Miller School Doctors Combining Telehealth with In-Person Visits to Advance Tinnitus Care

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In a new paper published in the journal Seminars in Hearing, researchers at the University of Miami Miller School of Medicine describe a hybrid care model for tinnitus patients, which combines in-person visits with virtual consultations. Initially implemented to mitigate COVID-19 risks, this approach has shown great promise and will continue to be an integral part of tinnitus care at the University of Miami.

Brianna Kuzbyt, Au.D.

"We rapidly transitioned to a hybrid approach in response to the pandemic," said Assistant Professor and co-author Tricia Scaglione, Au.D., director of the UHealth Tinnitus and Sound Sensitivities Program. "This was not part of our normal care plan but was a positive result of having to quickly identify options to care for new patients and provide continuity of care for existing ones."

While a cure does not currently exist, tinnitus (ringing in the ears) is a treatable condition, that affects around 50 million people in the U.S. For some, tinnitus is barely noticeable while others find it quite disabling.

"It can disrupt an individual’s sleep, impact their concentration at work, affect mood and emotional state, and place strain on relationships with family and friends," Dr. Scaglione said. "It is not uncommon for patients develop anxiety or depression secondary to their tinnitus."

Increased Demand for Program

In recent years, as demand for its services have increased, the UHealth Tinnitus and Sound Sensitivities Program has tested innovative ways to deliver care. One early refinement was the implementation of group education sessions to help patients understand their condition.

"Patients learn what the expected outcomes can be, and then they can determine whether they want to pursue treatment," said co-author and Assistant Professor Brianna Kuzbyt, Au.D. "This helps us focus our in-clinic time on patients who feel they need further services."

ear inspection
Tricia Scaglione, Au.D.

These teaching sessions proved invaluable, helping people gauge the severity of their tinnitus, understand their therapeutic options, and self-select whether they would like to pursue treatment. When COVID-19 hit, these interactive presentations were quickly taken online.

In the paper, Drs. Scaglione and Kuzbyt illustrate the care flow with a case study on a 59-year-old patient, with the pseudonym Gabby, who attended a virtual tinnitus education session and opted for further treatment.

Looking to Expand

Dr. Scaglione gave Gabby an in-person assessment to identify the sounds she was perceiving, as well as their pitch and volume, and her overall sensitivity to noise. Eventually, Gabby was treated with a combination hearing aid and sound generator, which produces soothing noises to help distract from the tinnitus and can be p adjusted virtually without her needing to return to the clinic. Without the telehealth component, this might never have happened.

"She expressed how thankful she was that we had this hybrid approach," Dr. Scaglione said. "She knew she had to take care of her tinnitus sooner than later, but with COVID, she really didn't want to have a lot of in-person appointments. She expressed that had she been required to come to the clinic for all of her needs, she probably would have delayed care."

The UM Tinnitus and Sound Sensitivities Program was the first to implement a virtual shared medical appointment model and, more recently, transition to this hybrid model at the university and has since shared their experience with other departments. The team is also looking at expanding their online offerings to people throughout Florida and possibly other states and/or countries.

"There are certainly limitations," Dr. Kuzbyt said. "We are licensed to practice in Florida, but there are so many people who need help managing their tinnitus across the U.S. and internationally. We would like to expand our reach and support them where we can."

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