The author of this article explains the evidence for connections between tinnitus and Posttraumatic Stress Disorder (PTSD). In the initial paragraph he lists several articles that support a co-occurring relationship and related neural mechanisms. The article jumps back and forth in presenting the information and keeps a central focus on PTSD and its impact on assessment protocols. The article is presented in the Journal of Audiology, so this could explain the emphasis on the psychological aspect of the equation. Audiologists have a unique perspective in their field of practice and would not need a substantial explanation of auditory pathology, hence the concentration on the psychological effects and the similarities in treatments for both PTSD and tinnitus.
The paper details the similarities in diagnostic criteria for symptoms of increased arousal compared to the diagnostic criteria for tinnitus, such as difficulty in falling asleep, irritability or outburst of anger, difficulty concentrating, hypervigilance and exaggerated startle response. The symptoms of sleep disorder and concentration difficulties translate directly to tinnitus screening measures along with hypervigilance and exaggerated startle response as relational to irritation and anger associated with tinnitus. The overlap of symptoms suggests that the presence of both diagnoses would exacerbate either condition bi-directionally. Of 300 patients studied, 34% had both conditions.
The author suggests that clinical evaluations and mental health screenings, when dealing with trauma related disorders and audiology assessments should include screening criteria for both tinnitus and PTSD. He suggests that audiology testing should incorporate sensitivities to patients with diagnosed and undiagnosed PTSD, as the startle responses could be increased with the sudden tones and high pitches related to auditory testing. Many patients self-report of the resounding silence within the sound booth as an anxiety stressor, and listed many offending characteristics of the hearing screening regimen.
One word used throughout the paper that struck me as possibly harmful in translation to the population was the repeated use of the word “complaint” and its many variations. The medical model uses many such words in addressing medicalized “problems” which maintain a distance between the medical profession and patients. With and understanding of comorbid etiology, social workers can better assess the individuals situation and provide a better chance of successful outcomes in treatment and referrals more conducive to the clients best interest. Recognition of treatment modalities that could benefit both conditions, the client can find relief from an efficient use of time and techniques employed by the educated social worker. Treatments indicated to work in both conditions are antidepressants and cognitive-behavioral therapy.
Fagelson, M. A. (2007). The association between tinnitus and posttraumatic stress disorder. American Journal of Audiology, 16, 107-117.