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In 2010, every VA medical facility audiology clinic received copies of the PTM clinical handbook, counseling guide and hundreds of patient-education workbooks. The repetitive stutter of a machine gun, shocking boom of mortars, the deafening drone of helicopter rotors; the sounds of war are hard to ignore and can leave many Veterans with permanent hearing damage.
Tinnitus is the number one disability among Veterans and it affects at least one in every 10 American adults. Some describe ringing sounds, a buzzing sound, a high-pitched whistle, or numerous other sounds. The model is designed to address the needs of all patients who complain about tinnitus, while efficiently utilizing clinical resources. The majority of people with tinnitus, about 80 percent, are not bothered by it; it doesna€™t affect their sleep or their ability to concentrate. Veteran account No.1August Firgau, an Army Veteran, has been living with tinnitus since 1951. The main thing that helped me was when we set goals for ourselves in cognitive behavioral therapy. Patients that need more guidance in finding a way to live with tinnitus are referred to group education workshops. Veterans are given a comprehensive self-help workbook with supporting materials, like worksheets and audio samples. Following up with management technique results in class has given the instructors a better understanding of the highly-individualized symptom they are trying to manage. Veteran account No.2Don Parrish had lived with a minor level of tinnitus since leaving the Air Force in 1969, but a few years ago he woke up in the middle of the night to a screaming in his ears. Another technique covered in the workbook and class is cognitive behavioral therapy (CBT) exercises that address the negative reactions tinnitus can trigger. Whether the Veteran is already in contact with a mental health specialist or not, the PTM program introduces them to a series of CBT exercises that have proven effective in helping many tinnitus patients. After completing the workshops, many Veterans are able to come up with an action plan to manage their tinnitus through audiologic, cognitive behavioral techniques or some combination of the two. Veteran account No.3John Foster was serving in World War II when he started hearing a ringing in his left ear. Once you find out it has no cure, the minute you do that, then you start to take steps to get better. I bought a little bubbly fountain and I always liked the sound of water; that was kind of soothing. I picture myself walking on a beach, and I tried to think of the sun hitting me on the side of the face and I think about a breeze and I actually feel the breeze and then when I turn back, I feel the sun on the other side of my face and I actually see my footprints in the sand and by the time I do that I usually fall asleep.
The number of Veterans that complete the group education stage of PTM and go on to need individualized support is very small. A sequential program emerges as one of the most promising, research-based methods to help veterans manage their tinnitus. In order to help patients, it is necessary to mitigate the functional effects of tinnitus, such as difficulties with sleep, concentration, and relaxation. People who experience tinnitus have most typically been exposed to loud noise that caused peripheral auditory damage, resulting in both tinnitus and hearing loss. Military personnel are exposed to numerous hazards associated with tinnitus and hearing loss, including but not limited to high levels of noise. These auditory problems can become significantly greater following military discharge due to aging and further insults to the auditory system.
Although many therapies for tinnitus are available, most are not supported by rigorous scientific research. Our research efforts in Portland have led to the development of Progressive Tinnitus Management (PTM), a detailed, comprehensive program endorsed by the VA central office for use at VA medical centers.
An initial referral is followed by a hearing evaluation and brief assessment of tinnitus impact. If needed, the patient is advised to attend education workshops designed to provide patients with skills to self-manage their tinnitus.
If the patient still experiences problematic tinnitus following the workshops, an interdisciplinary (audiology and psychology) evaluation is completed. PTM was developed specifically for efficient implementation at VA medical centers, but there are still some barriers to providing comprehensive tinnitus services at all VA medical centers. To address these issues and as part of an overall effort to make tinnitus services available to all veterans, we conducted a pilot program to provide national in-home tinnitus education.
Since telemedicine technology is advancing rapidly, it is now possible to develop PTM as a full telemedicine program using different delivery models. In addition, the infrastructure for conducting telemedicine is already in place at most VA medical centers. Tinnitus is a problem that is recognized at all levels of the Veterans Health Administration.
Tinnitus (pronounced TIN-ih-tus) is when you hear sounds which originate in your head and not out in the world. People with tinnitus often have some hearing loss, and sometimes also suffer from loudness hyperacusis - when moderately loud sounds are perceived as being very loud.


When tinnitus is caused by a medication, stopping or changing the medication can eliminate tinnitus in those cases.
Sound Therapy - Background noise has been shown to diminish the prominence and loudness of tinnitus in many people.
Counseling – Counseling can help people manage the side-effects of tinnitus, including its impact on concentration, sleep, thoughts and emotions. 28% of people who used hearing aids reported a moderate to substantial reduction in their tinnitus when they used their hearing aids. 66% of people who wore hearing aids said that it alleviated their tinnitus most of the time, and 30% of people said that hearing aids alleviated their tinnitus all of the time. The more comprehensive the hearing aid fitting protocol that was used, the more relief the patients had from their tinnitus.
MARYLAND: Montgomery County, Bethesda, Rockville, Gaithersburg, Germantown, Olney, Kensington, Potomac, Chevy Chase, and Silver Spring. The causes and effects of tinnitus vary from individual to individual, so researchers at the National Center for Rehabilitative Auditory Research approached treatment options the same way. Myers is a member of the VA research team that developed the Progressive Tinnitus Management (PTM) approach. There are five hierarchical levels of management: (1) Triage, (2) Audiologic Evaluation, (3) Group Education, (4) Interdisciplinary Evaluation, and (5) Individualized Support. For health care providers, the authors of PTM organized a triage procedure to help identify tinnitus patients and access exactly what kind of medical services will best serve their needs. Cheri Ribbe, audiologist at the Boston VA Healthcare System where they started using PTM over two years ago.
The small percentage of people who struggle with the noise in their head can be more prone to other debilitating mental health problems, like depression and anxiety.
Finding a place, a very restful fishing spot, and enjoying taking in the different environmental sounds and the smells. I can go along in the daily things of life and not be aware of the tinnitus a€” not because ita€™s not there, because I can ignore it.
During the exam audiologists counsel patients regarding hearing loss, tinnitus and provide Veterans with educational materials. The self-help workbook offers many sample sounds and patient examples that Veterans can try out. Ia€™ve got seven little iPods with more sounds on them; the one like a babbling brook is really helpful to me. Relaxation techniques, distraction by planning pleasant activities and changing how patients think about tinnitus are the three main techniques taught in the class. Providers follow up six weeks later to check on their progress and set up additional assistance for the few patients who need it. Living with the pain over the years, he lost sleep, gained weight and became a very angry person. I found out that if I woke up I would hear the water, but I would focus more on the visualization and the breathing. So PTMa€™s hierarchical approach provides VA medical facilities with the most efficient means to educate Veterans and teach them self-management techniques.
Anything that can cause hearing loss can also cause tinnitus, including noise exposure, and the odds of having tinnitus increase as hearing loss increases.
In spite of awareness about these potential exposures and increased efforts to use hearing protection in the field, a substantial number of military personnel still experience auditory damage.
The Veterans Benefits Administration reports that in fiscal year 2011, tinnitus was the most prevalent service-connected disability, with 840,865 affected.
A cure for tinnitus does not yet exist, and despite claims to the contrary, no method has been proven to provide long-term suppression of tinnitus loudness and intensity. Two years later, the VA National Center for Rehabilitative Auditory Research was established at the same location, which included tinnitus research.
After possibly receiving a hearing aid at this time, the patient is assessed to determine if tinnitus-specific intervention is needed. This in-depth assessment of the patient’s tinnitus needs determines whether the patient requires individualized support.
As reported in the Journal of Rehabilitation Research and Development in 2012, it demonstrated the feasibility and efficacy of performing PTM intervention over the telephone, with educational materials provided by mail.
The VA Rehabilitation, Research, and Development Service has supported most of the tinnitus research that we have conducted, as well as studies conducted by other investigators. Tinnitus can become serious enough to impact your everyday life, so it's important to have it evaluated by an audiologist or physician as soon as you notice it.
But for most people who suffer from tinnitus, there isn't a cure to eliminate it from their lives. Some wearable devices can be worn with or without hearing aids to mask the sound of the tinnitus. Tinnitus Activities Treatment is a type of individualized counseling focused on each of these areas.
Using hearing aids doesn't just improve overall hearing, including speech and other environmental sounds, but hearing aids reduce the strain to hear speech, and this can reduce the stress that people with tinnitus feel from straining to hear over the ringing or buzzing in their ears.


Anzola is very attentive, listens very carefully to what ou have to say, will answer all guestions and will change whatever that can be changed to accommidate your wishes. Many times I have called or gone to their office to correct a problem or answer a question. The culmination of years of studies and clinical trials, PTM evolved into a national management protocol for VA medical centers. Throughout the process, patients work with a team of clinicians to create a personalized action plan that will help manage their reactions to tinnitus and make it less of a problem. James Henry, PTM author and Research Professor in Otolaryngology at the Oregon Health & Science University.
Her audiology clinic has seen over 500 Veterans take part in PTM a€” some who just came in for more information, and some who have gone on to higher levels of the PTM program. Myers explained that instructors have the flexibility of using the provided handouts, slides, sound demonstration CDs, and DVDs to teach the workshops. She said that she never would have considered traffic noise as sound therapy, but for one Veteran who had grown up in the city those sounds brought him back to his childhood and pleasant memories. Tinnitus was also the most prevalent service-connected condition for veterans who first began receiving benefits (87,261 veterans).
As a result, in order to help patients, it is necessary to mitigate the functional effects of tinnitus, such as difficulties with sleep, concentration, and relaxation. Many methods of sound therapy have been developed, and numerous companies are promoting sound therapy products. Our tinnitus research has remained focused on developing effective, evidence-based methods of tinnitus management for veterans. Additionally, for PTM intervention to be effective, veterans must travel multiple times to a VA medical center, which some veterans are simply not able to do.
The workshops, evaluations, and individualized support efforts in PTM are ideally suited to telemedicine implementation. We will continue to develop and evaluate these methods to improve tinnitus services and to make them available to all veterans who need them.
James Henry [author of the accompanying story] that was available to veterans and involved several types of treatments. Non-wearable devices are very popular also – they include fans, music and noise machines with sounds like waves or raindrops. Talk to your audiologist about what approach would work best for you, to help you enjoy hearing again.
Thanks to her I have new hearing aids which are extraordinarily better than anything I had before.
Anzola is totally professional, helpful and experienced - it is a pleasure to use her services. She made sure I had devices to fit mt needs and took the time and care to make sure I was satisfied. Clearly, tinnitus is a high-priority healthcare issue for the military and the Department of Veterans Affairs (VA).
It remains unknown, however, if there is any difference among the various sound therapy methods. Eighteen tinnitus projects have been funded, including four that are currently in progress. The infrastructure for providing in-home tinnitus self-help education is fully developed, and participants are being recruited into the study. She takes time to analyze your hearing loss and then creates the best solution tailored to your needs. Anzola immediately put me at ease, explained the process and educated me on available options. They worked with me to make sure that I got the help I needed and got the comfort that I wanted. I am very pleased with my choice to get assistance from Ascent Audiology for my hearing needs.
I was thoroughly evaluated for hearing loss and was given a masker and a hearing aid, which have been a big help to me in coping with the tinnitus.
Christina is so helpful and her calls to remind me of my next appointment are much appreciated. I was invited to sit in as the aids were prepared and how to use and care for them was explained. She took A LOT of time going over everything, answering questions, and explaining everything in detail.



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