Tinnitus. III: The practical management of sensorineural tinnitus.

A weekly tinnitus clinic at University College Hospital, London, has been in existence since 1976. By developing a holistic and multidisciplinary approach to the management of tinnitus, we have been able to help the majority of patients referred with severe and disabling tinnitus. We have developed a protocol for the clinical assessment of tinnitus as a disability, and a strategy of investigation and reassurance based on the patient's understanding of the underlying mechanisms involved in tinnitus generation. Most treatment is aimed at bringing about a process of habituation (which occurs naturally in the majority of people experiencing tinnitus over a period of time). Symptom control is required in about half the patients referred, and various techniques are discussed including prosthetic masking devices, psychological approaches, drug therapy and electrical tinnitus suppression.