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Advanced Tinnitus Treatment Considerations

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1.  Factors related to the perception of “relief contrast” include: Tinnitus is more noticeable after a listening session due to the “contrast” from experiencing relief with the device Decreasing the volume for 5-10 minutes prior to ending a session to facilitate a gradual reintroduction of the tinnitus is a strategy to help minimize the perception Removing the device in an environment that is not completely quiet is a strategy to help minimize the perception All of the above

2.  According to this presentation, the treatment approach to consider for patients with hyperacusis and tinnitus is: Hyperacusis and tinnitus treatment can proceed simultaneously Hyperacusis must be targeted initially with treatment before tinnitus can be effectively addressed Only tinnitus can be treated Tinnitus must be targeted initially with treatment before hyperacusis can be effectively addressed

3.  Which of the following statements is TRUE regarding transition decision considerations? It is important to look at all factors when transitioning, not just the TRQ and test battery – listen to patient reports and ask questions All patients, regardless if indicated, should be transitioned at the Transition Appointment in order to progress through treatment on schedule In cases where it is not clear, err on the side of caution and stay in Stage One longer Transition is appropriate even if TRQ score has not decreased since baseline a and c

4.  What are some ‘non-standard’ patient attributes that will require modifications to the standard treatment approach? Decreased Sound tolerance and Hyperacusis Reactive tinnitus High TRQ>70 Large degree of hearing asymmetry between the ears All of the above

5.  What measurements can illustrate incremental progress during treatment? TRQ, including tinnitus awareness and disturbance % levels Minimum Masking Levels (MMLs) and Loudness Discomfort Levels (LDLs) Patient customized treatment specific goals Data Logging to explore increasing/decreasing trends is average volume setting All of the above

6.  If a patient experiences a progress setback during the course of treatment, according to this presentation, what should the clinician be prepared to do?: Provide a systematic and detailed trouble-shooting approach to identify the specific issue(s) Terminate treatment for the patient Inform the patient that treatment usage guidelines do not need to be followed Provide remedial actions as suggested in the Clinician’s Counseling Guide a and d

7.  What are some common reasons NOT to transition the patient from Stage One to Stage Two? No significant change in disturbance level: TRQ% Disturbance Unmanaged stress: relaxation response not conditioned Inconsistent/inappropriate device usage inhibiting progress Patient report of not being ready to transition All of the above

8.  What steps are recommended when managing a patient with high tinnitus disturbance level as noted by a TRQ score> 70? This is a highly suitable patient who does not require any treatment modifications Inform the patient that a longer treatment time frame , with additional clinician appointments are often needed to realize treatment benefits Inform the patient that it is often appropriate to consider outside intervention prior to beginning the Neuromonics tinnitus treatment. Provide the patient with a list of clinics in the area that specialize in Cognitive Behavior therapy Inform the patient that it is often appropriate to consider outside intervention after Neuromoicns tinnitus treatment has been successfully complete b and c

9.  The following are examples of common everyday life issues that can impede progress with the Neuromonics Tinntus Treatment: Reactive Tinnitus, Hyperacusis, and pulsitile tinnitus Tinnitus topic monitoring, Phase One stimulus causes anxiety, and low TRQ score Recent noise exposure, extended periods of straining to hear clearly, recent illness, and recent stress Cognitive distortions, low treatment interaction, and fear of transition

10.  If a patient is dependent on a high level of interaction and therefore apprehensive regarding transitioning to less interaction with the Phase Two stimulus, the following strategies can be used: Acknowledge that it may be difficult for the patient who has been used to receiving a high degree of relief to now aim for a lower level of interaction to increase exposure to tinnitus. This is no cause for concern as this is part of the evolution of their treatment program Reassure that a very gradual decline of the Phase One stimulus and therefore gradual increase in tinnitus exposure can be used in preparation for transition to the Phase Two stimulus Reassure the patient that if they are having a “bad tinnitus day” or increase in perception, they can increase the volume to achieve more relief. All of the above