Tinnitus retraining therapy:
was first introduced by Jastreboff during 1980. This therapy has been found to be highly successful. This therapy is based on strong neurophysiologic evidence that any person can habituate to acoustic or acoustic like sensations in their environment. The major aim of this treatment protocol is to train the brain to treat tinnitus like any other routine environmental sound (like the hum of refrigerator in the kitchen which does not bother them).
Tinnitus retraining therapy has two key elements:
1. Direct counseling
2. Sound therapy
The counselling session is very critical to the success of this programme. Some patients may actually achieve relief through counselling alone. The counseling process involves an in depth discussion with the patient regarding the physiology of hearing and tinnitus. The negative emotions associated with tinnitus could easily be removed by counseling.
These patients are fitted with white noise devises at the ear level. These devises look like small hearing aids and can be comfortably worn throughout the day. The sound is initially set at a very low level so as not to interfere with normal hearing. After several weeks of use most patients do not hear the sound unless they really try to hear it. These devises help the brain to ignore the random signals of tinnitus. This process is known as auditory habituation.
Within 6 – 24 months many patients are fully benefited.
What is tonsillectomy audit?
This is a medical audit performed on all tonsillectomy procedures performed in a tertiary care institution.
What are the parameters used?
1. Indications for the procedure
2. Comparison between the various types of tonsillectomy procedures, which include safety, complication rates, time taken to complete the procedure.
What are the procedure types compared in the audit?
1. Cold steel tonsillectomy
2. Hot tonsillectomy
Recommendations of one such audit conducted by Royal college of surgeons England:
1. Patients (parents of the child) should be carefully informed about the complications following the procedure (especially bleeding).
2. While explaining the risk it should always be quantified using the surgeon’s statistics as well as national / international statistics.
3. Hot tonsillectomy techniques should be used with caution
4. All trainee surgeons should be fully competent in cold metal tonsillectomy before embarking on other techniques
5. Inexperienced surgeons should be supervised by a senior competent surgeon until the requisite competency is achieved.
6. If techniques like coablation is used the surgeon irrespective of seniority should undergo training in the procedure in an approved center
7. Hospitals should encourage use of machines with clear information on powersettings
8. Evolving strict standards for diathermy machines.