Tinnitus Management: Perspectives and Pathways

Tinnitus challenges patients, providers, educators, and students. It challenges people who do not have tinnitus but whose lives intersect someone who does. Patients express tinnitus effects as influencing, among other things, sleep, concentration, emotional state, listening effort, and quality of life. Patients also express their disappointment (admittedly the kindest word available) with many elements of the hearing health care profession. Providers confronted by the myriad clinical concerns and heterogeneous presentations of patients bothered by tinnitus may lack the ability or willingness, perhaps owing to a lack of formal preparation or education, to adequately address patient's needs. The next generation of hearing health care providers must do a better job.

This edition of Seminars in Hearing is focused on information supporting the provision of clinical services for patients bothered by tinnitus. We start with Dr. Jim Henry addressing patient triage, interprofessional pathways, and a stepped care model, Progressive Tinnitus Management, that is advocated throughout the Veterans' Affairs system in the United States. One step in the model employs group counseling for patients, and in the next piece, Sandridge and Newman review the group session model they implemented for decades at the Cleveland Clinic. Their tinnitus clinic was an early example of the unique benefits afforded by collaborative care. Next, Zitelli and Alscher expand considerably upon elements of value to the provider who seeks to initiate tinnitus-related services. The authors report, comprehensively, evidence supporting the development of optimal clinical settings and reasonable patient pathways, in addition to options for patient management that fit squarely into audiology's scope.

Two review articles provided by Grant Searchfield's group follow. The first serves as an update on this group's prior reviews addressing the use of hearing aids as an element of tinnitus management, and the piece builds upon Dr. Searchfield's already-considerable contributions illustrating the putative value of hearing aid fittings for patients bothered by tinnitus. He also offers a scoping review of the role attention plays across studies of tinnitus management and concludes by offering a model built upon the influences of sound, perceptual training, and their effects on attention. Relatedly, Morse and Campbell review auditory gating studies, some of which suggest a measure to identify aspects of central function, in particular inhibitory components, that distinguish patients with tinnitus from those without. Their review clarifies the value of an important counseling element: tinnitus may emerge as a natural and predictable consequence of central disinhibition that makes available to the patient, previously undetectable neural activity.

The negative effects of tinnitus, while variable across patients, are likely to be most intrusive for those patients whose livelihood and self-image are determined by their relationship to sound, and specifically music. Frank Wartinger is an audiologist who specializes in the care and management of musicians who experience tinnitus and hearing impairment. His Field Guide highlights ways in which the barriers to care for musicians may be addressed; arguably, the barriers for musicians are more detrimental than barriers addressed above by Henry, Zitelli, and Alscher. Wartinger identifies resources available for musicians, and it is our hope that organizations such as the American Tinnitus Association (ATA) contribute to profession-wide improvements in care that would support not just music-exposed individuals, but other at-risk groups: firefighters, members of law enforcement, construction workers, and veterans. Patrick Lynch is the ATA's CEO, and he closes our issue of Seminars with a brief update on the ATA's research and service initiatives. His words, and those of the other authors, highlight the challenges we face as a profession and as individuals when it comes to the care of patients bothered by tinnitus. Our hope with this special issue is that the needle will continue to move in the right direction so that the next generation of patients and providers conceive of tinnitus as a less unreasonable impediment than we do at present to living life well.

Publication History

Article published online:
04 April 2025