Henry James A, Manning Candice
Veterans Affairs Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR.
Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland.
Am J Audiol. 2019 Apr 22;28(1S):152-161. doi: 10.1044/2018_AJA-TTR17-18-0038.
Purpose Clinical services for tinnitus are needed by millions of people annually. These services have not been standardized, and patients are vulnerable to receiving services that may appear legitimate but are not based on research evidence. The purpose of this clinical focus article is to promote standardization of tinnitus services by proposing an efficient clinical protocol for audiologists. Method The suggested clinical protocol is based primarily on research conducted at the National Center for Rehabilitative Auditory Research for the past 2 decades, with the focus on 2 randomized controlled trials completed recently that showed efficacy of an audiologic protocol involving hearing aids and brief tinnitus counseling. The protocol is mostly consistent with clinical practice guidelines that have been published. Results The two National Center for Rehabilitative Auditory Research randomized controlled trials revealed significant reduction of tinnitus functional effects for both hearing aids and "combination instruments" (hearing aids with a built-in sound generator), although there were no significant differences between devices. Existing clinical practice guidelines for tinnitus are summarized with respect to their common recommendations for assessment and intervention. Conclusions A defined clinical protocol is suggested for audiologists, which includes a case history, appropriate referral, audiologic assessment, use of the Tinnitus and Hearing Survey ( Henry, Griest, et al., 2015 ), brief tinnitus counseling, hearing aids or combination instruments as warranted, follow-up assessment, and criteria for determining if further tinnitus-specific services are needed. Use of this protocol can help to promote standardization of tinnitus practice by audiologists.
目的 每年有数百万人需要耳鸣临床服务。这些服务尚未标准化，患者容易接受看似合理但并非基于研究证据的服务。这篇临床聚焦文章的目的是通过为听力学家提出一种高效的临床方案来促进耳鸣服务的标准化。方法 所建议的临床方案主要基于国家康复听觉研究中心在过去20年进行的研究，重点是最近完成的两项随机对照试验，这两项试验表明一种涉及助听器和简短耳鸣咨询的听力学方案具有疗效。该方案与已发表的临床实践指南基本一致。结果 国家康复听觉研究中心的两项随机对照试验显示，助听器和“组合器械”（带有内置发声器的助听器）对耳鸣功能影响均有显著降低，尽管不同器械之间无显著差异。总结了现有耳鸣临床实践指南中关于评估和干预的常见建议。结论 为听力学家建议了一种明确的临床方案，包括病史、适当转诊、听力学评估、使用耳鸣与听力调查问卷（亨利、格里斯特等人，2015年）、简短耳鸣咨询、根据需要使用助听器或组合器械、随访评估以及确定是否需要进一步耳鸣专项服务的标准。使用该方案有助于促进听力学家耳鸣诊疗的标准化。
