AudiologyOnline Phone: 800-753-2160
CaptionCall Certification Method - October 2019

What Does a Complete Tinnitus Evaluation Comprise Of?

Brianna Young, AuD, FAAA

October 29, 2018

Share:

Question

What does a comprehensive tinnitus evaluation comprise of?

    Answer

    The comprehensive tinnitus evaluation is comprised of the following components:

    1. Hearing assessment
    2. Questionnaires
    3. Tinnitus evaluation

    Hearing Assessment

    The hearing assessment is a multi-step process. First, we start with a case history/tinnitus intake interview. We obtain medical referrals as needed. As an audiologist, you are within your scope of practice to see patients without a medical referral. However, 10 to 15% of the population currently has some sort of tinnitus, and about 0.4% are significantly bothered by it. Subjective tinnitus is where patients hear ringing in their ears, with no identifiable sound source. It may be caused by hearing loss, or perhaps not. For those patients, we have to rule out any vascular, muscular, skeletal, or respiratory structure-function issues. That's where medical referrals may be necessary.

    We must also conduct an audiometric evaluation, which is important to test high frequencies, in particular at higher resolutions around where the tinnitus is suspected. Rather than the interoctaves that are commonly done at 2000, 3000, 4000 Hz, it is helpful to break down those frequencies into something a little bit smaller, like 4010 Hz, 4020 Hz, 4030 Hz. In addition, a total MCL and UCL can be beneficial during that evaluation process. Another part of the hearing assessment involves immittance measures and otoacoustic emissions. OAEs are a sensitive indicator of cochlear damage beyond what is seen on the behavioral audiogram. Often, we see OAEs affected before we see it on an audiogram. 

    Questionnaires

    Some commonly used tinnitus questionnaires include:

    • Tinnitus Functional Index
    • Tinnitus Handicap Inventory
    • Tinnitus & Hearing Survey
    • Beck Depression Inventory
    • Spuelberger State-Trait Anxiety Inventory
    • Primary Care PTSD Screen

    The first three questionnaires are commonly used: the Tinnitus Functional Index (TFI), the Tinnitus Handicap Inventory (THI), and the Tinnitus and Hearing Screening (THS). The last three inventories (Beck Depression Inventory, the State-Trait Anxiety Inventory, and the Primary Care PTSD Screen) are listed because approximately 35% of our patients with tinnitus have anxiety, between 13 to 28% of tinnitus patients have depression, and 33% approximately have insomnia. About 25% of our patients have some sort of comorbid psychiatric disorder, and about 33% of our patients with tinnitus have some sort of PTSD or Post Traumatic Stress Disorder. These inventories are a great way to help screen these patients. They might be coming to you because of the ringing in their ears, and they might not associate that with their insomnia or their anxiety. As hearing care practitioners, we can help make that connection and start that conversation with them.

    Two other inventories that might be useful: the Six Item Cognitive Impairment Test (6CIT) and the General Practitioner Assessment of Cognition (GPCOG). These questionnaires are geared more at cognition and memory issues. It does fall within the scope of practice for an audiologist to administer these inventories. However, if you're not comfortable doing that, by all means, defer it to another professional. Bring it up with the patient's general physician. If you're working in conjunction with an otolaryngologist, mention it to them and they can introduce these topics. That being said, these additional inventories are nice to have in your back pocket, especially when you suspect something else is going on.

    The Tinnitus Functional Index (TFI) is one of the newer questionnaires that has come out. It consists of 25 questions covering eight sub-scales. It includes sleep disturbance, relaxation, and quality of life. Similarly, the Tinnitus Handicap Inventory (THI) is also a 25-question inventory used to assess the patient's self-reported perception of how much their tinnitus influences their life. Both of those are good questionnaires to administer because they don't take terribly long. In addition, they've also been heavily researched and peer-reviewed. The Tinnitus Hearing Survey (THS) consists of 10 questions. It's helpful as a supplemental inventory, but it's not validated as a primary outcome measure. I would strongly caution you against using that as your only source of a tinnitus questionnaire.

    We have three tinnitus questionnaires built into our system that can be accessed through Noah: the TFI, the THI, and the THS. Figure 1 shows an example of the TFI. This is a screenshot from our Astera² Tinnitus Module. You can print this out and have the patient complete it on paper, or they can answer these questions on a touchscreen. If they complete it online, the system will score it for you and break down the patient's answers into separate categories.

    Figure 1. Tinnitus Functional Index (TFI).

    Tinnitus Assessment

    To reiterate, the following components are traditionally included in the overall tinnitus evaluation:

    • Hearing Assessment
      • Case History/Tinnitus Intake Interview (Questionnaires)
      • Medical Referrals
      • Otoscopic Examination
      • Audiometric Evaluation
        • High Frequencies
        • High Resolution around Tinnitus
        • Interoctaves
        • MCL & UCL
      • Immittance
      • Otoacoustic Emissions
    • Questionnaires
    • Tinnitus Evaluation

    When we're talking about the actual tinnitus assessment, the four key indicators are pitch matching, loudness matching, minimum masking level and residual inhibition. These indicators are important to keep in mind whenever we're billing for tinnitus. The CPT code to use for tinnitus assessment (which includes pitch, loudness, matching, and masking) is 92625. If you're only doing one ear, you will need to use the 52 modifier with that. Again, after today's general overview, if you want more detail on how to perform each of these indicators, I would strongly encourage you to check out the white papers that we've attached to this presentation, as well as the resources at the end. 

    This Ask the Expert is an excerpt from the text course, Tinnitus Toolbox. For more information please visit please visit www.otometrics.com or the Otometrics Partner Page on AudiologyOnline. 


    brianna young

    Brianna Young, AuD, FAAA

    Product Manager - Hearing Assessment

    Brianna Young, Au.D. is a part of the product management team at Otometrics Global, and has been with the company since August of 2014. She has previously worked in the North American Otometrics team and in an Otolaryngology practice with multiple locations preforming pediatric and adult diagnostic hearing evaluations, counseling, and adult hearing aid fittings. Dr. Young also has previous experience with balance testing & electrophysiological testing, as well as working in an audiology management position. She obtained her bachelors of science in Communicative Disorders from Northern Illinois University and graduated with her Doctor of Audiology degree from The Ohio State University


    Related Courses

    Tinnitus Toolbox
    Presented by Brianna Young, AuD, FAAA
    Recorded Webinar
    Otometrics North America, a division of Natus (formerly Audiology Systems)

    Presenter

    Brianna Young, AuD, FAAA
    Course: #273781 Hour
      'everything broken down and easily explained'   Read Reviews
    As Audiologists we need to understand the components of a tinnitus evaluation and have knowledge of different tinnitus management strategies. This presentation will review the basics of a tinnitus examination, as well as management options. Management options include Cognitive Behavioral Therapy (CBT), Tinnitus Retraining Therapy (TRT), Apps for a cell phone or tablet and holistic approaches. In addition to management options, a review of the “Big Six” hearing aid company’s avenues for tinnitus management will also be outlined.

    View this Course for FREE.
    Need CEUs? Become a AudiologyOnline member to get unlimited CEUs.

    Only $99/yr

    Learn More

    Capella2 - Orientation & Training
    Presented by Brianna Young, AuD, FAAA
    Recorded Webinar
    Otometrics North America, a division of Natus (formerly Audiology Systems)

    Presenter

    Brianna Young, AuD, FAAA
    Course: #307901 Hour
      'clear explanations and screen shots of actual situations'   Read Reviews
    The Capella2 is a PC based diagnostic OAE device that lives in the Otosuite universe. This course is intended to give you an overview of the hardware, software, basic test features and troubleshooting.

    View this Course for FREE.
    Need CEUs? Become a AudiologyOnline member to get unlimited CEUs.

    Only $99/yr

    Learn More

    Tinnitus Assessment in Young Musicians
    Presented by Frank Wartinger, AuD
    Recorded Webinar
    AudiologyOnline

    Presenter

    Frank Wartinger, AuD
    Course: #225901 Hour
      'ability to relate to the presenter's personal experience'   Read Reviews
    This course will review tinnitus and clinical tinnitus assessment including use of questionnaires and audiologic assessment. Various considerations and potential complications relating to the care of young musicians will be discussed.

    Please note: You may earn ABA Tier 1 credits for this course if you complete it as part of course 22950, "Current Topics in Noise Induced Hearing Loss." course 22950 contains recordings of all four events from our 2013 NIHL Series. ABA Tier 1 CEUs can be earned only when all modules are completed as part of course 22950.

    View this Course for FREE.
    Need CEUs? Become a AudiologyOnline member to get unlimited CEUs.

    Only $99/yr

    Learn More

    Proof of Zen – A Review of Research Articles
    Presented by Nancy Heflin Bridges, AuD, CCC-A
    Recorded Webinar
    Widex

    Presenter

    Nancy Heflin Bridges, AuD, CCC-A
    Course: #237431 Hour
      'interesting class'   Read Reviews
    This course will review completed research on the use of Widex Zen for tinnitus sufferers. A look at why Zen was developed, results of studies, and suggestions for clinical applications gleaned from the research will be discussed.

    View this Course for FREE.
    Need CEUs? Become a AudiologyOnline member to get unlimited CEUs.

    Only $99/yr

    Learn More

    Review of Blast Injury, Its Effects on the Ear, and Assessing Patients Who are Veterans, Presented in Partnership with the Defense Hearing Center of Excellence Supported by the Department of Veterans Affairs and the Department of Defense
    Presented by David Chandler, PhD, Mark Packer, MD, Kyle Dennis, PhD
    Recorded Webinar
    AudiologyOnline

    Presenters

    David Chandler, PhDMark Packer, MDKyle Dennis, PhD
    Course: #238341 Hour
      'This course is very interesting'   Read Reviews
    This webinar is part of a series of webinars on AudiologyOnline in June 2014 entitled, Auditory Assessment of the Blast-exposed Patient, presented in partnership with the Defense Hearing Center of Excellence supported by the Department of Veterans Affairs and the Department of Defense. This webinar will provide a review of blast injury, a discussion of the anatomical and physiological effects of blast on the ear, and cover considerations for assessing patients who are veterans.

    Please note: You may earn ABA Tier 1 credits for this course if you complete it as part of course 24668, "Auditory Assessment of the Blast-exposed Patient; Presented in Partnership with the Defense Hearing Center of Excellence supported by the Department of Veterans Affairs and the Department of Defense.” Course 24668 contains recordings of the four events from this virtual conference on the topic of Blast Exposure. ABA Tier 1 CEUs can be earned only when all modules are completed as part of course 24668.

    View this Course for FREE.
    Need CEUs? Become a AudiologyOnline member to get unlimited CEUs.

    Only $99/yr

    Learn More