The patient petitioned her insurance company for coverage of the Neuromonics devices, and after a delay of five months, she was approved for 80% coverage.

She was fit with the Neuromonics device and encouraged to use it at least 3 hours per day.

At her two week follow up visit, she was very happy, saying she was already showing strong reduction in awareness.

At six weeks post fitting, her awareness and distrubance ratings were decreased from 100% to 75%; however, the sensation level of her tinnitus match was increased from 11 to 20 dB SL and her minimumm masking level was also increased marginally (BBN: from 44 to 46 dB, NBN 28 to 29.)  Her loudness discomfort levels were about 7 dB higher (improved) in the left ear, and 11 dB improved in the right ear.  It was recommended that she increase the amount of time she uses the device.  She was reported to be “ecstatic” about her progress.  Her TRQ was 9.

She was seen again at 4 months.  Her awareness of the tinnitus was steady at 75% of the time, but it was now bothersome only 60% of the time that she was aware of its presence.  Her tinnitus sensation level was down somewhat, to 16 dB SL.  The BBN masker needed to be 46 to mask the sound; the NBN masker 29-32 dB.   She is “appreciative of the big gains” she is making.  Her TRQ was 20.

Here are excerpts from emails she sent:

“I have to tell you I am sooo surprised at the results of my first few deays of wearing the device to bed. WOW!  The first day after … my tinnitus was cut by half or more! Right now I am enjoying quiet tinnitus at work!  I am overjoyed!  I cannot wear the deice when I watch TV or really need to hear something FYI. Gotta run, just wanted to share the good news!”

• The patient reported less annoyance, and a lower TRQ score was achieved; however, the tinnitus was not matched to a significantly softer sound and still required just as much noise to mask. In sum, it does not seem that the tinnitus itself had changed substantially. Does that constitute treatment failure?