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Level 4 Case Study

Level 4 Case Study. 62yo Vietnam Veteran Level 2 Audiologic Evaluation reported years of constant bilateral tinnitus, only bothersome within last 4-5 months when entering the VA system for the first time. Hearing was found to be normal, bilaterally. HHIE-S: 8 of 40 (mild handicap)

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Level 4 Case Study

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  1. Level 4 Case Study 62yo Vietnam Veteran Level 2 Audiologic Evaluation reported years of constant bilateral tinnitus, only bothersome within last 4-5 months when entering the VA system for the first time. Hearing was found to be normal, bilaterally. HHIE-S: 8 of 40 (mild handicap) Seeking VA MH services for the first time for possible PTSD.

  2. Tinnitus Questionnaires Administeredat Level 2 • Tinnitus and Hearing Survey: • Section A – 9 • Section B – 4 • Section C – 0 • Tinnitus Handicap Inventory: 38 (moderate subjective handicap) • SMRT: 70/170 • Referred to Level 3 Educational Workshop

  3. Attendance at Level 3 • Active participant, identified “falling asleep” as his most bothersome tinnitus situation. • Developed Sound Plan: music and a fan as both a soothing and background sound to help him fall asleep easier at night. • Second workshop: not helping, only made him concentrate more on his tinnitus. Encouraged to keep trying and modifying sound plan over next several weeks.

  4. 6 week follow up phone call • Actively using his Sound Plan and trying a variety of sounds. Tried Deep Breathing and Imagery, wearing earbuds so as not to disturb his wife. Still struggling to find a Sound Plan that helps him fall asleep easier. • “Not confident” in his ability to manage his tinnitus. • Based on phone call, Level 4 Interdisciplinary Evaluation scheduled.

  5. Level 4 Interdisciplinary Evaluation • Re-administered Tinnitus Questionnaires: • Tinnitus and Hearing Survey Section A – 8 Section B – 9 Section C – 3 • Tinnitus Handicap Inventory: 62 (severe subjective handicap) a +24 increase compared to Level 2 • SMRT: 74/170, stable as compared to Level 2 • Accompanied by spouse

  6. Tinnitus Interview • Loudness of tinnitus changes whenever "conscious" of it. • Introducing other sounds makes tinnitus softer, but tinnitus seems even louder once sound is turned off. • Tinnitus causes him to lose concentration, "drives me crazy“ mostly in left ear. • Prior to PTM, for falling asleep he tried music (didn't help) talk radio during the day which helps (politics), and central A/C for sleeping, which helped a little.

  7. Tinnitus Interview, Cont. • After developing sound plan at Level 3, he tried the same sounds with the same results. Deep breathing and imagery helped a little. • He has a variety of stationary and portable devices to generate sound, including his iPhone which he already has loaded with pleasurable music that he uses at home and in the car. Some other devices he does own, but has not tried such as a box fan.

  8. Assessment/Plan • Discussed at length with veteran and spouse the correlation of the timing of several sources of stress this past year and the increase in bothersome tinnitus. • Recent move/life change • Recent financial worries • Actively seeking MH services for newly diagnosed PTSD; medication, therapy, and discussing these issues for the first time since Vietnam

  9. Assessment Plan, Cont. • Developed a new Sound Plan for "getting back to sleep at night". • Demonstrated the Sound Spa which he liked, particularly ocean waves. • He does have a sound dock/radio for his iPhone and he will down load soothing ocean waves or other relaxing nature sounds. His wife thought this would not disturb her.

  10. Assessment/Plan Cont. • He will also try his box fan which may help better than his Central A/C. • He may also try interesting sounds in the form of Pontian music or talk radio. • Also, tried the Resound Live TS demo device first in his left ear only, and he immediately noted less awareness of his tinnitus and liked it very much, although then the right ear tinnitus seemed louder. He preferred listening with both devices and wanted to try them during quiet times in order to relax.

  11. Fitting of Resound Alera TS combination instruments. • One month later, veteran was fit with bilateral Resound Alera 61 TS Receiver in the Canal combination instruments, open domes. • Activated TSG only and he was very pleased with instant “relief” from tinnitus. • 3 months later: doing well, wearing daily throughout the day. Wife notices less agitation while wearing devices. Even wears them in the middle of the night to help him fall back asleep if wakes up due to PTSD related issues. • Satisfied and confident in tinnitus management. • No further help needed or wanted.

  12. Conclusion • Level 4 Evaluation provided opportunity to revise Sound Plan and demonstrate new devices, after Level 3 education was established • Opportunity to discuss comorbid MH conditions as contributing factors (his MH provider was contacted for tinnitus interdisciplinary care) • Including family members can be invaluable to tinnitus management

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