The first nail in the coffin.

“It’s tinnitus. There’s nothing we can do for you. You’ll just have to learn to live with it.” Those words—so frequently uttered by an authority figure in a white coat—all too often hammer the first nail into the coffin of fear and despair in a person turning to a doctor for enlightenment and hope. As I see it, from a clinical perspective, we have three duties to patients presenting to us with tinnitus—three questions to answer: 1. Is the tinnitus caused by something that is a threat to health or life? 2. Is the tinnitus caused by something that, given the current state of knowledge and technology, can be effectively addressed and in so doing cure the tinnitus? 3. Questions 1 and 2 being answered in the negative, what can be done in the absence of a cure to afford the patient meaningful relief to his or her great satisfaction ... until the day of that cure arrives? Somehow, in the assembly line climate that has been forced upon us by the economic realities of managed care, the third question—every bit as important as the first two—gets relegated to the back seat of the otologic bus, if it gets a ride at all! There are numerous ways to afford relief to tinnitus patients in the absence of a cure— masking, pharmacologic approaches, cognitive behavioral therapy, Tinnitus Retraining Therapy, many more. Not to mention these avenues toward relief and how to access them is, in my opinion, not to adequately address the reason that patient knocks on our doors in the first place—the suffering! “Mr. Jones, you have tinnitus—learn to live with it.” or “Mr. Jones, you have tinnitus. Although I see that your tinnitus does cause you considerable discomfort and distress, I am pleased to tell you and your wife after a thorough evaluation that it is not caused by something that is a threat to your health—you do not have a tumor or other underlying disease. Unfortunately, in your case as in many, the tinnitus is not caused by something that we can cure with current technology, but there is legitimate hope for that in the future. Meantime, let’s see what we can do to get you some effective relief—so you can set your tinnitus aside and get on with your life. Here are some things we might consider.... [Or] Let me put you in touch with someone who has a particular interest in this field.... [Or] Here’s the web site of the American Tinnitus Association (http://www.ata.org) and the telephone numbers (503-248-9985, 800-634-8978). The ATA might be a good place to start your journey on the path to relief that best suits you. And be sure to stay in touch to let me know of your progress.” As a tinnitus patient myself, I learned first hand the devastating impact of the quicker of the two options above. It takes but 5 minutes to make the move from just being a doctor ... to being a healer. Five minutes. Otology & Neurotology 22:429 © 2001, Otology & Neurotology, Inc.