tinnitus. If the noise is so loud that the patient needs to shout to be heard, then s/he should consider using hearing protection Does the patient use hearing protection / earplugs? Hearing protection should not be worn at times when there is no significant noise. If s/he can hear the tinnitus over the ambient noise levels, then s/he might be over-using hearing protection Has the patient recently had changes in their overall health? A cold, flu, allergy, eustachian tube dysfunction, excessive ear wax, etc. can enhance tinnitus. Also, changes in medication or dosage may also affect tinnitus. If a change is medication is suspected, refer the patient back to his/her practitioner. Has the patient had extended periods of straining to hear clearly? Reintroduction of Extended exposure to softly spoken children or adults, a conference or meeting can draw attention to auditory system dysfunction, and enhance hearing-loss related neural dysfunction. Pleasurable activities into the Patient’s lifestyle Circumstances to Return to Stage 1 Often people give up hobbies or other social Extreme of a patient regressing may require returning to Stage One (Phase 1 activities because of the stimulus). This is usually evidenced by increased TRQ, Awareness & Disturbance disturbance associated percentage levels, increased MMLs and decreased LDLs. If this occurs, then: with their tinnitus Refer to Getting Worse” protocol in Clinician’s Guidelines or NTT “Tinnitus As this reduces over time Clinician Counseling Guide for trouble- shooting recommendations. with treatment, it can be Call Neuromonics Clinical Specialist to discuss. useful to ask the patient Considerations for returning to Phase 1 stimulus: to think about the sort of Significant psychological involvement; as evidenced by TRQ activities he/she can Significant increase in stress levels resume or perhaps Patient is unable to obtain necessary relief with Phase 2 stimulus initiate, and encourage Patient is not managing life well him/her to start making the first steps. This can also help move Appointment Notes: the patient’s focus in a Next Steps: positive way to a future that is not restricted by tinnitus. To help make these proposed activities concrete and increase motivation, the clinician can collaborate with the patient to devise an action plan.
Reintroduction of Pleasurable activities into the Patient’s lifestyle Often people give up hobbies or other social activities because of the disturbance associated with their tinnitus As this reduces over time with treatment, it can be useful to ask the patient to think about the sort of activities he/she can resume or perhaps initiate, and encourage him/her to start making the first steps. This can also help move the patient’s focus in a positive way to a future that is not restricted by tinnitus. To help make these proposed activities concrete and increase motivation, the clinician can collaborate with the patient to devise an action plan. tinnitus. If the noise is so loud that the patient needs to shout to be heard, then s/he should consider using hearing protection Does the patient use hearing protection / earplugs? Hearing protection should not be worn at times when there is no significant noise. If s/he can hear the tinnitus over the ambient noise levels, then s/he might be over-using hearing protection Has the patient recently had changes in their overall health? A cold, flu, allergy, eustachian tube dysfunction, excessive ear wax, etc. can enhance tinnitus. Also, changes in medication or dosage may also affect tinnitus. If a change is medication is suspected, refer the patient back to his/her practitioner. Has the patient had extended periods of straining to hear clearly? Extended exposure to softly spoken children or adults, a conference or meeting can draw attention to auditory system dysfunction, and enhance hearing-loss related neural dysfunction. Circumstances to Return to Stage 1 Extreme of a patient regressing may require returning to Stage One (Phase 1 stimulus). This is usually evidenced by increased TRQ, Awareness & Disturbance percentage levels, increased MMLs and decreased LDLs. If this occurs, then: Refer to “Tinnitus Getting Worse” protocol in Clinician’s Guidelines or NTT Clinician Counseling Guide for trouble- shooting recommendations. Call Neuromonics Clinical Specialist to discuss. Considerations for returning to Phase 1 stimulus: Significant psychological involvement; as evidenced by TRQ Significant increase in stress levels Patient is unable to obtain necessary relief with Phase 2 stimulus Patient is not managing life well Appointment Notes: Next Steps:
CL10-0010-Pull-out-Stage-2.docx