1. Welcome to The Path to Better Life

2. Presented by (Photo) (Your Name and Title here)

3. (Your Clinic Name Here) Introduction of Staff (Photos) (Names and Titles)

4. (Your Clinic Name Here) Location of Clinic (Photo here) (Address here) (Contact Information here)

5. You Are Here Because You or Someone You Love Has Tinnitus

6. You are Not Alone 50 million Americans report tinnitus 17 million report significant or debilitating problem #1 disability reported by veterans Epidemiology statistics are consistent all over the world

7. Some are bothered more than others

8. What is Tinnitus? The perception of sound when no actual sound exists –Commonly called “Ringing in the Ears” –Described as ringing, hissing, crickets, etc. What is hyperacusis? –Sound tolerance problem –Can occur with tinnitus

9. Effects on Lifestyle Difficult to Concentrate85% Difficult to Relax85% Irritable or Nervous83% Uncomfortable in quiet83% Tired or Stressed81% Interfere with Social Activities74% Hard to Interact Pleasantly73% Problems with Sleep73% Cause you to feel depressed70% Interfere with work activities66% -Martin et al., 2002 Results from Oregon Health Sciences University Tinnitus Clinic

10. Tinnitus can significantly alter your Lifestyle !

11. The fears and questions regarding tinnitus are usually the same What caused my tinnitus? Do I have a life threatening condition? Am I going to lose my hearing? Will it get worse? What can I do to get rid of it?

12. Is there a Cure? You may have heard these words –“Nothing can be done” –“You need to learn to live with it!” You may have already tried many of the methods for treating tinnitus such as –medication, surgery, masking, electric stimulation, laser stimulation, acupuncture, relaxation therapy….. just to name a few

13. It can be very confusing

14. But….There is Hope! Our current knowledge of the ear and the auditory system has lead to numerous clinical trials and validation that a combination of counseling and sound therapy can remove or reduce the perception of tinnitus Audiologists have had much success in improving the lifestyle of their patients, even those that are completely debilitated by their condition

15. What is an Audiologist? Audiologists (Au-di-ol-o-gists) are the primary health-care professionals to evaluate, diagnose, treat, and manage hearing loss, tinnitus and balance disorders in adults and children. Audiology is a highly recognized profession and has been ranked by U.S. News and World Report as one of the Best Careers in 2006, 2007, and 2008. Most audiologists earn a doctor of audiology (AuD) degree, but, there are also other doctoral degrees that audiologists can obtain (i.e., PhD, ScD, etc) from accredited universities with special training in the prevention identification, assessment, and treatment of hearing disorders. Audiologists must be licensed in most states.

16. What is the TPA? Although all audiologists are educated and skilled in hearing loss, tinnitus and balance disorders, some choose to “specialize” in tinnitus An association was created to certify and to support the audiologists dedicated to tinnitus care I have met the qualifications of the TPA

17. What Causes Tinnitus? MedicalNon-Medical Meniere’s DiseaseCardiovascular DiseaseNoise Induced DiabetesHearing LossHead Trauma HypertensionPost SurgicalBarotrauma HyperthyroidismAllergiesHydrotrauma TMJAnemiaWhiplash VascularOtosclerosisStress Induced Drug InducedEar WaxSubstance Induced Ear DiseaseHigh Impact Aerobics Tumors, neuromasLoose Hairs in the Ear Canal

18. Most of the time, these conditions have made structural changes in the delicate structures of the inner ear and this is the source of the problem.

19. Anatomy of the Ear

20. The Inner Ear

21. The microscopic “hair cells” of the inner ear have structural changes and are not able to send a clear signal to the brain It’s like walking on the grass, if you continue to walk on the grass, it can be weakened and no longer spring back

22. The brain tries to compensate for the weakened signal and patterns begin. Non auditory structures may begin to exacerbate the situation.

23. The Neurophysiological Model of Tinnitus Dr. Pawel Jastreboff, a Neurophysiologist, described what is happening in the brain by developing The Neurophysiological Model of Tinnitus. It postulates that: the abnormalities in the cochlear function (damage to the inner ear) along with auditory central pathways (nerve sending the message to the auditory part of the brain) and some of the non-auditory related brain structures (subconscious and conscious brain) ….have to be included in the emergence and maintenance of the phenomenon of tinnitus.

24. The Neurophysiological Model of Tinnitus

25. Although the original “insult” may have occurred in the ear, …. tinnitus continues because of what is happening in the subconscious and conscious parts of the auditory system It’s what happens between the ears that creates the ongoing and continuing problems with tinnitus

26. There is Hope Now that we know this, we know that we can do things to reduce the perception of tinnitus This happens many times a day with all of our perceptions, and also sometimes with tinnitus. That is why you may hear from some people “yes, I have tinnitus, but it doesn’t really bother me” If this doesn’t happen automatically, and people are “bothered” by tinnitus, we have some tools to help it along to occur naturally

27. Individualized Treatment Each patient has a unique set of circumstances and treatment is most effective when it is individualized Therefore, we need to consider your unique situation What will happen? –Evaluation –Consultation –Recommendation

28. Evaluation The purpose of the Initial Evaluation is to determine the extent of your tinnitus problem in three specific areas Hearing sensitivity Reaction to tinnitus Sound tolerance

29. Evaluation We will use a series of subjective and objective measurements to develop a comprehensive individualized treatment plan Self-administered questionnaires and handicap inventories Case history, interview and review of self-administered questionnaires Audiological assessment including hearing, tinnitus and sound tolerance testing

30. Consultation We will discuss the results of your testing with you Review of subjective measurements (questionnaires, case history, inventories) Review of objective measurements (hearing, tinnitus and sound tolerance evaluations) Instructional Counseling based on individualized correlation of subjective and objective measurements

31. Recommendations We will consider all the information gathered about your tinnitus and the problems associated with the tinnitus to develop an individualized treatment plan for you Instructional and Cognitive Counseling Sound Therapy Lifestyle Recommendations Follow Up Schedule

32. Treatment Components Counseling – Instructional (how tinnitus happens) – Cognitive (how your thinking and reaction to your thinking affects tinnitus) Sound therapy – Generalized (sound enrichment) – Individualized (instrumentation)

33. Counseling During instructional counseling the tinnitus patient participates in an in-depth discussion in which the source and meaning of his or her tinnitus is explained through demonstrations of anatomy (structure), physiology (function) and real examples to make the tinnitus phenomenon understandable Cognitive counseling identifies negative thoughts and emotions and teaches techniques which enable you to change the way you view and react to the tinnitus

34. Sound Therapy Decrease the contrast between the tinnitus and background sound (dark auditory room; brightening of the auditory room) Interfere with the detection of the tinnitus (distract, divert, deflect) Decrease the gain in the auditory system De-tune activity in the autonomic nervous system Create distraction Provide relaxation

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38. Sound Therapy Generalized Acoustic Environmental Enrichment Table top sound machine Sleep pillow Music (ipod, MP3, radio) Fans, water fountains Individualized Sound generators Amplification Combination units Neuromonics

39. What Can You Do Now? If you have tinnitus Avoid silence (provide low level sound enrichment) Do not “overprotect” your ears, but, use ear protection in loud environments (lawn mowing, loud music, power tools, factory, hunting) Do things you enjoy Do things which will take your mind away from tinnitus Get enough sleep, exercise regularly Make an appointment for a complete evaluation

40. What Can You Do Now? If you do not have tinnitus but you know someone who does Protect your ears in excessively loud environments Come with your loved one to the appointment to learn about tinnitus Be supportive and encourage them to get an evaluation

41. There is Hope There is Help You are in the Right Place!

42. (Your Clinic Contact Information Here)