In February, Judge Sean F. Cox of the US District Court for the Eastern District of Michigan dismissed a lawsuit filed by the Academy of Doctors of Audiology (ADA). At issue was the International Hearing Society (IHS)’s Tinnitus Care Provider Certificate Program, which offers practitioners a comprehensive curriculum focused on physiology, psychology, measurement, management, and practice organization.
The ADA said the program certified “persons not legally permitted or professionally competent to provide such care” and sought an injunction, arguing that holders of the certificate would be in violation of the federal Lanham Act, which prohibits false or misleading advertising.
To the relief of the IHS’s directors and the practitioners they have certified, Judge Cox refused to issue an injunction. He found that the Lanham Act doesn’t allow the federal government to overrule state licensing authorities, nor that the ADA could prove the certificate itself contains any erroneous claims.
The decision means audiologists and hearing aid experts can continue to obtain and practice under the IHS certification, but it also raises an important issue: Should practitioners treat tinnitus, and if so, how might it benefit your practice?
A Pressing Need
Hearing care practitioners who open their doors to tinnitus sufferers stand to gain a number of new patients. According to the results of a recent study of 75,000 US adults conducted by the American Academy of Otolaryngology–Head & Neck Surgery (AAO-HNS), nearly 10% of Americans are affected by the disorder, including 10.5% of men and 8.8% of women. Other numbers gleaned from the study include:
- The majority (84.8%) of tinnitus sufferers had never tried any form of remedy, and more than half (50.6%) said they had not discussed it with their primary care physician.
- More than half (56%) of tinnitus sufferers said they had lived with the problem for more than five years, and more than one-quarter (27%) had lived with it for more than 15 years.
- More than one-third (36%) of tinnitus sufferers reported “near-constant” noticeable symptoms, 15% said symptoms were noticeable at least once per day, and 14.6% said they were noticeable at least once per week.
The study was conducted two years after the AAO-HNS published guidelines for treating tinnitus in 2014. The guidelines recommend a hearing aid evaluation and sound therapy and downplay the use of antidepressants, anticonvulsants, or intratympanic medications.
Unfortunately, based on the results, analysts said it’s clear doctors are not following that guidance. Their findings indicate tinnitus sufferers would be better served by a hearing care professional.
Process of Elimination
Writing for The Hearing Review, Maurice H. Miller, PhD, professor emeritus of audiology at New York University’s Steinhardt School of Culture, Education, and Human Development, made the case for putting otolaryngologists and audiologists on the front lines of tinnitus care.
Miller explained that otolaryngologists specializing in ear and hearing problems must first eliminate the possibility of a tumor of the auditory nerve or surrounding structures, noting that unilateral tinnitus is often the first symptom.
From there, the patient can be referred to an audiologist or hearing aid expert with specialized training, Miller wrote, noting that, although hearing aids can be the answer, they won’t work for everyone, and they are “essentially useless” at bedtime.
“Professionals who are dispensing hearing aids to treat tinnitus problems should have at least some specialized training in this area, and also become knowledgeable about recommending a continuum of options that can range from hearing aids, to counseling, to buying a fan, to obtaining a dedicated tinnitus sound generator and treatment program.”
Armed with training, certification, and a comprehensive grasp of the treatment options available to tinnitus sufferers, hearing care professionals can open their practices to this group. The only question left is whether you are prepared for the patients themselves.
In addition to the many tinnitus sufferers who have never discussed the problem with their doctors or sought any remedy, you will meet many who have tried medications, supplements, and meditation. The condition, coupled with their frustration, may have left them unduly stressed out and sleep-deprived by the time they get to your office. They will likely be in search of a panacea that simply doesn’t exist.
Your job will be to counsel those patients through yet another attempt to alleviate their suffering. If the treatment plan you prescribe works, you will have won the patient’s admiration, trust, and referrals. Offering patients the option to finance the purchase of a hearing device through a provider like CareCredit could also alleviate any anxieties related to cost. If not, unfortunately, your office will represent one more stop on the frustrating journey taken by countless tinnitus sufferers.
In response to the AAO-HNS study, Jennifer Gans, PhD, a San Francisco-based clinical psychologist and the founder of MindfulTinnitusRelief, wrote that the findings shed light on a “major public health concern” and should help promote awareness among healthcare providers. A proponent of mindfulness and cognitive behavioral counseling, Gans expressed hope that more tinnitus sufferers would seek and find relief from a variety of treatments.
“While we cannot look, at this time, to a pill or operation to ‘cure’ tinnitus, there are multiple effective management tools to help shift tinnitus from the ‘bothersome’ category into the ‘non-bothersome’ category,” Gans wrote. “Mindfulness and cognitive behavioral counseling may not be as easy to administer as a pill or surgical intervention, but what we are learning is that the management of bothersome tinnitus involves changing one’s perspective.”