something called a tympanogram – this is to make sure there is no fluid hanging out behind your eardrums where it certainly does not belong.
Now, if you’ve already done some research on tinnitus, or gone down the various rabbit holes about it on the internet, you may have heard of something called psychoacoustic evaluation. Psychoacoustic evaluation with regards to tinnitus can come in many different forms, all of which require some attempt to quantify the tinnitus – either by matching its pitch or loudness using the audiometer, or testing the minimum level of noise needed to mask, or cover up, the tinnitus. While these measures can be very useful for helping the patient (you!) feel heard and understood about the severity of their tinnitus, it is important to understand that there is very little hard evidence in favor of the validity of these measures, and they have very little clinical utility. They are also difficult, requiring an intense amount of focus for an extended period of time, both for the audiologist and the patient, so it’s important that they are used in their appropriate context, when absolutely necessary.
And with that, we’ve finished another section of Tinnitus 101 by Andros Audiology!! I hope that you found this information helpful and instructive, and that you’ll join us again for our next series on tinnitus, which will cover tinnitus treatment or management techniques!
In the meantime, audiology friends, stay safe and be so well!