TINNITUS RESOURCES

Download this survey to determine how much of a problem you have with tinnitus and with hearing difficulties. The survey is designed so that any problems with tinnitus are not confused with hearing problems. Likewise, any problems with hearing are not conflated with tinnitus. A third section determines if you have a problem tolerating sound, which often occurs along with tinnitus. This survey is provided for educational purposes only and is not to be used for self-diagnosis. Please consult with a licensed audiologist for a formal assessment.

DOWNLOAD SURVEY This worksheet is used with Progressive Tinnitus Management (PTM) to develop a plan for how sound will be used to manage a "bothersome tinnitus situation" (#1 on the worksheet). The sound plan consists of the answers recorded for #2, #3, and #4 on the worksheet. When the plan has been used for a week or two, #5 is completed to rate how well the plan worked. Comments can be provided in #6. Note that this worksheet is used for developing a single sound plan. More plans can be developed as needed.

DOWNLOAD WORKSHEET This worksheet is used with Progressive Tinnitus Management (PTM) to develop a plan for how cognitive behavioral therapy (CBT) will be used to manage a "bothersome tinnitus situation" (#1 on the worksheet). The plan itself consists of what is filled in for #2 and #3 on the worksheet. When the plan has been used for a week or two, #4 is completed to rate how well the plan worked. Comments can be written in #5. Note that this worksheet is used for developing a single CBT skills plan. More plans can be developed as needed. This process continues until any plans used are considered effective for reducing effects of tinnitus.

DOWNLOAD WORKSHEET This checklist is used to identify a person's most bothersome tinnitus situation, which can be any of the problem areas listed as response choices. Whatever the most bothersome tinnitus situation is, that situation is addressed first by developing a plan to manage that situation (using either the Sound Plan Worksheet or the Changing Thoughts and Feelings Worksheet). The Tinnitus Problem Checklist also includes items to identify the person's second- and third-most bothersome tinnitus situations. Any situation that is impacted by tinnitus can be identified and separate plans developed to manage that specific situation.

DOWNLOAD CHECKLIST The Sound Hypersensitivity Interview is a rather lengthy interview that may require up to an hour to complete. It is intended to be administered face-to-face for maximum effectiveness. It should not normally be self-administered because of the difficulty a person might have interpreting the responses. It can, however, be completed by an individual and then sent to a clinician for interpretation and diagnosis purposes—which would probably still require a conversation to clarify the responses.

DOWNLOAD INTERVIEW For clinical purposes, it is important to distinguish between ear/head noise and tinnitus to determine if clinical services are needed. Although it may seem straightforward that people know whether they have tinnitus, "tinnitus" can mean different things to different people. Different categories include transient ear noise, temporary ear noise, occasional ear noise, intermittent tinnitus, and constant tinnitus. If the category is unsure for a patient, the Tinnitus Screener is an instrument to determine which of these categories would be most appropriate.

DOWNLOAD SCREENER Tinnitus questionnaires are helpful but further information may be needed to fully understand why a patient has not made sufficient progress after completing treatment. A comprehensive face-to-face interview between the audiologist and the patient is needed at this stage. The Tinnitus Interview was developed for this purpose, and provides a uniform format for asking a series of in-depth questions.

DOWNLOAD INTERVIEW This flowchart shows the six steps of Tinnitus Stepped-Care, starting with Step 1 Triage and ending with Step 6 Expanded Treatment.

DOWNLOAD FLOWCHART Use of this clinical algorithm is suggested for providing initial audiology services for a patient seeking help for tinnitus.

DOWNLOAD DECISION TREE CBT Self-Help Resources. Self-help resources are available for people to learn different CBT techniques:

• The book Tinnitus Treatment: Clinical Protocols has a chapter that describes relaxation exercises in detail "to guide the patient in practicing at home." (pp. 105-110)
• The book Tinnitus: A Self-Management Guide for the Ringing in Your Ears has been available for over 20 years and describes how to self-manage tinnitus using CBT techniques.
• The book Cognitive Behavioral Therapy for Tinnitus is fairly recent and is designed to be used as a self-help guide.
• Online CBT training programs are available, and some offer support from a tinnitus therapist.
• A step-by-step guide to self-management with CBT is available online. It includes learning relaxation exercises (deep breathing and imagery; pp. 38-43), changing thoughts (pp. 54-60), and planning pleasant activities to "help you enjoy life and pay less attention to your tinnitus" (pp. 44–47).
• Videos are available online that teach deep breathing, imagery, planning pleasant activities, and changing thoughts.

Third Wave CBT Resources. Resources are available to learn about third wave CBT techniques:

• Website for Dr. Bruce Hubbard - CBT therapist and tinnitus expert who uses third wave CBT techniques with his patients.
• Articles cited in appendix H of The Tinnitus Book fully explain third wave CBT techniques used for tinnitus treatment.

References for CBT Resources:

• Andersson G, Kaldo V. Cognitive-Behavioral Therapy with applied relaxation. In: Tyler RS, ed. Tinnitus Treatment: Clinical Protocols. Thieme Medical Publishers, Inc.; 2006:96-115.
• Henry JL, Wilson PH. Tinnitus: A Self-Management Guide for the Ringing in Your Ears. Allyn & Bacon; 2001.
• Beukes EW, Andersson G, Manchaiah V, Kaldo V. Cognitive Behavioral Therapy for Tinnitus. Plural Publishing; 2021.
• Beukes EW, Manchaiah V, Allen PM, Baguley DM, Andersson G. Internet-based interventions for adults with hearing loss, tinnitus, and vestibular disorders: A systematic review and meta-analysis. Trends in Hearing. 2019;23:1-22.
• Henry JA, Zaugg TL, Myers PJ, Kendall (Schmidt) CJ. How to Manage Your Tinnitus: A Step-by-step Workbook, Third Edition. Plural Publishing Inc.; 2010.

Tinnitus Retraining Therapy (TRT) Resources:

• Any website, video, or article from Drs. Pawel, Margaret Jastreboff, Jonathan Hazell, Susan Gold, and Jacqueline Sheldrake.
• Stephen M. Nagler, MD, FACS and Atlanta Tinnitus Consultants, LLC - Access to articles, interviews, Q&A, and information consistent with the principles of TRT; Dr. Nagler is also available to provide telephone and Skype consultation.
• Michael J. A. Robb, MD - Robb Oto-Neurology Clinic, Phoenix, Arizona; 20 years specializing in diseases and disorders of the ear and the brain; co-author of two TRT books published in 2007.
• Gail B. Brenner, AuD - Dr. Brenner has been a TRT practitioner since the mid-1990s.
• The original book describing TRT: Tinnitus Retraining Therapy: Implementing the Neurophysiological Model.
• Word-for-word (scripted) TRT counseling in The Tinnitus Retraining Therapy Book is based directly on the contents of the original TRT book. The scripted counseling has been adapted from a previous book that I authored. My previous book was written for professionals, while the current book is written for the general population of people who experience tinnitus. A companion flip-chart counseling book is available that corresponds topic-by-topic with the counseling script.

References for TRT Resources:

• Henry JA. The Tinnitus Retraining Therapy Book: Walking You Through TRT. Ears Gone Wrong, LLC. 2023.
• Henry JA, Trune DR, Robb MJA, Jastreboff PJ. Tinnitus Retraining Therapy: Patient Counseling Guide. Plural Publishing, Inc.; 2007.
• Henry JA, Trune DR, Robb MJA, Jastreboff PJ. Tinnitus Retraining Therapy: Clinical Guidelines. Plural Publishing, Inc.; 2007.
• Jastreboff PJ, Hazell JWP. Tinnitus Retraining Therapy: Implementing the Neurophysiological Model. Cambridge University Press; 2004.

Progressive Tinnitus Management (PTM) Self-Help Resources:

• The PTM self-help workbook (Henry JA, Zaugg TL, Myers PJ, Kendall (Schmidt) CJ. How to Manage Your Tinnitus: A Step-by-step Workbook, Third Edition. Plural Publishing Inc.; 2010.)
• Links to videos of the PTM Level 3 Skills Education Counseling. These videos correspond with the self-help workbook. They should be used together.
• A sound tolerance handout, "What to Do When Everyday Sounds Are Too Loud"

Tinnitus Activities Treatment (TAT) Self-Help Resources:

• University of Iowa website describing their tinnitus and hyperacusis services; also includes links to questionnaires, information documents, videos, and the TAT counseling presentations.
• Recent book chapter describing TAT: "Perreau A, Tyler RS, Mancini PC, Witt SA. Tinnitus Activities Treatment. In Perreau A & Tyler RS, Tinnitus Treatment: Clinical Protocols. Thieme, New York. pp. 42–70, 2022." Appendixes include the Tinnitus Primary Functions Questionnaire, patient handouts, and a tinnitus diary. Videos are available on the companion website that accompanies the chapter.

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