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

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

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

4. 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]

5. 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

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

7. Goal of Today’s Workshop Develop an action plan for using sound to manage your reactions to tinnitus – a “sound plan”

8. 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

9. Review 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)

10. 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

11. Section 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

12. 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

13. Next 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”

14. Tear out a copy of the Sound Plan Worksheet from the back of your Workbook Take a moment to…

15. How do I fill out #1 on the Sound Plan Worksheet?

16. #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

17. 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) Take a moment to…

18. Group 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)

19. Write the “most bothersome” situation from the Tinnitus Problem Checklist at the top of the Worksheet (#1) Take a moment to…

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

21. Three types of sound Three types of sound We’ll begin by learning about three types of sound to manage tinnitus

22. What is Soothing Sound?

23. Soothing 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

24. 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) Let’s try it!

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

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

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

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

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

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

31. Soothing 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

32. Martha 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

33. Tell me in your own words: What is the purpose of Soothing Sound? Explain the concept rather than giving an example HINT:

34. What is Background Sound?

35. Background 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

36. Imagine a Lit Candle in a Dark Room The candle is the only light in the room The candle is the only light in the room There is sharp contrast between the bright candle and the dark room There is sharp contrast between the bright candle and the dark room The candle naturally attracts a lot of attention The candle naturally attracts a lot of attention

37. 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

38. Same Candle – Different Backgrounds This same idea works for tinnitus…

39. Imagine “Tinnitus” in a Quiet Room The tinnitus is the only “sound” The tinnitus is the only “sound” There is sharp contrast between the tinnitus and the quiet room There is sharp contrast between the tinnitus and the quiet room The tinnitus naturally attracts a lot of attention The tinnitus naturally attracts a lot of attention

40. 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

41. Same Tinnitus – Different Backgrounds

42. 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 Activity Let’s try it!

43. Background 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

44. Janet 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

45. Tell me in your own words: What is the purpose of background sound? Describe the concept rather than giving an example HINT:

46. What is “Interesting Sound”?

47. Interesting 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

48. 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

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

50. Raise your hand if 25% of your attention was focused on the passage

51. Raise your hand if 50% of your attention was focused on the passage

52. Raise your hand if 75% of your attention was focused on the passage

53. Raise your hand if 100% of your attention was focused on the passage

54. Interesting 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 to manage your reactions to tinnitus 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 to manage your reactions to tinnitus

55. Patrick 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 This is an example of using interesting sound

56. Tell me in your own words: What is the purpose of interesting sound? Describe the concept rather than giving an example HINT:

57. Pop 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? Soothing Background Interesting

58. Answer Interesting Sound - helps to shift attention away from tinnitus

59. Pop Quiz Which type of sound helps to reduce stress or tension that is caused by tinnitus? Soothing Background Interesting Which type of sound helps to reduce stress or tension that is caused by tinnitus? Soothing Background Interesting

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

61. Pop Quiz Which type of sound reduces contrast between tinnitus and a quiet environment to make it easier to ignore the tinnitus? Soothing Background Interesting Which type of sound reduces contrast between tinnitus and a quiet environment to make it easier to ignore the tinnitus? Soothing Background Interesting

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

63. You now understand the three types of sound! Soothing Sound Background Sound Interesting Sound

64. Take a moment to… 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)

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

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

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

68. To help you come up with ideas for choosing sounds… You can use…

69. Environmental 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…

70. Music 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

71. Speech 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

72. Nine Combinations of Sound to Manage Reactions to Tinnitus

73. How Do I Choose Soothing Sound?

74. Soothing Sound Can be Environmental Sound, Music, or Speech

75. 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? Think of a specific example Volunteers share your ideas Take a moment to discuss…

76. How do I Choose Background Sound?

77. Background Sound Can be Environmental Sound, Music, or Speech

78. What Background Sound might help your most bothersome tinnitus situation? Think of a specific example Volunteers share your ideas What Background Sound might help your most bothersome tinnitus situation? Think of a specific example Volunteers share your ideas Take a moment to discuss…

79. How do I Choose Interesting Sound?

80. Interesting Sound Can be Environmental Sound, Music, or Speech

81. What Interesting Sound might help your most bothersome tinnitus situation? Think of a specific example Volunteers share your ideas What Interesting Sound might help your most bothersome tinnitus situation? Think of a specific example Volunteers share your ideas Take a moment to discuss...

82. Example Worksheet: Bob

83. Bob Listening to talk radio helps Bob get his mind off of his tinnitus at night This helps him get to sleep This is an example of using interesting sound Listening to talk radio helps Bob get his mind off of his tinnitus at night This helps him get to sleep This is an example of using interesting sound

84. 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!

85. Another 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?

86. Bob’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 This is an example of using background sound

87. 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

88. Take a moment to… 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 Be as specific as you can (Stop here until everyone has written down sounds they will try)

89. Write down the devices you will use Be as specific as you can (Stop here until everyone has written down the devices they will try) Write down the devices you will use Be as specific as you can (Stop here until everyone has written down the devices they will try) Take a moment to… NOTE: I’ll walk around and peek over your shoulders while you work

90. You can make a different Sound Plan for any other tinnitus-problem situation You Have Completed Your First Sound Plan!

91. 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 Meeting

92. Ongoing 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

93. 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:

94. New 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.

95. 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

96. Questions? www.ncrar.research.va.gov