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STEM Case Study

STEM Case Study. 64yo veteran, many years of bilateral severe to profound precipitously sloping high frequency hearing loss. Unsuccessful hearing aid trials in the past due to loudness discomfort from hearing aids. Well documented sound intolerance for years.

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STEM Case Study

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  1. STEM Case Study 64yo veteran, many years of bilateral severe to profound precipitously sloping high frequency hearing loss. Unsuccessful hearing aid trials in the past due to loudness discomfort from hearing aids. Well documented sound intolerance for years. Seen in 2008 complaining of continued sound intolerance and inability to wear hearing aids due to discomfort. Audiologist fit him with custom Sound Defenders. (pre PTM implementation)

  2. Repeat Audiologic Evaluation 2009 as part of Level 2 • THS: • Section A - 14 • Section B – 16 • Section C – 6 • THI: 100 (severe subjective handicap) Referred to Level 3 workshops first, he thought he could handle the group environment.

  3. Level 3 • Identified “concentrating on reading” as his most bothersome tinnitus situation • Continued to report during group his inability to tolerate sounds which can increase tinnitus. • Many years of MH intervention for anxiety, panic disorder, agoraphobia, OCD. He attributes many of these to his tinnitus, sound intolerance and difficulty hearing and communicating with loved ones. • Recommended STEM upon completion of 2nd Level 3 workshop.

  4. STEM • Sound Tolerance Interview: Overprotecting his ears by using his Sound Defenders 60% of the day. Developed Sound Tolerance Plan: • Incorporating enjoyable sounds throughout the day • Wean from use of Sound Defenders • Ordered musician earplugs with both 25 and 15dB filters • Noticeable dysfluency.

  5. 1 month follow up • Fit with musician earplugs, tolerated 15 filter. • Has cut back on wearing Sound Defenders • Taking enjoyable walks • Notices he likes listening to “radio static”, “relaxing”. • Recognizes that he is most bothered by sounds he cannot control; neighbor’s dog barking, others getting ice from the icemaker (although he can tolerate it if he is getting the ice) • Starting to date, and anxiety is increasing over inability to communicate with partner and “going out” to difficult environments; movies, restaurants. Longterm goal to be fit with combination instruments. • Dysfluency also concerning to him. • Using Sound Spa at night time for tinnitus management.

  6. Seen for 8 more visits over course of following year. • Continuing to reduce use of musician earplugs • Began using VCO telephone for easier communication over the telephone. • Listening to radio static when taking walks. • Motivated to try combination instrument for tinnitus sound generator AND improve hearing ability to further reduce stress related to communicative difficulties. • Referred to Speech Pathology Department to address dysfluency.

  7. Continued Progress • Fit with Resound Live TS Receiver in the Canal combination instruments, open domes. Turned on TSG only until he felt comfortable enough to turn on amplification. • Continuing to reduce amount of time using musician earplugs and is noticing that he is able to tolerate some sounds again. • VA Psychologist began to notice an improvement in his MH conditions.

  8. Continuing Progress • Enjoying the TSG when walking and reading, rather than radio static. • Eventually able to turn on amplification to improve communication with others which further assisted in reducing stress and anxiety.

  9. Continuing Progress • Added following programs: • amp+TSG program with environmental steering, • HA only program with conservative amount of gain • TSG only program with limited gain/headroom so as not to overmask tinnitus He handled multiple programs well and having a sense of control of the device and listening environments was important to his management.

  10. Continuing Progress • Once comfortable with combination instruments with open dome array, added custom open earmolds due to severity of hearing loss and less feedback. He could tolerate an increase in amplification. • Began attending a Stress Management group through MH. • Communicating much easier with others and feels more confident in management of tinnitus and hyperacusis. • Able to attend movies, restaurants. Support from family and friends has helped tremendously. • Gaining strides with managing dysfluency.

  11. Re-administered Tinnitus Handicap Inventory: • Score of 50 (moderate handicap) Statistically improved as compared to Level 2 THI score of 100. “I have part of my life back”

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