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Volume 42 Number 4, July/August 2005, Supplement 2
Pages 95 — 116

Abstract - Clinical management of tinnitus using a "progressive intervention" approach

James A. Henry, PhD;1-2* Martin A. Schechter, PhD;3 Carl L. Loovis, PhD;4 Tara L. Zaugg, MA;1
Christine Kaelin, MBA;1 Melissa Montero, BS1,4

1Department of Veterans Affairs (VA) Rehabilitation Research and Development Service, National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, OR; 2Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, OR; 3VA Audiology Clinic, VA Medical Center, Portland, OR; 4VA Audiology Clinic, Puget Sound VA Health Care System, Seattle, WA
Abstract — Chronic tinnitus is experienced by 10%-15% of the population, of which only about 20% require clinical intervention. People requiring intervention have different levels of need, ranging from the provision of basic information to long-term, individualized treatment. We address this clinical need by outlining a five-level "progressive intervention" approach to the management of tinnitus that would provide a systematic framework for treatment by audiologists. At each level, patients must be appropriately referred-usually to otolaryngology, psychology, and/or psychiatry. Level 1 is an interview method of screening for determining if the person requires clinical intervention (and addressing basic questions). Level 2 is the provision of structured group educational counseling. If the screening determines that care is urgently required or if further help is needed following the group session(s), a tinnitus intake assessment (Level 3) should be performed. The intake assessment, which includes educational counseling, can often meet a patient's needs. If not, then a program of continuing treatment (Level 4) would be indicated. If significant benefit were not achieved through consistent treatment over 1-2 years, longer-term treatment (Level 5) would be indicated, which could include alternate or multiple treatment modalities. At all levels, the goal is to minimize the impact of tinnitus on the patient's life as efficiently as possible.
Key words: assessment, counseling, education, hearing disorders, quality of healthcare, rehabilitation, screening, tinnitus, treatment, triage.

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