In today’s healthcare environment, it can feel like there’s a specialist – or several – for just about every ache and pain. Even a problem as seemingly isolated as tinnitus can have us navigating care with primary care clinicians, audiologists, and otolaryngologists (a.k.a. Ears, Nose and Throat or ENT doctors).
So how do we know which specialist to choose when the ringing in our ears requires professional help?
Audiologists, ENTs, and PCPs all play a valuable role in managing tinnitus. Specifically, ENTs diagnose, assess, and treat underlying medical issues related to the condition. This can be something as straightforward as an ear infection, such as otitis media, for example, which can be treated with medication. Tinnitus may also be symptomatic of more serious medical issues such as an acoustic neuroma or Meniere’s Disease. If the root cause of the tinnitus is due to a medical condition, an ENT will be crucial in the management of tinnitus – this can include addressing the underlying condition through steroids or antibiotics for acute conditions, or more intensive interventions in serious cases.
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"Treble Health helped me reduce my tinnitus by about 80%, and now I can live my life again!"
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Audiological evaluations are often either part of the ENT assessment to identify whether there is any accompanying hearing loss, and if so the degree and type of hearing loss and whether it is in one or both ears. Audiologists are involved in the monitoring of hearing status and the non-medical management of tinnitus. In some cases, audiologists will work closely with ENT when monitoring the hearing status of someone experiencing tinnitus due to an underlying medical condition – as a change in hearing and/or tinnitus status can impact the course of treatment. In other cases, where there is not necessarily an underlying medical condition, audiologists will monitor the patients’ hearing for the purpose of management – such as programming of hearing aids.
While audiologists may work in private practice independently, typically ENT physicians will have an audiologist that they work with, often in the same office, as there is a lot of overlap in patient care and usually a need for both specialties to work as part of an interdisciplinary team.
The Role Of The ENT
Ears, Nose and Throat (ENT) physicians are a subspeciality of doctors who specialize in the assessment and treatment of medical conditions that affect the head and neck. This includes tinnitus, which is the perception of sound in the ear without an external auditory stimulus. Tinnitus can occur with or without an underlying medical cause. The role of the ENT is to assess and determine whether there is an underlying cause, if so – what is the cause, and then lastly, how it should be managed.
The ENT will obtain a thorough history from the patient to determine when the tinnitus began, whether it is occurring in one or both ears, what it sounds like and if there are any other symptoms (i.e. dizziness, ear drainage). These can be clues that can help narrow determine whether there is an underlying medical cause. The ENT assessment will also include a physical exam that will include check the external ear, the tympanic membrane and often beyond the tympanic membrane under a microscope to assess if there is any issue that can be contributing – i.e. cerumen (wax), otitis media, otitis externa, cholesteatoma.
Following the exam, the ENT will likely refer the patient to an audiologist for a complete audiological evaluation. Depending on the results of the hearing test, it may be determined that further testing such as an MRI or CT scan is necessary. Based on the results of the physical exam and imaging, treatment may be provided in cases where there is an infection and or other symptoms with an underlying cause. In other cases, such as when there is accompanying hearing loss but no other medical conditions or if the tinnitus is determined to be “idiopathic,” meaning there is no underlying hearing loss or medical concern, referral will usually be made to an audiologist for non-medical management.
The Role Of The Audiologist
An audiologist is a specialist qualified in the assessment and management of disorders impacting the hearing and balance systems. This includes tinnitus assessment and management. The first step is a complete audiological evaluation, which will include testing to assess how the middle ear system is functioning, hearing levels and speech discrimination testing. Based on these results, the audiologist will be able to determine whether there is any hearing loss, if it is occurring in one or both ears and the type of hearing loss (i.e. a conductive hearing loss that is originating in the outer or middle ear vs. a sensorineural hearing loss originating from the inner ear or nerve).
Depending on the results, a referral may be made back to the ENT for medical management, treatment and/or further testing to further identify an etiology. If there is hearing loss, hearing aids may be recommended. Further in depth testing may be performed as a tinnitus assessment that may include pitch matching of tinnitus, a process whereby the exact sound the patient is experiencing is attempted to be determined, which can be useful for certain types of tinnitus therapy. Other types of management may include hearing aids, tinnitus masking devices and or Tinnitus Retraining Therapy (TRT), which is a behavioral type of therapy aimed to help cope with tinnitus.
Where Should I Go First?
It’s usually a good idea to start with your PCP- who can help direct your concerns and make a referral to an otolaryngologist (ENT) based on the complaint– or in many cases individuals may go straight to an ENT physician for an evaluation of the tinnitus, complete with an audiological evaluation by an audiologist.
Increasing interdisciplinary support is making it easier for providers in a range of specialities to work together to ensure your pain is understood and treated.
By beginning treatment with your PCP, you’re creating a powerful hub of health coordination to facilitate care. Indeed, many PCP offices today have behavioral health practitioners or meditation professionals who can assist in easing pain through therapeutic interventions and stress management modalities that don’t involve pharmaceutical means.
Managing Tinnitus
To be sure, management of tinnitus isn’t always straightforward and may necessitate engaging a full range of professionals to rule out or treat larger health problems – or just support in managing everyday stressors that cause tinnitus to flare up. In any case, trusted healthcare professionals are an essential part of navigating care.
And remember that, in the very broadest of terms, ENTs are typically called upon for medical intervention, audiologists for management of the condition, and PCPs as healthcare generalists able to adeptly coordinate care across specialties. All serve as advocates and allies in your health.
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