Tinnitus patients need more support and advice on healthcare options

As many as one in seven people will experience tinnitus, or ringing in their ears, at some time of their life, but not enough is being done to support patients who experience this distressing condition, according to an extensive research review in the November issue of the Journal of Clinical Nursing.

Tinnitus is the most common injury arising from the conflicts in Afghanistan and Iraq and 75% of 18 to 30 year-olds who go to nightclubs and concerts may experience temporary tinnitus.

"Despite the fact that it is a very distressing condition and can affect people's lifestyle and quality of life, around 94% of patients are simply told that nothing can be done to alleviate the condition" says Professor Susan Holmes from Canterbury Christ Church University, Kent, UK.

"Tinnitus is a widespread condition that affects millions of people across the world and there is considerable debate about its causes. The condition, which can be permanent or temporary and acute or chronic, increases with age and can also occur after bereavement or during stressful periods.

"It is sometimes referred to as a 'phantom sensation' as the sound - often a high-pitched noise with mechanical, electrical or musical qualities - is experienced in the absence of external stimuli."

Professor Holmes teamed up with Mr Nigel Padgham, an ear nose and throat surgery specialist from Kent and Canterbury Hospital, to carry out an extensive research review of nearly 150 papers published since 1983.

This showed that although considerable research has been carried out on the subject, nurses - who are often the first people patients turn to - have received very little guidance or information on the condition.

"We believe that affected patients need considerable support and advice on healthcare options, encouragement to try different treatments and recognition that help and hope are available" says Professor Holmes.

"Though patients may have to learn to live with tinnitus, the most important thing is that they recognise that help is available."

Other key findings of the research review include:

• Ten to 15% of people experience tinnitus at some time in their life. Five per cent of the UK's 4.7 million sufferers experience severe and persistent tinnitus that affects their lifestyle. 19% of Americans have the condition - with only 12 million seeking help. 14.5% of Italians have prolonged spontaneous tinnitus and 1.5 million German adults experience 'considerably annoying tinnitus'.

• Tinnitus increases with age and hearing impairment and 85% of patients also have hearing loss. Only 1% of people under 45 get tinnitus, compared with 12% between 60 and 69 and 25% to 30% over 70. Women appear to experience more complex tinnitus, but the reasons are unclear.

• It is unlikely that tinnitus has a single underlying cause. Many cases relate to ageing and hearing loss, but other causes appear to be damage to the middle ear, cochlea and audiovestibular nerve and cerebral pathways between the cochlear nucleus and primary auditory cortex.

• Temporary or permanent tinnitus may be due to ototoxic medications, such as certain antibiotics and antimalarial drugs, cancer chemotherapy drugs, non-steroidal anti-inflammatory agents and diuretics.

• In most cases the onset is gradual and not attributable to any specific event. It can arise in the absence of any hearing problems.

• Various studies show that 62% of tinnitus sufferers have a "lifetime prevalence of major depression", 63% display "defined psychiatric disturbance" and 62% have "signs of lifetime depression".

"While there is debate about what causes tinnitus, it is acknowledged that both acute and chronic tinnitus can be distressing and, for some, persistent tinnitus affects their lifestyle and quality of life" says Mr Padgham.

"Although there has been a significant amount of research on tinnitus, most of this has focused on developing a better understanding of the cause and therapy rather than on its impact on patients or ways of helping them to cope with the condition.

"Most patients are told that nothing can be done, making them feel hopeless and enhancing the effect the condition has on them.

"But steps can be taken to treat or alleviate tinnitus in many cases, including medication, surgery, hearing aids to amplify external sounds and mask the tinnitus or distraction techniques, such as TV and radio. Healthcare professionals also need to tackle the psychosocial distress caused by the condition, which can include tension, frustration, anger, loss of concentration and sleep disturbance."

The researchers believe that nurses and other healthcare professionals can play a key role in making patients aware of the fact that help is available and providing them with the support they need to live with their condition.

"Telling patients that nothing can be done is not acceptable" concludes Mr Padgham. "Providing nurses and other health professionals with more information on the condition, and how to manage it, is the first step in that process."