Progressive tinnitus management (PTM) is a 5-step structured clinical protocol for management of tinnitus which may include tinnitus retraining therapy. The five steps are: 1) triage - determining appropriate referral, . audiology, ENT, emergency medical intervention, or mental health evaluation; 2) audiologic evaluation of hearing loss, tinnitus, hyperacusis and other symptoms; 3) group education about causes and management of tinnitus; 4) interdisciplinary evaluation of tinnitus; 5) individual management of tinnitus.  The . Department of Veterans Affairs (VA) now employs PTM to help patients self-manage their tinnitus.