A Conceptual Framework to Aid the Diagnosis and Treatment of Severe Tinnitus

Diagnostic and treatment efforts for severe tinnitus are currently impeded by the lack of standardised methods for measuring the negative impacts of tinnitus upon the affected individuals. Such efforts could benefit from application of the World Health Organization (WHO) method for categorising the negative effects caused by chronic conditions. The WHO method starts by defining the relevant impairment (physical or mental), which leads to disability, and finally to handicap. Evaluating each patient's status using the WHO categories of impairment, disability, and handicap can facilitate diagnostic and treatment efforts by clarifying relationships between specific problems and corresponding treatment needs. Systematic classification of patients' tinnitus-related problems in this way can serve as a basis for comparing the content domains of different tinnitus questionnaires, and also can contribute unifying themes to aid in developing standardised methods for evaluating the severity of tinnitus. Such standardised measures are needed in order to provide a rational basis for stratifying patients for assignment to different treatment groups, and they will greatly facilitate meta-analyses and other types of comparison and evaluation of treatment results obtained at different centers.