Do GPs Need Better Training When it Comes to Tinnitus?

[Ed209]

It's not such an easy question to answer, in my opinion, because we don't have a standard protocol of treatment. There is only really CBT and counselling that can, potentially, be offered. I say potentially because in the U.K. it is difficult to get enrolled onto things like that through the NHS. TRT has also been removed from most hospitals.

I bring this up because I had the most interesting discussion (for about 40 minutes) with the parents of some kids that I teach, who are all GPs. They bring the subject up, every now and then, as they know I have it and ask how I'm doing; they offered me tea and cakes after the lesson and I wasn't going to say no to that . The discussion somehow went towards tinnitus, so I told them about the latest research and what's going on in the world of all things tinnitus. They are all related and the mother of one of them also has it.

I told them straight, that in some of the most serious cases, there are people ending their lives. She told me she has a patient with hyperacusis who is suicidal and that it's soul destroying that she can't do much to help him. Anyway, I filled them in on the latest info and it was a good discussion, and so were the cakes . It got me thinking today, other than not delivering the dreaded 'learn to live with it line', what more can they do? I think they should say they can offer support, first and foremost, and also be there to listen to people's concerns. It was interesting hearing things from their perspective in a very candid manor.

 

[IAmCalifornia]

What can they do? Check for TMJ, if they can't, maybe a referral to a maxillo facial or neuromuscular dentist. Not that? Maybe check for vitamin deficiencies. Maybe update their hearing tests to go above 8khz. Refer to CAT/MRI, instead of being dismissive and cold and act like oh god, I need to make an extra effort?!

If anything these will eliminate potential causes to tinnitus for certain people. This is just basic stuff to start with and not a single GP, ENT, audiologist did any of these things. And then work on bedside manners which are sorely needed.

For reference in my experience I saw multiple medical "professionals" about my tinnitus. All that was done:

-Instant offer of pills, for sleep/depression
-Quick check of the ears to see if anything inside
-Offer of hearing aids
-A couple of audiologists told me to "look into" T.R.T. (I was in a state of shock when they told me to look into that myself and I had no idea where to start)
-Quick hearing test
-Told to live with it, sorry.

Also, I'm pretty sure doctor was adamant I was making it all up.

 

[Ed209]

What can they do? Check for TMJ, if they can't, maybe a referral to a maxillo facial or neuromuscular dentist. Not that? Maybe check for vitamin deficiencies. Maybe update their hearing tests to go above 8khz. Refer to CAT/MRI, instead of being dismissive and cold and act like oh god, I need to make an extra effort?!

We discussed all this. My initial post was a bit brief. The problem is that those tests are up to the specialists who deal with the referral. What usually happens - from my experience- is that little tests are done by the ENT, and they are quick to diagnose subjective tinnitus. However, that's in my case. Maybe things are dealt with differently if one's history doesn't include being in a noisy band?

Anyway, back to the original point, the GPs are the gatekeepers so they often get the brunt of everybody's problems. They only have 10 minutes to deal with each patient (in the UK), so the question remains: what should they do and do they need more training/awareness when it comes to tinnitus?

 

[glynis]

@Ed209,
When a patient goes to see their doctor about having tinnitus ,after having their ears checked for any wax or infection I would like the doctor to give patients the following information-

For tinnitus support please contact-

American Tinnitus Association .
800-634-8978
www.ata.org

British Tinnitus Association .
0800 018 0527
helpline@tinnitus.org.uk

Tinnitus Talk 24hr support
www.tinnitustalk.com

Tinnitus Hub Facebook group
24hr support.
www.facebook.com/tinnitushub

Action On Hearingloss
www.actiononhearingloss.org.uk

 

[Ed209]

@Ed209,
When a patient goes to see their doctor about having tinnitus after having their ears checked for any wax or infection and maybe tested for hearing loss I would like them to give patients the following information-

For tinnitus support please contact-

American Tinnitus Association .

British Tinnitus Association .
0800 018 0527
helpline@tinnitus.org.uk

Tinnitus Talk 24hr support
www.tinnitustalk.com

Tinnitus Hub Facebook group
24hr support.
www.facebook.com/tinnitushub

You tell 'em, Glynis! Coincidentally, at my last ENT appointment - which my GP made me attend (after my MRI incident) - the ENT gave me an Action On Hearing Loss leaflet which had nuggets of great info such as this:

But I agree, something with a list of support groups needs to be handed out at the very least.

 

[Bam]

@Ed209 In the abscence of a cure I would like my kindly GP to provide me with enough opioid based pain killers and Valium to sink a battleship....she owes me that much surely?!?

 

[JohnAdams]

Well yeah.

 

[JohnAdams]

How does someone this stupid even learn to write in the first place?

 

[RoeTaKa]

I feel like GPs should also look more into some of the physical problems so the patient has more options. Besides taking a blood test to rule out any possible abnormalities they should check to see if any physical movements in the upper body have any effect on the tinnitus they are hearing. If there are clear signs of muscle movement from the shoulders up that are doing that then they should consider the patient's posture, muscle tension and spine might be contributing or causing to the problem. Then give the patient some options about physical therapy whether that's chiro, osteo, physio or massage as well as explain the benefits of exercise.

When you first have tinnitus, some people could spend a lot of time waiting for GPs, hearing tests, MRI and the like. And any waiting in that period is a real struggle especially when GPs possibly hope for it to go away and kind of need some time to pass to rule out some factors. So some of this stuff might be of real benefit to some and they probably would never have thought of it.

 

[Vicki14]

How does someone this stupid even learn to write in the first place?

Clearly, this is someone who has never had the misfortune of this experience!! Idiot!!!

 

[Vicki14]

@JohnAdams - I was referring to 'them' as the idiot John and not you!!!

 

[Ed209]

Besides taking a blood test to rule out any possible abnormalities they should check to see if any physical movements in the upper body have any effect on the tinnitus they are hearing. If there are clear signs of muscle movement from the shoulders up that are doing that then they should consider the patient's posture, muscle tension and spine might be contributing or causing to the problem. Then give the patient some options about physical therapy whether that's chiro, osteo, physio or massage as well as explain the benefits of exercise.

This is why I ask the question: do they need more training when it comes to tinnitus? Your answer is obviously yes because I can tell you that the vast, vast majority, will not do any of that. They will refer you to an ENT. Truth be told, I honestly don't think many GPs are clued up about tinnitus. In fact, most will openly admit that they don't know much about it.

This can potentially cause a problem because people are likely to leave the Dr's office feeling isolated, especially after the ENT will inevitably tell them there's nothing they can do.

Like Glynis said, support should be offered immediately. But with that said, there are situations where the GP's hands are tied. The simplest way to achieve this is probably via third party support groups like what the BTA promote (I know Glynis is involved with one).

 

[GregCA]

This is why I ask the question: do they need more training when it comes to tinnitus?

Perhaps GPs could send T patients to the ENT docs, who would hopefully, in absence of a root cause they can diagnose, help the patient follow the https://www.tinnitusresearch.net/index.php/for-clinicians/diagnostic-flowchart in addition to providing support info.

 

[Ed209]

Perhaps GPs could send T patients to the ENT docs, who would hopefully, in absence of a root cause they can diagnose, help the patient follow the https://www.tinnitusresearch.net/index.php/for-clinicians/diagnostic-flowchart in addition to providing support info.

It's a mystery to me why the diagnostic route is hardly ever taken. I can understand to some degree in my case, because of my history, but there are many reports of people having the same experiences.

 

[Bam]

How does someone this stupid even learn to write in the first place?View attachment 22424

I would like to put this tiny minded nob in a small room for a week and offer them the opportunity to be joined by either a humming fridge or a screaming baby.

Me: what do you want? Baby or fridge?

Nob head: Umm. i'll take the fridge please.

Me: why?

Nob: because it's you know it's much quieter.

Me: well I actually need the fridge whereas the kid not so much.....but don't worry most people are not bothered by how loud it is or what it sounds like.

 

[Vicki14]

@Ed209

I think that the words and actions of medical professionals are FUNDAMENTAL when a patient first experiences Tinnitus. I, like most, went into a state of shock when discovering this sound in my head, only to be told be my Doctor that I was 'over reacting'!!!!! Followed by a trip to a dumb ass Audiologist who told me 'I wasn't coping well & my hearing wasn't great' both of which were untrue.... sent me into a spiral of panic and fear! To me, it felt like some sort of sick kick they got out of it.....

If my experience was different I'd be coping much better as it set off some internal alarm which can't now be silenced

 

[Ed209]

I think that the words and actions of medical professionals are FUNDAMENTAL when a patient first experiences Tinnitus.

I totally agree.

 

[RoeTaKa]

It's a mystery to me why the diagnostic route is hardly ever taken. I can understand to some degree in my case, because of my history, but there are many reports of people having the same experiences.

This is pretty much what I was alluding to (didn't know it existed). I don't know how realistic it is to train GPs about all the facets of tinnitus when there's still limited information on some of the causes and treatments. But I feel diagnosis is really critical especially early on. If during my onset a GP showed me this flowchart and guided me through it then I feel I would have had a lot more peace of mind about what I was experiencing and where to go from there.

A lot of what's on this flowchart I simply had no idea about at that time. When you're basically forced to search the internet for anything about tinnitus then most people will not discover enough to make a diagnosis. A lot of people make a connection and think "that's me too! I'll do what you're doing" and that's not always going to be of benefit because it's not the same diagnosis. What I've learned on my own now gives me confidence to see a GP if I need to, but a better diagnosis at the start would have made starting my "tinnitus journey" far less worrying.

 

[Bam]

@Ed209

I think that the words and actions of medical professionals are FUNDAMENTAL when a patient first experiences Tinnitus. I, like most, went into a state of shock when discovering this sound in my head, only to be told be my Doctor that I was 'over reacting'!!!!! Followed by a trip to a dumb ass Audiologist who told me 'I wasn't coping well & my hearing wasn't great' both of which were untrue.... sent me into a spiral of panic and fear! To me, it felt like some sort of sick kick they got out of it.....

If my experience was different I'd be coping much better as it set off some internal alarm which can't now be silenced

I would be genuinely curious what the results would be if they said to people, 'don't worry we have pill that cures that now.' Then calmly proceed to give people sugar pills or whatever. Would the terror being removed and placebo be enough to stop the chronic onset?

 

[Ed209]

I would be genuinely curious what the results would be if they said to people, 'don't worry we have pill that cures that now.' Then calmly proceed to give people sugar pills or whatever. Would the terror being removed and placebo be enough to stop the chronic onset?

Problem is, Bam, I'm a f**ker for going online and researching every inch of any drug or medical advice I'm given. In this respect, I'd probably convince myself it's a crock of sh*t and end up with chronic T anyway.

I'm too curious for my own good!

 

[Vicki14]

I'd say it'd definitely be MUCH more helpful than exiting their door with sloped shoulders and absolutely NO offer of help and support other than a hearing test/ent appointment in say 12 weeks.... by which point you've turned yourself inside out with fear & anxiety!!!! @Bam

 

[Tinniger]

At least ENT doctors should have read and understood this publication:
https://www.researchgate.net/publication/266571024_Clinical_Practice_Guideline_Tinnitus

 

[Bam]

Problem is, Bam, I'm a f**ker for going online and researching every inch of any drug or medical advice I'm given. In this respect, I'd probably convince myself it's a crock of sh*t and end up with chronic T anyway.

I'm too curious for my own good!

We all are. And in fairness as much as I love chatting with you good folk TT does as much harm as good in many ways. Let's be honest If someone reads my posts a week in to this they're going to be bricking it just as I was when I got T. I mentioned this to the BTA. The coping industry will be increasingly washed away in a tsunami of internet horror stories that are far more compelling and convincing. It just won't work in the face of the harsh reality. Only a cure can put the genie back in the bottle.

 

[JohnAdams]

Problem is, Bam, I'm a f**ker for going online and researching every inch of any drug or medical advice I'm given. In this respect, I'd probably convince myself it's a crock of sh*t and end up with chronic T anyway.

I'm too curious for my own good!

You're not a fucker. Youre a man that had a passion for music and it bit you in the ass. Just like me. None of us are fuckers man.

 

[JohnAdams]

@JohnAdams - I was referring to 'them' as the idiot John and not you!!!

Yeah I never thought that. Much love.

 

[Manny]

GPs need to prescribe steroids and recommend HBOT if there's any chance they'll help (ASAP following an acoustic trauma or sudden HL). These are the only two things with any evidence at all that they help afaik.
But of course most doctors apparently don't give a damn about T. Fckers.

 

[Greg Sacramento]

If there are clear signs of muscle movement from the shoulders up that are doing that then they should consider the patient's posture, muscle tension and spine might be contributing or causing to the problem.

Totally agree and this is why tinnitus patients should have specialized care.