Treatment of Tinnitus with Bilateral Moderate Sensorineural Hearing Loss in a 65-Year-Old Female
This patient should be fitted with bilateral hearing aids as the primary treatment, which will address both the hearing loss and provide significant tinnitus relief by improving quality of life and reducing psychosocial burden. 1
Primary Treatment: Bilateral Hearing Aids
The American Academy of Otolaryngology–Head and Neck Surgery Foundation strongly recommends counseling patients with sensorineural hearing loss and tinnitus about audiologic rehabilitation, with hearing aids as the cornerstone of management 1. This recommendation is based on systematic reviews demonstrating that amplification improves quality of life by reducing psychosocial and emotional manifestations in patients with both hearing loss and tinnitus 1.
Evidence for Hearing Aid Efficacy in Tinnitus
Bilateral hearing aids provide substantial tinnitus benefit: Studies show mean reductions of 32-42 points on the Tinnitus Handicap Inventory (THI) after hearing aid fitting, with significant improvements in tinnitus severity, discomfort, and persistence 2, 3
Both bilateral and unilateral fitting improve tinnitus: Even unilateral hearing aids can improve bilateral tinnitus, though bilateral fitting may offer superior outcomes for bilateral symptoms 3
Quality of life improvements are measurable: 86% of patients with hearing loss report hearing handicap, and 56% with tinnitus demonstrate handicap on validated inventories; hearing aids significantly reduce these burdens 1
Specific Hearing Aid Options for This Patient
Given bilateral moderate sensorineural hearing loss, the following options should be considered in order of preference:
1. Standard Bilateral Hearing Aids (First-line recommendation)
- Conventional bilateral amplification addresses both ears simultaneously 1
- Provides natural binaural hearing and best speech discrimination 1
- Most effective for bilateral moderate hearing loss with tinnitus 3
2. Hearing Aids with Tinnitus-Specific Programming
- Digital hearing aids with tinnitus-specific algorithms show mean THI reductions of 43.5 points 2
- These devices optimize amplification patterns specifically for tinnitus masking 2
3. Hearing Aids with Built-in Sound Generators/Maskers
- Provide the greatest tinnitus benefit with mean THI reductions of 51.9 points 2
- Combine amplification with therapeutic sound enrichment 2
- Particularly useful if amplification alone provides insufficient tinnitus relief 4
Assessment Tools to Document Baseline and Monitor Progress
Before fitting, document tinnitus severity using validated instruments 1:
- Tinnitus Handicap Inventory (THI): Measures functional, emotional, and catastrophic domains of tinnitus impact 1, 2
- Visual Analog Scale (VAS): Quantifies tinnitus loudness, severity, and discomfort 4, 3
- Hearing Handicap Inventory for the Elderly (HHIE): Assesses hearing-related quality of life impact 1
Counseling Points for This Patient
Address these specific concerns during the fitting process 1:
- Realistic expectations: Hearing aids will improve both hearing and tinnitus, but tinnitus may not completely resolve 1
- Adjustment period: Full benefit typically requires 1-2 months of consistent daily use (aim for 12+ hours daily) 4
- Bilateral vs. unilateral: For bilateral moderate loss, bilateral fitting provides superior outcomes for both hearing and tinnitus 3
- Psychosocial support: Consider referral to support groups (e.g., Hearing Loss Association of America) for adjustment counseling 1
Follow-Up Protocol
- Reassess at 1 month: Measure THI and VAS scores to document early response 4, 3
- Formal evaluation at 3-6 months: Determine if communication goals are met and hearing-related quality of life has improved 1
- Annual audiometry: Monitor for progression of hearing loss 1
Alternative/Adjunctive Options if Hearing Aids Insufficient
If standard bilateral hearing aids do not provide adequate tinnitus relief after appropriate trial:
- Upgrade to hearing aids with built-in maskers: Provides additional therapeutic sound beyond amplification 2
- Hearing assistive technology systems: Can supplement hearing aids in specific listening situations 1
- Cochlear implantation: Reserved for severe-to-profound hearing loss with persistent tinnitus; 96% of patients report tinnitus improvement post-implantation 1
Common Pitfall to Avoid
Do not delay hearing aid fitting: Many patients do not recognize hearing aids as tinnitus treatment and may resist amplification 5. Emphasize that hearing aids serve dual purposes—improving communication AND reducing tinnitus—and that waiting for tinnitus to resolve spontaneously is inappropriate when hearing loss is present 1. Patient dissatisfaction is significantly higher among those not fitted with hearing aids (61% vs. 45%) 5.