Tinnitus and Insomnia Patient - any ideas?

**omar.sharifa** · Tue 19th Oct 2010, 03:57 PM

I have a patient female , 42 years old , working as a bank teller ,
her Pure tone audiometry showed bilateral slopping to high frequency ( like presbycusis shape )

she suffered from Vertigo positional which is highly to be BPPV

she suffered from Tinnitus in both ears , lack of sleep , anxiety is highly appears

more than 12 ENT saw her and no improvement ,

finally she came to my clinic

any ideas ?

**lvscrewloose** · Sat 26th Feb 2011, 05:58 PM

Dear Omar

Just joined the forum so hope you will get my reply.I work with patients who have vestibular problems as well as those with tinnitus and anxiety and depression tend to be major factors in both groups of patients. Your patient has likely seen 12 ent staff who will likely have spent 5-10 mins with them and have told them the same thing. It won't go away and they have to live with it. What I feel I am able to do as an audiologist is to listen to the patient and let them talk. This fosters trust and encourages the patient to share the real issues that are at the heart of their problems. Look for triggers which may have occured at the same time as the tinnitus began and if there try and get them to link the 2. This may be the balance issues which your patient has also been experiencing.

A patient I had the other day has been reading up on tinnitus. We made the link with onset of tinnitus and its prevalence with a series of health issues she has had over the past year. Unfortunately the reading and meeting with ent have helped her consolidate the belief that not only will her tinnitus not go away it won't get better. I have to find a way to get through to her that the 2 statments are not one and the same!

**omar.sharifa** · Sat 26th Feb 2011, 06:15 PM

Thank you for relaying ,
but sorry your moving to psychologist job , it is nice to hear from the patient and let him talk but that is not everything ,

**lvscrewloose** · Sat 26th Feb 2011, 07:08 PM

I am sorry you feel that way. But seeing patients who have had problems going on for months and who feel no one has actually listened to them does not mean they have psychological issues. It means they are often marginalised by members of the medical profession who can't fix them with pills or surgery. The last patient I wrote about has been offered a referral to a site with CBT and psychological support however she is elderly and anxious. Also she believes no one can help. I sat and talked with her for an hour an she is wiling to give it a try. Counselling is a major part of what we do. Another elderly patient came in with her daughter this week for a hearing aid review. It transpires she has tinnitus. Her daughter told me she thought her neighbours (who are very nice) were taking it in turns to put the washing machine on during the night and keep her off her sleep. I discussed with her some of the theories of tinnitus, discussed sleeping patterns and gave her a sound generator to try at night. Her GP who knew about this told her it was tinnitus but she didn't believe him. Some patients do need psychological help because tinnitus is part of a larger issue going on - however most will respond very well with counselling and if suitable amplification.

**lvscrewloose** · Sat 26th Feb 2011, 07:20 PM

If your patient has still got vertigo I would be carrying out Hallpikes and Epleys as appropriate. I would be fitting her hearing loss which will hopefully help her tinntius symptoms and help the stress surrounding her hearing loss which likely effects her work. RNID website had good patient advice leaflets such as good night sleeptight to try and help develop a better sleep routine. I would also provide details of sound generators for bedtime or chant style music which also help with relaxation.

This post was some time ago. What did you do with your patient?