Purpose: Individuals complaining of tinnitus often attribute hearing problems to the tinnitus. In such cases some (or all) of their reported "tinnitus distress" may in fact be caused by trouble communicating due to hearing problems. We developed the Tinnitus and Hearing Survey (THS) as a tool to rapidly differentiate hearing problems from tinnitus problems. Method: For 2 of our research studies, we administered the THS twice (mean of 16.5 days between tests) to 67 participants who did not receive intervention. These data allow for measures of statistical validation of the THS. Results: Reliability of the THS was good to excellent regarding internal consistency (a = .86-.94), test-retest reliability (r = .76-.83), and convergent validity between the Tinnitus Handicap Inventory (Newman, Jacobson, & Spitzer, 1996;Newman, Sandridge, & Jacobson, 1998) and the A (Tinnitus) subscale of the THS (r = .78). Factor analysis confirmed that the 2 subscales, A (Tinnitus) and B (Hearing), have strong internal structure, explaining 71.7% of the total variance, and low correlation with each other (r = .46), resulting in a small amount of shared variance (21%). Conclusion: These results provide evidence that the THS is statistically validated and reliable for use in assisting patients and clinicians in quickly (and collaboratively) determining whether intervention for tinnitus is appropriate.T innitus has been defined as head or ear noise lasting at least 5 min and occurring more than once a week (Dauman & Tyler, 1992). For most people who have tinnitus, the sound is constant or near-constant. Epidemiologic studies reveal that tinnitus is experienced by 10%-15% of the adult populations in different countries (Heller, 2003;Hoffman & Reed, 2004;Shargorodsky, Curhan, & Farwell, 2010). It is often reported that for about 80% of those who experience tinnitus, the tinnitus is not particularly bothersome, and clinical intervention for the tinnitus is not required (Cima, Vlaeyen, Maes, Joore, & Anteunis, 2011; Davis & Refaie, 2000;Jastreboff & Hazell, 1998;Krog, Engdahl, & Tambs, 2010). When intervention for tinnitus is desired by, and appropriate for, a given patient, the amount of intervention provided should depend on the individual's specific needs Tyler & Baker, 1983).Dobie's (2004) multilevel pyramid analogy is helpful in conceptualizing how tinnitus affects people differently (see Figure 1). The base of the pyramid contains those who have tinnitus but are not bothered by it. The next higher level contains people whose tinnitus is "bothersome," ranging from "mild" to "moderate" to "severe." The tip of the pyramid contains those relatively few individuals who are "debilitated" by their tinnitus. This pyramid analogy highlights the fact that most people who experience tinnitus do not need clinical intervention specific to the tinnitus. Those who do differ widely with respect to their clinical needs, ranging from answering a few questions (e.g., they want assurance that their tinnitus does not reflect some serious disease) to providin...

A controlled clinical study was conducted to evaluate prospectively the clinical efficacy of tinnitus masking (TM) and tinnitus retraining therapy (TRT) in military veterans having clinically significant tinnitus. Qualifying patients were placed into the two groups in an alternating manner (to avoid selection bias), and treatment was administered at 0, 3, 6, 12, and 18 months. Outcomes of treatment were evaluated using three self-administered tinnitus questionnaires (Tinnitus Handicap Inventory, Tinnitus Handicap Questionnaire, Tinnitus Severity Index) and the verbally administered TRT interview forms. Findings are presented from the three written questionnaires, and from two of the interview questions (percentage time aware of, and annoyed by, tinnitus). Outcomes were analyzed on an intent-to-treat basis, using a multilevel modeling approach. Of the 123 patients enrolled, 118 were included in the analysis. Both groups showed significant declines (improvements) on these measures, with the TRT decline being significantly greater than for TM. The greater declines in TRT compared to TM occurred most strongly in patients who began treatment with a "very big" tinnitus problem. When patients began treatment with a "moderate" tinnitus problem, the benefits of TRT compared to TM were more modest.

Findings are presented from the three written questionnaires with respect to three categories of patients: describing tinnitus as a 'moderate,' 'big,' and 'very big' problem at baseline. Based on effect sizes, both groups showed considerable improvement overall. In general, TM effects remained fairly constant over time while TRT effects improved incrementally. For the patients with a 'moderate' and 'big' problem, TM provided the greatest benefit at 3 and 6 months; benefit to these TRT patients was slightly greater at 12 months, and much greater at 18 months. For patients with a 'very big' problem, TM provided the greatest benefit at 3 months. For these latter patients, results were about the same between groups at 6 months, and improvement for TRT was much greater at 12 months, with further gains at 18 months.

This article explains each of these assessment components in detail. Adoption of the ATM assessment protocol by audiologists can contribute to the establishment of uniform procedures for the clinical management of tinnitus patients.

Management of tinnitus generally involves educational counseling, stress reduction, and/or the use of therapeutic sound. This article focuses on therapeutic sound, which can involve three objectives: (a) producing a sense of relief from tinnitus-associated stress (using soothing sound); (b) passively diverting attention away from tinnitus by reducing contrast between tinnitus and the acoustic environment (using background sound); and (c) actively diverting attention away from tinnitus (using interesting sound). Each of these goals can be accomplished using three different types of sound—broadly categorized as environmental sound, music, and speech—resulting in nine combinations of uses of sound and types of sound to manage tinnitus. The authors explain the uses and types of sound, how they can be combined, and how the different combinations are used with Progressive Audiologic Tinnitus Management. They also describe how sound is used with other sound-based methods of tinnitus management (Tinnitus Masking, Tinnitus Retraining Therapy, and Neuromonics).