Dr. Nagler's Tinnitus Corner
Latest Topics
 
 
 


Reply
  Author   Comment  
Peggy Humber

Member
Registered:
Posts: 3
 #1 
Hello Dr. Nagler

I am a new member to this forum and I have been a tinnitus sufferer for approximately 4 years. I have been doing alot of research in this condition as it has had a very profound impact on my life.  I have been in discussions with the University of Buffalo, Dr. Richard Salvi and Dr. Marc Fagelson at the University of Tennesse.  I am very interested in the mutual reinforcing factors of PTSD and Tinnitus.  I believe that these two factors are not even being address when audiologist are screening new patients complaining about tinnitus and  I would like to hear your thoughts on this subject. 


Dr. Nagler

Owner
Registered:
Posts: 1,764
 #2 
Quote:
Originally Posted by Peggy
I am a new member to this forum and I have been a tinnitus sufferer for approximately 4 years. I have been doing alot of research in this condition as it has had a very profound impact on my life.  I have been in discussions with the University of Buffalo, Dr. Richard Salvi and Dr. Marc Fagelson at the University of Tennesse.  I am very interested in the mutual reinforcing factors of PTSD and Tinnitus.  I believe that these two factors are not even being address when audiologist are screening new patients complaining about tinnitus and  I would like to hear your thoughts on this subject.

Hi Peggy. Welcome.

As I noted elsewhere, the relationship between stress and tinnitus is complex and inconsistent. I personally believe that neurotransmittors play a role in this phenomenon. Regarding tinnitus and PTSD specifically, Dr. Fagelson is one of the leading authorities in this area, and I would totally defer to his knowledge and expertise in that regard. (He's also one helluva guitar player!)

You bring up a very good point regarding the audiological assessment of tinnitus patients. There is really no set formula for assessing tinnitus patients, but I agree with you completely that in taking a history one should always inquire about stressors - and obviously PTSD would fall under that umbrella.


Dr. Stephen Nagler
Atlanta Tinnitus Consultants, LLC

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
Peggy Humber

Member
Registered:
Posts: 3
 #3 
Thanks for the reply.  Here are a couple more questions

Regarding the assessment protocol for tinnitus disturbance to a sufferer.  
My question is to you  .... Is there a standard form that are given to patients to rate the level of disturbance? If so What is the standard practice the audiologist takes when the patients level is ranked as severe.  I know that currently there is no standard method of referral for other medical intervention .  Each audiologist goes by "past practice" to service the patient ...... which to me is extremely puzzling and dangerious.     
Also another question.  
Many of audiologist seem to take on the responsibility of tinnitus within their practice but only refer suffers to TRT or CBT.  Why do they send them on false paths or ill proven coping methods. There is nothing on PTSD coping methods.  When tinnitus is perceived by the sufferer to be severe and the patient is in desperate for intervention CBT is therapy is counter productive to the patient as the trauma brain does not comprehend CBT therapy. Sleep deprivation does not allow cognitive thinking or comprehension.
What are your thoughts on this theory.

Dr. Nagler

Owner
Registered:
Posts: 1,764
 #4 
Quote:
Originally Posted by Peggy
Thanks for the reply.

You are welcome.

Quote:
Here are a couple more questions
Regarding the assessment protocol for tinnitus disturbance to a sufferer.  
My question is to you  .... Is there a standard form that are given to patients to rate the level of disturbance?

No, Peggy. There isn't. There are a number of forms or scales that have been proposed and that are actually in use, but none has been universally accepted. One of the problems is that since tinnitus is totally subjective, the responses on such scales are subjective. So since some people tend to be exaggerators and some people tend to be minimizers (and everything in-between), even using the same scale one person's 88/100 cannot really compare in a truly meaningful fashion with another's 88/100. In my own practice we use Newman and Jacobson's Tinnitus Handicap Inventory - but only as a measure of progress. So if a patient starts out with a score of 88/100, and six months later has a score or 32/100, that is a very good reflection of progress indeed.

Quote:
What is the standard practice the audiologist takes when the patients level is ranked as severe.

To the best of my knowledge there is no standard practice among audiologists regarding the treatment of tinnitus patients. I have given a number of presentations to groups of ENTs and audiologists regarding how I personally believe the evaluation and treatment of individuals who present with tinnitus should be undertaken, but I have no way of knowing the extent to which the approaches I discuss in those presentations have been adopted. The biggest problem, in my opinion, is that the management of patients with severe tinnitus is very time-intensive - and financial realities more often than not simply do not allow ENTs and audiologists to devote that kind of time.

Quote:
I know that currently there is no standard method of referral for other medical intervention .  Each audiologist goes by "past practice" to service the patient ...... which to me is extremely puzzling and dangerious.

The same holds true for much of health care. Add to it the fact that tinnitus is so subjective, and it's a real problem.
   
Quote:
Also another question.  
Many of audiologist seem to take on the responsibility of tinnitus within their practice but only refer suffers to TRT or CBT.

Actually most ENTs and audiologists do not even go that far. They just throw up their hands in frustration and tell their tinnitus patients to "learn to live with it." Or they recommend various worthless vitamins and herbs while hoping that time will heal all. Or they sell them a pair of maskers and send them out the door. At least that was my own experience.

Quote:
Why do they send them on false paths or ill proven coping methods.

I'm not sure what false paths you are talking about there in particular - although there are certainly a number of false paths out there.

Quote:
There is nothing on PTSD coping methods.  When tinnitus is perceived by the sufferer to be severe and the patient is in desperate for intervention CBT is therapy is counter productive to the patient as the trauma brain does not comprehend CBT therapy. Sleep deprivation does not allow cognitive thinking or comprehension. What are your thoughts on this theory.

Peggy, it's not as black-and-white as that. For instance, while sleep-deprived individuals with PTSD might have a tougher time applying the principles of cognitive behavioral therapy, that does not mean the effort is of no value at all. I am sure that Dr. Fagelson will agree with me there.

Moreover, PTSD coping really doesn't fall within the scope of audiology. Hopefully PTSD sufferers will avail themselves of the appropriate psychological and supportive services to assist them with this increasingly recognized serious challenge.

I may be wrong here, but from your postings in this thread I sense that you feel your own PTSD may be impeding your own progress in overcoming tinnitus. If that is the case, I hope that you will come to see that there is a world of difference between "impeding" and "preventing."

I wish you the best with it.

Dr. Stephen Nagler

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
Previous Topic | Next Topic
Print
Reply

Quick Navigation:

Easily create a Forum Website with Website Toolbox.



Dr. Nagler's Tinnitus Corner is provided for education and information only. It is not intended for the purpose of providing medical care and should in no way substitute for appropriate in-person consultations with qualified healthcare professionals. By using this site, participants agree to hold Dr. Nagler and Atlanta Tinnitus Consultants, LLC harmless with respect to any loss, injury, claim, liability, or damage arising from following the postings herein.