A Message to All ENTs

I thought I would take a moment to address all ENTs out there who bother to see tinnitus patients and charge them to be seen. This especially goes out to the second of the two ENTs I saw:

Fuck you.

Seriously, I don't think I have ever wasted more time in my entire life than going to see an ENT. That appointment was a two months wait just to be told "Well we don't know why you have it and nothing can be done about it". I mean, shit, I could have told myself that. My second ENT just read off a list of "things to avoid" as a means of dealing with tinnitus and recommended masking and coping. He wrote everything down for me to follow and I threw it in the trash as I was leaving. I told him not to insult my intelligence by telling me of treatments I already know of, to which he got smart with me.

I've been told an audiologist that specializes in tinnitus is worth it. Otherwise, do not bother going to see an ENT unless you suspect its from a clear treatable problem such as earwax or ETD. Otherwise they and are pretty worthless.

 

If you go this way, ensure that it is someone who maintains a real interest in the specialty, and is fully qualified. I've seen a real audiology specialist with no commercial interests, and I've seen the modestly curious short-course-qualified hearing-device salesperson pretending to have specialized knowledge. There is a world of difference.

 

I can only concur whole-heartedly.

 

Yes, I agree with you. My last ENT deserves these two words too. My next step is an a appoinment with an otologist, although the date I'll be given is still unknown because of the long waiting lists of our Health System. I want to get a Baha implant if possible, but I might die trying with such a long wait.
I'm sorry about you having a horrible time, I'm not in a better situation, believe me.
I wish you well.

 

I agree. They are all a bunch of c**ts. Only in it for the money and ruining peoples lives.

 

Hi @Gl0w0ut

I am sorry to hear of the experience you have had when seeing your ENT doctor. I do believe the majority of them want to do the best for their patient. Unfortunately if there is no underlying medical problem that is causing the tinnitus there is not much they can do. The right and proper thing to do which is what happens here in the UK, when tinnitus becomes a problem, is to be referred to see a Hearing Therapist or Audiologist who's trained in the treatment and management of tinnitus. In the UK, all medical treatment consultations equipment etc, are free at the point of delivery. Our health system isn't perfect and also has its problems. Some people in the UK have told me they've been treated in a cavalier way by their ENT doctor, once tests show there is underlying medical problem causing the tinnitus. The attitude by some is: There's no cure you have to learn to live with it. It still happens but things are improving.

Yesterday I wrote a post on a thread that I had started. Against my better judgement I later edited that post and regret it. I believe in expressing what I believe in as long as it's in the terms and conditions of this forum. I say again, I have a lot of respect for doctors and health professionals. In 2010 my tinnitus reached very severe levels and if it wasn't for the dedication and care of my: GP, ENT consultant and Hearing Therapist, I don't know what I would have done and have a lot to thank them for. Anyone that is interested please see my post below as I originally intended it to be read.


The Tinnitus experts

I first got tinnitus twenty one years ago and with it severe hyperacusis. This was caused by listening to music through headphones at too high a volume, although at the time I wasn’t aware I was causing harm to my auditory system. I had TRT which required wearing two white noise generators for up to 10 hours a day and used a sound machine at night for sound enrichment. The treatment lasted two years and fortunately the tinnitus reduced to a low manageable level and the hyperacusis was completely cured and has remained so till this day.

In 2008 my tinnitus increased severely and believe this was caused by a second noise trauma although I’m not completely sure. One evening I listening to some classical music through my HI-FI. Afterwards went to bed and the next morning woke with the tinnitus much more intrusive. This grew louder over the following days and weeks requiring me to return to ENT. I started TRT for the second time and it took four years for me to habituate.

I have counselled people with tinnitus on the telephone, corresponded with them by email and at tinnitus forums. Many things can cause this condition and therefore do not consider myself a tinnitus expert. Neither am I medically qualified in this field but want to explore tinnitus when it was caused by “loud noise” and not an underlying medical condition and those we seek for help with it. The most common cause of tinnitus is loud noise exposure. It is frequently brought on by using headphones at high volume and regularly attending venues where high sound levels are easily reached. Clubs, concerts and even the cinema.

I have mentioned the above as I want to convey my personal experience with “noise induced tinnitus” and the people that have contacted me for help with it. Anyone that has read my posts on headphone use and tinnitus, will know I am resolute in my belief, that those with noise induced tinnitus should not use headphones, earbuds, earphones or any type of headset to listen to audio even at low volume. Although some people with noise induced tinnitus use headphones and have no adverse effects, I believe there is always a risk of making the tinnitus spike resulting in it becoming louder and more intrusive. I have read many emails and posts from people regretting returning to headphone use after they have habituated and notice their tinnitus increased and will not reduce to its previous manageable level.

I have every respect for ENT doctors and other health professionals that work in ENT that are committed to helping people with tinnitus to have a better quality of life. I was once told by an ENT doctor, he is a physician not a tinnitus expert. When there is no underlying medical problem causing the tinnitus, the patient is usually referred to a Hearing Therapist or Audiologist that specialises in the treatment and management of tinnitus. It is not unusual to find some of these health professionals, were either born with tinnitus or acquired it at some time in their life. They will usually have a level of understanding of tinnitus and be able to empathise with a patient in a way that ENT doctors can’t.

@Taylorslay is a member of this forum and has recently acquired tinnitus and hyperacusis listening to loud music through headphones/earbuds. She is in the early stages and many of us know how stressful this can be. She recently contacted me for help and explained how her tests and consultation went at ENT. Her doctor and Audiologist have said her bilateral hearing tests show that she has perfect hearing. This will not come as a surprise to some people as it’s well known not everyone with tinnitus has hearing impairment. However, what I found most alarming was the fact these health professionals told Taylorslay, they can’t understand the reason she has tinnitus and hyperacusis. I
kid you not and I’m aghast at their level of ineptness. Taylorslay cannot understand it either and goes on to say: she is concerned that these health professionals went through years of education and can’t give her an answer.
Taylorsaly asked the health professionals a number of questions about tinnitus and their adroit reply was: The brain and ears are mysterious things don’t worry you’ll be fine.

Michael

 

It's not really their fault there is currently no real treatment. What did you expect? That he would come up with some magical cure?

Some could be more understanding but really, that's all they can do.

 

I posted this on another thread, sometimes I think our anger is misdirected. Hate the message not the messenger. No one wants to be told they have to live with a chronic condition. An audiologist is not going to have a cure either.

I do think delivery of the message matters, too. One ENT tried to sugarcoat it, which annoyed me, but one of the best ear specialists was brutally honest and thought that masking was a poor substitute for an actual permanent cure.

 

In the link below contains the 'Clinical Practice Guideline: Tinnitus' It's 40 long pages.

* Most ENTs are employed by hospitals
* Hospitals place pressure on associated doctors to schedule volume
* Besides doctors receiving a salary they often get a base paid insurance premium
* ENTs will offer MRIs because there's a large profit in received payment from insurance companies
* ENTs will prescribe drugs because drugs companies give incentive payments
* Often ENTs will not offer a team approach
* Some who have seen one ENT with being told to 'live with it' have received compassion from another
ENT where therapy, often having limited results, Will have some results
* Tinnitus can be caused by other things besides just hearing loss, wax in ears, ETD, fluid, infection and viruses
Not all ENTs bother to have patients examined in finding the condition or disease that's underlining

Most ENTs therefore do not follow this Practice Guide - The system doesn't allow it

http://journals.sagepub.com/doi/pdf/10.1177/0194599814545325

 

I did not, but you appear to have missed the point of my complaint. Why see patients you know you can do nothing for? I know the answer to that question, but it remains still.

 

They have to have a consultation with the patient @Gl0w0ut and then carry out various tests on a person's auditory system to try and find out what is causing the tinnitus. The text below is taken from my article Tinnitus A Personal View. Please take note of the last paragraph.

Your consultant or ENT specialist will usually start off by asking you a series of questions that will probably begin with, how long have you been experiencing tinnitus and when did it start? Is this the first time that you have noticed ringing in your ears? Do you experience the noise in just one ear or is it in both and whether the tinnitus is constant or intermittent? You will probably be asked to explain in detail what the tinnitus sounds like, does the noise change or remain the same? Tinnitus can vary considerably between people from buzzing, whistling, ringing and sometimes musical tones are heard. Some people hear multiple tones.

One of the most common sounds is hissing, which resembles white noise as if a radio has been tuned between two stations. These questions are important so try to remain calm. You will probably be asked when does it bother you the most and how does it affect your quality of life and day to day living and whether you are able to work? A common question is do you have any idea what might have caused the tinnitus, as many things can cause it. Whilst this is going on your doctor will be listening and observing your body language as this can give an indication of how the tinnitus is affecting you physically and emotionally. The questions are necessary for it is you that is experiencing the tinnitus, as no one else can know what you are going through. Notes will be taken about your medical history and whether you are taking any medication. Some medicines, beta-blockers for example can cause ringing in the ears and aspirin has been known to cause it too.

Your occupation could also give an indication as to the cause of your tinnitus, especially if you work in a noisy environment or operate machinery where noise levels are high. You may be off work sick due to your tinnitus which is not uncommon. An important piece of information is what do you like to do socially. Do you attend nightclubs or visit places where music is played loud regularly? Many people enjoy a night out on the town and have experienced ringing in the ears after they have left a club. Going to gigs and clubs and subjecting one’s hearing to high sound levels over a period of time can cause tinnitus to become permanent so it’s something to keep in mind.

At some point your doctor is likely to look into your ears using an Auriscope to inspect the ear canal and also the eardrum. It is similar in size to a small hand held torch and has a magnifying glass attached. A light shines through this allowing the doctor to see if there is any wax-build up in the ear which is another thing that can cause tinnitus. If everything is fine this part of the consultation will be drawing to a close. The next step is, you will probably be asked to take a hearing test, which will be carried out by an Audiologist in a sound proof room. You will be given a pair of headphones to wear and a selection of audible tones will be played and you will be asked to press a trigger on a hand held device when you hear each one.

Another test that the audiologist might perform is a Tympanometry examination. This will check the condition of the middle ear and mobility of the eardrum (tympanic membrane) and how the three smallest bones in the human body are fuctioning: the Malleus, incus and stapes. The test will measure your ears response to both sound and pressure and can detect things like hearing loss, fluid in the middle ear, otitis media (ear infection) and a perforation or tear in the eardrum and other problems associated with the inner ear. A small plastic bung rests in the ear and seals it. A machine gently changes the pressure in the ear canal and the results will be recorded on a graph called a tympanogram. Afterwards you will wait to see the ENT specialist again who will go through the results of your hearing tests that were plotted on an audiogram. With the onset of tinnitus especially caused by exposure to loud noise, it is not unusual to find there are signs of some hearing loss but not in all cases.

Another procedure that tinnitus patients are likely to have is an MRI scan. Magnetic Resonance Imaging. It will enable the ENT specialist to closely examine the inside of your ear and brain to see if there is an acoustic neuroma present. An acoustic neuroma is a benign slow growing tumour attached to the eighth cranial nerve, also known as the vestibulocochlear nerve. It connects the inner ear to the brain. It can cause problems such as hearing loss, dizziness and tinnitus.

If your hearing test and MRI scan show no abnormalities, then it’s likely your doctor will discuss with you the different treatments that are available to help you manage and cope with your tinnitus better. Most people will be referred to a Hearing Therapist.

 

Without examining you, he did not know he could do nothing for you. There are some causes of tinnitus that can be addressed. And if he already knew — reviewed previous tests or another ENT’s report — he likely thought you made an appointment because you wanted additional information and guidance.

In what scenario would you have been pleased with your ENT appointment? Does that scenario involving anything that was actually in his control?

 

@Michael Leigh From my post above, I respectfully don't think that many ENTs get involved with cause and treatment to the extent mentioned in your post. At least not on the West coast of the USA.

ENTs do perform surgery if something shows up on a scan - ears or neck. In fact ENTs spend more time in surgery than seeing patients per appointments.

Audiologist are more concerned in finding problems. There's also a large profit made with hearing aids.

It often depends on the area where there may be many lower and middle incomes and that often reflects on insurance. Medicare does not cover full expenses unless a patient has over plan coverage.

I had worked for one of the largest trauma level 1 hospitals on the US West coast. At that time, the average time a patient spent with an ENT without hearing assessment was 25 minutes. This hospital employed 22 ENTs. Most of these ENTs had practicing rights with other hospitals or other contracted companies. Waiting rooms had patients standing because all the chairs were taken.

 

This was my SECOND ENT visit, meaning my initial examination was already done. I mean, hell, after a hearing test he only speculated that it was potentially HFHL. This guy knew nothing could be done, and my only regret was not getting in his face more about wasting my time and telling him how worthless of a doctor his is to tinnitus patients.

Even if diagnostics were done, he would still conclude with "nothing can be done about it".

 

HI @Greg Sacramento

Thank you for enlightening me on what happens on your side of the pond. I wrote my article: Tinnitus, A Personal View, based on the experience I had at my first consultation at ENT. From what I gather, this is the way tinnitus is diagnosed and treated in the UK under NHS healthcare. There maybe slight variations in the procedure throughout UK hospitals but essentially it is this: When there is no underlying medical problem found to be causing the tinnitus after tests have been carried out. A patient at some point (if not immediately) is referred to a Hearing Therapist for treatment and management of the tinnitus. This can involve the following depending what is available at that NHS trust. TRT, CBT, Mindfullness, White noise generators. Hearing aids, relaxation classes. Sound therapy equipment. Tinnitus counselling.

Michael

 

Thanks for clarifying that this was your second appointment with him. Did he set up the second appointment or did you request it?

 

Now that you have explained in full the experience you have had at ENT, I am not surprised that you are so upset. This is quite frankly outrageous.

Michael

 

I got the appointment two months prior, then out of desperation I saw my first ENT before seeing him. So he was supposed to be my first but ended up not being.

 

You have a right, to be angry. I totally get it, BUT keeping ENTs/DRs that failed you, in your mind only make you more angry/frustrated. You already go through enough pain, with your tinnitus, relax that mind/soul.

A ignorant DR failed me and gave me fibromyalgia 10 years ago. At times my life is a living hell and it's hard to live(muscular pain 247..whole body hurts). I don't keep that DR in my mind, there is no point for me, to frustrate myself and create conflict inside my soul.

Relaxation of the mind/body has helped me, deal with all my demons and it pushes me forward, in this tough life...

 

You probably have, but have you tried a TENs unit? It's supposed to be effective for people w/ chronic pain and has shown to work in some cases for fibromyalgia and tinnitus.

 

My way of dealing with the fibro, is by just keeping the muscles active and doing stuff. not being active and letting the muscles sit, hasn't been helpful..in the past... Thanks for your post

 

The delivery of the message is everything in the beginning. A flippant Specialist who treats the whole thing like its him interviewing you to see how much money he can make from you (and bills you for the interview), then waves you away when it doesn't look worth his trouble can do untold damage at a very vulnerable time. This can be a danger point where self-harm becomes a possibility as fear meets up with despair.

 

Dr Nagler when he was here conducted a very useful little straw-poll among us asking if any of us had an ENT get up close and listen just to see if the tinnitus was objective. That is a baseline assessment, yet no one had experienced this in their consultations.

 

Cannot believe a health professional can behave in such a manner. I suppose anything is possible where money is an incentive.

 

I find that to be an extraordinary statement. On that basis he has no business taking referrals. Its like the Cardiologist who isn't a chest-pain expert.

 

I waited six weeks for that.

 

ENT's don't help the majority of people, but some are lucky. Finally got around to seeing my first one after 6 months of waiting yesterday, and all she told me was 'It gets better' and 'Expose yourself to loud situations so that you can get used to them again'.
I've 'habituated' to my tinnitus even though it is severe, but it is annoying to have to wait so long for an appointment only to be told everything you already know and then given advice that'll just screw your ears up more. Only good thing that came out of it was a referral for an MRI but that's for my pulsatile tinnitus, and I'll end up having a spike from the noise of the machine anyhow; win-lose situation.

 

Indeed @PaulBe But the way tinnitus diagnoses works in the UK is this. A Patient has a consultation with an ENT Dr. Tests are carried out. Hearing and MRI scan. If they are normal and there is no underlying medical condition causing the tinnitus. The patient is referred to a Hearing Therapist for tinnitus treatment and management. More than one doctor has told me this in 21 years of having tinnitus.

My present consultant whom I have a lot of respect for and have a good rapport with. Told me one day: I know more about tinnitus than her. Just for the simple reason she has never experienced it. My Hearing therapist was born with tinnitus and I couldn't ask for a better health professional She has an understanding of the condition that surprised me. I asked her one day you seem very knowledgeable about tinnitus. She then said: " I was born with tinnitus" Many Hearing therapists and Audiologists that work with tinnitus patients have tinnitus. They wore either born with it or acquired it at some time in their life.

Michael

 

I would say that an audiologist for tinnitus is the better choice than an ENT doctor. Of course, the audiologist probably wants to sell a hearing aid..., - but you can understand that, - and avoidable.....

 

When scheduling An ENT appointment, tell them you have a hearing loss if you have one and avoid mentioning the word 'tinnitus'. If you think that you may have a wax problem causing pain or ETD tell them that.

Most ENTs never read the Clinical Practice Guide that I posted a link to above. I think that this guide is a must read for all who have tinnitus and wish to seek medical help.