Collaborative audiological and psychological intervention where tinnitus and hearing loss co-exist

Abstract

Tinnitus is the perception of sound in the absence of an external sound source and is estimated to be experienced by 10-15% of the population. The majority of tinnitus patients present with some form of hearing loss and intervention aimed at reducing the effects of auditory pathology is indicated in tinnitus management. A significant number of tinnitus patients are also suffering from psychological distress. Psychological interventions aimed at addressing the emotional distress caused by the tinnitus and helping the patient to reclassify his/her thoughts and beliefs about tinnitus are becoming more popular. The optimal model for tinnitus intervention may be a team approach between audiology and clinical psychology. The objective of the study was to determine the effect of a combined multidisciplinary approach in the treatment of tinnitus, using psychological and audiological intervention methods, in comparison to a single approach on tinnitus severity.

The study followed a quantitative research approach, employing a randomised quasi-experimental within-subject, repeated measures design with a varied order of procedures. Eleven participants were assigned to three different treatment groups based on counter-balanced assignment. Each group received in a different order psychological intervention comprising cognitive behavioural therapy (CBT), audiological intervention involving hearing aid fitting and the counselling component of tinnitus retraining therapy (TRT) and a combination of audiological and psychological interventions. Intervention periods were each two months long, with a one-month rest period between each intervention. In total, seven tinnitus assessments were conducted during the course of data collection to evaluate the changes in Tinnitus Handicap Inventory (THI) and Tinnitus Functional Index (TFI) scores, along with tinnitus pitch, tinnitus loudness, minimum masking levels (MML) and residual inhibition (RI) before and after interventions.

The results indicated that both the singular approaches as well as the combined intervention approach lead to clinically relevant shifts in the THI and TFI scores. Although the study results support the evidence for audiological intervention and for psychological intervention, it was not successful in proving that a combination of audiological and psychological intervention was more successful than a singular approach. It did, however, still indicate that a combination approach yielded clinically relevant reductions in THI and TFI scores and, therefore, that a combination approach is successful and effective. The assessment results of the psychoacoustic properties of tinnitus did not yield any relevant results, and failed to identify any patterns or trends with regard to the effect of intervention on the psychoacoustic properties of tinnitus. None of the results indicated statistical significance of the findings. The study serves as another stepping stone in the direction of tinnitus intervention to be delivered as a conscious multidisciplinary effort where psychology and audiology complement each other. Further research to determine the effects of a collaborative intervention approach for tinnitus is recommended.