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U.S Military Tinnitus Survey

U.S. Military Tinnitus Survey - for MicroTransponder

This survey is designed for former and active members of the U.S. Armed Forces. MicroTransponder is developing neurostimulation therapy that will retrain the brain so patients no longer perceive tinnitus, or constant ringing in their ears. This is being done by stimulating the vagus nerve in the neck which then directs the brain to release specific neuromodulators. We will be using the summary results of the survey to support our military grant submissions.

1. Which of the following age groups are you in? *This question is required.
2. What is your gender *This question is required.
3. Which branch of the U.S. military did you serve or currently serve in? *This question is required.
4. How many years did you serve in the military or have currently served thus far? *This question is required.
5. How long have you experienced tinnitus? *This question is required.
6. Where is your tinnitus located? *This question is required.
7. What does your tinnitus sound like? *This question is required.
8. Do you experience several different types of tinnitus sounds? *This question is required.
11. Is your tinnitus continuous? (without interruption and constant) *This question is required.
12. Do you also have hearing loss? *This question is required.
13. Does your tinnitus impair your ability to listen to other people speaking *This question is required.
14. Because of your tinnitus, do you feel frustrated? *This question is required.
15. Do you feel as if you cannot escape your tinnitus? *This question is required.
16. Does your tinnitus cause difficulties in being able to sleep at night?
17. What do you think was the cause of your tinnitus? *This question is required.
18. How many days of work have you missed because of your tinnitus in the past 12 months? *This question is required.
19. Now we are going to ask some questions around insurance and potential therapies.

First off, do you currently have medical insurance? (note that this will not impact the selection choices for clinical trials.) *This question is required.
20. If you have insurance, which of the following best describes the type of insurance you have
21. Do you currently receive disability payments from the VA specifically for your tinnitus? *This question is required.
22. Does your insurance currently cover and reimburse for any devices or therapies to treat tinnitus?
23. What is the total amount of money you have spent on Tinnitus products or therapies so far? *This question is required.
24. Has a clinician at the VA ever suggested a therapy for treating your tinnitus? *This question is required.
25. Are current treatments at the VA effective in treating your tinnitus? *This question is required.
26. How many different therapies or techniques have you tried to treat your tinnitus? *This question is required.
38. Which of the following represents the MOST amount of money that you personally would be willing to spend if there was a therapy that could reduce your tinnitus loudness and annoyance by 1/2? *This question is required.
39. Which of the following represents the MOST amount of money that you personally would be willing to spend if there was a therapy that could eliminate your tinnitus?
41. Would you like to participate in a future tinnitus trial?
This question requires a valid email address.
43. Would you be willing to participate in a phone survey regarding tinnitus at some point in the future? *This question is required.
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