Artikel
Differentiation of the psychological strain due to tinnitus (hardness of hearing, hyperacusis, ear pressure) leads to different approaches to treatment
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Veröffentlicht: | 22. September 2005 |
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Gliederung
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The experience gained over the past few years shows clearly that the psychological strain experienced by chronic tinnitus patients is frequently either not attributable at all to the actual ringing in the ears, or is not attributable to this alone.
In addition to the ringing in the ears, a decisive role is played by hardness of hearing, hypersensitivity to noise, and ear pressure.
In order to assess the individual components of the psychological strain on a differentiated basis, a differentiation aid (ABI questionnaire) was compiled [Ref. 1]. By employing this audiological stress inventory, it is possible to clarify and observe the focus of the psychological strain in a highly reproducible manner. If these questionnaires are employed in combination with familiar audiological test methods, then it is additionally possible to make statements on the potential stigmatization of hearing aids, general problems with concentration, phonophobic tendencies and measurement overreactions.
With case material of around 300 chronic tinnitus patients, hearing problems were additionally seen in 67% of the cases, hyperacusis problems in around 50% of the cases and ear pressure problems in around 25% of the cases.
On the individual focal points:
a) Hearing aid provision
Targeted hearing aid provision improves tinnitus management (15%-20% in the Göbel and Hiller tinnitus questionnaire) with the correct indication and tinnitus-specific fitting rules:
- no hyperacusis
- open-ear style
- gentle, step-by-step alignment
- discrimination not decisive
- hearing aid with volume control
b) Ear pressure
Contrary to physical and balneological therapy, mental relaxation methods contribute towards reducing ear pressure (25%-30% in the ABI questionnaire) with:
- individual selection of the method (autogenic training, progressive muscle relaxation, etc.)
- effective education.
c) Hyperacusis
Consistent hyperacusis training [Ref. 2] makes it considerably easier (30%-35% in the tinnitus questionnaire) to cope with tinnitus if correctly applied:
- specific education
- individual choice of sound
- continuous checkups
- patience and discipline
The following steps have thus proved to be a basic prerequisite for successfully coping with tinnitus and reducing the suffering due to tinnitus:
- tinnitus-specific diagnostics
- differentiation of the psychological strain due to tinnitus
- consistent interdisciplinary education [Ref. 3]
- therapy focused on the key points
- continuous checkups
References
- 1.
- Pilgramm M, Lebisch H, Pehle W. Ein neues Frageninventar zur Schwerpunktsbestimmung des Leidensdruckes bei chronischen Tinnituspatienten. Zeitschrift für Audiologie. 2001;(Suppl. IV):191ff.
- 2.
- Lebisch H, Pilgramm M. Hyperakusisdiagnostik und Therapie bei Tinnituspatienten. In: 6te Jahrestagung der Deutschen Gesellschaft für Audiologie [CD-ROM]. Würzburg; 03/2003.
- 3.
- Pilgramm M, Lebisch H. Nutzen der allgemeinen psychaudiologischen Aufklärung bei chronischen Tinnituspatienten. In: 5. Jahrestagung der Deutschen Gesellschaft für Audiologie [CD-ROM]. Zürich; 03/2002.