Beltone True TM with Tinnitus Breaker Pro

Transcription

1 Beltone True TM with Tinnitus Breaker Pro

2 Beltone True Tinnitus Breaker Pro tinnitus datasheet How to use tinnitus test results It is important to remember that tinnitus is a symptom, not a disease. It is always recommended that a full medical evaluation be obtained before fitting Beltone True with Tinnitus Breaker Pro to rule-out, or otherwise treat, any underlying tinnitus-related pathology. Once it has been established that there are no underlying tinnitus-related pathologies, there are a number of baseline assessments one can use in the measuring and characterizing tinnitus that can be useful in fitting a tinnitus sound generator (TSG) device, such as Beltone True with Tinnitus Breaker Pro. Case History/Consultation A thorough case history is vital in identifying and understanding the primary issues related to one s tinnitus. This can involve onset of the tinnitus, description of the tinnitus, how it affects their daily lives, sound tolerance issues, psychological issues and many other factors that are important in helping to manage and counsel a tinnitus patient. Questionnaires Questionnaires are useful tools to evaluate the severity of one s tinnitus, and to get more information about specific areas affected for that person. Some of the more common questionnaires are the Tinnitus Handicap Inventory (THI) and Tinnitus Reaction Questionnaire (TRQ). Questionnaires can be measured as pre-therapy and post-therapy measures, providing insight as to the effectiveness of a therapy/counseling method, or to monitor changes or improvements in one s tinnitus perception. Audiometric Evaluation The basic audiometric evaluation is useful in determining basic hearing status, as well as recommendations for hearing instruments, TSG devices or further medical evaluation. Most audiometric tests are appropriate for tinnitus patients, although careful consideration should be made for acoustic reflex or decay testing, as the presentation level of these signals can exceed tolerance levels for many tinnitus sufferers. Often times extended high-frequency threshold testing (> 8kHz) is recommended to better understand and characterize the tinnitus, although a specialized high-frequency audiometer is needed to do this. Otoacoustic emission (OAEs) can also be tested to investigate the function of the cochlea.

3 Pitch Matching Pitch matching is where you match the tinnitus to a specific frequency, using a pure tone or narrow band noise. Pitch matching can be useful in helping to characterize the psychoacoustic properties of the tinnitus, but may not tell you much about the tinnitus itself. Recording and monitoring these results can help identify changes to the perception of the tinnitus, but consider there may be test/retest reliability issues. Pitch matching results can help with the TSG settings, should frequency shaping the TSG noise signal be preferred over a narrow band noise signal. Loudness Matching Loudness matching is where you match the tinnitus to a specific intensity. Loudness matching can be useful in helping to characterize the psychoacoustic properties of the tinnitus, but is not highly relevant to the severity of the tinnitus. Recording and monitoring these results can help identify changes to the perception and/or habituation of the tinnitus, but consider there may be test/retest reliability issues. Loudness matching results can be helpful with the TSG volume settings. Loudness Discomfort Level (LDL) LDLs indicate a person s tolerance for a signal. This measure is important for setting the TSG instrument, especially for those with hyperacusis and tolerance issues, as high level sounds can be uncomfortable and counterproductive. Minimum Masking Level (MML) MMLs indicate the least amount of noise needed to mask the tinnitus. This measure is important for identifying the preferred volume of the TSG instrument and can help monitor changes throughout therapy/counseling. A reduction of the MML (requiring less noise to mask the tinnitus) over time can imply improvement to tinnitus perception and detuning of neural patterns from tinnitus detection. Mixing Point The mixing point is where the tinnitus and noise generated from the TSG instrument are perceived to mix or blend together, without overmasking/completely masking the tinnitus. This measure is important for identifying the preferred volume of TSG instrument. Residual Inhibition Residual inhibition is when the tinnitus is lessened or disappears for a period of time after some sound exposure. The length of time that residual inhibition can last will vary from person to person. The reduction of tinnitus perception is the result of decreased neural activity, where the level of spontaneous activity is decreased after some sound stimulation. If residual inhibition occurs, it could indicate good candidacy for sound therapy (and a TSG device), as it suggests the tinnitus can be altered by some sound stimulation. Caution should be taken when testing for residual inhibition, as an increase in tinnitus perception can occur. FOLLOW UP After a period of sound therapy/counseling (results can vary), habituation to one s tinnitus might occur, and the symptoms might lessen. Therefore, it is important to follow up on the perceived severity of the tinnitus and reestablish some of the initial described baseline measurements to monitor one s progress, and set the TSG instrument to new preferred settings if necessary. Retesting of all baseline measures can be undertaken to monitor the effectiveness of the tinnitus management program. Questionnaires Administer as post-therapy measures. By comparing pre- and post-therapy scores, a therapy/counseling method, or changes/improvements in one s tinnitus perception can be monitored. Pitch Matching Reestablishing pitch matching results can help with frequency shaping the TSG noise signal, if this is preferred over a narrow band noise signal. It can also be helpful in identifying perceptual changes to one s tinnitus. Loudness Matching Reestablishing loudness matching results can be helpful with resetting the TSG volume settings. It can also be helpful in identifying perceptual changes to one s tinnitus. Minimum Masking Level (MML) MMLs can be reestablished for identifying the preferred volume of the TSG instrument and can be used to reset the TSG volume setting. Follow the same steps as the initial MML identification procedure to compare preand post-therapy measurements. A reduction of the MML (requiring less noise to mask the tinnitus) can imply improvement to tinnitus perception and detuning of neural patterns from tinnitus detection. Mixing Point If using the mixing point method, reestablish the mixing point, using the same initial procedure, to identify where the tinnitus and noise generated from the TSG instrument are perceived to mix or blend together, without overmasking/completely masking the tinnitus. This measure can be important for identifying the preferred volume of TSG instrument. Similar to the MML, if a reduction of the mixing point is established, this can imply improvement to tinnitus perception.

4 Name: DOB: Date: Gender: M F Serial Number(s): R: L: Case history (can be filled out by patient alone, or during consultation): How long have you experienced tinnitus? Triggers? Onset? Has it gotten worse or remained the same? Use a 2-alternative forced choice method to determine a matched pitch. Present tones at 10dB SL to ensure audibility. Begin by presenting a 500 Hz tone followed by a 1000 Hz tone and determine which tone subject perceives as being closer in pitch to their tinnitus. Then use selected tone to compare to successive frequencies until subject selects the first tone presented in series twice. See Table 1 below for illustration of this method. Comparison Tone Tone Judged to be Closest Trial Hz vs Hz 2000 Hz Trial Hz vs Hz 3000 Hz Trial Hz vs Hz 3000 Hz Trial Hz vs Hz 3000 Hz FINAL 3000 Hz Table 1. Comparison Method example Is your tinnitus in your Right Ear, Left Ear, or Both? (circle one) Describe the characteristics of your tinnitus: (e.g. high vs. low pitch, multi-tonal, constant, fluctuating, pure-tone or rushing) Record the frequency which is described as closest to tinnitus: Right ear Left ear Loudness Matching: Using the pitch measured during the previous procedure, or 1000 Hz if there is significant hearing loss, or tolerance issues may be present at the pitch matched frequency, present a pure-tone or narrow band of noise in the same ear used for the previous procedure. Present the signal at threshold and increase intensity in 5dB or 1dB steps. Loudness is determined when the test tone is equal in loudness to the tinnitus. Record the loudness level which is equal to the tinnitus: Previously worn hearing instrument/tinnitus devices? How many years?: Right ear Left ear Questionnaires: Tinnitus Handicap Inventory (THI) Record score Tinnitus Handicap Questionnaire (THQ) For scoring the THQ go to: Record score Factor 1 Record score Factor 2 Record score Factor 3 Record total score Pitch Matching: In an audiometric test booth, present pure-tones or narrow bands of noise to the contralateral ear if tinnitus is unilateral or perceived as louder in one ear. If hearing is asymmetrical use the better ear. If hearing and tinnitus are symmetrical then randomly select the ear. Beltone True with Tinnitus Breaker Pro fitting measurements: Establish the tinnitus sound generator (TSG) threshold. This is the lowest level where TSG noise can be heard. Recorded TSG level (Threshold) R: L: If using the Threshold of Audibility method, set the TSG volume 5-10dB above the TSG threshold. Recorded TSG level R: L: If using the mixing point method, from the TSG threshold, increase in 1-2dB increments until the mixing point is established. The mixing point is where the TSG noise and tinnitus start to blend. Recorded TSG level (mixing point) R: L: From the mixing point, adjust 1-4dB below the mixing point for the preferred level of the TSG. Recorded TSG level (preferred level of TSG) R: L: Establish the minimum masking level (MML). This is the lowest level where the TSG noise begins to mask the tinnitus. Recorded TSG level (MML) R: L: Note: The above measures are suggested fitting methods for Beltone True with Tinnitus Breaker Pro, but patient comfort should be always be considered. All these measures can be re-administered to monitor the status of tinnitus therapy/counseling, as well as perceptual improvements of the tinnitus itself.

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