Tinnitus Triage COVID-19

COVID-19 and Our Tinnitus Service: Triage Patients with Tinnitus, Hyperacusis and Misophonia Using Telephone Appointment

Background:

Patients are actively encouraged to change their appointment type to telephone in order to minimise physical contact during COVID-19 outbreak in the UK and elsewhere in the world. This interview form has been designed in order to facilitate triage of new patients experiencing tinnitus, hyperacusis, and misophonia using telephone appointments. Application of this form will assist the therapist to gather all the essential information needed to explore the relevant medical red flags and the impact of the symptoms on individual’s life and their psychological wellbeing. By clicking on the submit button, you will receive the form securely to the email address you provided. No other copy will be saved anywhere else.

Instructions on how to use this form:

Arrange a suitable time to telephone your patient. See the basic requirement listed below. Add your name or a pseudo name, a code to identify your patient, and the email address that you would like the form to be sent to. For your telephone clinical interview, read the questions to them and complete this form online. Once all questions are answered, click the submit button.

Before ending the call, please make sure to offer the patient an opportunity to ask their questions. You may choose to use some sections from the papers below to offer reassurance and advice:

• Simplified Tinnitus Retraining Therapy
• Specialised Cognitive Behaviour Therapy for tinnitus, hyperacusis and misophonia
• Patient-Centred Tinnitus Management Tool

What are the basic requirements for a telephone clinic?

• Telephone and PC or Laptop with internet access
• Identify quiet location in which to contact patient
• Confirm the patient’s identity in full by asking them to state their full name, DOB, first line of address and postcode
• Obtain patient agreement to proceed to telephone consultation
• Ask whether the patient wishes anyone else to join the consultation and, if so, document who was present during the consultation; their name and relationship to the patient.
• Record your consultation as you would do normally

Triage Patients with Tinnitus, Hyperacusis and Misophonia Using Telephone Appointment

Ear pain?	Yes	No
Ear discharge (otorrhea)?	Yes	No
Balance problem?	Yes	No
Seen ENT?	Yes	No
Hearing difficulties in noise and in quiet?
Onset of tinnitus? When did it start and any known reason that might have caused it?
What does tinnitus sound like? Ringing, buzzing, continuous, pulsing, etc
Where tinnitus is perceived? Right ear, Left ear, head, external to them

Any relevant medical history?
Hyperacusis/Misophonia?

Screening for Anxiety and Depression-Tinnitus/Hyperacusis/Misophonia (SAD-T) or SAD-T (Parent)

Over the last 2 weeks, how often have you **your child for parents***been bothered by any of the following problems?
Feeling nervous, anxious or on edge	0-1 day	2-6 days	7-10 days	11-14 days
Not being able to stop or control worrying	0-1 day	2-6 days	7-10 days	11-14 days
Little interest or pleasure in doing things	0-1 day	2-6 days	7-10 days	11-14 days
Feeling down, depressed or hopeless	0-1 day	2-6 days	7-10 days	11-14 days

• Scores of 4 or more indicate possible symptoms of anxiety and/or depression.
• Patients with score of 6 or more are at higher risk of developing suicidal and/or self-harm ideas.

History of mental health illness:	Yes		No
Seen mental health services:	Yes		No
Suicidal ideations (Only ask if needed based on your clinical judgment of patient’s mood or when SAD-T questionnaire score is 6 or more):	Not indicated, No, Yes but no plan, Yes with plan