Managing Your Tinnitus: What to Do and How to Do it (Session 1 of 2)

Managing Your Tinnitus: What to Do and How to Do it(Session 1 of 2)

Managing Your Tinnitus: What to Do and How to Do it(Session 1 of 2)

This workshop was developed by researchers at the VA Rehab, Research & Development (RR&D) National Center for Rehabilitative Auditory Research (NCRAR), located at the Portland, Oregon VA Medical Center

This workshop was developed by researchers at the VA Rehab, Research & Development (RR&D) National Center for Rehabilitative Auditory Research (NCRAR), located at the Portland, Oregon VA Medical Center

IntroductionsIntroductions

Please share your name and what you hope to get out of today’s workshop

Please share your name and what you hope to get out of today’s workshop

Can Tinnitus be Cured?Can Tinnitus be Cured?

“Cure” = eliminate or reduce the tinnitus No cure yet – research underway It can’t be cured, but you can learn to manage your

reactions to it

[Note: “managing tinnitus” really means “managing reactions to tinnitus” – you can’t change the sound of the tinnitus, but you can change how you react to the sound]

“Cure” = eliminate or reduce the tinnitus No cure yet – research underway It can’t be cured, but you can learn to manage your

reactions to it

[Note: “managing tinnitus” really means “managing reactions to tinnitus” – you can’t change the sound of the tinnitus, but you can change how you react to the sound]

Goals of Tinnitus Management (All Methods)Goals of Tinnitus Management (All Methods) Emotional reactions are reduced Stress is reduced Little if any attention is given to tinnitus Tinnitus does not affect any life activities in a major

way Further help is not needed or wanted

Emotional reactions are reduced Stress is reduced Little if any attention is given to tinnitus Tinnitus does not affect any life activities in a major

way Further help is not needed or wanted

These goals can be reached even if the sound of your tinnitus doesn’t change!

These goals can be reached even if the sound of your tinnitus doesn’t change!

Goal of Today’s WorkshopGoal of Today’s Workshop

Develop an action plan for using sound to manage your reactions to tinnitus – a “sound plan”

Develop an action plan for using sound to manage your reactions to tinnitus – a “sound plan”

Ground Rules…Ground Rules…

Time is limited, so we will focus on learning to use sound to manage reactions to tinnitus Feel free to ask questions about using sound to

manage tinnitus Questions about other topics will be answered at

the end of the meeting

Time is limited, so we will focus on learning to use sound to manage reactions to tinnitus Feel free to ask questions about using sound to

manage tinnitus Questions about other topics will be answered at

the end of the meeting

Review the Tinnitus and Hearing SurveyReview the Tinnitus and Hearing Survey

If you do not have a completed Survey in front of you, please fill one out now

(Stop here until everyone has completed the Survey)

If you do not have a completed Survey in front of you, please fill one out now

(Stop here until everyone has completed the Survey)

I Completed the Tinnitus and Hearing Survey—What Does it Tell Me? I Completed the Tinnitus and Hearing Survey—What Does it Tell Me? Tinnitus problems and hearing problems are often

confused Hearing problems are often blamed on tinnitus

The Survey helps you know: How much of a problem is due to tinnitus How much is due to hearing problems

Tinnitus problems and hearing problems are often confused Hearing problems are often blamed on tinnitus

The Survey helps you know: How much of a problem is due to tinnitus How much is due to hearing problems

Section ASection A

Today we will focus on learning how to manage tinnitus (Section A) problems

We will not learn how to manage hearing (Section B) or loudness tolerance (Section C) problems

Today we will focus on learning how to manage tinnitus (Section A) problems

We will not learn how to manage hearing (Section B) or loudness tolerance (Section C) problems

Volunteers?Volunteers?

It is helpful to discuss your own responses on the Tinnitus and Hearing Survey

If you’re comfortable, please share your responses with the group

It is helpful to discuss your own responses on the Tinnitus and Hearing Survey

If you’re comfortable, please share your responses with the group

Next You Will Make a “Sound Plan” to Manage Your Reactions to TinnitusNext You Will Make a “Sound Plan” to Manage Your Reactions to Tinnitus We will use the Sound Plan Worksheet as a guide to

making your “Sound Plan”

We will use the Sound Plan Worksheet as a guide to making your “Sound Plan”

Tear out a copy of the Sound Plan Worksheet from the back of your Workbook

Tear out a copy of the Sound Plan Worksheet from the back of your Workbook

Take a moment to…Take a moment to…

How do I fill out #1 on the Sound Plan

Worksheet?

How do I fill out #1 on the Sound Plan

Worksheet?

#1 on the Sound Plan Worksheet#1 on the Sound Plan Worksheet

The first step in completing a Sound Plan Worksheet is to write down a bothersome tinnitus situation

We will begin with the Tinnitus Problem Checklist

The first step in completing a Sound Plan Worksheet is to write down a bothersome tinnitus situation

We will begin with the Tinnitus Problem Checklist

Fill out the Tinnitus Problem Checklist (p. 29 in the Workbook)

Make sure each situation you choose is a tinnitus problem and not a hearing problem

(Stop here until everyone has completed the Checklist)

Fill out the Tinnitus Problem Checklist (p. 29 in the Workbook)

Make sure each situation you choose is a tinnitus problem and not a hearing problem

(Stop here until everyone has completed the Checklist)


Group DiscussionGroup Discussion

Please share your most bothersome tinnitus situation with the group

Be sure that it is a tinnitus problem (Survey Section A) and not a hearing problem (Section B)

(Stop here until everyone has shared their most bothersome tinnitus situation)

Please share your most bothersome tinnitus situation with the group

Be sure that it is a tinnitus problem (Survey Section A) and not a hearing problem (Section B)

(Stop here until everyone has shared their most bothersome tinnitus situation)

Write the “most bothersome” situation from the Tinnitus Problem Checklist at the top of the Worksheet (#1)

Write the “most bothersome” situation from the Tinnitus Problem Checklist at the top of the Worksheet (#1)


How do I fill out #2 on the Worksheet? How do I fill out #2 on the Worksheet?

Threetypes

ofsound

Threetypes

ofsound

We’ll begin by learning about three types of sound to manage tinnitusWe’ll begin by learning about three types of sound to manage tinnitus

What is Soothing Sound?What is Soothing Sound?

Soothing SoundSoothing Sound

What is it? Sound that makes you feel better as soon as you

hear it How can it help?

By giving you a sense of relief from tension and stress caused by tinnitus

When can it help? Any time your tinnitus bothers you

What is it? Sound that makes you feel better as soon as you

hear it How can it help?

By giving you a sense of relief from tension and stress caused by tinnitus

When can it help? Any time your tinnitus bothers you

While you listen to the sound, choose the amount of relief you feel

Choose either 0, 1, 2, 3, 4, or 5 Be ready to share your rating with the group

While you listen to the sound, choose the amount of relief you feel

Choose either 0, 1, 2, 3, 4, or 5 Be ready to share your rating with the group

Relief Scale (for Soothing Sound)Relief Scale (for Soothing Sound)

Let’s try it!

Raise your hand if you felt no relief from the stress or tension caused by your tinnitus

Raise your hand if you felt no relief from the stress or tension caused by your tinnitus

Raise your hand if you felt slight relief from the stress or tension caused by your tinnitus

Raise your hand if you felt slight relief from the stress or tension caused by your tinnitus

Raise your hand if you felt mild relief from the stress or tension caused by your tinnitus

Raise your hand if you felt mild relief from the stress or tension caused by your tinnitus

Raise your hand if you felt moderate relief from the stress or tension caused by your tinnitus

Raise your hand if you felt moderate relief from the stress or tension caused by your tinnitus

Raise your hand if you felt nearly complete relief from the stress or tension caused by your tinnitus

Raise your hand if you felt nearly complete relief from the stress or tension caused by your tinnitus

Raise your hand if you felt complete relief from the stress or tension caused by your tinnitus

Raise your hand if you felt complete relief from the stress or tension caused by your tinnitus

Soothing Sound: Things to RememberSoothing Sound: Things to Remember The sound you just heard is more soothing to some

people, and less soothing to others Your job is to find sounds that are soothing to you It might take time and patience to find the sounds that

are most soothing and helpful for you

The sound you just heard is more soothing to some people, and less soothing to others

Your job is to find sounds that are soothing to you It might take time and patience to find the sounds that

are most soothing and helpful for you

MarthaMartha

When Martha reads at home, she plays soothing music The sense of relief she feels from the music makes it

easier for her to concentrate This an example of using soothing sound

When Martha reads at home, she plays soothing music The sense of relief she feels from the music makes it

easier for her to concentrate This an example of using soothing sound

Tell me in your own words:Tell me in your own words:

What is the purpose of Soothing Sound?What is the purpose of Soothing Sound?

Explain the concept rather than giving an example

HINT:

What is Background Sound?What is Background Sound?

Background SoundBackground Sound

What is it? Any sound that is neutral (not soothing, not

interesting, and not annoying) How can it help?

Reduces contrast to make it easier to ignore your tinnitus (we’ll explain!)

When can it help? Any time

What is it? Any sound that is neutral (not soothing, not

interesting, and not annoying) How can it help?

Reduces contrast to make it easier to ignore your tinnitus (we’ll explain!)

When can it help? Any time

Imagine a Lit Candle in a Dark RoomImagine a Lit Candle in a Dark Room

The candle is the only light in the room

There is sharp contrast between the bright candle and the dark room

The candle naturally attracts a lot of attention

Turn on the Lights!Turn on the Lights!

This is the same lit candle, but with the lights on

The contrast between the candle and the room has been reduced

The candle is just as bright as before, but attracts less attention because now there is other light in the room along with the candle

This is the same lit candle, but with the lights on

The contrast between the candle and the room has been reduced

The candle is just as bright as before, but attracts less attention because now there is other light in the room along with the candle

Same Candle – Different BackgroundsSame Candle – Different Backgrounds

This same idea works for tinnitus…

Imagine “Tinnitus” in a Quiet RoomImagine “Tinnitus” in a Quiet Room

The tinnitus is the only “sound”

There is sharp contrast between the tinnitus and the quiet room

The tinnitus naturally attracts a lot of attention

Turn on the Sound!Turn on the Sound!

Same tinnitus, but in a background of sound

The contrast between the tinnitus and the quiet room has been reduced

The tinnitus is just as loud as before, but attracts less attention because of the background sound

Same tinnitus, but in a background of sound

The contrast between the tinnitus and the quiet room has been reduced

The tinnitus is just as loud as before, but attracts less attention because of the background sound

Same Tinnitus – Different BackgroundsSame Tinnitus – Different Backgrounds

Spend a few moments listening to your tinnitus in quiet

Then, with the background sound turned on, notice the reduced contrast

Reducing contrast makes it easier to ignore your tinnitus

Spend a few moments listening to your tinnitus in quiet

Then, with the background sound turned on, notice the reduced contrast

Reducing contrast makes it easier to ignore your tinnitus

Tinnitus Contrast ActivityTinnitus Contrast ActivityLet’s try it!

Background Sound:Things to RememberBackground Sound:Things to Remember Tinnitus is less likely to get your attention when you

add background sound You might not notice background sound helping you

right away—that doesn’t mean it’s not helping you Using constant background sound over weeks or

months can help you get better at ignoring tinnitus Never use sound that is irritating or annoying to you

to manage your reactions to tinnitus

Tinnitus is less likely to get your attention when you add background sound

You might not notice background sound helping you right away—that doesn’t mean it’s not helping you

Using constant background sound over weeks or months can help you get better at ignoring tinnitus

Never use sound that is irritating or annoying to you to manage your reactions to tinnitus

JanetJanet

Janet keeps a tabletop fountain running on her desk The background sound from the fountain makes it easier

for her to ignore her tinnitus This is an example of using background sound

Janet keeps a tabletop fountain running on her desk The background sound from the fountain makes it easier

for her to ignore her tinnitus This is an example of using background sound


What is the purpose of background sound?What is the purpose of background sound?

Describe the concept rather than giving an example

HINT:

What is “Interesting Sound”?What is “Interesting Sound”?

Interesting SoundInteresting Sound

What is it? Sound that keeps your attention Sound that involves active listening

How can it help? Shifts your attention away from your tinnitus

When can it help? When you do not need to concentrate on

something else When you want to relax or sleep

What is it? Sound that keeps your attention Sound that involves active listening

How can it help? Shifts your attention away from your tinnitus

When can it help? When you do not need to concentrate on

something else When you want to relax or sleep

Attention Scale

Let’s try it!

While you listen to the sound passage, choose the percent of attention focused on the passage

Choose either 0, 25, 50, 75, or 100% Be ready to share your rating

Raise your hand if 0% of your attention was focused on the passage










Interesting Sound: Things to RememberInteresting Sound: Things to Remember We’re all different!

The passage you just heard is more interesting to some people, and less interesting to others

Your job is to find sounds that are interesting to you It might take time and patience to find the sounds that

are most interesting and helpful for you Never use sound that is irritating or annoying to you


We’re all different! The passage you just heard is more interesting to

some people, and less interesting to others Your job is to find sounds that are interesting to you It might take time and patience to find the sounds that

are most interesting and helpful for you Never use sound that is irritating or annoying to you


PatrickPatrick

Patrick talks to his friends on the telephone to keep his mind off of his tinnitus

This is an example of using interesting sound

Patrick talks to his friends on the telephone to keep his mind off of his tinnitus



What is the purpose of interesting sound?What is the purpose of interesting sound?

Describe the concept rather than giving an example

HINT:

Pop QuizPop Quiz

Which type of sound helps to shift attention away from tinnitus?

Soothing Background Interesting

Which type of sound helps to shift attention away from tinnitus?


AnswerAnswer

Interesting Sound - helps to shift attention away from tinnitus

Interesting Sound - helps to shift attention away from tinnitus

Pop QuizPop Quiz

Which type of sound helps to reduce stress or tension that is caused by tinnitus?


Which type of sound helps to reduce stress or tension that is caused by tinnitus?


AnswerAnswer

Soothing Sound - helps to reduce stress or tension that is caused by tinnitus

Soothing Sound - helps to reduce stress or tension that is caused by tinnitus

Pop QuizPop Quiz

Which type of sound reduces contrast between tinnitus and a quiet environment to make it easier to ignore the tinnitus?


Which type of sound reduces contrast between tinnitus and a quiet environment to make it easier to ignore the tinnitus?


AnswerAnswer

Background Sound - reduces contrast between tinnitus and a quiet environment to make it easier to ignore the tinnitus

Background Sound - reduces contrast between tinnitus and a quiet environment to make it easier to ignore the tinnitus

You now understand the three types of sound! You now understand the three types of sound!

Soothing Sound

BackgroundSound

InterestingSound


Put a check mark next to each type of sound that you will try to manage your most bothersome tinnitus situation

(Stop here until everyone has checked at least one type of sound)

Put a check mark next to each type of sound that you will try to manage your most bothersome tinnitus situation

(Stop here until everyone has checked at least one type of sound)

How do I fill out #3 on the Worksheet? How do I fill out #3 on the Worksheet?

For #3, you will choose specific sounds for each type of sound you checked in #2

For #3, you will choose specific sounds for each type of sound you checked in #2

To help you come up with ideas for choosing sounds… To help you come up with ideas for choosing sounds… For each type of sound… For each type of sound…

To help you come up with ideas for choosing sounds… To help you come up with ideas for choosing sounds…

You can use… You can use…

Environmental SoundEnvironmental Sound

Sounds of nature Moving water Beach sounds Forest sounds Animals Wind Storms

and more…

Sounds of nature Moving water Beach sounds Forest sounds Animals Wind Storms

and more…

Manmade sounds Masking noise Electric fan noise Shower sound Aircraft noise Wind chimes Traffic noise Radio static

and more…

Manmade sounds Masking noise Electric fan noise Shower sound Aircraft noise Wind chimes Traffic noise Radio static

and more…

MusicMusic

There are many styles of music We all have our preferred styles Any music that is neutral or pleasant can be used to

manage tinnitus – as long as it is not too loud

There are many styles of music We all have our preferred styles Any music that is neutral or pleasant can be used to

manage tinnitus – as long as it is not too loud

SpeechSpeech

Speech can be used as part of your plan to manage tinnitus

There are many kinds of speech, and we react differently depending on the type of speech and the situation

Some examples: Talking on the phone Listening to an audio book Listening to a lecture

Speech can be used as part of your plan to manage tinnitus

There are many kinds of speech, and we react differently depending on the type of speech and the situation

Some examples: Talking on the phone Listening to an audio book Listening to a lecture

Nine Combinations of Sound to Manage Reactions to TinnitusNine Combinations of Sound to Manage Reactions to Tinnitus

How Do I Choose Soothing Sound?How Do I Choose Soothing Sound?

Soothing Sound Can be Environmental Sound, Music, or SpeechSoothing Sound Can be Environmental Sound, Music, or Speech

What Soothing Sound might help your most bothersome tinnitus situation?

Think of a specific example Volunteers share your ideas

What Soothing Sound might help your most bothersome tinnitus situation?


Take a moment to discuss…Take a moment to discuss…

How do I Choose Background Sound?How do I Choose Background Sound?

Background Sound Can be Environmental Sound, Music, or SpeechBackground Sound Can be Environmental Sound, Music, or Speech

What Background Sound might help your most bothersome tinnitus situation?


What Background Sound might help your most bothersome tinnitus situation?


Take a moment to discuss…Take a moment to discuss…

How do I Choose Interesting Sound?How do I Choose Interesting Sound?

Interesting Sound Can be Environmental Sound, Music, or SpeechInteresting Sound Can be Environmental Sound, Music, or Speech

What Interesting Sound might help your most bothersome tinnitus situation?


What Interesting Sound might help your most bothersome tinnitus situation?


Take a moment to discuss...Take a moment to discuss...

Example Worksheet: BobExample Worksheet: Bob

BobBob

Listening to talk radio helps Bob get his mind off of his tinnitus at night This helps him get to sleep


Listening to talk radio helps Bob get his mind off of his tinnitus at night This helps him get to sleep


Won’t Interesting Sound Keep Me Awake?Won’t Interesting Sound Keep Me Awake? Interesting sound can be a powerful way to get your

mind off of your tinnitus This helps some people relax enough get to sleep It might not be helpful for others

Be open to using sound in surprising or unusual ways to manage your reactions to tinnitus!

Interesting sound can be a powerful way to get your mind off of your tinnitus This helps some people relax enough get to sleep It might not be helpful for others

Be open to using sound in surprising or unusual ways to manage your reactions to tinnitus!

Another Sleep Challenge for BobAnother Sleep Challenge for Bob

Listening to talk radio helps Bob get to sleep when he goes to bed at night

However, he wakes up in the middle of the night and has trouble getting back to sleep because of his tinnitus

He does not like to listen to interesting sound in the middle of the night

What did Bob do?

Listening to talk radio helps Bob get to sleep when he goes to bed at night

However, he wakes up in the middle of the night and has trouble getting back to sleep because of his tinnitus

He does not like to listen to interesting sound in the middle of the night

What did Bob do?

Bob’s SolutionBob’s Solution

Keeping a fan running all night long reduces the contrast between Bob’s tinnitus and the quiet of his bedroom

The reduced contrast helps Bob stay asleep all night long

Keeping a fan running all night long reduces the contrast between Bob’s tinnitus and the quiet of his bedroom

The reduced contrast helps Bob stay asleep all night long This is an example of

using background sound

As you fill out the rest of your Sound Plan…As you fill out the rest of your Sound Plan… Develop a plan that is easy to do and practical for

you Use sounds and devices that you already have As you try the plan, you will learn what helps the

most You will get ideas about how to improve your plan

Develop a plan that is easy to do and practical for you

Use sounds and devices that you already have As you try the plan, you will learn what helps the

most You will get ideas about how to improve your plan


For every type of sound you checked, write down the sounds you will try

Be as specific as you can

(Stop here until everyone has written down sounds they will try)

For every type of sound you checked, write down the sounds you will try


(Stop here until everyone has written down sounds they will try)

Write down the devices you will use


(Stop here until everyone has written down the devices they will try)

Write down the devices you will use


(Stop here until everyone has written down the devices they will try)


NOTE: I’ll walk around and peek over your shoulders while you work

You can make a different Sound Plan for any other tinnitus-problem situation

You can make a different Sound Plan for any other tinnitus-problem situation

You Have Completed Your First Sound Plan!You Have Completed Your First Sound Plan!

Rate each sound after trying it for at least 1 week

At the next meeting, we’ll discuss your ratings

Rate each sound after trying it for at least 1 week

At the next meeting, we’ll discuss your ratings

Use Your Sound Plan Until the Next MeetingUse Your Sound Plan Until the Next Meeting

Ongoing Use of the Sound Plan WorksheetOngoing Use of the Sound Plan Worksheet For every tinnitus-problem situation, make a new

Sound Plan It takes trial and error to learn what works best in

each situation Revise your Sound Plans as needed

For every tinnitus-problem situation, make a new Sound Plan

It takes trial and error to learn what works best in each situation

Revise your Sound Plans as needed

Talk about how to improve your Sound Plan Discuss new ideas for getting sound into your ears

Make a new Sound Plan

Talk about how to improve your Sound Plan Discuss new ideas for getting sound into your ears

Make a new Sound Plan

In the next meeting, we will:In the next meeting, we will:

New Topics to be Covered in the Next MeetingNew Topics to be Covered in the Next Meeting Other sound-based methods of tinnitus management

Tinnitus Masking Tinnitus Retraining Therapy Neuromonics Tinnitus Treatment

Other things you can do to minimize your tinnitus problem Protect your ears, reduce stress, etc.

Other sound-based methods of tinnitus management Tinnitus Masking Tinnitus Retraining Therapy Neuromonics Tinnitus Treatment

Other things you can do to minimize your tinnitus problem Protect your ears, reduce stress, etc.

Bring to the Next Meeting:Bring to the Next Meeting:

Your workbook and handouts The Sound Plan Worksheet you filled out today

Be sure to have #5 filled out Questions or concerns about your Sound Plan

You can write them on #6

Your workbook and handouts The Sound Plan Worksheet you filled out today

Be sure to have #5 filled out Questions or concerns about your Sound Plan

You can write them on #6

Questions?Questions?

www.ncrar.research.va.gov www.ncrar.research.va.gov

Documents

Managing Your Tinnitus: What to Do and How to Do it (Session 1 of 2)