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The Montreal Tinnitus Clinic uses methods derived from the most recent research to achieve durable improvement for subjective noise, hyperacousis and vestibular disorders. By virtue of my position with a hearing instrument manufacturer, I have the opportunity to visit clinics all over the world.
In particular, it makes good sense for the audiologist and dispensing professional to lead the way in tinnitus management.
Although audiologists should be at the forefront of tinnitus management, a multidisciplinary team can be very useful in helping to break the vicious cycle that many tinnitus sufferers fall victim to (Figure 1).
The biggest hurdle clinicians face when it comes to tinnitus management is that most of us do not have the knowledge base to help these individuals. The University of Iowa holds an annual conference (June 14-15 in 2013), and the Tinnitus Practitioners Association (TPA) holds multiple conferences yearly that offer practical clinical information that can easily be incorporated into your clinic right away. This article also aims to provide guidance and direction on how to incorporate tinnitus into your practice, but should be considered only as an outline of first steps, as further education from your side will be necessary to successfully incorporate tinnitus services fully. The ultimate role of the hearing care professional in tinnitus management is to provide the patient with guidance through professional knowledge. Although the primary responsibilities fall on the hearing care professional, tinnitus management starts at the first point of contact. In addition, consumer seminars can be valuable, as this can help both the local community understand tinnitus better, while highlighting your expertise and clinical services.
In addition to objective measures of tinnitus perception, there are other guidelines that are recommended for successful tinnitus management. Finally, one of the most vital aspects of successful tinnitus management is to establish a tinnitus protocol for your clinic.
As each case of tinnitus is unique, making individualized modifications along the way will customize the management course for each individual. Establishing a protocol can be one of the more challenging tasks when incorporating tinnitus into your practice.
One of the most important elements of any clinic is to create public awareness of the services that you offer. In addition, since successful tinnitus management is largely about counseling, it is not uncommon to spend more time on the front end of a tinnitus management plan educating your patient. As we have discussed, many people struggle living with tinnitus and more people are being identified every day. There are courses and conferences that provide deep insight on how to work with tinnitus patients and how to make these services a fundamental part of your clinic.
This can take place in the same visit as the Tinnitus Consultation (Step 1) in some instances, or can be done at a separate visit.

1) Follow the fitting instructions of the preferred sound solution for tinnitus sound generators (TSG), sound stimulators, etc. The Tinnitus Clinic is the leading provider of the latest evidence-based tinnitus treatments in the UK.
Our video explains the neurological causes of tonal tinnitus and how audiologists at The Tinnitus Clinic are able to treat it with a pioneering therapy known as Acoustic CR® Neuromodulation.
Tinnitus is usually accompanied by hearing loss, and sometimes accompanied by loudness hyperacusis (when moderately loud sounds are perceived as very loud).
One reason is that, even though the exact cause of tinnitus is still unknown, we do know that the auditory system plays a significant role in tinnitus perception.
On the other hand, the Tinnitus Research Initiative (TRI) conference offers a yearly conference that involves higher-level neuroscience applications of tinnitus, which help identify sites of causation and future research involved with tinnitus.
Many of your referral sources and colleagues in other professional disciplines may not be up-to-date on the latest management options for tinnitus. A number of questionnaires are available, including the Tinnitus Handicap Inventory (THI), Tinnitus Reaction Questionnaire (TRQ), Tinnitus Functional Index (TFI), and Tinnitus Handicap Questionnaire (THQ). Goals and milestones within achievable time frames should be established, but understand each person experiences tinnitus differently. There are things that can be done to help treat tinnitus, but it is also important to set realistic expectations.
This is why it is important to be knowledgeable about the different approaches to tinnitus management, as one paradigm will not work for everyone. A common concern among clinicians seems to be the perception that tinnitus patients require a lot more time than traditional hearing instrument patients.
In general, the many people who struggle with tinnitus simply do not know what can be done, or who can help them.
Holding seminars that help explain to the public what tinnitus is and what can be done can prove beneficial in identifying yourself as the tinnitus leader in your community. As you advance further into your protocol, and if the patient is progressing, the amount of counseling will most likely decrease, and more time will be spent on what they are doing to manage their tinnitus and how it is affecting their life. We offer a highly personalised service and a commitment to audiological best practices to significantly reduce your tinnitus symptoms and hearing loss. In some, the sound of the tinnitus competes with or masks speech or environmental sound perception. Some tinnitus sufferers report that they have difficulty focusing on a task because of their tinnitus. There is no pill or surgery that has been shown to eliminate tinnitus in scientific studies that have been replicated and accepted by the healthcare community.

One way to learn the first steps to incorporate tinnitus management into your practice is at one of the numerous tinnitus conferences offered annually.
Offering professional educational seminars to the community is a good way to educate your referral network about tinnitus. The most common approaches to tinnitus management are hearing instrument amplification (for those with hearing loss), Sound Therapy, Tinnitus Retraining Therapy (TRT), Progressive Tinnitus Management (PTM), Mindfulness-based Therapy, and Cognitive Behavioral Therapy (CBT).
Incorporating tinnitus into your marketing plan can help create public awareness, while distinguishing you from your competitors who may not offer total hearing care services. But many clinicians feel that a bundled charge for tinnitus services is more effective at having patients commit to the protocol, rather than charging for services separately as you go. Individuals battling tinnitus need our help, and until we find our Superman of tinnitus, we are the best hope for people suffering from it. Many tinnitus patients may require considerably longer than 6 months of treatment (eg, 12 to 18 months),4 and severe cases may warrant referral.
Sometimes a medication can cause tinnitus, and stopping or changing medications can eliminate the tinnitus (check with whoever prescribed the medication). And, because of the importance of sound therapy, the diverse professional disciplines typically involved in tinnitus management tend to agree that audiologists should play a fundamental or even primary role on the care team. Having your staff understand basic tinnitus terminology can help you collect valuable patient information prior to their first visit. But once you get comfortable working with tinnitus patients, the amount of time spent with these individuals can be similar to follow-up appointments for hearing instruments. An example of a bundled package can include a set number, or unlimited, clinic visits for 12 months that include tinnitus counseling and fine-tuning adjustments of any instruments. Tinnitus can originate in the middle ear (behind the eardrum) or in the sensorineural auditory system.
Because tinnitus can be a symptom of a more serious disorder, it is important to have an appropriate health evaluation, from an audiologist or physician. Clinic staff also can be responsible for sending out tinnitus information to the patient before the appointment, so the patient can arrive with a fair and realistic expectation of your services. Subjective comments are very important, as this offers the patient a platform to express their thoughts regarding tinnitus.
Since a key component to tinnitus management is counseling, it is important to have direction and goals set for each appointment (see sidebar for a sample protocol).

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