Date of Degree


Document Type

Capstone Project

Degree Name





Dorothy Neave-DiToro

Subject Categories

Speech Pathology and Audiology


audiology, tinnitus, antioxidants, nutraceutical, clinical practice guideline, subjective tinnitus, bothersome tinnitus


Objective: This project aims to implement an evidence-based clinical practice guideline at the International Hearing Centre (IHC) in Lagos, Nigeria for future research and data collection of their subjective tinnitus management using a nutraceutical formulation called ‘NHANCED Hearing (NH). After learning the IHC had incomplete charting in regard to tinnitus questionnaires pre- and post-administration of the NH formula, this capstone project sought to apply evidence-based guidelines for proper diagnostic evaluations and charting to assist in future research of the NH formula.

Methodology: A review and synthesis of current clinical practice guidelines in the United States, Germany, the Netherlands, Sweden, Denmark, and Japan allowed this research to present a complete diagnostic evaluation template and suggested timelines for administering subjective measures of tinnitus disturbance. Future research with IHC will benefit from complete charting for a retrospective chart review including tinnitus-specific case history, audiologic pure tone thresholds, tympanometry and acoustic reflex thresholds, distortion product otoacoustic emissions, and completed Tinnitus Handicap Inventory (THI) administered at 3-month intervals.

Results: Future research will be analyzed for clinically significant changes (p

Discussion: Anecdotal reports from clinicians at the IHC suggest significant improvements in subjective tinnitus as per patients taking the NH formulation. A proper, evidence-based, framework for implementing and measuring subjective improvement in tinnitus percept is necessary for future research. In addition to subjective reports, the distance traveled and cost out of pocket for the nutraceutical reveal a strong indication of perceived benefit.

Conclusion: The goal of this project is to implement an evidence-based clinical protocol at the IHC to standardize patient care in order to evaluate and statistically analyze the efficacy of the NH formulation on subjective tinnitus sufferers in the future. Future research can use this project as a template to assess changes to tinnitus percept in patients taking the NH formulation.