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Dr. Fagelson, (Professor Audiology, ETSU) will discuss the unusual challenges facing patients and providers when tinnitus severity is linked to traumatic exposure. Interactions between neural mechanisms associated with tinnitus, posttraumatic stress-disorder (PTSD), and traumatic memory will be reviewed with particular attention to the way and degree to which such interactions affect tinnitus and disorders of sound tolerance. Conference attendees will be provided theoretical models of emotional memory consolidation that underscore trauma‘s durable effects on a patient‘s emotional state, reaction to the tinnitus signal, and to potentially-triggering environmental sounds. The putative benefits of tinnitus counseling will be presented in the context of trauma interventions that employ well-established counseling techniques as an element of patient-centered care. Audiologists must provide trauma patients a safe environment and opportunity for dialogue that contributes to a holistic understanding of the patient‘s situation and perceptions; the ultimate goal is to employ interventions and self-assessment instruments that can be used to evaluate patient needs and progress when tinnitus is related to trauma. The potentially-exacerbating effects of comprehensive audiologic assessment will also be addressed.

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Purpose: Posttraumatic stress disorder (PTSD) affects nearly 10% of the population, a prevalence comparable with that of tinnitus. Similarities between the way PTSD and tinnitus influence auditory behaviors include exaggerated startle responses and decreased loudness tolerance. Tinnitus loudness is often exacerbated by sounds that trigger PTSD-related anxiety. This report addresses physical and psychological relations between PTSD and tinnitus. Method: A chart review of veterans seen over a 4-year period for tinnitus services was conducted. Case history and self-assessments of tinnitus handicap were examined in all patients. A review of the literature related to triggers and effects of PTSD was conducted to explore potential consequences related to the presence of PTSD in the Veterans Affairs Medical Center (VAMC) tinnitus population. Results: Chart review confirmed that 34% of the first 300 patients enrolled in the VAMC Tinnitus Clinic also carried a diagnosis of PTSD. Patient reports citing tinnitus severity, suddenness of tinnitus onset, sound-tolerance problems, and sound-triggered exacerbation of tinnitus were more common for patients with a PTSD diagnosis than patients with tinnitus only. Conclusions: Several neural mechanisms linked to both tinnitus and PTSD affect auditory behaviors. Audiologists should be aware that patients with tinnitus and PTSD will require test protocols and referrals that address these powerful responses.

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