UNDERSTANDING YOUR ASSESSMENT   

Understanding Tinnitus  

Tinnitus is a sound in the ears or head when there is not an external corresponding sound. People with tinnitus hear sounds within the body that other people cannot hear. Tinnitus sufferers commonly describe ringing, buzzing, humming, roaring, whistling or other noises in their ears. At today’s appointment, we measured several parts of the tinnitus which include the pitch, the amount of noise required to cover the tinnitus and the tinnitus disturbance. These measures are also used to monitor progress of treatment and are found in the “Your Audiogram” or in the “The Tinnitus” sections in the following pages.  

Approximately 15% of people experience tinnitus. For people over the age of 55, this number increases to over 30%. For many people, tinnitus is a mild irritation and may be only temporary. Tinnitus can be caused by many different reasons. Tinnitus typically starts as a result of hearing loss. Some causes of hearing loss include exposure to loud noises, taking certain types of drugs and medication or middle ear infections. In a small number of cases tinnitus may require medical or surgical intervention.

For some people that have tinnitus another part of the brain (the limbic system) attaches an emotional response to the tinnitus. Similar to the ‘feeling’ you get when you scratch your fingernails down a blackboard, tinnitus can be more than just a sound.

Tinnitus can cause anxiety and stress responses in the body, through the autonomic nervous system. The autonomic nervous system controls involuntary processes in the body such as heart rate, breathing and blood distribution. Around 1-2% of people with tinnitus are bothered so much that sleep, relaxation and concentration are affected.

Tinnitus can restrict people’s quality of life as sufferers avoid situations that can make the tinnitus more noticeable such as quiet environments or particularly noisy situations. For some, tinnitus is a condition which can have a negative impact on work, family and social life.

Note: This report is intended for personal use. If you or another clinician would like a more detailed report about your hearing and tinnitus assessment resultsUnderstanding an Audiogram… , please ask your Neuromonics clinician to provide a clinical report.

When we are speaking, we use a limited range of pitches

demonstrated by the shaded area. Unless we are shouting, we normally do not talk much louder than 60dB.

Profound Loss

0.2Low

Your Audiogram… PITCH (kHz)

0.25 0.5 1 2 3 4 6 8 10 12.5

PITCH (kHz) 5 0.5 1 2 3 4 6 8 10 12.5

High

Normal Hearing

Mild Loss

Low High

Moderate Loss

Severe Loss

A sound is described by two variables: what pitch or frequency it is and how loud it is. These two variables can be plotted on a graph called an

audiogram. The horizontal scale moves from low pitched sounds, e.g. a drum or the bass notes on a keyboard, up to high pitch sounds, e.g. a whistle or the high end of the keyboard. The pitch of a sound is measured in kilohertz (kHz). The vertical scale

measures how loud a sound has to be, at any pitch, before you can hear it, e.g. very quiet sounds would be close to the top and very loud noises

would be at the bottom. The loudness of sounds it measured in decibels (db HL).

Volume required to hear sound (dB HL)

Loudness Discomfort Left └Loudness Discomfort ┘

TinnitusT

O

Hearing Left X Hearing Right

Based on the measurements we have taken, we can plot your hearing in both

ears. The softest that you can hear in the left ear is plotted on the graph with the crosses, whereas the circles indicated

the softest volumes you can hear in the right ear.

Speech

Speech

-10 0

10 20 30 40 50 60 70 80 90

100 110 120

Soft

Loud

-10 0

10 20 30 4050 60 70 80 90

100 110120

Soft

Loud

Your Assessment Results…

Your Audiogram Results show that you have a __________________ hearing loss. The frequency of your tinnitus pitch is approximately ____________ kHz. The level of white noise required to mask your tinnitus was ________ dB SL. Your Tinnitus Reaction Questionnaire determined that you have a clinically significant / mild level of tinnitus disturbance. You have normal / decreased sound tolerance.

Notes:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

UNDERSTANDING YOUR ASSESSMENT  

Your Tinnitus During your assessment, we measured the pitch of the tinnitus (see ‘T’ symbol on the audiogram). Pitch is like the keys on a piano and refers to how sharp or flat the tinnitus sounds to you. Pitch does not affect loudness. This is an approximate measure, since the perceived sound of the tinnitus is generated by the brain rather than an actual external sound. For many people this sound will vary from time to time.

If you look at where the tinnitus pitch (T) falls on the hearing test, you will typically find that the tinnitus occurs in approximately the same region as your hearing loss.

The amount of noise required to cover your tinnitus was also measured. We monitor this over the treatment period and find that as the amount of noise needed to cover the tinnitus decreases, people report being less aware of the tinnitus.

We are also interested in how bothered you are by the tinnitus. Your tinnitus disturbance was measured using the Tinnitus Reaction Questionnaire. When you choose to proceed with treatment all of the tinnitus levels are used to monitor progress throughout the treatment program.

Your Sensitivity to Sounds People with tinnitus are often sensitive to moderate and loud sounds. Some people find that moderate sounds are uncomfortably loud. In other cases, it is not the loudness of sounds that is bothersome, but that certain types of sounds are uncomfortable. Reduced tolerance to sound is often triggered by a hearing loss. External sounds seem louder than normal because the brain is receiving less information due to hearing loss. Someone with normal loudness tolerance has results that are greater than 85dB HL. People with decreased sound tolerance would have results lower than 85dB HL. Clinical trials have shown that, not only can the Neuromonics Tinnitus Treatment help to reduce tinnitus symptoms, but also can improve sound tolerance for people who are more sensitive to sounds.

* Wilson, P.H., Henry, J., Bowen, M., & Haralambous, G. (1991). Tinnitus reaction questionnaire: Psychometric properties of a measure of distress associated with tinnitus. Journal of Speech and Hearing Research, 34, 197-201.

UNDERSTANDING YOUR ASSESSMENT  

Starting Treatment When you choose to proceed with the Neuromonics Tinnitus Treatment, the results from your testing are used to customize your Neuromonics Device with your individual treatment prescription.

The Neuromonics Device is a medical device that is small and lightweight - approximately the same size and weight as a mobile phone, and used with high fidelity earphones. It delivers a pleasant sound signal (along with music) at a comfortable listening level. This sound stimulates a wide range of the auditory system. This stimulation is much wider than you would receive from listening to normal music, MP3 players, hearing aids or other sound devices. Since the signal is pleasant to listen to, it helps to promote positive changes in relaxation, concentration, stress, anxiety and sleep. This helps decrease disturbance from tinnitus during treatment.

The appearance of the Neuromonics Device is designed to be compact and discreet, so that you can easily and comfortably use your treatment.

In addition to the Neuromonics Device, the treatment involves several follow up appointments. The appointment schedule is outlined in the following pages.

UNDERSTANDING YOUR ASSESSMENT  

Different Stages of Treatment

There are two stages during treatment:

Stage One: The first stage is designed to help you get relief from the tinnitus while using the treatment and also to help you relax.

The main goal of Stage 1 of treatment is to provide tinnitus relief while using the treatment. An additional signal is added to the music, commonly referred to as the “shower sound”. This is added to help get as much blending of your tinnitus and the music as possible. Most people experience relief from their tinnitus while using treatment, so we recommend you use it at those times when your tinnitus is most disturbing. Consistent usage is recommended with 2-4 hours per day. This stage prepares you for the next stage of treatment.

Stage Two: The purpose of the second stage of treatment is to help re-train your brain to be less aware and bothered by the tinnitus

The signal is changed in Stage Two to help with retraining the brain to be less aware of the tinnitus. The music will remain the same. You will begin to slowly see benefit to treatment even when you are not wearing the device. At first, you may find you are not getting quite the same relief while listening as you did in Stage One. Do not worry because this is normal and should improve quickly. You should see results during this stage that include decreased awareness and disturbance from the tinnitus even when not using the treatment. During this stage, you will continue to use the treatment for 2-4 hours a day.

UNDERSTANDING YOUR ASSESSMENT  

Step by Step Process As a result of over 15 years of research and clinical trials, the Neuromonics Tinnitus Treatment has been refined to deliver an effective and efficient treatment for tinnitus in a way that does not interfere with one’s daily routine.

The typical treatment program involves:

Ordering of your Neuromonics Device

• Your Neuromonics Tinnitus Treatment device is customized to your hearing profile

Fitting of your Neuromonics device and starting treatment

• Instruction on use of the Neuromonics device

• Guidance on how to obtain the best results

• Discussion on how to integrate treatment into your lifestyle

• Information on expectations for Stage One

Stage One

• 2-4 hours of listening per day at the times when your tinnitus is most bothersome

• Signal is designed to maximize tinnitus relief

Stage Two

• 2-4 hours of listening per day when your tinnitus is most bothersome

• Signal is designed to assist in re-training the brain to be less aware and bothered by the tinnitus

Progress Reviews

• Scheduled throughout treatment to monitor progress

• Review usage data stored on your device

• Transition to Stage 2 when appropriate

UNDERSTANDING YOUR ASSESSMENT  

Common Goals Achieved with Neuromonics Tinnitus Treatment

Outcomes from the Third Clinical Trial:

• 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; Ear and Hearing, 2007)

Upon completion of the Neuromonics Tinnitus Treatment, we ask people for their comments. Commonly, people report the following:

• “I noticed an improvement in falling sleep as well as an improvement in the quality of sleep”

• “I felt a reduction in the need to have ambient sound around” • “I find it easier to concentrate and work” • “I find that treatment has taken the edge off the tinnitus” • “I generally only hear the tinnitus when I stop and think about it” • “If I do hear the tinnitus now I no longer worry about it” • “I am able to go out without worrying about being exposed to loud sounds” • “I enjoy socializing”

Although tinnitus is an internal phenomenon, its impact can affect family members. This occurs because people with tinnitus can often have to spend all their energy dealing with the tinnitus so that they have little tolerance or energy for other things. Therefore, we like to ask family members if they have noticed anything different in their family member since completing treatment. Here are some common responses.

• “No longer grumpy” • “No longer talks about the tinnitus” • “Appears to be more energetic”