Case Study

The alias for this patient will be Jon. When Jon came into the clinic, he was 64 years of age.

Jon was first seen by an audiologist in 2018 for a diagnostic hearing assessment. At that time he had been experiencing a low-level tinnitus which was described as a constant high pitch ringing sound in both ears. Test results at that time demonstrated normal hearing thresholds with normal middle ear function and excellent word recognition. Recommendations at that time were generalized coping strategies. When asked about his experience at this appointment, he remembered feeling brushed off, unheard, and like a burden to the provider. Tinnitus continued to be an annoyance, which he coped with as best he could [1].

In 2020, Jon developed encephalitis which required hospitalization and impacted his fine motor skills, speech, cognition, and ears. After treatment for encephalitis, Jon’s tinnitus sky-rocketed to an all-time high. He felt the sound to be unbearable to the point where it was preventing him from sleeping and reinforcing severe anxiety and depression. Jon felt lost and afraid yet, he was hesitant to seek guidance from an audiologist because of his previous experience. After seeking answers about tinnitus online and through his medical doctors, Jon was at a loss. He was met with answers we audiologists are all too familiar with: “You are just going to have to live with it”, “There is nothing we can do about it”, “Try to just relax, it is not really there”.

As the tinnitus became an unmanageable beast of burden, Jon finally reached out for a new hearing test [2]. This is when I first met Jon.

At our hearing evaluation appointment, Jon was clearly in distress. Reading his body language, he was apprehensive, anxious, and defeated. Given his unwashed clothing, red eyes, and messy hair, it was clear he was in a depressive state. As we went through the general case history questions, Jon remained stoic and cold. To open up a dialogue and to ease tension, I began to ask openended questions about his life passions. He offered that he used to be a very active person but did not give any more explanation than that. Pressed for time and meeting communication resistance, I continued with testing which showed the following: mild to moderate sensorineural hearing loss from 3000-8000 Hz, Type A tympanograms, excellent word recognition, present acoustic reflex, normal loudness tolerance levels, and tinnitus matched to 2000 Hz at 12dBSL. Hearing had dropped 15-30dBHL in the high frequencies since his previous audiogram. News of this change was of a surprise to Jon and this is when I was first able to break through to him.

“There is no medical cure to tinnitus, but there are plenty of management strategies. Would you be interested in scheduling a time to discuss your options?”

This statement is one I have used multiple times a day in the clinic for years. This is the first time a patient has welled up with emotion because of this statement. With a more open and relaxed demeanor, Jon scheduled a tinnitus consultation with me.

Come our tinnitus consultation, Jon brings in his wife to be an extra set of ears and to help him remember what was being said. Today, Jon is still very anxious but less closed-off (perhaps because he has the support of his wife). To my advantage, I have plenty of time today to dive deeper into his needs as a tinnitus patient. Through our conversation, I learned a lot about Jon before his encephalitis changed the trajectory of his life [3].

From early childhood Jon had an undying passion for life. Jon loved learning new things, being creative, and building long-lasting relationships with others. Although there were many things in life Jon enjoyed, he most of all enjoyed exercise. Jon wanted to do nothing more in life than to push his physical boundaries and discover new limits. Jon was an avid runner since early adulthood and became so immersed in the sport that he began entering races. The environment of a long-distance race allowed for Jon to push himself to his physical limits unlike anything else. It made him feel whole. It was his expression of self. After encephalitis, Jon was unrecognizable to himself. He was afraid and lost and looking for answers that no one could give him.

Our tinnitus consultation consisted of a detailed anatomy review, a detailed hearing test review, a detailed explanation of tinnitus theories and how different management techniques work. Given his sensorineural hearing loss, we discussed how hearing aids would be a great option to try. Jon and his wife left the office with a positive disposition. He said that he felt more in control about the tinnitus but he was not ready to move forward with any amplification.

“Today is not the end of this conversation. I would like to call you in a few months to check on how you are habituating to your tinnitus. Please reach out sooner if anything comes up.”

A few months later, I give Jon a call and he is now ready to try hearing aids. Since our office visit, Jon explored: mindfulness, sound generation, massage therapy, acupuncture, and he joined a tinnitus support group. With all of these management strategies, he felt tinnitus was less bothersome but it could still be intrusive at times. We set up a hearing aid fitting of RIC hearing aids with tinnitus support. Jon’s first reaction to hearing aids was what every audiologist hopes for- immediate tinnitus relief. Of course, realistic expectations had to be promptly set as this overwhelming feeling of hope brought Jon to tears. We were set for a follow-up in a month to check in again about tinnitus habituation [4].

One month later, a new Jon entered my office. This man was about 15 pounds lighter, color in his cheeks, and had a pep in his step. I learn that he has found a way to be active and feel like himself again, rowing. He tells me his tinnitus is manageable when he wears hearing aids consistently. He now tells me “I can still hear my tinnitus, but it is not taking over my life”. Though he gets relief with the hearing aids, he continues mindfulness strategies to help with tinnitus habituation and anxiety management (Table 1).

Table 1: Tinnitus Reaction Questionnaire. This questionnaire is designed to find out what sort of effects tinnitus has had on your lifestyle, general well-being, etc. Some of the effects below may apply to you, some may not. Please answer all questions by circling the number that best reflects how your tinnitus has affected you over the past week.

Another key component to Jon’s success story was his determination to find a way to be active again. He told me that the wave of hope he experienced from the hearing aid fitting motivated him to find solutions to his problems. He learned that with the right tools, he will be able to overcome the obstacles in his health [5,6].

As we run routine hearing tests, it is easy to treat patients like another item on our assembly line. We can empower our patients by actively listening, thoroughly explaining results, and letting them lead their own explorations into treatment options.

“Thank you for not giving up on me when everyone else had.” – Jon