Harvey Abrams, PhD

by Harvey Abrams, PhD

A recent post  in this section referenced the Ida Institute in an appeal to have us refocus our efforts on the patient rather than on the technology.  The post provided an excellent overview of Ida, its mission (to foster a better understanding of the human dynamics associated with hearing loss) and its activities.

I thought this might be a good opportunity to take a deeper dive into the activities of the Ida Institute and how their impressive array of tools might be just the medicine we, as hearing healthcare providers, need to differentiate ourselves and the services we provide in a disruptive and ever-changing healthcare landscape.  

 

The Oft Overlooked Rehabilitation Component

 

I’ve been privileged to part of the Ida Institute  since its beginnings in 2008 and have contributed to planning and contributing to their seminars and toolbox development. If you’ve been following my posts for the last several years, you know how important I consider the rehabilitative component of audiology care to be as an essential adjunct to the technology we provide to our patients. The goal of the Ida Institute (which resonates with this rehabilitative focus) is to positively impact hearing impaired persons and hearing care professionals around the world by making person-centered care the core of hearing care practice.

While most audiologists appreciate the value of patient-centered care and the importance of the rehabilitation component, few provide much more than a brief discussion of the expectations associated with the technology they deliver to their patients. Fewer provide information about computer-based auditory training programs and even fewer (“We few, we happy few”) provide ongoing individual or group rehabilitation programs. Reasons given for not providing post-fitting rehabilitation services include the lack of time, resources, and comfort/confidence with the delivery of these services.

Well, I’ve got great news for those of you who want to provide a true patient-centered model of hearing health care – Ida has done all the heavy lifting and you have access to an impressive armamentarium of information and resources, free of charge.

 

Ida to the Rescue

 

What follows is a brief description of the resources that the Ida Institute has developed. They are yours for the taking – you just need to register (no charge) here

The Seminars: These 2 to 3 day educational and highly interactive workshops are designed to allow the participants to collaborate, explore and develop new knowledge and tools associated with important aspects of hearing loss. Ida provides stipends to the participants to cover most of the costs associated with attending the workshops in Skodsborg, Denmark. To date, seminars have explored the following topics:

  • Defining hearing
  • Communication Partnerships
  • Motivational Engagement
  • Cochlear Implant Journey
  • Living Well with Hearing Loss
  • Managing Change

These workshops often result in the development of practical tools that become available to persons with hearing loss, their communication partners, educators and the professional community at no cost. The Toolbox developed by Ida and collaborators include:

  • Motivational Engagement – The “Line, Box, and Circle” tools are designed to assist the patient, with the healthcare professional serving as facilitator, to thoughtfully reflect on the benefits and barriers to taking action improve their communication performance as a prelude to moving forward on their journey.
  • Communication Partners – Based on the understanding that hearing loss impacts not only the individual with the hearing loss but also the people who serve as his or her primary communication partner, these tools are designed to integrate the communication partner into the discussion leading to identifying the goals and strategies for improving communication performance.
  • Living Well with Hearing Loss – These tools are designed to help the patient and communication partner identify the most critical needs created by the hearing loss leading to a more focused and patient-centered plan of treatment.
  • My World Pediatric Tool – Ida has attempted to extend its reach beyond adults with hearing loss. The pediatric tool is designed to facilitate a conversation between the child and provider leading to a more trusting relationship and better understanding of the specific needs of the child with hearing loss and a more appropriate treatment strategy.
  • Group AR Guide – Many audiologists are reluctant to initiate group AR in their practices because of lack of information and resources. The Ida Group AR Guide provides an impressive toolbox of resources from preparation, planning and publicizing to specific content, strategies and resources required to conduct a comprehensive 8-session program covering topics on communication strategies, speechreading, assistive technology and patient advocacy, speechreading and community resources.
  • Tinnitus Management – A tool designed to improve the counseling skills of clinicians dealing with patients with disturbing tinnitus through delivering a holistic approach to tinnitus management.
  • Transitions Management – These tools designed for children and young adults, as well as their parents, school teachers and hearing care providers, contain valuable information, resources, and strategies associated with negotiating the changes facing the lives of children and young adults with hearing loss.
  • Telecare – An online platform that provides persons with hearing loss tools and resources that help to extend hearing care services beyond the clinic environment to include preparation for their first appointment, preparation for follow-up appointments, and issues associated with everyday experiences living with hearing loss.
  • Telecare for Teens and Tweens – Telecare resources designed specifically for preadolescents and adolescents.
  • Balance – A tool designed to improve awareness of BBPV among patients and providers leading to earlier diagnosis and more effective treatment.
  • My Turn to Talk – A tool designed for parents of children with profound hearing loss facing cochlear implantation. The tool helps parents prepare for their first appointment with the CI team by providing them with the means to articulate their fears, needs and concerns prior to meeting with the team.

 

A Veritable Treasure Trove

 

In addition to the tools described above, Ida has developed additional resources designed to improve professional skills including Time and Talk, Change Guide, E-Learning Lab, Self-Development in the Clinic, and a Video Library containing a collection of fascinating and compelling ethnographic and clinic films. There are also tools for educators including material on the basics of patient-centered care, a clinical supervisor kit, and a comprehensive curriculum for a university course designed to educate students on the human dynamics of hearing loss.

The Ida Institute has developed a centralized treasure trove of resources for the professional, parent, educator, person with hearing loss and communication partner. If you think that hearing care is more than technology, here is the place to begin your own professional journey toward a more patient-centered approach to improving the quality of life of persons with hearing loss.

For a more detailed description of the tools and resources described in this post, including downloadable materials and videos, please visit the Ida Institute.

 

Harvey Abrams, PhD, is a consulting research audiologist in the hearing aid industry. Dr. Abrams has served in various clinical, research, and administrative capacities in the industry, the Department of Veterans Affairs and the Department of Defense. Dr. Abrams received his master’s and doctoral degrees from the University of Florida. His research has focused on treatment efficacy and improved quality of life associated with audiologic intervention. He has authored and co-authored several recent papers and book chapters and frequently lectures on post-fitting audiologic rehabilitation, outcome measures, health-related quality of life, and evidence-based audiologic practice.  Dr. Abrams can be reached atharvey_abrams@starkey.com

feature photo from Ida Institute

Today’s topic is a vexious problem that gets far less attention by hearing health professionals than you would think.  Tinnitus is a big issue for patients, but not one that is treatable by pills, surgery, or other traditional treatments.  However, there are treatments that are effective for some people.

 

What It Is

 

Tinnitus (pronounced “tin EYE tus”) is a frequent, unpleasant companion to hearing loss.  Moreover, it is an invisible, unpleasant companion because it is heard in almost every case only by the person who has it, not by others.  Many people describe their tinnitus as sounding like bells or crickets. 

For some, tinnitus is occasional, low level and largely ignored.  For others, it is worrisome or frightening – they wonder if they have mental problems or if they have a brain tumor. Fortunately, tinnitus is not a sign of mental problems and only a tiny fraction of a percent of people with tinnitus and/or hearing loss have so-called “eighth nerve tumors.”

There is one small but important group of people who are tinnitus sufferers – their tinnitus is constant, extremely distracting, loud- to-blaring. For those people, tinnitus is a disabling condition. 

 

The Clinical Picture

 

“Tinnitus is one of the most common clinical syndromes in the US, affecting 12% of men and almost 14% of women who are 65 and older.  It only rarely afflicts the young, with one significant exception: those serving in the armed forces.  Tinnitus affects nearly ½ the soldiers exposed to blasts in Iraq and Afghanistan” (Gropman, 2009).

Important neurophysiologic research is being conducted on tinnitus. Researchers are using rats to test theories of tinnitus and find drugs that suppress tinnitus. They have yet to identify a successful suppression treatment, but they have definitively proven that tinnitus is caused by biological changes in the brain, not by psychological processes. In other words, it’s not just something people imagine –although it certainly affects those who have it psychologically. 

The idea that brain changes underlie tinnitus is a game-changer for audiologists and their patients. We used to think that tinnitus resulted from damage to the inner ear.  That’s still the case, especially for tinnitus caused by high aspirin dosage. But now we know that it’s not that simple. There is a “central” origin (or probably multiple centers) in the brain which regulates a person’s perception of tinnitus.  This is in line with new thinking on hearing loss and hearing aids:  the initial insult that causes hearing loss occurs in the inner ear, but the changes in auditory perception that occur because of that insult are in the auditory centers of the brain.  That is why hearing aids are now considered to be a first line of defense against losing auditory perceptual capability, and possibly auditory cognitive deficits as well.

 

Help for Tinnitus Sufferers

 

What is available to help people who suffer from tinnitus?  There are no FDA approved drug therapies for tinnitus treatment, but antidepressants and anti-anxiety medications are prescribed for some people to ease their suffering, much as they are for people who suffer from chronic pain. Those drugs do not suppress tinnitus, they just make it more bearable. 

On the other end of the treatment spectrum, Tinnitus Retraining Therapy relies on sound therapy and patient-centered psychological counseling to remove negative connotations of tinnitus. TRT takes 12 to 18 months, which makes patient compliance a serious concern. In general, success rates with drugs or counseling based treatments are hard to pin down but none are stellar. 

The most successful treatment for tinnitus is some form of amplification, either with hearing aids alone or those fitted with tinnitus “masker” circuitry which pumps tailored noise into the wearer’s ear to cover or compete with the sound of the tinnitus. In one report, hearing aids “often have a beneficial effect on the underlying tinnitus.  Relief from tinnitus may persist for hours after the hearing aid has been removed” (Castillo & Roland, 2007). In another study, about two thirds of 1440 patients fitted with hearing aids on one or both ears reported improvement in their tinnitus (Trotter & Donaldson, 2009).  In a survey of hearing health care providers, 88% reported that they recommended hearing aids as the treatment of choice for tinnitus (in the presence of hearing loss).  Those providers reported a success rate of 60%:  22% of their patients experienced major benefit and 38% found their tinnitus reduced to some extent. 

 

What Tinnitus is Not and What to Do About It

 

Tinnitus is a symptom and not a disease. That makes it confusing to patients and primary care physicians when it comes to deciding how to handle it, especially in cases of mild hearing difficulty.

The first step in EVERY case is a comprehensive diagnostic audiology evaluation to rule out or identify presence of an auditory nerve tumor, middle ear disorders, and even impacted wax.  Audiometric testing takes about an hour, can be covered under Medicare, and points patient and physician to the appropriate management strategy. 

Additionally, audiologists can administer the Tinnitus Handicap Inventory, a self-report measure, to assess the impact of tinnitus on a patient’s daily life.  If audiometric test results show deficits in speech audibility and intelligibility, hearing aids may be in order to correct speech processing deficits as well as potentially mitigate tinnitus effects reported by patients.

 

References

 

Castillo MP & Roland PS.  Disorders of the auditory system.  In Roeser R, Valente M & Hosford-Dunn H (eds), Audiology:  Diagnosis (2007, 2nd Ed).  New York:  Thieme.

Groopman J (2009).  That buzzing sound: The mystery of tinnitus.  The New Yorker, Feb 9 & 16, 42-49. 

Henry JA et al (2009). Tinnitus Retraining Therapy: Clinical Guidelines. San Diego: Plural Publishing.

Kaltenbach JA (2009). Insights on the origins of tinnitus: An overview of recent research.  Hearing Journal 62(2), 26-31.

Kochkin S & Tyler R (2008).  Tinnitus treatment and the effectiveness of hearing aids: Hearing care professional perceptions.  Hearing Review, Dec, 14-17. 

Korres S, et al. Tinnitus Retraining Therapy (TRT): outcomes after one-year treatmentInt’l Tinnitus Journal, 2010; 16(1): 55-9.

Newman CJ et al.  Development of the Tinnitus Handicap Inventory. Arch Otolaryngol Head Neck Surg. 1996;122:143-148. 

Sereda M et al.  Consensus on Hearing Aid Candidature and Fitting for Mild Hearing Loss, With and Without Tinnitus: Delphi ReviewEar Hear. 2015 Jul; 36(4): 417–429. 

Trotter M & Donaldson I (2008). Hearing aids and tinnitus therapy: a 25-year experience. J Laryngol & Otol 122(10):1052-6. 

 

feature image courtesy of thisismedtech