Etiam sit amet est -...

1

Etiam sit amet est

Troubleshooting Techniques

Counseling Suggestions Frequently Asked Questions

NEUROMONICS TINNITUS TREATMENTCLINICIAN COUNSELING GUIDE

Recapturing Everyday Moments with

Breakthrough Tinnitus Treatment

www.neuromonics.com 2

Welcome

Dear Clinicians,

Congratulations on your decision to become a Neuromonics Tinnitus Treatment provider. Neuromonics continues to raise the bar in terms of clinically efficacy and validation, which is supported by the most extensive body of clinical research of any tinnitus treatment on the market.

This Clinician’s Counseling Manual aims to outline the key recommendations for counseling patients during the course of their Neuromonics Tinnitus Treatment program. Many prominent current authors view the counseling process as a unique interaction between the clinician and the patient. It is important to remember that counseling approaches are both highly tailored to the unique needs of the patient while also reflecting the personal style of the clinician. An integral part of this process involves not only general tinnitus education, but also how Neuromonics works to specifically address the individual needs of patients.

Expectation management is certainly one of the central aspects of Neuromonics counseling, as our tinnitus patients almost invariably hope the process would be quicker and more dramatic than what we know is physically and neurologically possible. The key areas to ensure that your patient understands are as follows:

-‐ Neuromonics can’t cure hearing loss (nor can anything else), or the fact our auditory system is noisy. However, it can gradually reduce how much the brain tries to amplify that neurological noise floor.

-‐ The initial goal of treatment is to obtain relief from the tinnitus while using the device, and in this way immediately overcoming its effects on lifestyle.

-‐ The usual mid-term goal is continuing use of the device at the key times to develop a sense of control over the tinnitus, thus makes the tinnitus seem so much less formidable.

-‐ The longer-term goal is reducing how often we are disturbed by the tinnitus, and improving our sound tolerance (if this was previously a problem). Most patients cut back on using the device when it no longer is a problem, but some still keep working towards also reducing how often they are aware of the tinnitus as well.

Writing specific lifestyle goals that have also been negotiated is always a good idea, so it can be shared with the patients significant others and also be revisited later. It can be a reminder of how much life has improved since beginning Neuromonics, and great insurance against patients inadvertently ‘moving the goalposts’ as time goes on. As always, realistic expectations but a positive outlook is key!

Another fundamental notion that needs to be appreciated by both the clinician and patient is the central role of relaxation in getting maximum effect from Neuromonics. When dispensing the device, it is thus critical to emphasize that conditioning a relaxation response to the music is key to full benefit. Fortunately, that is a very pleasant prescription.

The practical aspects of Neuromonics counseling have a lot to do with the application of the protocol to the patient’s particular lifestyle requirements. Much of this is related to volume setting. In the first few months, the goal to use higher levels of volume to get most relief, but the overriding consideration is to always maintain comfort and relaxation. Once the Neuromonics Treatment is providing the appropriate sense of control, then volume can be reduced to a more intermittent level so that a more permanent reduction in disturbance can gradually be afforded. Measuring their current MML through the device and then cross-referencing the actual usage from the data logging can help verify adherence to the protocol. A very useful notion to impress upon the patient is that successful treatment outcomes are linked to the amount of time spent listening to their device (and definitively related not the loudness it is played at).

http://www.neuromonics.com



The third Neuromonics clinical trial found clear dose-relationship with success. So in the initial treatment stages of moderate to severe tinnitus, they should be using the device a great deal since their tinnitus would be a problem for a large part of the day. As their tinnitus becomes less of a problem, the treatment can be used correspondingly less.

As treatment progresses, a typical challenge is that the patient feels that they are not making as much progress as they did initially. This is normal, and the average response in the clinical trials is for the biggest gains to be in the first two months, and then more gradual thereafter. However, these further incremental improvements do really add up, and we need to use external benchmarks like TRQ, MMLs and LDL’s to monitor this progress and then be able to provide feedback on the usually happy news. This is far more reliable than the patient trying to monitor their tinnitus, and not at cross purposes with the goal of eventually reducing awareness.

Trouble-shooting is the next major area of Neuromonics counseling, and is the main focus of this manual. A fundamental notion that your patients need to understand is that all the usual things that make tinnitus worse still can still do during treatment. These exacerbating factors can reduce potential benefit, so they should be properly controlled.

Despite the time spent in the clinic tailoring the treatment to the individual, there is still a huge role for also making full use of the written and online information we have made available. This aids tremendously in recalling the necessary information and goals, and is wonderfully helpful in involving the patients’ significant others as allies in the rehabilitation process. Neuromonics offers a number of such patient-use tools in the Clinicians Guidelines CD/Manual and online. These tools can greatly increase efficiency, and reduce clinical time. This streamlining of the counseling process, in combination with a far more sophisticated and tailored acoustic stimulus, are the main reasons why Neuromonics only requires at least half the 15 hours of clinic time required for TRT, and yet obtains the same success rate in a third of the therapy time elapsed.

The following pages outline the most common challenges encountered by clinicians when administering Neuromonics, and how they can be approached through counseling. Of course some patients have very unique circumstances that may not neatly fit in with these more general recommendations, so your clinical judgment may sometimes be required to tailor treatment to that patient. Please don’t hesitate to also contact Neuromonics so that you can avail the invaluable input of the Clinical Specialists.

Thanks again and I hope you enjoy the experience of helping your patients get relief from their tinnitus.

Paul B Davis PhDFounder/Scientific Advisor




Table of Contents

Welcome ........................................................................................................ 3In Their Words .............................................................................................. 5 Common Everyday Life Issues............................................................. 6 Patient with recent illness/ change in medication .................................. 6 Recent Noise Exposure .......................................................................... 6 Extended periods of Straining to Hear Clearly......................................... 6 Managing Stress ................................................................................... 6 Psychological Factors Affecting Treatment.............................................. 7 Excessive Tinnitus Monitoring ............................................................... 7 Tinnitus Topic Monitoring..................................................................... 7 “Counting Clicks” and Device “Settings Stress....................................... 7 Changes in Hearing ............................................................................ 8Managing Patient Expectations .......................................................................... 9 Overcoming Mindset Barriers/Cognitive Distortions/Unrealistic Expectations 9 Managing Patient Expectations....................................................... 9 Anxiety Prohibiting Milestone Achievement.......................................... 10 Addressing Anxiety/Depression and Suicidal Ideations............................. 10Non-Standard Patient Troubleshooting ............................................................. 11 Addressing Obstacles to Success ............................................................ 11 Managing Decreased Sound Tolerance and Hyperacusis........................ 11 Reactive Tinnitus .................................................................................... 12 Managing Low TRQ Patients................................................................... 13 Managing High TRQ Patients.................................................................. 13 Patient is Experiencing Low Treatment Interaction ................................... 14 Managing Hearing Loss ............................................................................ 14 Managing Multi-Tonal Tinnitus................................................................. 15 Managing Pulsatile Tinnitus ..................................................................... 15Managing Treatment Specific Issues.................................................................. 16 Incorrect Device Usage ............................................................................ 16 Patient is not Using Device at Right Volume ........................................... 16 Patient is not Meeting Usage Requirements ............................................ 16 Patient is not Using Treatment in Right Auditory Environment ............... 17 Patient is not Using Treatment Appropriately............................................ 17Stage Progression Considerations....................................................................... 18 Questions to Consider Before Transition to Stage Two ........................... 18 Moving to the Maintenance Phase of Treatment .................................... 19 Possible Patient Complaints........................................................................ 20 My Tinnitus is Getting Worse................................................................. 20 Tinnitus Perception is Worse Since Initiation of Treatment..................... 20 My Tinnitus is Worse in Quiet................................................................ 20 My Tinnitus is More Noticeable Following Treatment Session ................ 21 Tinnitus is Impacted by Exposure to Certain Sounds............................. 21 My Tinnitus is Changing......................................................................... 21Managing Issues with Neuromonics Stimulus........................................... 22 Patient is Experiencing Low or No Interaction ........................................ 22 Patient is Unable to Achieve High Level of Interaction ........................... 22 Patient Dependent on High Interaction/Fearful of Transition .................. 23 Phase One Stimulus Produces Anxiety .................................................... 23 Patient Sees Treatment as a Chore/Causing Anxiety.................................. 24 Specific Tracks Cause Annoyance or Anxiety.............................................. 24Reducing Returns and Keeping Patients in Treatment................................. 25 Use Your Resources.................................................................................... 25 Troubleshooting Suggestions..................................................................... 25 Be Prepared for Patient Setbacks and Issues.............................................. 25 You Are The Expert................................................................................... 25FAQ’s ..................................................................................................................... 26Conclusion .............................................................................................................. 28


In Their Words

“I think counseling is the most critical aspect of any tinnitus management program. I use lots of examples about sensations that are regularly habituated. Things such as the feeling of a wrist watch, your feet in your shoes, a ring on the finger, etc.; these are sensations that one could turn their attention to, but generally ignore. This can happen with the tinnitus. It may be present, but does not have to be an annoyance or disturbing sensation.”

“Reviewing the auditory and central anatomy and discussing where the tinnitus may be coming from and how it got to be an annoyance can help reduce the fear and mystery of how this became such a disturbing sensation.”

-Jill Meltzer, Au.D. - North Shore Audio-Vestibular Lab, Highland Park, IL

Neuromonics Provider since 2006

“I like to remind patients that treatment is a journey with the ultimate goal being to reclaim their lives from tinnitus. The Neuromonics device is a short-term solution for long-term benefit. It is a tool that allows them to function and participate in activities they enjoy. Over time, the treatment helps them to re-prioritize tinnitus so that it is no longer a consideration in their daily lives.”

“My role is to partner with them in this journey by answering their questions, monitoring their progress, being their cheerleader, holding them accountable, and even providing “tough love” when necessary. I have found the Neuromonics Tinnitus Treatment works best when you connect with patients on a personal level and they feel you have their best interest at heart.”

-Lisa Fox-Thomas, Ph.D., CCC-A, UNCG Speech and Hearing Center, Greensboro, NC.Neuromonics Provider since 2007

“Ongoing support and encouragement are keys to successful outcomes. Availability is also critical: involvement with Neuromonics Tinnitus Treatment requires a strong commitment to being available to your patients.”

-Steve Benton, Au.D., Atlanta VA Medical CenterNeuromonics Provider since 2007

“I think tinnitus patients must want to get help, be motivated to improve, be committed to whatever treatment option they choose. Patients should understand there is no quick fix and improvement will take at least a month or two at the quickest and usually longer for most patients.”

“Patients should also know that treatment options are available and there is hope even if their doctor has told them they need to learn to live with it.”

“For any clinicians beginning the Neuromonics Treatment, please realize that it is easy to use and successful 85% of the time, however it typically takes anywhere from 6-10 months to achieve the desired results.”.

-Mark Sanford, M.S., CCC-A, CSG Better Hearing Center, Walnut Creek, CA


“I begin by telling patients that education is the first step in managing tinnitus. I walk them thorough a review of the ear anatomy and the process of how sound reaches your brain. Then I talk about how your brain deals with sound. By using lots of examples, I create an image of the tinnitus and its effect on you, the patient. Effective counseling is the strongest component of all tinnitus management solutions including Neuromonics.”

-Beth Alberto, Au.D., Hearing Care of Summerville, SC


“Tinnitus patients are all different, and their individual problems related to emotions, hearing, sleep and concentration need to be addressed in a collaborative, not directive, fashion. Engaging patients in practice activities, where they take responsibility for changing their reactions, is helpful for most.”

-Rich Tyler, Ph.D. Department of Otolaryngology and Department of Communication Sciences and Disorders,

The University of IowaNeuromonics Provider since 2007




Common Everyday Life Issues

• Patients with a Recent Illness and /or a Change in Medication:

o A cold, flu, allergy, or excessive ear wax can enhance tinnitus. Changes in medication or dosage may also affect tinnitus.

What To Do: In these instances, counsel your patient to return to their practitioner to rule out, or receive treatment for, any underlying medical problems/medication change that may be aggravating their tinnitus.

• Recent Noise Exposure:

o A period of noise exposure at a sporting event, wedding, etc can exacerbate tinnitus.

What To Do: A good standard to use is that that if the environment is loud enough for the

patient to shout, then wearing hearing protection is indicated. Also remind your patient that exposure to loud noise without protection can be a setback to their treatment. The setback is not irreversible, but ear protection should be used in similar situations moving forward.

• Extended Periods of Straining to Hear Clearly:

o Based on the neurophysiological model of tinnitus, straining to hear places the brain on “high alert” searching for sound and amplifying internal sounds. This is turn leads to an increased tinnitus awareness.

What To Do: Counsel regarding patient-specific examples of strenuous listening environments/

situations for the patient to avoid. Also advise your patient to not listen to their treatment at times when they are straining to hear.

• Managing Stress:

o Stress and tinnitus are interconnected. It is important to manage stress before and during tinnitus treatment. Previous studies and patient feedback indicates that stress management support and counseling prior to, or in conjunction with, NTT will enhance the probability for a successful treatment.

What To Do: Provide/review general tinnitus management strategies as covered in patient handouts. Brainstorm with the patient to identify and prioritize issues that have the most impact on the patient and treatment success. If your patient exhibits excessive levels of stress, then a referral to a professional specializing in Cognitive Behavior Therapy is recommended.

The goal of Cognitive Behavior Therapy is to help the patient identify any unhelpful or incorrect thinking and to bring about a more realistic understanding and approach to deal with this way of thinking. Relaxation training is often incorporated into this process. Both Cognitive Behavioral Therapy and relaxation training have been proven effective in the management of the tinnitus patient.

Additional ways of managing stress include regular exercise, minimizing stimulants and consistent sleep patterns.

Refer your patient to the www.myneuromonics.com website for tips in stress management and relaxation techniques.



http://www.myneuromonics.com



Psychological Factors Affecting Treatment

• Excessive Tinnitus Monitoring

o Patients attempting to monitor their tinnitus are being counterproductive to the goal of reducing awareness. Changes in tinnitus tend to be gradual and hard to benchmark so reductions can be hard to determine without proper monitoring by a clinician. Tinnitus perception also tends to fluctuate in loudness and the loudness experienced is also affected by attention. When patients attend to their tinnitus, they may actually begin to perceive it as louder.

What to Do: Remind your patient that they should not “over monitor” their tinnitus. The idea is to teach the brain to put the tinnitus in the background, so if they are continually checking in with their tinnitus they are inhibiting that process. There is no need to journal, chart or make notes about their tinnitus perception on a daily basis. This is what their follow-up visits are for.

Additional clinic appointments or follow-up phone calls can be added in order to monitor effective use of treatment. Advise the patient to be involved with an activity while wearing the device (work, reading etc.). This will provide the ability to “set and forget” the treatment. Advise patient to “distract the brain” with pleasant music etc. when not using the treatment and avoid the temptation to monitor their tinnitus.

• Tinnitus Topic Monitoring:

o Patients need, and will benefit from, current, accurate, and research based information about their tinnitus and treatment. If patients have unresolved questions and issues regarding tinnitus topics and it’s management, then progression through treatment may be compromised until the patient ascertains up-to-date and valid information.

o Surfing the internet or spending time in chat rooms or message boards can actually inhibit a patient’s progress in treatment. It is vital to advise your patients that the more time they spend researching and focusing on their tinnitus the more likely they are to further cement their awareness. Restricting and limiting the time spent on these activities can greatly benefit the overall treatment outcome.

What to Do: Suggest exposure to only up-to-date internet sites/written information:

www.ata.org, www.asha.org or www.myneuromonics.com

Providing copies of the Neuromonics Clinical Data Summary or other published articles will often provide comfort to your patients as they can better understand the time frame of expected changes as well as the mechanisms you are using to gauge progress.

• “Counting Clicks” and Device Setting Stress

o There may be times data logging and patient reports confirm that the patient is counting clicks to determine volume level. Remember though that the first and most important factor is that the treatment be comfortable and pleasant while providing as much relief as possible. The volume level should allow the patient to “set and forget” the treatment.

What to Do: Counsel patient not to be hesitant to “push the envelope” and use more volume while still avoiding any volume level that prevents the treatment from being pleasant and relaxing. Remind your patient that appropriate volume levels would be expected to vary from day to day as tinnitus perception as well as listening environments may vary.



http://www.ata.org

http://www.ata.org

http://www.asha.org

http://www.asha.org




• Changes in Hearing:

o The Neuromonics treatment is based on stimulating the auditory system with a customized acoustic stimulus prescribed for the auditory thresholds of each ear. If a significant change in hearing occurs, an SD card change may be necessary to accommodate a change in hearing profile.

What to Do: In this situation, counsel your patients regarding hearing loss change and

management, and how hearing change can enhance tinnitus perception. Assure the patient that a new SD card will allow treatment to resume per protocol. Consult your Clinical Specialist to consider and discuss suspending treatment until a new SD card is available.

Don’t forget to register at www.neuromonicsprofessional.com to gain access to everything you

will need to help your patients and practice thrive with the Neuromonics Tinnitus Treatment

Did You Know?

91% of people who used the Neuromonics Tinnitus Treatment reported a significant reduction in the tinnitus disturbance

86% had a significant reduction in the tinnitus awareness 70% had a significant reduction in the tinnitus volume

78% had a significant improvement in their tolerance to loud sounds

97% would recommend the treatment to others

(Davis, Paki and Hanley; 2007. Ear and Hearing)



http://www.neuromonicsprofessional.com

http://www.neuromonicsprofessional.com


Managing Patient Expectations

As a clinician it is imperative that you convey the appropriate expectations to your patient. Neuromonics is not a

cure for their tinnitus. Impacts of the treatment are dose related and progress is largely determined by the amount

of effort put forth by the patient. Some appropriate treatment expectations include:

o Incremental reductions in tinnitus disturbance levels

o For Tier 1 candidates, Clinical Trial results are appropriate benchmarks for success

o Tier 2 and Tier 3 candidates should adjust expectations accordingly. Refer to the Neuromonics Private Practice data for specific results by patient type.

o Expectations can be divided into short, medium and long-term goals.

o It is often helpful to write out patient specific goals and reasonable time frames for patients at the fitting appointment.

o Using the treatment for specific lifestyle issues such as helping with sleep onset or concentration while reading are commonly achieved goals.

• Overcoming Mindset Barriers /Cognitive Distortions/Unrealistic Expectations

o Cognitive Behavior Therapy, or CBT, is a common tool used to hep patients deal with the impact of tinnitus on their overall well being. CBT is often used to help patients cope with major life changes or events that have intruded on their day-to-day existence. The purpose of Cognitive Behavior Therapy is to alter negative thinking and to bring about a more realistic assessment and understanding of a problem. This type of therapy has been proven effective in the management of the tinnitus patient.

What to Do: Direct questioning can be used to identify the presence of cognitive distortions, mindset barriers, and unrealistic expectations Direct questioning can be used to assist patients in gaining a realistic, balanced perspective. Appropriate questions are, “what evidence supports this idea?” and “what is the evidence that this idea is not true?” Alternative perspectives and rationales can be offered.

Writing ideas down on paper to review may bring a more balanced perspective than trying to hold ideas in the mind. Counsel patient to consider if further counseling and support is indicated.

Provide patient advice sheets including, “How Can A Psychologist Help?” Provide patient with a list of clinics that specialize in Cognitive Behavior Therapy.

Most remedial actions and counseling guidelines in this section would be pertinent for this type of patient.

• Managing Patient Expectations

o Tinnitus patients often want an immediate fix and cure for their problem. This is understandable considering what they have gone through. At times, this mindset can lead to unrealistic expectations for treatment. Often times, when a patient is meeting their treatment goals and expectations early in treatment, the bar of expectations will get raised. When this happens you need to be ready.




What to Do: Review and restate patient-specific information and recommendations from their assessment and other previous appointments. Use evidence tools to reinforce that incremental progress has been made, that treatment is progressing and milestones are being met. Specifically you should refer to:

• TRQ changes

• MML and LDL changes

• Treatment Specific Goals set at the fitting appointment

You may also want to refer to the “patient expectations” document completed during the fitting appointment. This can help bring expectations back into alignment. It also important to validate that treatment is going well, and staying the course can lead to greater dividends down the road. It can be useful at this time to ask the patient to consider activities once eliminated because of the negative impact of their tinnitus and then an action plan should be devised to identify steps that can be taken to resume once pleasurable activities. Help the patient to brainstorm a future not restricted by tinnitus.

• Anxiety Prohibiting Milestone Achievement:

o Excessive levels of anxiety can reduce the potential benefit of the Neuromonics treatment. If your patient’s level of anxiety is inhibiting their progress, then they should consider outside help for stress and anxiety management. Since tinnitus severity is positively correlated with patients’ level of anxiety it is quite possible that their anxiety will hinder their success with treatment.

What to Do: Suggest to your patient that they consider additional counseling and support. Provide patient advice sheets including, “How Can A Psychologist Help?”

Remember to promote the patient’s feelings of hope and to reinforce realistic expectations. You can also suggest up-to-date internet sites/written information: www.ata.org, www.asha.org, www.myneuromonics.com. and advise of local self-help groups or tinnitus support groups.

• Addressing Anxiety, Depression and Suicidal Ideations

o Any score other than “0” on question 24 of the TRQ must be addressed. Due to the nature of tinnitus and the debilitating impact it can have on patients, suicidal thoughts are often present. As a clinician, you should be prepared for this type of situation and have a protocol in place in the event this topic presents itself.

What to Do: If there is indication of active contemplation of suicide reported by patient, refer to patient’s PCP/GP or psychologist or follow your clinic’s practice guidelines in managing patients with suicidal tendencies.

Strongly advise that In parallel with the NTT, a referral to a tinnitus coach (psychologist) is indicated for patient’s well being and progression with treatment. Provide patient with a list of clinics that specialize in Cognitive Behavior Therapy

Consider delaying the start of treatment until the patient has begun treatment for additional psychological factors that are outside the scope of your practice.



http://www.ata.org

http://www.ata.org

http://www.asha.org

http://www.asha.org






Non-Standard Patient Troubleshooting

• Addressing Obstacles to Success

o The Neuromonics Tinnitus Treatment is a program that lasts, on average, 6-8 months, however some individuals have non-standard individual characteristics which may lengthen the duration of treatment. These variables need to be addressed as a patient moves through treatment. Remember that individuals respond at different speeds and may have a variety of experiences, therefore modifications of, or additions to, the standard treatment protocol may be recommended. When considering modification to the standard protocol be sure to consult your Neuromonics Clinical Specialist.

What to Do: Assure your patient that you will work together with a Neuromonics Clinical Specialist to identify the variable(s) impeding treatment progress and will collaborate to develop a remediation plan. Remind the patient that compliancy with suggested remedial actions is vital so that potential treatment gains are not compromised. Additional regular clinic appointments or follow-up phone calls can be added as indicated for monitoring effective use of treatment.

• Managing Decreased Sound Tolerance (DST) and Hyperacusis

o DST is a common phenomenon found with the presence of tinnitus. In order to maximize the chance of success this condition cannot be overlooked during their treatment.

o Often these patients have such a reduced sound tolerance that they are not able to gain sufficient relief from their Neuromonics treatment. A modified protocol is suggested in order to address sound tolerance issues so that the tinnitus can then be treated. Please refer to the “Hyperacusis Protocol” for a comprehensive discussion on dealing with this topic. Below are some principles to consider when DST is an issue.

After completing the tinnitus evaluation always review the patient’s Loudness Discomfort Levels even if tinnitus is the primary complaint. Hyperacusis can easily become a condition that the patient is oblivious to as often times they will alter their environment to accommodate the condition.

Be sure to consider misophonia and phonophobia as well. If LDL’s are not normal, there may be specific sounds that the patient is averse to. This condition can be due to a negative psychological experience associated with a sound as opposed to actual decreased sound tolerance.

IF decreased sound tolerance is present, in addition to tinnitus, then the patient must go through the process of desensitizing to sound by using the Neuromonics treatment. Once this has occurred, tinnitus can be addressed. If not addressed, sound tolerance issues can prevent the treatment from being used at the appropriate volume and often times contribute to stress which will make tinnitus relief less likely.

Consult your Neuromonics Clinical Specialist to determine whether a hyperacusis protocol is warranted.




• Reactive Tinnitus

o Reactive tinnitus is a rare and extreme condition whereby an individual’s tinnitus is worsened after exposure to a mild to moderate level of sound. With reactive tinnitus this increase tends to last for more than a day.

o Reactive tinnitus is suspected in individuals who report an overuse of hearing protection, have found nothing reduces their awareness of tinnitus, and when trials of other acoustic based treatments clearly aggravated their tinnitus.

o Reactive tinnitus may not be identified at an assessment appointment or, in very rare cases it is possible for reactive tinnitus to develop during treatment. If patient reports tinnitus perception appears louder after treatment and it stays that way, immediately consult your Neuromonics Clinical Specialist.

What to Do: Emphasize to your patient that this is not a cause for grave concern, that a protocol designed for Reactive Tinnitus will be followed. It differs from the standard protocol in that only the Phase 2 stimulus will be used and volume will be set at a lower volume. It is important to monitor patients carefully if the exhibit these symptoms.

Any patient with reactive tinnitus symptoms may need the assistance of a Tinnitus coach to facilitate a successful treatment. If possible provide a list of clinics in your area that specialize in Cognitive Behavior Therapy. Also provide appropriate patient advice sheets (e.g. Progressive Relaxation Training).

Patients that report their tinnitus is worsening often times have issues related to compensation and/or pre-existing anxiety issues that should be addressed before continuing treatment.




• Managing Low TRQ patients

o You may encounter a patient with a TRQ score below 17 that would like to proceed with treatment. Even though this TRQ score is not considered “clinically significant”, there are still numerous benefits which can be achieved with the Neuromonics Tinnitus Treatment.

o The Neuromonics Tinnitus Treatment will still address numerous effects measured on the TRQ i.e. tension, concentration, ability to relax, decreased sound tolerance, ability to sleep.

What to Do: You can counsel your patient to expect appropriate efficacy outcomes despite their low TRQ score. While more dramatic/ noticeable outcomes for higher TRQ scores are common, their levels of improvement are likely to be more subtle.

Make a list of personal goals that the patient would like to achieve from their treatment, then develop a treatment plan and usage schedule to meet these objectives.

• Managing High TRQ Patients

o Patients with a TRQ score above 70 are typically considered “non-standard” patients. This does not mean that they can not achieve significant benefit from the Neuromonics treatment, rather it is in indication that there are additional factors contributing to the patient’s level of disturbance.

o In these instances it is often appropriate to consider outside intervention prior to beginning the Neuromonics treatment.

What to Do: In these instances, additional support, through the use of a Tinnitus Coach, is indicated. Counsel that without this additional support, potential treatment outcomes may be compromised. Inform your patient that a longer time may be needed to realize treatment benefits. Additional clinic appointments are often recommended for this patient type.

Provide your patient with a list of clinics in the area that specialize in Cognitive Behavior Therapy and Psychiatry

Did you Know?

Neuromonics provides assistance with consumer seminars including direct

mail, advertising and public relations assistance. For more information

contact Neuromonics Customer Service at 1-866-606-8926




• Patient is Experiencing Low Treatment Interaction

o The goal of the Neuromonics stimulus is to blend with the patient’s tinnitus at a comfortable and relaxing level while ultimately reducing the volume to create a more intermittent interaction with the tinnitus.

o DST and or a very high level of hearing loss can make it difficult for some patients to achieve a high level of interaction with the treatment.

What to Do: Inform your patient that the volume level will be regulated by comfort rather than degree of interaction.

Counsel patient that the initial low volume level may not provide satisfactory interaction, but the ability to increase the volume level may improve over time (see DST/ Hyperacusis remedial action section) for a more satisfactory interaction.

Expectations should be set for the treatment of the DST prior to tinnitus treatment. If, after following the DST/ Hyperacusis protocol the volume level of the stimulus is able to be increased to a level of offering some degree of relief, then tinnitus treatment can be initiated.

Set expectations that once tinnitus treatment begins, extra time (>2 months) may be needed in Stage One to meet milestones before transitioning to Stage Two. Counsel that LDLs and BBN MML will be measured at intervals to document progress.

• Managing Hearing Loss

o When a large degree of asymmetry exists between ears, some patients find that relief is achieved at a more comfortable listening level when a contralateral prescription is used. This prescription provides less stimulation to the poorer ear. In this instance, the effective stimulus is only (or largely) delivered through the better ear.

o When considering the use of the contralateral prescription, it is important to factor in the patient’s word discrimination scores. While their audiometric thresholds may be within the recommended fitting range, if poor WDS’s are present, the treatment will sound distorted just as speech does. If this is the case, the contralateral prescription may be a better choice.

o Always consult with a Neuromonics Clinical Specialist if you believe a contralateral prescription is warranted.

What to Do: If patient has been fit with a contralateral prescription you should be aware of the following possible complaints: low interaction, lack of stereo effect, the music is not engrossing, or slow progress with treatment. If you hear this then review expectations with your patient.

Remember that the amount of stimulation and degree of interaction achievable is lower than would be the case with a standard prescription due to asymmetrical hearing loss considerations.

Inform your patient that good outcomes are expected however there may be a longer treatment course (>8 months). They should also know that gradual and incremental progress is to be expected rather than dramatic improvement.

Consult your Neuromonics Clinical Specialist to determine if the patient should listen to the treatment through only the earphone in the better ear and not in the other ear. You will still use the worst tinnitus side as the one to mask.




• Managing Multi-Tonal Tinnitus

o It is not uncommon for patients to report that their tinnitus has many tones and iterations. This can cause worry that the treatment will not be effective due to the nature of their tinnitus.

What to Do: Remind your patient that during assessment, measurements were completed on the tone that was reported by the patient to be the most prominent and disturbing.

Set expectations that the aim is to have treatment interacting with the most prominent tonal tinnitus, but treatment is likely to have effect on other tones due to multi-frequency nature of the stimulus.

• Managing Pulsatile Tinnitus

If pulsatile tinnitus is present with ‘classical tinnitus’(and ‘classical tinnitus’ is most disturbing) counsel that the aim is to have treatment interacting with the ‘classical tinnitus’ to allow for some reduction or masking of symptoms.

Set expectations that there may or may not be any benefit on the pulsatile component.

If pulsatile tinnitus is the most disturbing but has at least a partial interaction with the treatment, set expectations that the goal of treatment will be primarily to reduce the negative association with the tinnitus perception which may in some cases lead to a reduction in awareness.

Did You Know?

Neuromonics will train additional clinicians at an existing clinics free of

charge. Check with your Neuromonics Clinical Specialist for details and

access to the Neuromonics Professional Website




Managing Treatment Specific Issues

• Incorrect Device Usage

o The Neuromonics protocol clearly defines that the right time to use the treatment is when tinnitus perception is most bothersome.

What to do: Counsel to use treatment when the patient is most disturbed by tinnitus (e.g. at a 7, 8, 9, or 10 when thinking of tinnitus on a 1 to 10 scale).

Counsel your patient to think about device use in the same sense as using an aspirin for a headache. When their tinnitus is bothersome, then use their device.

Assist the patient in considering the times and situations that are impacted most by tinnitus and counsel to focus the use of treatment at those times to get relief and control.

Counsel to use treatment as soon as the tinnitus becomes bothersome rather than to “fight through” the tinnitus and allow it to escalate.

• Patient is Not using Treatment at the Right Volume

o The protocol defines the appropriate volume level for listening as a comfortable level to allow for relaxing and pleasant listening.

o Listening at too high of a volume can take away from the desired relaxation element of the treatment and can actually become a source of irritation.

What to Do: Counsel on setting volume to a level that is always comfortable and pleasant, but provides as much relief as possible.

An appropriate volume level should allow the patient to ‘set and forget’ the treatment.

Counsel patient not to be hesitant to ‘push the envelope’ and use more volume while still avoiding any volume level that prevents the treatment from always being pleasant and relaxing.

Remind patient that relief from tinnitus, within this pleasant and relaxing context, is what will break any negative emotional involvement with the tinnitus.

• Patient is Not Meeting Usage Requirements

o The protocol defines appropriate usage time as 2-4 hours per day, when tinnitus is most bothersome, for an approximate duration of 6-8 months (varies per individual).

What to Do: If complaint is regarding anxiety/auditory fatigue while using device: Counsel to avoid a “too long and too loud” scenario that can contribute to anxiety and auditory fatigue.

Remind your patient that usage can be in small segments of time: 15 or 30 minute sessions based upon individual needs.

Remind patient that a daily total of 2 hours is proven sufficient for outcome success if additional treatment time is not needed, however there is a clear dose related outcome effect in terms of usage. Patients who use the device between 2-4 hours per day tend to get better results.




If a patient complaint is regarding lack of time in their day for treatment, counsel regarding 2 hour daily total (see above). Review the convenient aspects of the treatment, and brainstorm specific situations in which the patient can fit the treatment into daily life.

• Patient is Not Using Treatment in the Right Auditory Environment

o The NTT protocol defines a “quieter” listening environment as a necessary component of the treatment.

o A noisy ambient environment requires the volume of the device to be increased beyond a comfortable, relaxing volume level.

What to Do: Strongly advise against using treatment in noisy ambient environments.

Brainstorm with your patient to identify specific environments that should be avoided.

Reinforce that the auditory environment during listening should be conducive to a “set and forget” volume level.

• Patient is Not Using Treatment Appropriately

o The NTT protocol defines suitable activities to perform while using the treatment as: office work, reading writing, leisure walking, non-strenuous/quiet hobbies, and non-strenuous housework.

o The protocol defines non-suitable activities that must be avoided as: driving, straining to hear, TV viewing, when heart rate is increased through exercise, and activities that might get the device wet.

What to Do: Brainstorm with the patient to consider activities within the patient’s daily life that are appropriate times for treatment. Strongly advise against using treatment during contraindicated activities.

Don’t forget that the sixty day return period for a patient can be

extended based on a conversation with a Neuromonics Clinical

Specialist. If you are having trouble with a patient let us know and we

can work with you to give the patient more time to experience the

benefits of the treatment.




Stage Progression Considerations

• Due to personal attributes and circumstances, many patients are not ready to progress from Stage One until they complete some additional time in the current stage.

• Remember that it’s better to use treatment in the most effective manner and to meet prerequisite milestones then it is to prematurely move your patient forward.

• Questions to Consider Before the Transition to Stage Two

o Prior to making the the move to Phase 2 and the Active Treatment Stage these questions should be answered:

Is the patient maintaining protocol compliancy?

Does the patient have unmanaged stress? Has the appropriate relaxation response been conditioned?

Does your patient report of a sense of control regarding tinnitus?

Have all milestones through Stage One been met?

Is there a progression toward treatment goals (while using device)?

Is there significant progress toward decreased tinnitus disturbance and TRQ score?

Has the patient indicated that they are ready for the transition?

o Be sure to review any progress made to date by using the TRQ to compare pre-treatment to current levels in order to assess whether transition criteria have been met.

If necessary counsel as to the importance of delaying transition to the Phase 2 stimulus until all prerequisite criteria have been achieved.

Assess current degree of interaction and relief. If not appropriate, see ‘Managing Issues with Neuromonics Stimulus’ section.

Measure LDLs, BBN MML, and audiogram if indicated.

Encourage patient to follow troubleshooting instructions which are necessary in order to use treatment in the most effective manner and to achieve the milestones/goals of Stage One.

Remind patient that not following identified remedial actions may compromise potential treatment gains.

Positively reinforce that delaying the transition is not a bad thing, in fact it is quite the opposite. Patients that spend additional time in Phase One are merely making sure that they are doing all the things necessary to ensure a positive treatment outcome.




• Moving To the “Maintenance Phase” of Treatment

o Meeting the following criteria is required before entering the maintenance phase of treatment:

Patient has met all Stage Two milestones

Individual treatment goals have been met

Tinnitus desensitization has occurred

Patients is “ready” to complete treatment

o In the event the above criteria are not met consider the following counseling tools:

Reassure your patient that is not uncommon for many patients to require an additional 1-3 months in active treatment. Recommend a progress monitoring office visit in one month.

Review progress made to date using evidence to compare pretreatment to current level of progress and demonstrating the progress the patient has made.

Assess current degree of interaction and relief. Assess if patient is using the treatment at the appropriate intermittent interaction level (50/50 blending) and achieving appropriate relief.

Reach for the device only when bothered by tinnitus, adjust to a ‘set and forget’ volume level that is covering and exposing tinnitus fifty percent of the time. Use the device on the ‘single’ setting and proceed with appropriate activities.

Positively reinforce that the patient is making great strides in treatment and that they need to stay the course with their treatment.




Possible Patient Complaints

• “My Tinnitus Is Getting Worse” - Contact Your Neuromonics Clinical Specialist

o It is important for your patient to know that no sound contained within the device will make tinnitus worse (exception Reactive tinnitus).

o Tinnitus changes can be caused by factors not directly related to the use of the device for example stress or life factors.

What to Do: Assure patient that you will work together to find the variable(s) that impede treatment progress and will collaborate to develop a remediation plan.

Remind patient that compliancy with following identified remedial actions is vital so potential treatment gains are not compromised.

Consider scheduling additional clinic appointments or follow-up phone calls to monitor effective use of treatment.

• Tinnitus Perception Is Greater Since Initiation of Treatment- Contact Your Neuromonics Clinical Specialist

o If this occurs within the first few weeks of the fitting, counsel that it may be part of the normal cyclic nature of tinnitus responding to intervention and it is good a prognostic indicator.

o Consider and counsel to all life factors (see Common Everyday Life Issues section) that could be aggravating the tinnitus.

o Consider and counsel to all treatment-specific factors that the patient needs to be compliant with. Ask the patient what he/she feels may have caused the worsening and counsel accordingly.

o Provide/review general tinnitus management strategies as covered in patient advice sheets. Recommend to use the device more to take advantage the relief it provides.

• “My Tinnitus is Worse When It’s Quiet”

o This is a common statement heard from tinnitus patients and a topic that is easily managed.

Counsel your patient to avoid situations where there are no background sounds when not wearing the device.

Counsel to use sound/pleasant music to “distract the brain” when not using treatment.

Suggest using the device on ‘single’ setting with a Track that provides the most relaxation at bedtime.




• Tinnitus is More Noticeable Following a Treatment Session

o After a period of enjoying relief from their tinnitus while using the device, a patient may be more conscious of their tinnitus by way of contrast (termed “relief contract”) even though it is actually unlikely to be worse. Unfortunately, just the worry about something making the tinnitus worse is enough to actually make it worse, so it is important to emphasize the importance of stress management during treatment. Relief contrast occurs because tinnitus appears louder in comparison to the relief experienced while using the device.

What to Do: Reinforce the concept of ‘relief contrast’ with the example of eyeglass wear. There is a contrast effect when people remove their glasses until their eyes have time to adjust.

You can also advise your patient to turn the device to a lower volume a few minutes before completing treatment much as you would use a dimmer switch for lights. By gradually easing back into perceiving tinnitus, it can be less noticeable when the treatment is ended.

Also, ending a treatment session and removing the device, if possible, in an environment that is not completely quiet can be helpful.

Counsel to avoid a “too long and too loud” scenario that can contribute to anxiety.

• Tinnitus Impacted by Exposure to Certain Sounds

o See Reactive Tinnitus under Non Standard Patient Attributes Section. Consult your Neuromonics Clinical Specialist to determine if the Reactive tinnitus protocol is appropriate.

• “My Tinnitus is Changing”

o If your patient experiences a “change” in their tinnitus, and it is within the first few weeks of their fitting, counsel that it may be part of the normal cyclic nature of tinnitus responding to intervention and this is a good prognostic indicator of future success.

Reassure your patient that a change in tinnitus is a good sign as it indicates that the tinnitus is breaking down. Help alleviate anxiety and concern over tinnitus change to prevent increased monitoring of tinnitus

o Some patients report that prior to treatment initiation, their tinnitus varied in intensity from time to time. For such patients, an increase in tinnitus that is experienced during treatment may be part of their natural cycle of variation.

Refer to THQ or any case history information to confirm if tinnitus variation occurred with the patient prior to treatment to help patient gain perspective

Remember to encourage your patients to visit the

www.myneuromonics.com website. They will find answers to many

questions, informational videos, relaxation exercises and

many other useful tools.






Managing Issues with the Neuromonics Stimulus

• Patient is Experiencing Low or No Interaction

o How well sound is tolerated can impact the level which the Neuromonics treatment will blend with a patient’s tinnitus.

o Hyperacusis/DST can inhibit interaction as the device cannot be turned to a volume sufficient to blend with tinnitus and provide relief.

o A clue to possible low interaction becoming a problem may come from the initial audiometric evaluation if a patient is unable to comfortably reach the minimum masking level with broad band noise.

o Low interaction cases can still gradually reduce their tinnitus awareness even without complete masking.

o Consult your Neuromonics Clinical Specialist about potentially keeping the patients in Stage One of treatment.

o If a large degree of asymmetry exists between ears, some patients find that relief is achieved at a more comfortable listening level when a contralateral prescription is used. Under this prescription, less stimulation is directed to the poorer ear.

If your patient has been fit with a contralateral prescription and reports low interaction, reinforce appropriate expectations for the patient. This means that the amount of stimulation and degree of interaction achievable is lower due to asymmetrical hearing loss.

An additional expectation may include extra time (>2 months) in Stage One to meet milestones before transitioning to Stage Two.

o If your patient’s interaction level has changed since their fitting date, it could involve: device and/or earphone malfunction, a change in hearing status or change in tinnitus perception

What to Do: Let your patient know that all pertinent variables causing a change in interaction will be explored and then contact your Neuromonics Clinical Specialist to explore possible solutions

• Patient is Unable to achieve a high degree of interaction or tinnitus is not completely blended

What to Do: Reassure the patient that the goal of the treatment is to provide some degree of relief from the tinnitus while also providing relaxation. It is not necessary for the tinnitus to be completely covered for the treatment to be effective.

For patients with DST/Hyperacusis, interaction can improve as a result of the relaxation associated with the treatment (as they can begin to “push the envelope” of volume) or through the additional support of a Tinnitus Coach. Once sound tolerance issues have been addressed and improved, the focus can turn toward higher interaction with their tinnitus.




• Patient is Dependent on High Level of Interaction- Fearful of Transition

o Long term desensitization to tinnitus, and therefore long term relief from tinnitus disturbance, occurs after a graded increase in exposure to tinnitus in a relaxed state. This means that in order to receive long-term benefit, the patient will need to proceed to the next phase of treatment.

Gently counsel that if initially the patient is not getting the same relief as they did in Stage One that this is normal and not a cause for concern. Over time most users report that the treatment and tinnitus go into the background during Stage Two and there is less disturbance from the tinnitus, even when not using treatment.

Reassure that a very gradual decline of the Phase One stimulus and therefore gradual increase in exposure can be used in preparation for transition. Transition does not need to occur until the patient feels it can be managed.

Acknowledge that it may be hard 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 since this is part of the evolution of their treatment program and necessary to achieve the long term goal of overall reduction in tinnitus disturbance and awareness.

Remind the patient that if they are having a “bad tinnitus day” or increase in perception, they should feel free to increase the volume on the device to achieve more relief. That options is always there and can be very reassuring to a patient during this phase. That being said, they should work towards 50/50 coverage of their tinnitus on days when it is less severe.

• Phase One Stimulus Produces Anxiety

o The Phase One stimulus is a customized acoustic stimuli with an added broad band neural stimulus that is more noticeable to some patients.

What to Do: If the patient has just been fit with the device, over the next few weeks, as the acoustic stimulus becomes less novel and more familiar, it should become less distracting and easier to let sink into the background of consciousness. Remind your patient to set volume at a comfortable level to allow the patient to “set and forget” the treatment.

It is possible that the patient is reacting negatively to the broad band neural stimulation and a change to the Phase Two stimulus with the broad band neural stimulation removed can be tried. Before taking this approach consult your Neuromonics Clinical Specialist.




• Patient Sees Treatment as a Chore Causing Frustration or Anxiety

o A treatment protocol of 2-4 hours daily can often seem overwhelming to new patients.

What to Do: Remind your patient that their daily dose is cumulative. Their treatment will be effective even in 15 minute increments as long as their daily total reaches two hours.

Counsel to avoid a “too long and too loud” scenario that can contribute to anxiety, auditory fatigue and frustration.

Remind your patient that using the treatment at times when tinnitus is most bothersome, will provide them with relief and control over their tinnitus. This should help ease their frustration and anxiety. Treatment should never become a chore and will ultimately hinder progress if it is viewed as such.

• Specific Tracks Cause Annoyance or Anxiety

o On occasion patients have reported an adverse reaction to one of the tracks played by the Oasis.

What to Do: Remind your patient that the music is intended to fade into the background and to not actively listen to the tracks if possible

Advise patient to skip listening to Tracks that cause anxiety or annoyance then work to get them back into their listening schedule.

If absolutely necessary, the tracks that are causing problems can be removed




Reducing Returns and Keeping Patients In Treatment

Neuromonics Tinnitus Treatment outcomes have been published in numerous peer reviewed, published journals

demonstrating the efficacy of the treatment. In order replicate these outcomes, it is imperative that you troubleshoot issues in

a detailed, efficient fashion so patients stay the course with their treatment and ultimately reduce their tinnitus disturbance.

Use Your ResourcesNeuromonics Clinical Specialists are here to help you with ANY and ALL patient issues you encounter. If you have a patient

that is struggling in treatment, your first step should be to contact your Neuromonics Clinical Specialist. Before returning a

device or accepting that your patient has decided to terminate treatment, it is imperative to speak with a NeuromonicsClinical Specialist. Our Clinical Specialists are here to support you as your patients progress through treatment.

Troubleshooting SuggestionsThe best way to reduce treatment issues it to take a systematic approach to troubleshooting.

• The first thing to consider is how long the patient has been in treatment. You should also review the data log and

examine the volume settings for correct usage. Depending on the length of time in treatment and the usage patterns

of the patient, treatment benefits can vary significantly. Knowing the correct milestone timeline for a patient is crucial

to counseling them correctly. Once you have determined where the patient fits into the treatment timeline you can

use the appropriate approach to help them.• Stage One Goals: Relief while wearing the device, sense of control over tinnitus, relaxation while wearing the device,

significant reduction in tinnitus disturbance.

• Stage Two Goals: Reduced awareness while not wearing the device. Here is where you should start seeing carry over

with the device off.

Be Prepared for Patient Setbacks and IssuesVery rarely will you have a patient that goes through treatment without some form of a setback. Stress is a known trigger for

tinnitus and is difficult to completely eliminate from our life, despite our best efforts. Remember, that the majority oftinnitus patients have been debilitated by their condition for a number of years and thus it makes sense that progress will be

gradual. If a patient comes in for the two-week follow up and feel they have not improved yet, that is OK and in fact is quite

normal. Your job in this situation is to remind the patient that whatever they are experiencing is manageable and they should

maintain a positive outlook. Being a cheerleader and a supportive element in the patient’s treatment is critical when dealing

with setbacks and issues.

Work with your patient to formulate a specific treatment plan to meet their individual needs. How will theyneed to wear the device in order to achieve optimal success? What usage pattern will be most beneficial in obtaining theirtreatment goals set at the fitting appointment? This is where your clinical expertise will shine. Feel free to consult yourClinical Specialist for ideas and ways that you can help your patients maximize benefit from treatment.

You Are the ExpertDon’t be surprised if one of your patients arrives for an appointment armed with information from the internet or other

“reliable sources” regarding tinnitus and their treatment. The reality is the average tinnitus patient spends a tremendous

amount of time and energy trying to diagnose and treat themselves. Your job is to gently encourage them to refrain from

these activities. As the clinician you are expert when it comes to the Neuromonics Tinnitus Treatment process and part of that

obligation is convincing your patient to stop researching and focusing on their tinnitus. Their obligation is to be the patient

not the audiologist.




Frequently Asked Patient Questions

Will my tinnitus get worse using this device? A: No, there isn't anything contained within the device that will make your tinnitus worse. While initially wearing the device, you may have immediate relief and relaxation from your tinnitus and once the device is removed your tinnitus may seem louder for a brief time, but will gradually begin to decrease. This is similar to individuals who wear eyeglasses; there is a contrast effect that occurs once they remove their glasses, until their eyes adjust. It is also common that your tinnitus changes pitch during the treatment. If you have any concerns about your tinnitus perception while using treatment, contact your clinician.

Q: If someone else in my family has tinnitus, can they use my device? A: Since the Neuromonics device is individually prescribed and contoured to your hearing profile and being classified as a FDA Cleared Medical Device, it cannot be shared with someone else (The FDA mandates that it is a one patient, one use device).

Q: If I fall asleep with my device on, does it count towards my 2-4 hours a day? A: The 2-4 hours per day only includes waking hours. Due to the relaxation provided by the device, it is an excellent way to help fall asleep at night. And it is safe to use while sleeping. However, keep in mind that it is important to wear your device throughout the day when your tinnitus is most bothersome (for a minimum of 2 hours total usage per day).

Q: Can I have different musical tracks for my device? A: No additional or alternate musical tracks can be programmed on the device. The musical tracks contained in the Neuromonics device are very specific and have been chosen to help counteract your tinnitus. In order to retrain your brain to ignore your tinnitus, the music needs to be redundant in nature. The sooner you can put the music into the background, the more quickly you will be able to put your tinnitus there as well.

Q: If I use hearing aids and Neuromonics, when should I use Neuromonics vs. hearing aids? A: If you use hearing aids, make sure that they are used for communication purposes and not while wearing your Neuromonics device. The Neuromonics device may be used during quieter times when there is nothing for the hearing aids to amplify. You will need to remove your hearing aids while using the Neuromonics device. Remember to reach for the your Neuromonics device when the tinnitus is most bothersome.

Q: Can I use my own earphones? A: No. Due to limitations of the frequency response, other earphones will not be calibrated to provide the full prescription of your treatment. If you have problems with the prescribed earphones, please contact your provider.

Q: What if the treatment is not completely covering my tinnitus? A: It is not necessary for the treatment to cover your tinnitus in order to be effective. The goal of the treatment is to provide some degree of relief from your tinnitus, while also providing relaxation. Factors that influence how much the treatment will blend with your tinnitus include your hearing loss, the perceived volume of your tinnitus and how well you can tolerate sounds.




Q: What if my earphones don’t sound balanced? A: For more balanced loudness perception, first adjust the earphone placement. Due to the size and shape of each patient's ear canal; loudness perception can vary. You can experiment with earphone placement in order to balance the loudness. Also be sure to check that the earphone jack is securely connected and inserted completely. For further tips on troubleshooting earphone issues, please see the “Device Troubleshooting” section of your Oasis workbook.

Q: How loud should I play my device? A: Your first goal should always be to listen at a comfortable volume level. If the device is too loud it can take away from the relaxation you should experience from the music. Be sure to turn up the volume if you feel you need more relief, but be certain it is a comfortable level.

Q: Will I have to use the device forever? A: At the completion of your 6-8 month treatment plan, we recommend that you continue to stimulate your auditory system by using the device from 2-4 hours per week. This additional period is called the maintenance phase and will vary from patient to patient.

Q: When am I done with treatment? A: Completion of the treatment process varies from patient to patient. This will depend upon a number of factors including how you have progressed through the treatment process and whether or not you have accomplished the goals you set out to achieve. Your clinician will be able to help you determine when this has been accomplished.



CL12-0001 Rev.1 www.neuromonics.com 28

Conclusion

Counseling tinnitus patients is often a challenge for even the most experienced clinician. It takes years of experience to become comfortable with the nuances of tinnitus counseling. This guide is written to help familiarize you with some of the basic tools, strategies and tactics that help facilitate a successful Neuromonics patient outcome.

The Neuromonics Tinnitus Treatment involves striking a balance between systematically covering all key elements and customizing treatment for each patient’s unique needs while also foreseeing potential “stumbling blocks.” Issues which impede progress can arise at any point during a patient’s treatment, therefore, consistent contact with the patient allows for proper monitoring and early intervention when indicated.

All suggestions in this guide are based upon the accumulated experiences of the Neuromonics team over the past ten years. The contents of this guide are meant to facilitate successful treatment outcomes and remain, at all times, subject to good clinical judgment.

If issues are encountered that were not covered, or if the suggested remedial actions are either not satisfactory or unclear, you are strongly encouraged to contact a Neuromonics Clinical Specialist. Our highly specialized clinicians are here to provide solutions based on their experiences with similar cases.

Remember that Neuromonics is committed to assisting you with any and all questions pertaining to your tinnitus patients. Our goal is provide you with the training and knowledge that will ensure positive outcomes for your Neuromonics Tinnitus Treatment patients.

Sincerely,

The Neuromonics Team



Etiam sit amet est -...

Documents

Transcript of Etiam sit amet est -...