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Initial Consultation

Initial consultation

Based on the research conducted by Dr. Aazh’s tinnitus team, 19% of the patients describe their tinnitus as buzzing noise, 12% as high-pitched noise, 12% as hissing noise, 12% as whistle, 10% as waterfall and grinding wheel, 2% as ringing, 2% as white noise, 2% as wind noise, 2% as aeroplane taking off, 2% as bubbles and clicks, 2% as beep, 2% humming noise, and about 20% were not able to describe the sound of their tinnitus. Hyperacusis is intolerance to certain everyday sounds that causes significant distress and impairment in social, occupational, recreational, and other day-to-day activities. Intolerance to certain sounds related to eating noises, lip smacking, sniffing, breathing, clicking sounds, burping, sneezing, coughing, and tapping noises is also known as misophonia or annoyance hyperacusis.

Your first appointment typically involves an initial assessment of the severity of your symptoms, counselling and discussing a rehabilitative therapy programme that suits you. Appointments are typically 60 minutes and offered either face-to-face in our Guildford and London clinics or via Skype.

In the first consultation, an in-depth interview will be conducted in order to explore the impact of tinnitus/hyperacusis/misophonia on the patient’s day-to-day activities or mood and the underlying mechanism that these disturb the patient’s life. The information gathered via the in-depth interview in combination with the data collected from a wide range of questionnaires will be used in order to formulate a treatment programme if needed.

For many patients the initial consultation is all they might need. Patients and parents (in the paediatric clinic) report that the initial consultation was the most enlightening in helping them to understand how to move forward.

During the initial consultation the following tasks will be taken (For more description of the questionnaires used see the factsheet for psycho-audiological assessment.

  • Detailed medical and audiological history
  • Mental health history
  • Assessment of the impact of tinnitus on your life
  • Assessment of tinnitus loudness and annoyance
  • Hyperacusis assessment
  • Misophonia assessment
  • Impact of tinnitus on your sleep
  • Anxiety and depression related to tinnitus, hyperacusis, noise sensitivity and misophonia
  • Exploring tinnitus/hyperacusis-related distress and cognitive behavioural formulation
  • Education and counselling so you fully understand appropriate management/coping strategies
  • You will be given clear guidance on what to do next
  • If the decision is that you would need to enrol in the therapy, then you will be given a clear treatment plan
  • All patients will receive a comprehensive report on the findings of the initial consultation with details of the treatment plan (if needed) and recommendations

research highlight

  • A recent study conducted by Dr. Aazh’s tinnitus team which was published in the International Journal of Audiology showed that the use of certain questionnaires can help audiologists to assess severity of the symptoms and emotional impact of tinnitus, hyperacusis and misophonia on patients. So in the initial assessment for tinnitus, hyperacusis or misophonia expect to be asked to complete a wide range of questionnaires. If you find any of them difficult then please feel free to ask your audiologist for assistance.
  • Abnormal scores on the questionnaires do not always mean that the patient is currently experiencing distress related to their tinnitus, hyperacusis or misophonia. Specialised version of cognitive behavioural therapy (CBT) for tinnitus/ hyperacusis/misophonia rehabilitation is only needed if the patient experiences current tinnitus and/or hyperacusis/misophonia-related distress, in the other words if their day-to-day activities or mood are affected due to their tinnitus or sound intolerance. A pioneering study by Dr. Aazh and his team showed that about 70% of patients with abnormal scores on questionnaires presented with tinnitus- and/or hyperacusis-related distress warranting specialised CBT. For 30% of patients there was no current tinnitus and/or hyperacusis-related distress, although approximately half of them were experiencing some form of emotional distress which they assumed was due to their tinnitus. For these patients (15% of the total) it was agreed that the emotional disturbances they were experiencing did not seem to be related to their tinnitus and/or hyperacusis/misophonia and were more likely to be related to an underlying psychological disorder. Hence, they were put in touch with appropriate mental health professionals for further psychological evaluations and treatment.
  • The interesting point is that there was no considerable difference in the scores on questionnaires between the patients who shown to have current tinnitus and/or hyperacusis/misophonia-related distress and patients whose symptoms did not interrupt their day-to-day activities or affect their mood. Therefore, use of questionnaires alone does not help to accurately identify patients who might benefit from specialised CBT and in-depth interview is needed during the initial consultation for patients with tinnitus, hyperacusis, and misophonia.