Tinnitus Service @ CGH

Dr Yuen Heng Wai, Consultant, Ear, Nose and Throat Dept, Changi General Hospital
Ms Joyce Lim, Tinnitus Counsellor , Ear Nose and Throat Dept, Changi General Hospital 

Tinnitus is a very common problem that could afflict people with normal hearing or with hearing loss. Patients with tinnitus have much fear and anxiety and they are worried it is a sign of serious disease. Despite tremendous advances in research, the exact mechanism for tinnitus is unknown. However, the causes of tinnitus may be multifactorial and treatment is multifaceted.

At CGH, our tinnitus management team runs a successful treatment programme known as the Tinnitus Evaluation-Rehabilitation Programme (TERP). This is a multi-disciplinary programme initiated in 2008 and aims to look at every aspect of the treatment process. It is the first of its kind in Singapore. To-date, the program has seen about 600 patients.

The focus of the tinnitus service is to provide information on hearing physiology and to educate the patient on tinnitus information, tools and coping strategies.

The aims of this tinnitus counselling are;

• To change the patient’s expectation for a ‘cure’
• To reduce anxiety, fear, depression and any negative reactions
• To introduce self-help coping strategies
• To let patients know that help is available when tinnitus becomes unbearable

PHASE ONE

At the counselling session, the patient is given a questionnaire to answer and the answers are discussed. An interview then takes place to find out the history of their tinnitus, localisation, intensity and temporal variability. Pictures, models and diagrams are used to help the patient understand the auditory pathway in correlation with their audiometric results. This interaction establishes a rapport with the patient.

Different types of coping strategies using environmental sounds, music therapy, non-wearable and wearable sound devices are explained. Detecting trigger factors and cognitive behavioural therapy, and how our brain’s interpretation of auditory signals is connected with our perception and thinking processes and how habituation works are explained.

Printouts on tinnitus are given at the end of each counselling session. The patient is given the opportunity be given an email address and hand phone as helpline. All patients are given a three-month appointment to review the outcome of their tinnitus management.

PHASE TWO

Patient who are unable to manage tinnitus despite initial counselling, will be offered the Tinnitus Retraining Therapy (TRT) concept. In this treatment package, the team (Otologist, Tinnitus Counsellor/therapist, Audiologist, Psychologist) will concurrently manage the patient over a 6-month period.

The neurophysiological model of tinnitus is explained and any medical concerns addressed. The patient will then meet the tinnitus counsellor/therapist to discuss sound therapy options. Patients can select a noise generator, hearing aids, music CDs, bedside sound device or use environmental sounds. Progress with habituation is monitored after one month then two months and three months. Depending on their profile and condition, the patient would be referred to the psychologist for evaluation.

Over a six month treatment programme, the patient would have undergone a full ENT (Ear Nose Throat) evaluation by the Otologist, received counselling and gained insights on tinnitus, clarified expectations of recovery and developed sufficient coping strategies, addressing any emotional or sleep issues and received technical inputs on any wearable sound devices.

For more information and details on the Tinnitus Service, please contact Changi General Hospital at 6850 3333.