Tinnitus and Sound Sensitivity Casebook E-Book

Suzanne H. Kimball

• Herausgeber: Thieme Medical Publishers
• Kategorie: Fachliteratur
• Sprache: Englisch

Veröffentlichungsjahr: 2021

Beschreibung

Tinnitus and sound disorder case studies provide invaluable guidance on enhancing quality and scope of patient care

Tinnitus affects nearly one in 10 people around the world and tinnitus-related disabilities are considered among the most common chronic conditions reported. Historically, many patients with these conditions have been ignored, misunderstood, or misguided by medical, audiological, and/or online communities. Tinnitus and Sound Sensitivity Casebook by renowned audiologists and educators Suzanne H. Kimball and Marc Fagelson provides evidence-based strategies for clinical management of patients with tinnitus as well as sound intolerance disorders, based on a diverse array of case studies drawn from clinics.

The book is divided into three sections and 29 chapters, with insightful clinical pearls from 24 multidisciplinary authors. The first section includes 15 cases on a full spectrum of underlying medical conditions, patterns of occurrence, and tinnitus with normal hearing, followed by two cases covering hyperacusis associated with an acoustic shock and diplacusis. Section two details psychological correlates for tinnitus and disorders of sound intolerance, with practical treatment strategies and coping skills for misophonia, fear hyperacusis, hyponatremia, pediatric cases, psychogenic tinnitus and dizziness, and PTSD. The final section, "Additional Considerations," includes two areas of practice currently growing in importance: patients with COVID who notice hearing changes and the co-occurrence of sound intolerance with normal pure-tone thresholds.

Key Highlights

• Background, references, and examples of specific conditions and interventions support audiology's scope while providing options for the practitioner who works with an otherwise underserved patient population
• Each case study demonstrates the complexity of audiologic rehabilitation associated with tinnitus and disorders of sound tolerance, including challenging and unsuccessful outcomes
• Clinical history, test results, diagnosis, outcomes, questions, answers, items to support both patient and clinician self-efficacy, and key points enhance acquisition of knowledge, while encouraging problem-solving skills

This is an important textbook for every graduate course in the area of clinical audiologic practice that addresses patient management related to tinnitus and sound tolerance. It is also a must-have reference for practicing clinicians to improve management and outcomes of patients with tinnitus, hyperacusis, and misophonia.

This book includes complimentary access to a digital copy on https://medone.thieme.com.

Leseprobe

Tinnitus and Sound Sensitivity Casebook

Suzanne H. Kimball, AuD, CCC-A, F-AAAAssociate Professor and Undergraduate Program Coordinator College of Allied Health University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma, USA

Marc Fagelson, PhD, CCC-A, F-AAAProfessor of Audiology Department of Audiology & Speech Pathology East Tennessee State University Johnson City, Tennessee, USA

49 Illustrations

ThiemeNew York • Stuttgart • Delhi • Rio de Janeiro

Library of Congress Cataloging-in-Publication Data is available from the publisher.

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAwww.thieme.com [phone], [email protected]

Cover design: Thieme Publishing Group Cover image source: piano: © Robert Ruidl/stock.adobe.com (audiogram: © Thieme) Typesetting by TNQ Technologies, India

Printed in USA by King Printing Company, Inc.                                     5 4 3 2 1

ISBN: 978-1-68420-167-9

Also available as an e-book: eISBN (PDF): 978-1-68420-168-6 eISBN (epub): 978-1-63853-684-0

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Contents

Foreword

Preface

Suzanne H. Kimball

Preface

Marc Fagelson

Contributors

Section A: Medical Cases

I. Tinnitus

1.Internet-Based Tinnitus Intervention

Eldre Beukes

1.1Clinical History/Description

1.2Questions for the Reader

1.3Discussion of Questions

1.4Final Diagnosis and Recommended Treatment

1.5Progress during and after Undertaking the Intervention

1.6Questions for the Reader

1.7Discussion of the Questions for the Reader

2.Chiari Malformation with Tinnitus and Hyperacusis

Suzanne H. Kimball

2.1Clinical History and Description

2.2Audiological Testing

2.3Tinnitus Evaluation

2.4Questions for the Reader

2.5Discussion of Questions for the Reader

2.6Diagnosis and Recommended Treatment

2.7Outcome

2.8Self-Efficacy Considerations for the Clinician

3.Tinnitus Treatment Following Acoustic Neuroma and Meniere’s Disease: A Single Case Study

Ann Perreau and Richard S. Tyler

3.1Clinical History

3.2Audiologic Testing

3.3Questions for the Reader

3.4Discussion of Questions for the Reader

3.5Additional Testing

3.6Final Diagnosis and Recommended Treatment

3.7Outcomes

4.A Case of Pulsatile Tinnitus with Predictable Pattern of Occurrence

Catherine M. Edmonds

4.1Clinical History/Description

4.2Audiologic Testing

4.3Questions for the Reader

4.4Discussion of Questions for the Reader

4.5Additional Testing

4.6Final Diagnosis and Recommended Treatment

4.7Outcomes

5.Otosclerosis with Tinnitus . . . .

Lauren Mann

5.1Clinical History and Presentation

5.2Audiological Evaluation

5.3Questions for the Reader

5.4Discussion of Questions for the Reader

5.5Recommendations and Outcomes

5.6Key Points

6.Tinnitus Following Concussion

Lauren Mann

6.1Clinical History and Presentation

6.2Audiological Evaluation

6.3Questions for the Reader

6.4Discussion of Questions for the Reader

6.5Recommendations and Outcomes

6.6Key Points

7.Tinnitus in a Case of Meniere’s Disease

Lauren Mann

7.1Clinical History and Presentation

7.2Audiological Evaluation

7.3Questions for the Reader

7.4Discussion of Questions for the Reader

7.5Recommendations and Outcomes

7.6Key Points

8.A Case of a Normal Hearing with Tinnitus

Wan Syafira Ishak

8.1Clinical History and Description

8.2Audiological Testing

8.3Questions for the Reader

8.4Discussion of Questions for the Reader

8.5Additional Testing

8.5.1Audiological

8.5.2Radiology

8.6Final Diagnosis and Recommended Treatment

8.7Outcome

9.Functional Audiogenic Seizure

David M. Baguley

9.1Clinical History/Description

9.2Audiologic Testing

9.3Questions for the Reader

9.4Discussion of Questions for the Reader

9.5Final Diagnosis and Recommended Treatment

9.6Outcome

10.Postconcussive Tinnitus and Hyperacusis

Aniruddha K. Deshpande and Diana Callesano

10.1Clinical History and Description

10.2Audiologic Testing

10.2.1Case History

10.2.2Audiologic Evaluation

10.2.3Tinnitus Pitch Match

10.2.4Tinnitus Loudness Match

10.2.5Minimum Masking Level

10.2.6Loudness Discomfort Levels

10.2.7Residual Inhibition

10.3Questions for the Reader

10.4Discussion of Questions for the Reader

10.5Final Diagnosis and Recommended Treatment

10.5.1Management of Tinnitus

10.5.2Management of Reaction to Tinnitus

10.5.3Management of Hyperacusis

10.6Outcome

11.Tonic Tensor Tympanic Syndrome

Erin Benear

11.1Clinical History and Description

11.2Audiological Testing

11.3Questions for the Reader

11.4Discussion of Questions for the Reader

11.5Tinnitus Evaluation

11.6Additional Questions for the Reader

11.7Discussion of Additional Questions for the Reader

11.8Final Diagnosis and Recommended Treatment

11.9Outcome

11.10Clinician Self-Efficacy Contents

12.Tinnitus Secondary to Barotrauma

Trevor Courouleau

12.1Clinical History/Description

12.2Audiologic Testing

12.3Additional Testing

12.4Questions for the Reader

12.5Discussion of Questions for the Reader

12.6Final Diagnosis and Recommended Treatment

12.7Outcome

12.8Self-Efficacy for the Clinician

13.Acoustic Shock Disorder

Marc Fagelson

13.1Background

13.2Assessment

13.3Questions for the Reader

13.4Discussion of Questions for the Reader

13.5Outcome

13.6Clinician Self-Efficacy

13.7What Evidence Is There to Support Desensitization Strategies?

14.Acoustic Shock

Don McFerran

14.1Clinical History

14.2Audiological Testing

14.3Questions for the Reader

14.4Discussion of Questions for the Reader

14.5Additional Clinical History and Testing

14.6Additional Questions for the Reader

14.7Discussion of Additional Questions for the Reader

14.8Final Diagnosis and Recommended Treatment

14.9Outcome

15.Pulsatile Tinnitus

Jamie Myers and Rebecca Jimenez

15.1Clinical History and Description

15.2Audiological Testing

15.3Question for the Reader

15.4Discussion of Question for the Reader

15.5Tinnitus Evaluation

15.6Additional Question for the Reader

15.7Discussion of Additional Question for the Reader

15.8Final Diagnosis and Recommended Treatment

15.9Outcome

15.10Clinician Self-Efficacy Contents

II. Disorders of Sound Tolerance

16.Hyperacusis and Military Noise Exposure

LaGuinn P. Sherlock

16.1Clinical History and Description

16.2Audiological Testing

16.3Questions for the Reader

16.4Discussion of Questions for the Reader

16.5Final Diagnosis and Recommended Treatment

16.6Additional Questions for the Reader

16.7Discussion of Additional Questions for the Reader

16.8Outcome

16.9Self-Efficacy for Clinicians

17.Diplacusis or the Affected Audiologist

Marc Fagelson

17.1Background

17.2Assessment

17.3Questions for the Reader

17.4Answers to Questions for the Reader

17.5Outcome

17.6Clinician Self-Efficacy

17.6.1Can Sound Enrichment Facilitate Recovery from Diplacusis?

Section B: Psychological Correlates

I. Tinnitus

18.Tinnitus and Misophonia in an Adolescent Patient

Suzanne H. Kimball

18.1Clinical History and Description

18.2Audiological Testing

18.3Questions for the Reader

18.4Discussion of Questions for the Reader

18.5Additional Testing

18.6Additional Questions for the Reader

18.7Discussion of Additional Questions for the Reader

18.8Final Diagnosis and Recommended Treatment

18.9Additional Questions for the Reader

18.10Discussion of Additional Questions for the Reader

18.11Self-Advocacy Tips

19.Severe Hyperacusis and Tinnitus

Erin Benear and Isabella Hillerby

19.1Clinical History and Description

19.2Audiological Testing

19.3Tinnitus Evaluation

19.4Questions for the Reader

19.5Discussion of Questions for the Reader

19.6Recommendations and Outcomes

19.7Self-Efficacy Considerations for the Clinician

20.Tinnitus and Hyponatremia

Christopher Kuykendall and Suzanne H. Kimball

20.1Clinical History and Description

20.2Audiological Testing

20.3Questions for the Reader

20.4Discussion of Questions for the Reader

20.5Tinnitus Evaluation

20.6Additional Questions for the Reader

20.7Discussion of Additional Questions for the Reader

20.8Final Diagnosis and Recommended Treatment

20.9Outcome

20.10Self-Efficacy for the Clinician

21.“Ellie”: Psychological Management of Tinnitus in the Context of Pediatric OCD

Myles S. Rizvi

21.1Clinical History and Description

21.2Audiologic Testing

21.3Questions for the Reader

21.4Discussion of Questions for the Reader

21.5Final Diagnosis and Recommended Treatment

21.6Outcome

22.Psychogenic Tinnitus and Dizziness

Suzanne H. Kimball and Christi Barbee

22.1Case History and Description

22.2Audiologic Evaluation

22.3Test Results

22.4Questions for the Reader; Audiologic Evaluation

22.5Discussion of Questions for the Reader; Audiologic Evaluation

22.6Tinnitus Evaluation

22.7Tinnitus Evaluation Test Results

22.8Questions for the Reader; Tinnitus Evaluation

22.9Discussion of Questions for the Reader: Tinnitus Evaluation

22.10Balance Assessment

22.11Questions for the Reader; Vestibular Evaluation

22.12Discussion of Questions to the Reader; Vestibular Evaluation

22.13Common Features to all Appointments

22.14Hearing Aid Fitting

22.15Additional Questions for the Reader

22.16Discussion of Additional Questions for the Reader

22.17Self-Efficacy for the Clinician

23.Tinnitus and Posttraumatic Stress Disorder

Aniruddha K. Deshpande, Colleen A. O’Brien, and Jason H. Thomas

23.1Clinical History and Description

23.2Audiologic Testing

23.2.1Initial Case History

23.2.2Initial Audiologic Examination

23.3Questions for the Reader

23.4Discussion of Questions for the Reader

23.5Final Diagnosis and Recommended Treatment

23.6Outcomes

23.6.1Hearing Aid Outcomes

23.6.2Cognitive Behavioral Therapy Outcomes

23.6.3Audiologic Follow-Up

23.7Key Points

II. Disorders of Sound Tolerance

24.Poor Outcome in Misophonia Intervention despite Evidence-Based Intervention Strategies

Michael Hoffman, Jenna M. Pellicori, and Tammy Riegner

24.1Clinical History and Description

24.2Audiological Testing

24.3Additional Audiological Testing

24.4Questions for the Reader

24.5Discussion of Questions for the Reader

24.6Final Diagnosis and Recommended Treatment

24.7Outcome

25.LM (“Lisa”): Coping Skills Development for Misophonia

Jennifer Jo Brout

25.1Clinical History

25.2Audiology Report

25.3Questions for the Reader

25.4Discussion of Questions for the Reader

25.5Diagnosis and Treatment Plan (Coping Skills Development)

25.5.1General Description

25.6Specific Case Intervention Discussion and Outcome

25.7Additional Question for the Reader

25.8Outcome

26.A Case of Early Adolescent Misophonia

Ana Rabasco

26.1Clinical History and Description

26.2Questions for the Reader

26.3Discussion of Questions for the Reader

26.4Final Diagnosis and Recommended Treatment

26.5Outcome

26.6Key Points Self-Efficacy Strategies for Patients

27.Superhero Treatment for Sound Sensitivity

Melissa Karp

27.1Clinical History and Description

27.2Audiological Testing

27.2.1Pure-Tone Testing

27.2.2Sound Tolerance Testing

27.3Questionnaires

27.4Questions for the Reader

27.5Discussion of Questions for the Reader

27.6Final Diagnosis and Recommended Treatment

27.7Outcome

Section C: Additional Considerations

28.Normal Hearing

Marc Fagelson and Suzanne H. Kimball

28.1Questions for the Reader

28.2Discussion of Questions for the Reader

29.Tinnitus and CoVID-19

Suzanne H. Kimball and Marc Fagelson

29.1Simulated Case

29.2History

29.3Audiometric Test Results

29.4Questions for the Reader

29.5Discussion of Questions for the Reader

29.6Recommendations and Outcomes

29.7Self-Efficacy for the Clinician Index

Index

Foreword

As a health care provider working with patients who present with complaints of tinnitus and/or sound intolerance, you are well aware of the diverse and complex needs of these patients. You are also acutely aware of the lack of resources available to assist us in providing the appropriate clinical services. In the recent years, we have seen an explosion in the literature addressing tinnitus, primarily, and to a lesser extent sound intolerance. Yet, there still is a lack of sufficient evidence-based research to support specific diagnostic assessments and management options related to tinnitus, and even less for sound-intolerance issues.

Perhaps the lack of evidence-based practice and solid research findings on outcomes for managing tinnitus and/or sound intolerance accounts for its lack of inclusion in academic curriculums. Many academic programs cover the topic of tinnitus (and perhaps sound intolerance) in a few lectures, and a few programs have an entire course dedicated to the topic. Henry, Sonstroem, Smith, and Grush (2021) reported that according to their survey of academic programs (32/75 programs participated), all the programs who responded provide training in tinnitus management. Yet, the survey was not an in-depth one so it is not known to what extent each program defined its academic preparation and clinical experience. In addition, it is possible that only programs offering sufficient academic and clinical training in the area of tinnitus responded as the response rate was less than one-half of the programs.

Although we continue to lack in academic preparation and clinical resources, it is improving. In 2017, the Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA) included tinnitus in their standards for the first time. This should drive increased inclusion of training in this area as academic programs continue to review and update their curricula. In the meantime, practicing clinicians need resources to support their clinical preparation in order to provide best services to their patients/consumers.

This book is an exquisite contribution to expanding the academic and clinical improvements needed in this area. Creating a resource such as this compilation of case studies—illustrating how it is done clinically—is a useful tool for both academic preparation and for the practicing clinician. Each case study demonstrates a unique complexity associated with tinnitus. The inclusion, as opposed to the exclusion, of a related but still independent symptom of sound intolerance further expands the book’s usefulness. Many clinicians feel comfortable working with patients with tinnitus. This is especially the case now that so many hearing aid manufacturers offer combination units and their own priority tinnitus management programs. Yet, far fewer feel the same comfort in working with sound-intolerance issues—as the evidence supporting assessment and management is sorely lacking.

The case studies span across both pediatric and adult patients. There are a total of 29 cases included by over 24 authors. These are divided into sections on medical cases, psychological correlates, and legal considerations.

In my review of a number of the case studies, I found each one not only interesting but incredibly educational. Although I have been working with patients with bothersome tinnitus for over 20 years, I found each case offering a pearl that will raise my skill level as a clinician and push me to think outside my clinical box. The design of each case presentation gives the opportunity to solve problem, create your own solution, or provide your expert opinion before launching into a discussion about each one of the questions posed. Each discussion provides the evidence to support the author’s opinion and/or actions for additional testing. I especially appreciate the diversity of the cases and the uniqueness of the inclusion of several more challenging cases. In fact, they include cases which could be considered “not successful” or treatment failure as opposed to the typical “textbook” cases.

Overall, I am so very honored to be asked to write this foreword, but more importantly, I am so excited about the publication of this book. It should become a supplementary textbook for every graduate course in the area of tinnitus and sound intolerance, and for those who are already practicing clinicians who provide services to this population of patients, it should become a book that is easily accessible and at your fingertips. I extend my deepest gratitude to Drs. Suzanne H. Kimball and Marc Fagelson for having the idea for this book and seeing it to fruition. The profession of audiology will be elevated because of their efforts as they have provided further evidence of the autonomous but interdisciplinary practice of our profession as we strive to provide the highest level of care to our patients.

Sharon A. Sandridge, PhD

VP

ASHA Audiology Practice;

Section Head

Allied Hearing, Speech and Balance Services

Head and Neck Institute, Cleveland Clinic

Ohio, USA

Preface

Most audiologists would agree that the evaluation and treatment of patients with chronic tinnitus and sound sensitivities can be quite challenging. Clinicians may find that the time needed to adequately and efficiently manage such patients is hard to come by in a busy clinical practice. Others may feel inadequately trained to manage patients who suffer from chronic tinnitus and sound sensitivities as these patients are generally known to be more arduous than a typical patient seen in a hearing clinic. Tinnitus is reported in close to 1 out of every 10 people in the United States alone, and tinnitus-related disabilities are considered some of the most common chronic conditions reported.1 This prevalence data is similar worldwide. Audiologists may find themselves in a situation where managing these patients is part of their daily clinical routine. It is likely that an equal number of patients with these conditions present to a clinic as those seeking amplification for hearing loss. Patients with tinnitus and sound intolerances often need more help than just hearing aids alone in terms of intervention. Giving support to the field audiologist in the trenches was the impetus for this book.

Dr. Marc Fagelson and I started from the ground up with this collection of tinnitus and sound sensitivity cases several years back. We were solidly into the preproduction of the collection when the CoVID-19 pandemic began. Once the darkest days of the pandemic had passed and we began seeing patients in our clinics again, we quickly came to realize how important such a collection of case studies may be to practicing clinicians, both new and seasoned, as well as to students who may have missed valuable clinical experiences after their clinical placements shut down. In addition, there has been an uptick in patients reporting newly onset and exacerbated preexisting tinnitus post diagnosis of CoVID-19. In other words, the chance that more patients will report to audiology practitioners in the near future is growing even as CoVID-19 vaccinations reach a greater proportion of the population.

The cases herein have been separated into two general categories, namely, tinnitus and sound sensitivities, and are further sorted into medical and psychological segments. Each includes a thorough description of the patient, with most including audiometric test results. Final patient outcomes are provided when available. Readers should note the section titled “Self-Efficacy Considerations” as this section highlights the general takeaway from each case, as well as suggestions to support provision of clinical services. References and Suggested Readings have also been provided. Of special note is that not all cases were written by clinical audiologists; several cases were provided by clinical psychologists. Audiologists should strive to establish professional connections with the mental health specialist community as many patients with chronic tinnitus and sound sensitivities require additional support outside the scope of audiology practice. It behooves an audiologist to establish relationships with local mental health providers, especially if patients with tinnitus and sound sensitivities show significant and life-threatening distress.

I personally established a tinnitus clinic almost a decade ago at the university speech and hearing center where I teach and supervise graduate students. This was done out of a great need which stemmed from lack of resources in our community and across our rural state for patients with tinnitus and sound sensitivities. Patients have literally flocked to our clinic as many patients with these conditions have been ignored or misguided by the medical, audiological, and/or online communities. Many of our patients are desperate, mainly to be “heard” by a practitioner, and to be guided through management with sound science and principles. The goal of this book is to do the same and help guide the practitioners navigate the challenges of tinnitus and sound sensitivity.

Indeed, guiding patients with tinnitus, hyperacusis, or misophonia through the evaluation and treatment process can be difficult. Proper training in tinnitus evaluation and management is essential. Seeing patients with these conditions successfully manage their symptoms has been one of the greatest accomplishments of my professional career. I hope you enjoy reviewing these cases as much as Dr. Fagelson and I enjoyed editing them.

I cannot end this preface without acknowledging many people. First, I want to thank the many hundreds of tinnitus and sound sensitivity patients I have seen throughout the years; my teaching, research, and clinical pursuits have all been because of wanting the best for each of you. To the many students I have taught over my decades in the university setting, I hope that I am able to leave a little part of me within each of you, so that my work in the classroom and in the clinic can be carried on for many years to come. My thanks also to my co-editor, Dr. Marc Fagelson, for teaming up with me on this crazy adventure, even in the midst of a pandemic! Thanks to my favorite people in this life, my husband Roger and kids Annette, Jared, and Madeline who are always there to support me with a kind and encouraging word.

My biggest “thank you” goes out to my mom and dad, Rita and Peter, for always believing in me, bragging on my every accomplishment, both big and small, and always calling me their favorite!

I hope you enjoy this collection.

Reference

[1]Bhatt JM, Lin HW, Bhattacharyya N. Prevalence, severity, exposures, and treatment patterns of tinnitus in the United States. JAMA Otolaryngol Head Neck Surg. 2016;142(10):959--965

Suzanne H. Kimball, AuD, CCC-A, F-AAA

Preface

Patients experiencing bothersome tinnitus and problems related to sound intolerance remain an underserved population, often in need of substantial help from audiologists, psychologists, and physicians. Many academic programs in audiology struggle to provide classroom and clinical opportunities for students to gain experience and confidence working with patients whose conditions may not respond favorably when compared to the more routine interventions practiced in audiology clinics, or covered in audiology classes. This book of cases will not solve the problem. However, it presents reports from clinicians whose experiences provide both enlightening and cautionary tales intended to support patient care, clinicians’ self-efficacy, and student learning.

Patients whose cases appear in the text represent some of the more challenging clinical encounters facing hearing health care providers. Sound intolerance comes in many forms, and the text offers several examples of clinicians employing innovative interventions that rely on desensitization and other forms of exposure therapies intended to reduce the patients’ powerful aversions to specific sounds and situations. Similarly, the text provides examples of clinical interventions that may be adapted in order to address, in a reasonable manner, patients' reported problems. Several of the chapters contain specific tips for clinicians to consider; these suggestions should support clinicians’ certainty, or self-efficacy, regarding their ability to provide for patients. As with any aspect of practice, the onus is on the provider to earn the patient’s trust. But this process likely begins with the providers feeling confident about their grasp of the patient’s condition, as well as their familiarity with the strategies available as clinical interventions. This text will support the audiologist who needs to understand and help guide the patients’ rehabilitation journey when confronted by tinnitus and sound intolerance.

Does the number of patients requiring services for tinnitus and sound intolerance resemble the number of patients who would benefit from hearing aid use? Clearly, audiologists have expressed their choice; many more practitioners appear more willing and able to fit hearing aids than to take on the challenges associated with tinnitus and sound intolerance. Professionally, this situation represents a failure on many levels, from programmatic instruction to the availability of clinical opportunities. Ironically, many individuals seek careers in audiology with the somewhat vague goal of “helping others.” Vague though it may be, the notion of reducing others’ suffering, in this area of audiology’s scope, requires a provider who is willing to learn novel strategies relevant to underserved and often-desperate patients. We hope that exposure to cases provided by active clinicians willing to take on the challenge will help others accept the feasibility of such a practice.

I am grateful for the collaboration required to produce this text. Dr. Suzanne H. Kimball contacted me a few years ago with support from Thieme Publishers. Dr. Kimball steered us through unprecedented circumstances, maintained focus, recruited authors, and somehow found the time to keep her own program’s needs met. I’ve worked closely with her for more than 2 years, and we’ve still not met in person. For all I know, each time we have spoken, she was sitting in a canoe in her office! During our discussions, we often came back to a point of emphasis: Patients who suffer the most, in many ways, offer the provider the greatest opportunity to help. We hope this modest text will spark interest in, and care for, patients whose needs often go unmet. Come join us in this endeavor, we need you!

Marc Fagelson, PhD, CCC-A, F-AAA

Contributors

David M. Baguley, PhD Professor in Hearing Sciences Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham Nottingham, UK

Christi Barbee, AuD Associate Professor University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma, USA

Erin Benear, AuD, CCC-A Clinical Assistant Professor–Clinical Coordinator Department of Communication Sciences and Disorders University of Oklahoma Health Sciences Center, College of Allied Health Oklahoma City, Oklahoma, USA

Eldre Beukes, PhD Audiologist and Lecturer Vision and Hearing Sciences Research Centre, School of Psychology and Sport Sciences Anglia Ruskin University Cambridge, UK

Jennifer Jo Brout, PsyD Licensed Professional Counselor JJB Counseling & Consultation, LLD International Misophonia Research Network Bay Pines VA Healthcare System Bay Pines, Florida, USA

Diana Callesano, AuD, CCC-A/FAAA Audiologist Hearing and Tinnitus Center Woodbury, New York, USA

Trevor Courouleau, AuD, CCC-A Clinical Associate Professor of Audiology Department of Communication Sciences and Disorders OSU Speech-Language-Hearing Clinic, 042 Social Sciences and Humanities Stillwater, Oklahoma, USA

Aniruddha K. Deshpande, PhD, CCC-A Associate Professor; Director The Hear-Ring Lab, Department of Speech-Language-Hearing Sciences Hofstra University Hempstead, New York, USA

Catherine M. Edmonds, AuD, CCC-A, ABA CH-TM Audiologist Bay Pines VA Health System Bay Pines, Florida, USA

Marc Fagelson, PhD, CCC-A, F-AAA Professor of Audiology Department of Audiology & Speech Pathology East Tennessee State University Johnson City, Tennessee, USA

Isabella Hillerby, BS Doctor of Audiology Student Department of Communication Sciences and Disorders College of Allied Health, University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma, USA

Michael Hoffman, PhD Nemours Children’s Health and Assistant Professor of Pediatrics Sidney Kimmel Medical College Thomas Jefferson University Philadelphia, USA

Wan Syafira Ishak, B. Audiology (Hons), PhD Senior Lecturer & Audiologist Audiology Program, Centre for Healthy Ageing and Wellness (H-CARE) Faculty of Health Sciences, Universiti Kebangsaan Kuala Lumpur, Malaysia

Rebecca Jimenez, AuD USA

Melissa Karp, AuD Audiologist Audiology & Hearing Service of Charlotte Charlotte, North Carolina, USA

Suzanne H. Kimball, AuD, CCC-A, F-AAA Associate Professor; Undergraduate Program Coordinator College of Allied Health, University of Oklahoma Health Sciences Center Oklahoma City, Oklahoma, USA

Christopher Kuykendall, AuD Audiologist Mercy Health Systems Oklahoma City, Oklahoma, USA

Lauren Mann, AuD, PhD School of Health Professions Department of Hearing and Speech University of Kansas Medical Center Kansas City, Kansas, USA

Don McFerran, MA, FRCS Consultant ENT Surgeon East Suffolk and North Essex NHS Foundation Trust Colchester, UK

Jamie Myers, AuD USA

Colleen A. O’Brien, AuD, CCC-A, F-AAA Research Audiologist NYU Grossman School of Medicine, Manhattan VA Medical Center New York, USA

Jenna M. Pellicori, AuD, CCC-A Nemours Children’s Health and Assistant Professor of Pediatrics Sidney Kimmel Medical College Thomas Jefferson University Philadelphia, USA

Ann Perreau, PhD Associate Professor of Communication Sciences and Disorders; Audiology Clinic Coordinator Augustana College Rock Island, Illinois, USA

Ana Rabasco, MA Department of Psychology Fordham University New York, USA

Tammy Riegner, AuD, CCC-A Nemours Children’s Health and Assistant Professor of Pediatrics Sidney Kimmel Medical College Thomas Jefferson University Philadelphia, USA

Myles S. Rizvi, PsyD Licensed Clinical Psychologist; Senior Clinician NW Anxiety Institute, NW Anxiety Pediatrics Portland, Oregon, USA

LaGuinn P. Sherlock, AuD, CH-TM US Army Public Health Center Army Hearing Program Aberdeen Proving Grounds Aberdeen, Maryland, USA

Jason H. Thomas, Au.D, CCC-A, F-ADA Clinical Coordinator of Audiology Adjunct Professor St. John’s University Queens, New York, USA

Richard S. Tyler, PhD Professor of Otolaryngology; Professor of Communication Sciences and Disorders Roy J. and Lucille A. Carver College of Medicine Department of Otolaryngology – Head and Neck Surgery, University of Iowa Iowa City, Iowa, USA

Section A: Medical Cases

I: Tinnitus

1 Internet-Based Tinnitus Intervention

2 Chiari Malformation with Tinnitus and Hyperacusis

3 Tinnitus Treatment Following Acoustic Neuroma and Meniere’s Disease: A Single Case Study

4 A Case of Pulsatile Tinnitus with Predictable Pattern of Occurrence

5 Otosclerosis with Tinnitus

6 Tinnitus Following Concussion

7 Tinnitus in a Case of Meniere’s Disease

8 A Case of a Normal Hearing with Tinnitus

9 Functional Audiogenic Seizure

10 Postconcussive Tinnitus and Hyperacusis

11 Tonic Tensor Tympanic Syndrome

12 Tinnitus Secondary to Barotrauma

13 Acoustic Shock Disorder

14 Acoustic Shock

15 Pulsatile Tinnitus

1 Internet-Based Tinnitus Intervention

Eldre Beukes

1.1 Clinical History/Description

Patient A attended his local tinnitus clinic due to distressing tinnitus. He had a mild hearing loss and was not using hearing aids. An initial tinnitus therapy session provided explanations about tinnitus and sleep hygiene. Practically arranging appointments was difficult as he was employed abroad and was not able to attend his local clinic frequently. The clinic suggested registering for a study looking at the effects of an Internet-based tinnitus intervention as this was prior to teleaudiology being frequently used. The patient registered and completed the screening questionnaire. This indicated that he was aged between 40 and 50 years. He had experienced tinnitus constantly for 2 years in both ears. The tinnitus was described as a complex presentation of ringing, buzzing, low and high pitched sounds, pulsating, clicking, music, voices, and humming. He attributed his tinnitus to long periods of exposure to noise without adequate hearing protection. He described being generally grumpy and irritable as a result of the tinnitus. Specific difficulties included trouble getting to sleep, concentrating, and hearing on his mobile phone and the television. Loud noises were annoying and aggravated the tinnitus. Hyperacusis together with tinnitus resulted in him being unable to do the things he previously enjoyed. Although he was struggling to hear, he did not want hearing aids. He explained that he hated anything in his ears.