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2/4/2020 Housekeeping Webinar Experience Welcome! If not using speakers and you haven’t already, please call into the call center number 02 8518 1923 and enter access code 802 708 089 Jud udy Gro robstein, AuD uD-FAAA AA, MAC ACAud Please be sure to keep microphones muted Manager of Education and Audiology If you have any questions, please type them in the chat box. You can view the chat box by clicking the chat bubble at the bottom of your screen Best option for audio is to call in using If you have any technical issues, please contact Dan Towns at Phone Number: 02 8518 1923 Access Code: 802 708 089 Dan_towns@starkey.com.au or call him direct at 02 8823 9005 For technical questions or log-in information please contact Dan Towns Direct line: 02 8823 9005 Dan_towns@Starkey.com.au Housekeeping Housekeeping Endorsed Session Learning Objectives This Session is endorsed for ACAud, AudA and HAASA points Identify causes and/or triggers of tinnitus You must stay logged on for the full session Identify patient populations likely to experience tinnitus AudA members must complete a 10 questions quiz with a passing score of 70% as well as your CPD Reflections and Evaluations List 5 steps for successful management of tinnitus ACAud, HAASA and NZAS members must complete the quiz to receive full points. Agenda Strategies for Successful Tinnitus Management 5 Steps to Defining Causes & Tinnitus Successful Tinnitus Triggers Populations Management Jud udy Gro robstein, AuD uD-FAAA AA, MAC ACAud Manager of Education and Audiology 1

2/4/2020 I want to hear birds chirping, THE SENSES but not my furnace My music /S/ sounds are sharp sounds flat Hearing Taste Smell Sight Touch 2

2/4/2020 tin·ni·tus NOT imagined [“ TIN-it-us ”, “ tin-NITE- us” ] NOT a disease noun Pathology Symptom of a malfunction, a constant or intermittent sound heard in the ears and/or head that does not have occurring anywhere within an outside source, often described as the hearing system ringing, humming, or buzzing Causes Causes Ear? Brain? Both? Other? The exact physiological mechanism of tinnitus is unknown . Many models and theories: BUT, research has consistently shown there are several likely ??? • Peripheral causes or triggers. • Central • Psychological • Non-auditory contributions Causes Causes Noise Hearing Noise Trauma Trauma Loss ● Single traumatic experience or Folmer & Griest, 2003; Hoffman & Reed, 2004; Baguely et al., 2013; Bauman, 2013 repeated exposure over time ● Tinnitus often first indicator of over exposure ● Onset may be sudden or gradual Health Head & Medications Problems Neck Injury 3

2/4/2020 Causes Tinnitus is more prevalent among Hearing Loss Almost any form or disorder individuals with impaired hearing involving the outer, middle, or Not all patients inner ear or the auditory nerve with hearing may be associated with tinnitus loss have tinnitus than it is among the normal hearing & vice versa population. Davis & Amr Rafaie, 2000 Brummett 1980; Shea, 1981 Tinnitus & Hearing Loss Causes • Can occur with any: Disease & Health Problems • degree of hearing loss Association between a number of • type of hearing loss conditions and tinnitus, including: ● Cardiovascular Disease • cause or type of onset • Changes in hearing loss and changes in tinnitus tend to occur ● Hypo/Hyperthyroidism independently of one another ● Diabetes ● Hypertension ● Depression ● Fibromyalgia Causes Causes Head & Neck Injury Disease & Health Problems Medications • Skull fracture, whiplash, blow to Association between a number of 500+ prescription and OTC drugs, face/head, TMJ/jaw related conditions and tinnitus, including: supplements associated with problems tinnitus: ● Cardiovascular Disease • Report onset shortly after ● Antibiotics ● Hypo/Hyperthyroidism injury/trauma ● Painkillers ● Diabetes ● Cancer drugs ● Hypertension ● Diuretics ● Depression ● Fibromyalgia 4

2/4/2020 Caffeine Alcohol Aggravators Folmer et al ., 2006; Henry et al., 2010 High Doses Salt of Aspirin have experienced tinnitus Noise Stress/ Exposure Anxiety Who Experiences Tinnitus? Other At Risk Populations People from all walks of life - but certain groups are more susceptible • Veterans and military personnel • Men (especially in professions that expose them to noise) • Workers in loud environments • Senior Citizens • Musicians and music lovers • Caucasians • Motorsports and hunting enthusiasts • People with certain common health problems (Brown SC, 1990; Coles R, 2000) What is the impact? Why Are Some More Bothered Than Others? • Research shows that there is no difference in psychoacoustic characterization of tinnitus when comparing groups of people who experience tinnitus and those who suffer from it. • The REACTION to tinnitus creates the distress, not the tinnitus itself. Stouffer JL, Tyler RS, 1990 5

2/4/2020 Reaction #1 Reaction #2 Make it High Level of Negative Arousal Reactions STOP! Escalating Tinnitus “The problem with Tinnitus, is that because there is still no cure, There is no cure people are told they just have to But it can be managed live with it. Most of them do, but that doesn’t mean they like it.” - Dr. Richard Tyler 6

2/4/2020 Steps for Success Amplification 1. Tinnitus Evaluation 2. Counseling & Education Relief 3. Treatment Plan 4. Fitting Multiflex Tinnitus Technology 5. Follow-up Care Sound Counseling Therapy Henry & Wilson, 1996; Nyenhuis et al., 2013 Henry & Wilson, 1996; Tyler, 2006; Newman & Sandridge, 2012; Tyler et al., 2012 Saltzman & Ersner, 1947; Surr et al., 1985; Sheldrake & Jastreboff, 2004; Henry et al., 2005; Sweetow & Sabes, 2010; Kochkin et al., 2011 Newman & Sandridge, 2012; Tyler et al., 2012 Tinnitus Evaluation Tinnitus Evaluation • Case History How long have you had your • Otologic tinnitus? • Medical • Audiologic What does your tinnitus sound • Lifestyle like? • Subjective experience • Previous treatments When did you first experience your tinnitus? Tinnitus Evaluation Tinnitus Evaluation Tinni nnitus tus Que Questi tionn nnai aire(s) • Case History • Tinnitus Questionnaire(s) • Identify problems or specific areas of a patient’s life that are affected • Audiologic Testing by tinnitus • Otoscopy • Quantify the magnitude of impact • Acoustic Immittance • Pure-Tone Audiometry • Monitor a patient’s progress with a particular treatment • MCL & UCL • Speech Recognition Threshold • Counseling tool • Speech Discrimination Scores 7

2/4/2020 Steps for Success Counseling and Education Review all test results: 1. Tinnitus Evaluation 2. Counseling & Education 3. Treatment Plan 4. Fitting Multiflex Tinnitus Technology 5. Follow-up Care Counseling and Education Counseling and Education Provide information: • How the hearing system works You don’t have to be a “ trained counselor ” to provide effective counseling…listening to the • What is tinnitus • Why hearing loss and tinnitus are often linked patient and addressing his/her concerns and • Prevalence of tinnitus questions is considered counseling! • Common known triggers • Known aggravators • Treatment is available Steps for Success Treatment Plan 1. Tinnitus Evaluation 2. Counseling & Education 3. Treatment Plan 4. Fitting Multiflex Tinnitus Technology 5. Follow-up Care 8

2/4/2020 Emergency Referral Emergency Referral • Physical trauma • Patient who demonstrates any of the following: • Facial palsy • Suicidal ideation • Sudden hearing loss • Or if you are concerned about the patient’s well -being It is not within the scope of practice for a hearing healthcare provider to treat mental health issues. Urgent Referral Treatment Options • Pulsatile tinnitus Medical • Unilateral tinnitus • Ear pain and/or drainage Alternative • Symptoms related to head or neck movement Amplification • Vestibular symptoms (dizziness/vertigo) Sound Therapy Counseling Treatment Plan Treatment Plan Normal Hearing + Tinnitus Hearing Loss + Tinnitus • Counseling • Counseling • Sound therapy • Hearing aid + sound therapy • Follow-up care • Follow-up care < 70dBHL (at least 1 threshold below 4000Hz) 9

2/4/2020 Treatment Plan Treatment Plan Hearing Loss + Tinnitus • Counseling Tinnitus questionnaire(s) Unsure Of • Hearing aid • Sound therapy - external Sleep, concentration, hearing, Device • Follow-up care emotional well-being Candidacy? Motivation level > 70dBHL at all frequencies Compare and Contrast Steps for Success “On a scale of 1 - 10, how noticeable is your tinnitus?” 1. Tinnitus Evaluation 2. Counseling & Education • Hearing aid turned off but on the ear 3. Treatment Plan • Hearing aid only 4. Fitting Multiflex Tinnitus Technology • Hearing aid + sound therapy stimulus • Sound therapy stimulus only 5. Follow-up Care 2400 | with Healthable Technology 2400, 2000, 1600, 1200 Flexible, Personal Relief TINNITUS RIC 312 Micro RIC 312 RIC R BTE 13 CROS System No NFMI Heart Rate Sensor compatible 130/70 matrix Telecoil Telecoil CROS System CROS System Snap Fit Smart Receiver Matrix Options: 107/40, 115/50, 120/60, 130/70 10