Progressive Tinnitus Management at Two Veterans Affairs Medical Centers: Clinical Implementation With Modified Protocols

Abstract

Purpose This is a description of the clinical implementation and outcomes of progressive tinnitus management (PTM) at 2 Veterans Affairs (VA) medical centers: Both programs modified the protocol originally described by PTM developers. Method Modifications at both sites were classified according to an evidence-based framework set forth by Stirman, Miller, Toder, and Calloway (2013) . The Iowa City VA PTM program clinicians made 2 modifications and the Asheville, North Carolina, VA PTM program clinicians made 6 modifications to the standard PTM protocol. Pre–post outcome measures were analyzed for 20 veterans who completed the Iowa City program and for 200 veterans who completed the Asheville program. Results Veterans who completed the Iowa City program showed a statistically significant decrease in the average Tinnitus Handicap Inventory score ( Newman, Jacobson, & Spitzer, 1996 ). Veterans who completed the Asheville PTM program showed a statistically significant decrease in the average Tinnitus Functional Index (TFI) score. Outcomes in Asheville were compared to outcomes of a clinical trial of PTM conducted by the developers of PTM. The clinical work in Asheville resulted in a greater mean reduction on the TFI and a larger effect size using the TFI as compared to the results of the PTM clinical trial. Conclusions Clinician-directed modifications to PTM that are made to address the unique needs and circumstances of an individual clinic have potential to result in positive outcomes for patients. Clinicians providing care for patients with tinnitus using PTM who modify the protocol to meet the needs of their local setting are encouraged to collect and report the outcomes of their modifications to improve understanding of the impact of various types of modifications to PTM and other evidence-based practices.

Associations Between Traumatic Brain Injury and Severity of Tinnitus-Related Functional Impairment Among US Military Veterans: A National, Population-Based Study

“…While there is no cure for tinnitus, some approaches have been shown to help improve patients' symptoms. For example, Progressive Tinnitus Management (PTM) is a well-established approach for managing the effects of tinnitus [27][28][29] that combines mental health and audiology services. Specifically, PTM includes sound therapies with elements of cognitive behavioral therapy (CBT).…”

“…A random sample of 1800 veterans was selected from this cohort of VA users with a tinnitus diagnosis using stratified random sampling. Strata were developed using age categories (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49), and 50-89 years of age) and TBI diagnosis status (yes/no). Three hundred veterans were sampled from each of these 6 age × TBI strata, so that approximately one-half of the sample had been previously diagnosed with TBI and approximately one-third were from each of the age groups (veterans with a TBI diagnosis were intentionally oversampled).…”

“…These data were used to characterize the veteran population with tinnitus and as covariates in multivariable regression models. Demographic variables included age at the time the sample was drawn (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49), and ≥50 years), sex (male and female), race (Black or African American, White, and all other races), education (high school diploma or less, vocational/associate's degree/some college, and college graduate or more), marital status (married/in a relationship, and separated/divorced/single), annual household income (<$25 000, $25 000-$74 999, and ≥$75 000). Military characteristics included military branch (Air Force, Army, Navy/Coast Guard, and Marine Corps), duration of military service (<1-4, 5-10, and >10 years), and whether participants experienced the onset of tinnitus during military service (no/cannot remember and yes).…”

Cognitive Behavioral Therapy for Tinnitus: Addressing the Controversy of Its Clinical Delivery by Audiologists

“…The behavioral health provider teaches coping skills from CBT, generally focusing on relaxation and distraction techniques, and cognitive restructuring. Learning these coping skills satisfies the needs of most patients who receive these services (Beck et al 2019; Edmonds et al 2017; Henry et al 2017).…”

Factors affecting the implementation of evidence-based Progressive Tinnitus Management in Department of Veterans Affairs Medical Centers

“…Martin et al [35] noted the impact of using evidence-based intervention and providing highlevel training on the long-term sustainability of a program. Beck et al [36] identified close collaboration between an audiologist and a psychologist as an important factor in providing tinnitus care (specifically PTM). They attributed the success of the program, in part, to the transdisciplinary approach of the clinicians involved, whereby the boundaries between disciplines are blurred.…”