Neuromonics Stage 2
Transition Follow-Up Call Post-Fit
Form Needed for
Courtesy Call
Patient Record:
Transition FollowUp Form
(~10 wks Post Fit)
~ 10 Weeks
(Record on Transition Follow-Up Form)
To assess how the patient is adjusting after transition. It is important to remind the
patient that the purpose of Stage Two of treatment is to gradually expose them to more
of the tinnitus by reducing the level of treatment interaction. Patients may need an
additional follow-up appointment to receive extra support while they are adjusting to
using the treatment and not receiving a high level of tinnitus relief as they did in Stage
One.
Review Patient’s initial response to Stage Two:
Is the treatment Comfortable
Yes
No (Why?)
Level of interaction with treatment and tinnitus?
Low
Moderate
At this prescribed interaction level do you feel
Satisfactory
Unsatisfactory that you are
High
achieving relief from the tinnitus?
Forms & Items
Needed at this
Appointment
Patient Record:
Stage Two
Tab Forms
Questions or comments?
Extra follow-up appointment or phone call?
Yes
Stage Two follow-up appointment (~ 16 weeks)
Date:
Stage 2 Appointment
Date:__________
____
~ 16 Weeks Post-Fit
(Record on Stage Two Form )
Computer with
Neuromonics
NeuroFit
Software and
NOAH 4
USB cable
Patient Oasis Device
1. Tinnitus Reaction Questionnaire (TRQ) - Complete and review
Determine % Awareness: Over the past week, what percentage of the time were you aware
of your tinnitus?
Determine % Disturbance: During the time that you were aware of your tinnitus, what
percentage of that time was it bothersome?
2. Broadband Minimum Masking Level
Only to be conducted if in discussion with the patient and in reviewing the TRQ in- sufficient
progress is being made. (See Assessment or Transition Guide for Instructions)
3. Loudness Discomfort Level & Residual Inhibition
Only to be conducted if the patient presented with reduced LDLs at the assessment
appointment. (See Assessment or Transition Guide for Instructions)
4. View Data Log from patient’s Oasis Device
5. Adjustment of any device features as indicated
6. Monitor and review Treatment Progression
7. Address any questions or concerns
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CL10-0010 Rev 2
View Patient Data Log
Select patient in NOAH 4 and open NeuroFit by clicking on icon:
Reading the Data
Log
Date: day/mo/year
Total Usage Time
Time of day: 00 - 24
hrs. military format
Average Daily Volume
Tracks
 Click on the settings
icon to open the Settings options
Phase: I vs. 2
You can select the date from which the data logging will be displayed. This will
otherwise default to the date of the first logged information
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
The appearance of the Legend for each track can be changed by clicking on the

Data logging is displayed on the Right Hand Side of the Fitting Module window. Use the
slide bars to view the desired time of day and date

View Legend for: Date, Total usage time, Time of day, Average daily volume, Tracks,
Phase
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CL10-0010 Rev 2
icon
Tips to Evaluating the Data Log
Stage Two
Designed to desensitize
the patient to tinnitus
using intermittent
interaction with the
tinnitus signal
Fostering
Desensitization
Recommended
strategies if
desensitization is not
occurring:
Use “single” setting
Reduce volume setting
to more moderate
interaction
Usage
 Is the patient undergoing treatment a minimum of 2 - 4 hours per day or < 2 hrs per
day? During Stage Two, patients are encouraged to use the device consistently
while starting to decrease overall usage.
 Discuss days without usage or <2 hours/day. If the patient occasionally misses a
day of use or achieves < 2 hrs per day, that can be a positive sign towards desensitization.
 Is the patient using the device too much? Is the patient allowing for breaks between
use or, is the patient wearing their device all waking hours? This could interfere
with desensitization to the tinnitus.
 If the patient is using the device at the exact same time each day, verify if that is
when their tinnitus is bothersome or when it’s convenient?
Volume
 Is the volume set appropriately? (i.e., intermittent 50/50 interaction with tinnitus)
 Are there fluctuations in volume use?
 If volume setting does not vary from day to day (vertical line), is he/she counting
clicks? Discuss how the patient is setting their volume.
 Explore any increasing or decreasing trend in the average volume setting.
 Decreasing volume may start to be appropriate if tinnitus perception is lowering.
Interaction
 What degree of interaction is the patient achieving during treatment?
Low
Moderate
High
Complete

What degree of tinnitus relief is the patient experiencing during treatment?
Low
Moderate
High
Complete
Adjustment of any device features as indicated
(Refer to NeuroFit Software User Guide for operation)
Feature
Reason for Adjustment
Adjustment Made
Audiometry values
Decrease overall usage
time.
Startup Volume
Balance
Headphone
Selection
Track Selection
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CL10-0010 Rev 2
Stage Two: Progress, Goals, and Progression
Treatment Progress - (record on Stage Two Follow-Up Form)
Treatment
Milestones
Middle of Stage
Two
Reduction in
disturbance from
tinnitus even when
not using treatment
(measurable on
TRQ)
1. Discuss when tinnitus most disturbing?
2. Is the patient using the treatment during the most
disturbing times? (see Usage Data)
Yes
3. How much interaction (blending) is the patient achieving
at a comfortable listening level?
Low Moderate High Complete
4. How much tinnitus relief is the patient achieving
when using the treatment?
Low Moderate High Complete
Review & Discuss Treatment Goals
Improvement in
tolerance of sounds
the patient previously found
uncomfortable
(measurable on
LDLs)
N/A
Not
at
All
No (action taken)
Small
Amt
Mod
Amt
5. Does the patient feel that the
treatment has improved his/her
ability to relax?
6. Does the patient feel that the
treatment has improved his/her
ability to sleep?
7. Does the patient feel that the
treatment has improved his/her
ability to concentrate?
End of Stage Two
Reduction in
awareness from
tinnitus even when
not using
treatment
Ceases need to
use their device
on a regular basis.
8. Does the patient feel he/she
has some control over the
tinnitus?
9. Is the patient able to ‘set &
forget’ treatment?
10. Note progress toward
To aid in maintaining
long- term benefit or
if tinnitus symptoms
flare up, the patient
may continue to use
treatment
intermittently with
positive relaxation
benefits
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customized goals
11. Does the patient feel that the
treatment is meeting his/her
expectations?
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CL10-0010 Rev 2
Large
Amt
Treatment Progress continued:
12. Is the patient using the treatment at the appropriate
YES
NO (why)
YES
NO (why)
YES
NO (why)
intermittent interaction level (50/50 blending) and achieving appropriate
relief?
13. Has the patient been using the treatment for the
required 2-4 hours a day?
14. Is the patient experiencing days when they forget
to use the treatment?
Reintroduction of
Pleasurable activities
into the Patient’s
lifestyle
15. Has there been an improvement in the TRQ?
16. Is there an improvement in the awareness and
No
Change
TRQ
TRQ
Decreased Increased
YES
NO (why)
YES
NO (why)
disturbance percentages? (see TRQ form)
Often people give up
hobbies or other social
activities because of the
disturbance associated
with their tinnitus
As this reduces over time
with treatment, it can be
useful to ask the patient
to think about the sort of
activities he/she can
resume or perhaps
initiate, and encourage
him/her to start making
the first steps.
This can also help move
the patient’s focus in a
positive way to a future
that is not restricted by
tinnitus.
To help make these
proposed activities
concrete and increase
motivation, the clinician
can collaborate with the
patient to devise an
action plan.
17. Is the patient experiencing periods of silence when
not using the treatment?
18. From the above responses is there evidence
YES
NO (why)
of desensitization occurring?
If No: Recommendations to promote desensitization
• Confirm the volume setting is allowing for intermittent interaction (50/50 blending)
• Use “single” setting
• Remind patient to only reach for device when tinnitus is bothersome.
• Recommend decreasing overall regular usage (<2-4 hrs/day and may occasionally skip days
Troubleshooting Tips
Is the patient setting the volume appropriately?
The volume should be set for intermittent 50/50 interaction with their tinnitus. Try to “set and forget”. Set
the volume at the beginning of a listening session and then let the music and their tinnitus move into the
background of the consciousness. The patient should never set the volume at a level that is
uncomfortable.
Is the patient listening in to the treatment too much or too little?
During non-sleep periods, the device should ideally be used while doing an activity, such as, reading,
writing, working on the computer, leisure walking, etc. Ideally, the patient uses the device 2-4 hours per
day, but may begin to have days with less usage at during treatment as desensitization begins.
Has the patient had a period of acute stress?
A stressful period can increase tinnitus levels despite ongoing treatment. Reinforce that the device can
be used to help at these times, and continual use over the long term will help the patient better deal with
other stressful incidents.
Has the patient had excessive noise exposure lately?
A period of noise exposure to a concert, wedding, machinery, sporting events, etc., can aggravate
tinnitus. If the noise is so loud that the patient needs to shout to be heard, then s/he should consider using
hearing protection
Does the patient use hearing protection / earplugs?
Hearing protection should not be worn at times when there is no significant noise. If s/he can hear the
tinnitus over the ambient noise levels, then s/he might be over-using hearing protection
Has the patient recently had changes in their overall health?
A cold, flu, allergy, eustachian tube dysfunction, excessive ear wax, etc. can enhance tinnitus. Also,
changes in medication or dosage may also affect tinnitus. If a change is medication is suspected, refer
the patient back to his/her practitioner.
Has the patient had extended periods of straining to hear clearly?
Extended exposure to softly spoken children or adults, a conference or meeting can draw attention to
auditory system dysfunction, and enhance hearing-loss related neural dysfunction.
Neuromonics Confidential
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CL10-0010 Rev 2
Circumstances to Return to Stage 1
Extreme cases of a patient regressing may require returning to Stage One (Phase 1
stimulus). This is usually evidenced by increased TRQ, Awareness & Disturbance
percentage levels, increased MMLs and decreased LDLs. If this occurs, then:
Refer to “Tinnitus Getting Worse” protocol in Clinician’s Guidelines or NTT Clinician
Counseling Guide for trouble- shooting recommendations.
Call Neuromonics Clinical Specialist to discuss.
Considerations for returning to Phase 1 stimulus:

Significant psychological involvement; as evidenced by TRQ

Significant increase in stress levels

Patient is unable to obtain necessary relief with Phase 2 stimulus

Patient is not managing life well
Appointment Notes:
Next Steps:
NEUROMONICS, INC
8774 YATES DR STE 220
WESTMINSTER, CO
80031 U.S.A.
Phone: 1-866-606-3876
Fax: 1-800-858-3031
E-mail:
info@neuromonics.com
Neuromonics Confidential
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CL10-0010 Rev 2