From the editor: special issue on tinnitus management.

Abstract

This issue of Trends in Amplification is devoted to tinnitus management by the audiologist, with special emphasis on sound therapy. Although most of us have had an episode of tinnitus at one time or another, some 50 million Americans have persistent tinnitus and 10 to 12 million of these people seek treatment because of the severity of their symptoms. Bothersome tinnitus can interfere with an individual's ability to concentrate or to sleep and can cause emotional disturbances. Various therapeutic approaches for managing tinnitus include sound therapy, psychological therapy, medication, and combinations of these approaches. In the first article, Henry, Zaugg, Myers, and Schechter describe a systematic approach for determining the required level of clinical management of tinnitus as determined by the severity of symptoms. Materials used during the assessment process are described and some of these materials are included as appendices. In the second article, Henry, Zaugg, Myers, and Schechter review general approaches to sound therapy, compare and contrast several different methods of using sound for tinnitus management, and present their own philosophy for using sound in the management of tinnitus symptoms. Theirs is a client-directed approach, wherein the person with tinnitus is given a role in deciding how sound will be used in specific situations. In this program, sound therapy, the primary mode of treatment, is supplemented by stress reduction and psychological counseling when needed. The client is educated with regard to three strategies for using sound and three types of sounds that can be used. Educational materials and materials to be used for the client in determining the helpfulness of the sound are provided. In the third article, Hanley and Davis describe a program of treatment that requires the use of a proprietary device for delivering a customized acoustic stimulus. The device is used as part of a 6-month program that includes education and counseling. The authors describe the rationale for the development of the device and the specific stimulus used. The results from clinical trials carried out during the development and modification of this treatment plan are reviewed, and descriptions of appropriate candidates for this form of treatment are included. One of the important components in evaluating any approach to the treatment of tinnitus is the availability of valid, reliable, and sensitive outcome measures. In the fourth article, Meikle, Stewart, Griest, and Henry critically review the methods currently used for evaluating tinnitus treatment outcomes: psychoacoustic measures, self-report questionnaires, rating scales, and global outcome measures. The authors point out the need for a standardized set of outcome measures responsive to treatment-related change for use in further studies of treatment efficacy. Next, Noble reviews the various approaches to the treatment of tinnitus symptoms—pharmacological, acoustic, and psychological—and the evidence or lack of evidence supporting their effectiveness. He points out the need for more research to support each approach. To date, the strongest evidence favors the use of cognitive behavior therapy. Finally, Levine, Namm, and Melcher provide a description of a form of pulsatile tinnitus with no apparent acoustic source. Physical examinations of 13 patients with pulsatile tinnitus were reported where the tinnitus could be either suppressed or induced by activating the somatosensory system of the head or lateral neck. The article includes a fascinating description of the process used by these physicians to determine the cause of such pulsatile tinnitus, including the examination methods and findings in each case. Two mechanisms are proposed to explain this form of pulsatile tinnitus; both implicate somatosensory modulation of auditory perception. The compendium of articles in this issue should serve as an introduction to tinnitus management for those uninvolved in this area and a resource for those who already use sound therapy in their audiology practices. Furthermore, the articles identify potential areas of research in the areas of intervention techniques and methods of assessing outcomes.