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Op: It's probably easy for them to say, "not my area of specialty," which is sometimes a covert suggestion that you should see a shrink about it.

Dirkh

Here's a letter various members of the TSMB collaborated on last year. The idea was, you could take it to your doctor, or sent it as a letter to the editor, or whatever:

Dear Doctor:

We are a group of tinnitus sufferers who provide support and information for newcomers at an Internet message site (tinnitusinfo.org). Since tinnitus is something of an orphan disorder with respect to medical specialities, we have compiled a list of suggestions for physicians dealing with patients whose primary presenting symptom is tinnitus.

We ask physicians to recognize that patients with sudden-onset tinnitus are extremely anxious, fearful, and confused about their condition. They need to be listened to with respect. The phantom noise known as tinnitus can disrupt lives and cause immense suffering. To offer the patient no alternative but to go and learn to live with it is needlessly harsh and misleading, as there are several treatment alternatives that often alleviate much of the suffering.

Examine the patient, and ask for a thorough history of the sounds as described by the patient. Explain the usefulness of audiograms and any other audiological testing deemed necessary. Explain what is required to rule out treatable medical conditions as the cause. Go over the results of the audiogram with the patient, and explain the different forms tinnitus may take. Are the audiogram results consistent with noise-induced tinnitus? With hydrops, or Menieres disease? Is the tinnitus pulsatile? Does it fluctuate? Is it associated with significant hearing loss?

Explain that, while tinnitus is often due directly to loud noise exposure, head trauma, ototoxic medications, or other causes, in most cases the specific cause is unknown. State frankly that there is no universally effective cure once known treatable causes are ruled out. More specifically, explain what is known or theorized about the mechanism of tinnitusthe cochlea, the hair cells, the brains auditory system.

Be prepared to address common questions: Will my tinnitus get worse? Will it get better? Is there something I can do to lower the noise? Many people find it difficult to explain tinnitus to family, friends and physicians. The stigma of hearing noises in your head is still a significant hurdle. Tinnitus can cause fatigue, irritability, increased stress, insomnia, ear pressure, ear pain, and increased sensitivity to sound. Additional problems such as hyperacusis, recruitment, and issues of hearing distortion and impairment may need to be addressed. Many tinnitus sufferers find that a pair of earplugs can make life much simpler in a loud environment.

Most importantly, discuss a treatment plan. Lay out for the patient the numerous tips and treatment approaches that have proven effective for some peoplelow-salt diets, elimination of caffeine and aspirin, adequate sleep, and the relationship between stress and increased perception of tinnitus. Doctors must do what they can to help the patient get beyond a state of pure anxiety about the condition. Patients should be told about the use of environmental sound enrichment such as music, fm radio white noise between stations, commercial tabletop and bedside sound generating machines, in-ear masking and habituation devices, and other external sound strategies that prove useful for some tinnitus patients. Point out that there are more formal programs designed to facilitate habituation when necessarytinnitus retraining therapy, hypnosis, and cognitive therapy among them.

Above all, patients need reassurance that this debilitating disorder can be dealt with, that it is rarely a symptom of a serious or life-threatening disease, and that there are numerous coping and habituating techniques designed for dealing with the loss of silence they are experiencing. Patients should be told that, as a general rule, most tinnitus sufferers find that their ability to tolerate their condition improves with time. By all means, schedule a follow-up appointment so that the tinnitus patient can count on continued consultations.

Failure to take these fundamental steps often results in a vicious cycle of fear and panic, in which the patient anxiously monitors tinnitus levels in a negative feedback loop of escalating despair. Doctors must recognize that patients experiencing intrusive tinnitus are often suffering from depression as well.

With these thoughts in mind, we hope you will join with us in improving the relationship between tinnitus sufferers and health-care professonials. Thank you for listening.

The Tinnitus Support Message Board
Tinnitusinfo.org