Tinnitus in Patients with Sensorineural Hearing Loss : Management and Quality of Life

Abstract: Approximately 15 % of Swedish people experience tinnitus, but only 2.4 % of them experience severe problems. Treatment modalities for tinnitus are varied, but the most common treatment model is counselling. The majority of patients with tinnitus report some degree of hearing loss, and in addition, hearing aids have been used for many years in patients who suffer from both tinnitus and hearing impairment.The aim of the present thesis was to investigate the disease management and identify the quality of life in patients with tinnitus and sensorineural hearing loss.Both studies described here are retrospective, descriptive studies of patients who sought care for tinnitus and hearing loss at the two ENT clinics in Östergötland County, Sweden, during 2004 - 2007 and who also received a diagnosis code. A medical record review of all patients (study I contained 1672 subjects) revealed that 714 patients were diagnosed with both tinnitus and SNHL between 2004 and 2007 and could be included in study II.The results showed that 70% of our cohort had tinnitus, but many of the patients initially did not receive a diagnosis for their tinnitus. Information about the patients’ vertigo, heredity for hearing loss and tinnitus, diabetes history, cardiovascular disease history and other factors related to their health was often missing from the medical records. Our findings showed that the Stepped Care Model, which however was only used in a minority of the cases, could be effective in patients with tinnitus and could provide a better care process for these patients. Of the cohort, 56% of the patients received a diagnosis of bilateral hearing loss. The pure tone average (PTA) of the left ear was significantly higher than that of the right ear. There were 314 patients (44%) who had hearing aids out of the total of 714, even though it is likely that hearing aids could be beneficial for these patients. We found that the overall scores for the Tinnitus Handicap Inventory (THI) were higher in female patients than male patients. All patients who participated in study II estimated their life quality and general health at a good level. This could be due to the fact that they were investigated 4.5 years after they first reported their tinnitus and that tinnitus annoyance decrease over time. Further, the outcomes of study II demonstrated that the majority of patients, who were dissatisfied with the care they obtained, had no hearing aids. This could indicate a support the use of hearing aids fitting as main treatment model in patients with both tinnitus and hearing loss.Future research is needed to investigate how hearing aid professionals could motivate patients who suffer from both tinnitus and hearing loss to use hearing aids.