효과적인 이명 클리닉을 운영하려면 프로그램 구성을 어떻게 하면 좋을까?

 

이명(귀울음) 문제를 갖고 있는 분들을 위해서 최근에 출시된 지노티나이터스 (이명완화기능을 제공)라는 제품이 있습니다. 문의 하시는 분들도 많이 계시는데, 자료를 찾아보다 이명 고객/환자를 케어할수 있는 프로토콜을 과연 어떤식으로 구성해서 운영할 것인가에 대한 내용이 있어서 소개하고자 합니다. 어떻게 클리닉을 셋업하고 어떠한 방법으로 이명 프로그램을 운영하면 좋을지에 대한 가이드 라인입니다. 사진 The Hearing Review  

 

 

아래 소개하는 프로토콜은 "How to Establish a Successful Tinnitus Clinic" 이라는 제목의 글 그리고 부제로 The basics of setting up a tinnitus patient protocol in your practice. 라는 내용의 글에서 발췌한 것입니다.  <원문 The Hearing Review May 2013>

 

 

 

아울러 고객/환자분이 이 블로그를 보고 있다면 오래동안 자신을 귀찮게하고 괴롭혀 온 이명을 하루 아침에 귀에서 사라지게 하는 방법은 이 세상에 존재하지 않다고 다시 한번 말씀드리고 싶다.

 

 

 

자신의 겪어온 그 오랜 시간을 생각해 보시길 바란다. 이명이란 증상이며, 완치는 어렵다.

 

 

 

다만 시간을 갖고서 꾸준하게 진득하게 상담받고 상담하고 하면서 극복해 가는 과정을 간과해서는 안된다고 당부드리고 싶다. 아래 프로토콜 구성 과정이 정답은 있을 수없지만 기본적으로 6개월 F/U 과정을 거치게 끔 되어 있다.  

 

 

 

 

 

An Example of a Tinnitus Protocol for Dispensing Offices

 

 

The following is an example of a tinnitus protocol:

 

 

Step 1: Tinnitus Consultation
1) Case history: Collect a thorough and detailed case history.
2) Questionnaires (eg, THI, TRQ, THQ, TFI, Tinnitus/Hearing Survey).
  > Understand the person's tinnitus better. Is hearing or tinnitus the primary concern?
3) Audiometric, tinnitus, and sound tolerance testing (if not completed previously).
4) Discussion and selection of treatment option (eg, TRT, PTM, Sound Therapy, etc).
5) Create and discuss realistic expectations of what treatment can provide.
6) Begin tinnitus counseling. 

>  providing education regarding possible causes, etiologies, and reassurance that tinnitus is a “real” condition that is treatable, but not yet curable. Address any sound tolerance issues, such as hyperacusis, misophonia, or phonophobia.

 

 

Step 2: Introducing Sound Stimulation
This can take place in the same visit as the Tinnitus Consultation (Step 1) in some instances, or can be done at a separate visit.
1) Follow the fitting instructions of the preferred sound solution for tinnitus sound generators (TSG), sound stimulators, etc. Note: Alternatively, you can start by using just the hearing
instrument amplification for individuals with treatable hearing loss.
2) Continue to discuss realistic expectations, emphasizing that sound therapy is a tool to be used during treatment, not to act as the complete solution.
3) Continue tinnitus counseling.

 

 

 

Step 3: Follow-up Visit 1
Starts about 2 weeks after first fitting.
1) Discuss subjective comments/feedback from the patient relative to:
 a. Perception of the tinnitus;

 b. How it is affecting him/her;
 c. Reactions to the TSG and hearing instrument (or other sound therapy options).
2. Provide tinnitus counseling to:
 a. Monitor progress;
 b. Foster realistic expectations;
 c. discuss do's and don'ts
3) Make necessary adjustments to TSG, but only if required. This may include:
 a. Frequency shaping the TSG noise;
 b. Volume changes.

 

 

 

Step 4: Follow-up Visit 2
About 4 weeks after first fitting.
1) Discuss subjective comments/feedback from patient.
 a. Perception of the tinnitus;
 b. How it is affecting him/her;
 c. Reactions to the TSG and HI (or other sound therapy options).
2) Provide tinnitus counseling.
3) Make necessary adjustments to TSG, but only if required. This may include:
 a. Frequency shaping the TSG noise;
 b. Volume changes.
4) Re-administer any questionnaires given at the start of treatment to monitor status of tinnitus perception.

 

 

 

Step 5: Follow-up Visit 3, 4, and 5

 

Follow-up Visit 3: 2 months after first fit.
Follow-up Visit 4: 3 months after first fit.
Follow-up visit 5: 6 months after first fit.

 

 

1) Follow-up Visits 3, 4, and 5 should follow the same steps as Follow-up Visit 2, including post-measure questionnaires.

 

More visits may be required for some individuals.

Keep in mind this is just an example layout for a tinnitus protocol. Actual management steps and timelines may vary, and should be considered on a caseby- case basis and/or in concert with a multidisciplinary team.

 

Many tinnitus patients may require considerably longer than 6 months of treatment (eg, 12 to 18 months),4 and severe cases may warrant referral.

 

 

The take-home message is that it is important to have some structure for both you and the patient to follow.