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Effect of Amplification on Tinnitus Among New Hearing Aid Users
Abstract
A tinnitus questionnaire was completed by 200 new hearing aid users. The results indicated that 62% experienced tinnitus, with 43.5% reporting frequent or continuous presence. Thirteen of the 200 patients rated their tinnitus as severe. Approximately one-half of the respondents with tinnitus reported that their hearing aids provided either partial or total relief from tinnitus. If the tinnitus was rated severe, partial instead of total relief was the most commonly reported effect. A few individuals indicated residual inhibition. A subjective evaluation of the aids' performance revealed that relief from tinnitus was frequently rated an important aspect of the user's satisfaction.
... In humans, changes in hearing function have been documented where there is a drop in thyroid hormone levels during sensitive stages of the neonatal and infantile periods of development 36 . Among rodents, thyroid hormone deficiencies that occur before the onset of hearing have been shown to cause irreversible changes to both the central and peripheral auditory systems 37 . The mechanisms of such changes have been hypothesized to be related to some form of changes occurring on the genetic level. ...
... Furthermore, we cannot comment on the severity, and the clinical phenotypes of tinnitus encountered in our study population nor provide any figures to quantify the hearing loss noted in our data. Interestingly, among those with hearing loss suffering from tinnitus, approximately half of them reported relief from their tinnitus in one study 37 after the implementation of hearing aids. Another study also showed improvement in tinnitus among patients with hearing loss after receiving a cochlear implant 38 . ...
This is a retrospective longitudinal study that uses data from the National Health Insurance Research Database (NHIRD) of Taiwan of which hypothyroid patients who received a diagnosis between 2000 and 2010 were selected and followed up until 2011. The primary outcome of this study was the occurrence of tinnitus (ICD-9-CM code 388.3). The relevant comorbidities were selected as potential confounders according to the literature, which included vertigo (ICD-9-CM code 386), insomnia (ICD-9-CM code 780), anxiety (ICD-9-CM code 300.00), and hearing loss (ICD-9-CM code 388–389). The overall incidence of tinnitus was significantly higher in the hypothyroidism cohort than in the non-hypothyroidism cohort (9.49 vs. 6.03 per 1000 person-years), with an adjusted HR of 1.35 (95% CI 1.18–1.54) after adjusting potential confounders. The incidences of tinnitus, as stratified by gender, age, comorbidity, and follow-up time, were all significantly higher in the hypothyroidism cohort than those in the non-hypothyroidism cohort. The incidence of tinnitus significantly increased with age (aHR = 1.01, 95% CI 1.01–1.02). In conclusion, we report the relationship between hypothyroidism and the increased risk for tinnitus. We also found that hypothyroidism patients are at increased risk of developing tinnitus when associated with comorbidities including vertigo, hearing loss, and insomnia.
... Hearing aid technology has developed significantly over the past years, but limited studies have investigated improvements in tinnitus following hearing aid use in patients with hearing difficulties. According to Surr et al., 62% of patients who began using a hearing aid had tinnitus, which declined in approximately half of them following hearing aid use [2]. However, there was no significant correlation between a degree of improvement in the tinnitus handicap inventory (THI) score after hearing aid use in patients with tinnitus and their satisfaction, measured with the Abbreviated Profile of Hearing Aid Benefit (APHAB)-a questionnaire that evaluates the performance of a hearing aid before and after its use [3]. ...
... Therefore, this study aimed to (1) compare improvements in the THI scores of patients who choose hearing aids with counseling and in those who choose only counseling and to (2) investigate the association between improvements in tinnitus and subjective patient satisfaction with hearing aids after the tinnitus improvements based on the THI score and the SADL questionnaire. ...
This study aimed to evaluate the effectiveness of and satisfaction with hearing aids as a treatment option for tinnitus with hearing loss.
Methods:
This retrospective study used the tinnitus handicap inventory (THI), the satisfaction with amplification in daily life (SADL) questionnaire, and a medical chart review. A total of 116 patients treated between August 2018 and December 2020 were included. All patients with tinnitus and hearing loss underwent the same counseling sessions. Sixty patients chose to have hearing aids fitted (aided group), whereas 56 patients chose not to (non-aided group). Both the groups had similar audiometric configurations, durations of tinnitus, and ages. Structured interviews were performed, with various measures evaluated using the visual analog scale (VAS) and the THI questionnaire, before and six months after fitting the hearing aids. The SADL questionnaire was administered 6 months after fitting the hearing aids.
Results:
The patients' THI scores reduced 6 months after the counseling, but the improvement in the THI scores was only significant in the group that received hearing aids. There were significant differences between the VAS scores of the two groups, and the changes in the VAS scores in the groups were statistically different. Subjective satisfaction with a hearing aid increased with improvements to tinnitus-related discomfort.
Conclusion:
The study's results indicated that patients with hearing loss and tinnitus can be treated with hearing aids and counseling.
... The use of hearing aids has long been recommended for tinnitus relief (Vernon and Schleuning, 1978;Coles, 1987;Hazell et al, 1985). Many studies reported a decrease in the prominence of tinnitus in up to 85% of patients with sensorineural hearing loss after hearing aid fitting (Hazell et al, 1985;Surr et al, 1985;Tyler and Bentler, 1987;Sandlin and Olsson, 1999;Henry et al, 2015). Many patients report tinnitus has helped when they receive hearing aids (Moffat et al, 2009;Schaette et al, 2010;Kochkin et al, 2011). ...
... Many studies have attempted to evaluate the efficacy of maskers and have reported tinnitus relief in up to 83% of the individuals using total or partial masking delivered by sound therapy devices (Vernon and Schleuning, 1978;Hazell et al, 1985;Surr et al, 1985;Jastreboff and Hazell, 1993;Vernon and Meikle, 2000;Bauer et al, 2017;Henry et al, 2017). The American Academy of Otolaryngology-Head and Neck Surgery Clinical Practice Guidelines did recommend that sound therapy be offered to patients with bothersome tinnitus, acknowledging that additional data were needed (Tunkel et al, 2014; see also; Moffat et al, 2009;Hobson et al, 2010;Schaette et al, 2010). ...
Background:
It is well accepted among clinicians that maskers and hearing aids combined with counseling are generally helpful to tinnitus patients, but there are few controlled studies exploring the efficacy of maskers alone to decrease the prominence of tinnitus.
Purpose:
We investigated the benefit of maskers for patients with chronic, bothersome tinnitus.
Research design:
Crossover single-participant design, where each participant served as their own control.
Study sample:
18 adults with subjective, nonpulsatile, sensorineural tinnitus.
Intervention:
Participants participated in two six-week trials: one with sound therapy and one without. No counseling was provided in either group. Masking devices were fit with sounds intended to reduce the tinnitus prominence.
Data collection and analysis:
Participants rated tinnitus loudness, tinnitus annoyance, and acceptability of the background sounds using a numeric 0-100 interval scale and completed the Tinnitus Primary Functions Questionnaire (TPFQ).
Results:
Three participants dropped out. On the total score of the TPFQ, 5 of 15 remaining participants (33%) showed a benefit. Using a derived score based on functions showing a handicap before the study, maskers benefit was observed in the areas of sleep (five of nine), hearing (three of eight), thoughts and emotions (three of four), and concentration (four of eight). The TPFQ and annoyance data complemented each other well.
Conclusions:
This study demonstrates the benefit of partial masking, encouraging patients to seek help from audiologists interested in providing support for tinnitus patients.
... Evidence suggests that the tonal quality of the perceived tinnitus 'sound' is either determined by the area of maximal hearing loss or it is perceived at the edge of the hearing loss slope i.e., 'ringing' tinnitus is associated with high frequency impairments and 'roaring' tinnitus is associated with mid or low frequency impairments [10,11]. Though it is well established in the literature that use of hearing aids can lessen the negative impact of tinnitus in individuals with hearing impairments, it has not been clearly established whether individuals with strictly unilateral sensorineural impairments and tinnitus, whether unilateral or bilateral, can receive the same benefit [12][13][14]. Research is needed in this regard as conditions that result in unilateral sensorineural hearing impairments and tinnitus may have differing pathogenisis, such as with Meniere's disease or sudden hearing loss, and may be differently affected by the use of a hearing aid. ...
... We observed a near equal distribution of males to females and effect size for comparison of means of the THI total score was not compromised by the small sample size. Consistent with published evidence showing that hearing aids can help reduce the perceived negative impact of tinnitus on individuals with hearing impairment; our data indicate that this may also be true of individuals with strictly unilateral sensorineural impairments, regardless of etiology [12][13][14]. As evidenced by the data presented in this report, there was an observed reduction in THI total/ sub-scale item and VAS scores from the 'unaided' to the 'aided' test conditions. ...
Tinnitus is a problem commonly associated with unilateral sensor neural hearing impairments; however, little has been published on the most efficacious approach to treating tinnitus in this population. Previous studies have shown that hearing aids are beneficial in treating tinnitus in individuals with hearing loss, but this has not been thoroughly assessed in individuals with strictly unilateral sensor neural impairments. This is a pertinent area of investigation as conditions that commonly result in unilateral sensor neural hearing loss may lead to different outcomes. Between September 2011 and August 2012, 16 individuals with unilateral sensor neural hearing loss and tinnitus were dispensed a hearing aid for a three month field trial. Each participant was given the Tinnitus Handicap Inventory (THI) in pre- and posthearing aid fitting conditions. Differences in THI total scores as well as sub-scale item scores were assessed between test conditions. The amount of reduction in individual THI sub-scale item group scores varied greatly between test conditions. The items with an ‘unaided’ starting score of 38 or higher, and saw the greatest reduction from ‘unaided’ to ‘aided’ conditions, involved the impact of tinnitus on hearing function. Paired differences t-test of THI total score group means was significantly reduced (p<0.05) from the ‘unaided’ to the ‘aided’ condition. A similar result was seen with the visual analog scale (VAS). A statistically significant positive correlation was observed between the THI total score and the VAS in both test conditions. The current study demonstrated that use of a hearing aid by individuals with unilateral sensorineural hearing loss may lessen the handicapping effects of tinnitus. Consistent with existing literature in the area, observed benefits were variable with some individuals reporting greater benefit than others. The reason for this variability is not clearly understood.
... Although this approach (acoustic stimulation) is very popular worldwide (Henry et al., 2008(Henry et al., , 2017Cima et al., 2020), and has been used for years (Saltzman and Ersner, 1947;Hazell and Wood, 1981;Surr et al., 1985), there is only weak evidence for it. Indeed, while many studies report some benefits after sound therapy most studies are not randomized control trials (RCTs) (Hobson et al., 2012;Hoare et al., 2014b;Sereda et al., 2018). ...
Tinnitus is prevalent among patients suffering from Single-Sided Deafness (SSD) and Asymmetrical Hearing Loss (AHL). In addition to bothersome tinnitus in the poorer ear, these patients also report issues with understanding speech in noise and sound localization. The conventional treatment options offered to these patients to improve auditory abilities are cochlear implantation, bone conduction devices or Contralateral Routing Of Signal (CROS) hearing aids. It was recently found that the benefit of cochlear implantation for tinnitus associated with AHL/SSD was greater than the other two approaches. It is conceivable that the lack of stimulation provided to the poorer ear in these last approaches explains their modest impact on tinnitus perception. A new technology that combines the ability to reroute the sound from the poorer ear to the good ear (CROS system) while still stimulating the poorer ear with conventional sound amplification has recently been developed: the StereoBiCROS system. The aim of this study was to investigate the effects of this new device on tinnitus. Twelve AHL and two SSD patients aged 70.7 ± 7.9 years with tinnitus were fitted with bilateral hearing aids that included 3 programs: Stereophonic, BiCROS and StereoBiCROS (CROS + bilateral amplification). The short-and long-term effect of the approach on tinnitus was assessed using a tinnitus Loudness Visual Analog Scale (VAS) and the Tinnitus Handicap Inventory (THI), respectively. Both the VAS and the THI were used before and one month after the hearing aid fitting. Of the 14 patients who used their hearing aids daily (12.6 ± 1.6 h per day) the StereoBiCROS program was the most used program (81.8 ± 20.5% of the time). The average THI total score decreased from 47 (± 22) to 15 (± 16) (p = 0.002) and the VAS-Loudness score decreased from 7 (± 1) to 2 (± 2) (p < 0.001) after the one-month trial period. In conclusion, StereoBiCROS stimulation strategy seems to offer an effective alternative to reduce tinnitus handicap and loudness for patients with AHL/SSD and tinnitus. This effect may be driven by sound amplification of the poorer ear.
... The primary purpose of fitting hearing aids is to reduce hearing difficulties and improve communication, which was observed as the greater change from baseline for the HHIE for the hearing aid group in the present study. Improvement in hearing and communication might lead to reduction in stress and anxiety that may be associated with hearing difficulties and in consequence may lead to changes in self-reported measures of tinnitus symptom severity [54]. Moreover, intervention adherence might be higher in those participants who perceived benefit for their hearing, potentially resulting in a perceived increased benefit for their tinnitus. ...
Background
Education and advice is provided for tinnitus management in all UK audiology clinics. Sound therapy, including provision of hearing aids may be offered, but this is often dependent on a clinician’s decision rather than UK policy. This inconsistent management reflects a lack of evidence around the effectiveness of hearing aids for tinnitus. This open-label, two-arm multicentre randomised controlled feasibility trial gathered data around recruitment, acceptability and outcome assessments to determine the feasibility of conducting a large randomised controlled trial investigating the effectiveness of hearing aids for tinnitus management.
Methods
Adults referred to audiology for tinnitus, with an aidable hearing loss were recruited at five UK audiology clinics. They were randomised 1:1 to either education and advice (treatment as usual (TAU), n = 41) or TAU plus hearing aids ( n = 42). Outcomes were collected by questionnaires 12 weeks after randomisation. After participation, interviews were conducted with a subset of both participants and clinicians from each trial centre.
Results
Eighty three participants from five sites were randomised. Non-aidable hearing loss was the main reason for ineligibility to participate in the trial reported by the sites. Seventy three percent of participants returned the 12-week questionnaires, with return rates by site ranging from 61 to 100%. Fifteen out of 33 participants (45%) reported using hearing aids for the clinician-recommended time, or longer, during the day. The Tinnitus Functional Index (TFI) was the outcome measure most responsive to change. The majority of participants also agreed it was relevant to their tinnitus and hearing loss. Qualitative data demonstrated that the trial was acceptable to participants. Feedback from clinicians revealed a potential lack of equipoise. It also highlighted the differences in referral and treatment pathways between departments and differences in audiometric criteria for fitting hearing aids. Health economic measures were well completed for those returned. No change in health-related quality of life was observed. Costs were higher in the intervention arm, but self-reports of healthcare service use indicated participant confusion in treatment pathways.
Conclusions
This feasibility trial is the first step towards obtaining high quality evidence to determine potential clinical effectiveness and cost effectiveness of hearing aids for tinnitus versus usual care. A definitive trial was deemed to be feasible, with some modifications based on feasibility findings and using the TFI as the primary outcome.
This trial was funded by the National Institute for Health Research, Research for Patient Benefit Programme (PB-PG-0816–20,014) and registered with ISRCTN (ISRCTN14218416).
... 5 Surr et al 6 reported that approximately 50% of tinnitus patients achieved some relief from a hearing aid. Yet another study by Surr et al 7 found an average of 10% improvement in tinnitus handicap over 4-6 weeks following hearing aid fitting. The likelihood of reducing tinnitus depends on the careful selection of hearing aid characteristics to reduce tinnitus audibility. ...
Background:
The study investigates the best amplification strategy that provides tinnitus relief in a quiet environment, for individuals with sensorineural hearing loss with bothersome tinnitus.
Methods:
The repeated measures research design was utilized. Twenty participants (age range 25 years to 65 years; mean: 48.28 years) with bilateral symmetrical sloping sensorineural hearing loss with bothersome unilateral tinnitus were recruited. They were sub-grouped into lowand high-pitched tinnitus groups. A preference score was obtained for each of the strategies in hearing aid fitting, using the paired comparison method. The 4 strategies used were the desired sensation level (input/output) and the National Acoustic Laboratories' nonlinear fitting method (version 1), at each of the low (30 dB SPL) and high (50 dB SPL) compression thresholds. Besides, the severity of tinnitus was assessed using the tinnitus severity index before and after 1 month of using the hearing aid in the best-selected strategy.
Results:
A repeated-measure ANOVA revealed no significant effect of the group on the preference score but was significant for strategies on relief from tinnitus. The desired sensation level (input/output) at a low compression threshold was the best strategy for alleviating tinnitus. Thirty-five percent of the study participants preferred the desired sensation level (input/output) strategy at low and high compression threshold, respectively. The remaining 25% preferred the National Acoustic Laboratories' nonlinear hearing aid (version 1) at low compression threshold, and 5% selected the same device at high compression threshold. Furthermore, a significant association was observed in the severity of tinnitus before and after the hearing aid fitting set at the preferred program.
Conclusion:
The desired sensation level (input/output) method at the low compression threshold is the best program to alleviate bothersome tinnitus.
... As such, the contrast between tinnitus and background stimuli can be reduced, facilitating habituation to tinnitus. Decreased communication stress, on the other hand, as a result of hearing aids use, can support coping with tinnitus (Surr, Montgomery, and Mueller 1985). A long term effect of hearing aids that has been proposed through animal studies is reversing the tinnitus-related cortical reorganisation (Eggermont 2008). ...
Objective
As tinnitus is often associated with hearing loss, hearing aids have been proposed for tinnitus relief in literature for more than 70 years. There is a need for recent literature to be reviewed and guide decision making in tinnitus management. This scoping review aims to provide an update of the available evidence on hearing aids for tinnitus, focussing on the effect of sound amplification or combination devices (i.e. amplification and sound generation within one device).
Design
Research studies were included if they investigated hearing aids or combination devices for tinnitus and were published after 2011.
Study sample
A total of 28 primary research studies were selected.
Results
Positive results of hearing aids in tinnitus patients were shown in 68% of the studies, whereas 14% demonstrated no change in tinnitus distress. However, the quality of the evidence across studies was variable.
Conclusions
Scientific support for hearing aids and combination devices for tinnitus relief was found. The standalone effect of sound amplification and the added value of sound generators and adjustment of sound processing strategies needs further investigation. Stronger methodology in future studies is needed to reach consensus on how to optimise hearing solutions in a multidisciplinary approach.
... Les principales thérapies utilisées sont les dispositifs auditifs et les thérapies d'habituation sonores (Sheppard et al. 2020;Tyler et al. 2020). De nombreuses études ont démontré une diminution des acouphènes importante (jusqu'à 85% des patients) après la mise en place d'appareils auditifs (Hazell et al. 1985;Surr et al. 1985;Sandlin et Olsson 1999;Henry et al. 2015). De plus, des thérapies sonores ont également été développées tels que la « cognitive behavioral therapy » (Andersson 2002;Hesser et al. 2011), le « progressive audiologic tinnitus management » ; la « tinnitus retraining therapy » (Jastreboff et al. 2000;Westin et al. 2011;Bauer et al. 2017); la « person-centered therapy » ( Mohr 2008) et le « tinnitus activities treatment » (Tyler et al. 2007). ...
Les acouphènes sont caractérisés comme étant des sons "parasites" (crépitement, bourdonnement, sifflement) provoqués en absence de stimulus externes. Ce trouble est présent dans plus de 10% (12 à 30%) de la population adulte dans le monde. La prévalence des acouphènes montre une courbe de croissance inquiétante. Les nouveaux modes de vie des pays développés et émergents (exposition au bruit, urbanisation, ect) accélèrent cette tendance et en fait un problème de santé publique majeur. La détermination de marqueurs physiologiques des acouphènes chez l'homme et chez l'animal reste un défi pour la communauté scientifique. L’objectif principal pour les chercheurs étudiant les acouphènes est de pouvoir fournir une mesure objective afin de quantifier les caractéristiques acoustiques/perceptives des acouphènes. Au cours des dernières années, les possibilités apportées par la résonance magnétique sont de plus en plus exploitées avec l’utilisation d’une variété de techniques IRM (Imagerie par Résonance Magnétique). De plus, des améliorations techniques et méthodologiques innovantes chez l’animal ont été apportées, notamment par l'utilisation de nouveaux agents de contraste à base de chlorure de manganèse (MEMRI) ou le sodium (23NaMRI).Dans cette étude, nous avons développé une méthode d’analyse quantitative innovante basée sur le taux de relaxation transverse (R2). Le but de cette méthode est de détecter précisément l'accumulation d'ions paramagnétiques Mn2+ accumulés dans les neurones actifs principalement au travers des canaux calciques voltage-dépendants. La mesure directe du signal RMN dans des régions spécifiques du cerveau permet de déterminer le pourcentage de changement de R2 entre les zones auditives d'intérêt par rapport aux régions non auditives. Nous avons démontré une absorption de Mn2+ nettement plus élevée dans le colliculus inférieur et le noyau cochléaire du côté ipsilatéral et controlatéral chez le groupe de rat traité au salicylate de sodium. Nous avons ensuite comparé la méthode ∆R2/R2 aux méthodes d’analyse MEMRI « standards », à savoir le rapport signal sur bruit (SNR) et le rapport d'intensité du signal (SIR). La méthode de ∆R2/R2 est la seule technique à avoir révélé des résultats statistiquement significatifs dans les colliculus inférieurs et les noyaux cochléaires de manière bilatérale.Puis, dans un second temps, nous avons développé une méthode d’analyse basée sur l’ion sodium (23Na IRM) sur un modèle animal induisant des acoupènes. Le sodium joue un rôle important dans le métabolisme et occupe donc une place importante dans les applications cliniques (tumeurs, accidents vasculaires cérébraux, et certaines maladies neurodégénératives). Les résultats préliminaires obtenus ont montré une potentielle augmentation du volume de l’espace extracellulaire dans les colliculus inférieurs chez le rat, en présence d’acouphènes. Néanmoins, cette augmentation du volume extracellulaire ne semble pas spécifique au système auditif en présence de salicylate de sodium.
... The amplification of sound by hearing aids can increase the level of neural activity, which can reduce the gap between the tinnitus stimuli and the background neural activity (Parra & Pearlmutter, 2007;Searchfield, 2008). The use of hearing aids can also indirectly help patients with both tinnitus and hearing impairment by reducing the negative effects of tinnitus annoyance, regardless of the severity of the hearing loss (Surr et al., 1985;Carmen & Uram, 2002). ...
... Amplification using conventional hearing aids is often the first recommendation for patients with hearing loss and tinnitus because it is effective for many patients in reducing tinnitus-related distress (Kochkin & Tyler, 2008;Kochkin et al., 2011;Oz et al., 2013;Parazzini et al., 2011;Searchfield et al., 2010;Shekhawat et al., 2013;Surr et al., 1985). Additionally, research shows that patients benefit from counseling for their tinnitus through interventions such as cognitive behavioral therapy (J. ...
Purpose
Smartphone apps for tinnitus relief are now emerging; however, research supporting their use and effectiveness is lacking. Research has shown that Tinnitus Therapy sounds intended for individuals with acoustic hearing provide relief to some patients using cochlear implants (CIs) with tinnitus. Here, we evaluated the use and acceptability of a smartphone app to help CI patients with tinnitus.
Method
Participants completed a laboratory trial (n = 19) and an at-home trial (n = 14) using the ReSound Tinnitus Relief app to evaluate its acceptability and effectiveness in reducing their tinnitus. During the laboratory trial, participants selected a sound that was most acceptable in managing their tinnitus (termed chosen sound). Word recognition scores in quiet were obtained before and after sound therapy. Participants were randomly assigned to one of two groups for the at-home trial, that is, AB or BA, using (A) the chosen sound for 2 weeks and (B) the study sound (i.e., broadband noise at hearing threshold) for another 2 weeks. Ratings were collected weekly to determine acceptability and effectiveness of the app in reducing tinnitus loudness and annoyance.
Results
Results indicated that some, but not all, participants found their chosen sound to be acceptable and/or effective in reducing their tinnitus. A majority of the participants rated the chosen sound or the study sound to be acceptable in reducing their tinnitus. Word recognition scores for most participants were not adversely affected using the chosen sound; however, a significant decrease was observed for three participants. All 14 participants had a positive experience with the app during the at-home trial on tests of sound therapy acceptability, effectiveness, and word recognition.
Conclusions
Sound therapy using a smartphone app can be effective for many tinnitus patients using CIs. Audiologists should recommend a sound and a level for tinnitus masking that do not interfere with speech perception.
... Participants had hearing loss ranging from mild to severe, and the average audiogram can be seen in Figure 1. To limit the potential effects of novel sound amplification on tinnitus (e.g., Surr et al., 1985), participants were experienced hearing aid users (M = 4.4 years, SD = 3.3 years) but were new to acoustic therapy via hearing aid tinnitus maskers. Individuals with hyperacusis, as indicated by a cumulative score > 4 on the Sound Tolerance section of the Tinnitus and Hearing Survey, were excluded from the study (Henry et al., 2010). ...
Purpose
The aim of the study was to investigate changes in autonomic function, as measured by heart rate variability, in individuals with tinnitus following acoustic therapy implemented using tinnitus maskers presented via hearing aids.
Method
Twenty-six individuals with tinnitus and hearing impairment completed an 8-week field trial wearing hearing aids providing acoustic therapy via three tinnitus masker options set just below minimum masking level. Tinnitus handicap was measured using the Tinnitus Handicap Inventory at baseline (before starting acoustic therapy) and posttreatment (at end of 8-week trial). Resting heart rate and heart rate variability were measured using electrocardiography at baseline and posttreatment.
Results
There was a significant decrease in tinnitus handicap posttreatment compared to baseline. There was no change in heart rate, but there was a significant increase in heart rate variability posttreatment compared to baseline.
Conclusions
Acoustic therapy using tinnitus maskers delivered via hearing aids provided tinnitus relief and produced a concurrent increase in heart rate variability, suggesting a decrease in stress. Heart rate variability is a potential biomarker for tracking efficacy of acoustic therapy; however, further research is required.
... There are many theories behind the use of sound therapy. Amplification may change the patient's focus on alternative sound rather than tinnitus thus reducing stress and anxiety [20,21]. Alternatively, amplified sound leads to Increased neuronal activity thus reducing the audibility and awareness of tinnitus. ...
Tinnitus often described as sound in the ear in absence of any external stimulus. It poses a challenge to the psychological and mental wellbeing of the patient and professional unsatisfaction to the clinician. The patient often an old aged individual usually approaches the outpatient department with various sounds in the ear, making him feel ill or unable to have a sound sleep. The middle-aged patient often complains of professional incapability and lack of concentration due to tinnitus. Despite vast academic research and advances, the efficiency of available treatment is debatable, often compelling the clinician to convey the message that “you may have to learn to live with it”. In the present overview of reviews, we tend to look into the management of tinnitus and present a comprehensive outlook of various evidence-based reviews from Cochrane and augmented with various studies from PubMed.
... Clinically significant improvement in tinnitus severity has been reported in the large majority of patients fitted with bilateral digital hearing aids. [23][24] The benefit of hearing aids combined with counselling over counselling alone has been demonstrated in a group of chronic tinnitus sufferers. [25] Tinnitus retraining therapy (TRT) uses acoustic stimulation combined with directive counselling to facilitate habituation to the tinnitus perception and decrease the emotional reaction to the tinnitus. ...
Śālākya Tantra is one among the eight branches of Aṣṭāñga Āyurveda. Śālākya Tantra deals with diseases that affect part above the neck like eyes, nose, throat, ear, and head. Karṇanāda is one among twenty eight Karṇarogas explained in Suśruta Saṁhitā, Bhāvaprakāśa and Yoga- Ratnākara. Karṇanāda can be correlated to the tinnitus in modern literature. When the Vāta gets localised in the channels of the ear the patient hears various types of sound like those of a Bherī (bulge/drum), Mṛdañga, Śaṁkha etc. are known as Karṇanāda. Tinnitus is defined as a phantom auditory perception-it is a perception of sound without corresponding acoustic or mechanical correlates in the cochlea. The prevalence of tinnitus in the adult population is estimated to range from 6% to 19%. Several theories have been proposed to explain the mechanisms underlying tinnitus. Treatments for tinnitus include Snigdha Virecana, Nāḍi Sweda, Piṇḍa Sweda, Dhūpana, Basti Karma Nāvana, Abhyañga, Karṇapūraṇa and in modern literature medical and surgical, pharmacotherapy, acoustic therapy, counseling and education, cognitive behavioural therapy (CBT), tinnitus retraining therapy, and electrical stimulation. This paper reviews the characteristics, causes, mechanisms, and treatments of tinnitus in Āyurveda and modern.
... Conventional hearing aids are thought to decrease tinnitus severity by increasing audibility for environmental sounds, which might then serve to mask or draw attention away from the tinnitus (Hoare et al., 2014). Additionally, amplification improves communication ability and has the potential to reduce perceived listening effort (Johnson et al., 2016), both of which can contribute to a reduction in stress, an important factor in tinnitus management (Searchfield et al., 2010;Surr et al., 1985). Though less well-established, it has recently been suggested that amplification might also serve to strengthen lateral inhibitory projections, thereby reducing a driver of maladaptive neuroplastic changes in the central auditory system (Haab et al., 2019;Okamoto et al., 2010;Strauss et al., 2017). ...
Introduction: Conventional hearing aids are commonly recommended for the treatment of tinnitus, though results of studies investigating the efficacy of hearing aid-based tinnitus treatments have been mixed. Recently, it has been suggested that the addition of a notch filter around the tinnitus frequency might enhance lateral inhibitory mechanisms and thereby improve tinnitus severity relative to traditional processing. The primary aim of this study was to compare the effects of conventional versus notch filter amplification strategies on subjective tinnitus severity in adults with mild-to-moderate hearing loss and no previous hearing aid experience.
Methods: Thirty-nine adults (mean age = 53.6 years; SD = 9.7 years) with bilateral, mild to moderate sensorineural hearing loss and an established clinical history of stable, tonal tinnitus participated in this double-blinded study. Each participant was randomly assigned to complete a 12-week hearing aid trial using either a conventional amplification strategy or a strategy which applied a notch filter at the given participant's tinnitus pitch match frequency. Tinnitus-related handicap and distress were assessed before and after the hearing aid trial via the Tinnitus Handicap Inventory (Newman et al., 1996) and the Tinnitus Questionnaire (Hallam et al., 1988).
Results: Average tinnitus severity did not differ significantly between the conventional and notch filter amplification groups following treatment. Moreover, average pre- to post-intervention change scores were relatively low for both groups, indicating minimal effect of either treatment on tinnitus symptoms. Participant age, high-frequency pure-tone average hearing threshold, average daily hearing aid usage, and pre-intervention tinnitus severity ratings were not predictive of treatment success or failure.
Discussion: Results of the present study suggest no significant effect of either conventional or notch filter amplification on average ratings of tinnitus severity following a 12-week hearing aid trial. However, as clinically meaningful changes in tinnitus severity were identified for some participants, future work is needed to better identify those individuals most likely to benefit, as well as optimal amplification characteristics.
... Since Saltzman and Ersner first reported effectiveness of HAs for controlling tinnitus about 70 years ago (Saltzman and Ersner, 1947), many studies have supported the use of HAs as a treatment option for tinnitus (Kiessling, 1980;Brooks and Bulmer, 1981;Surr et al., 1985;Surr et al., 1999). Even though at a metaanalytic level there is no support for the use of HAs with or without maskers (Sereda et al., 2018), still approximately half of patients using HAs experience an improvement of tinnitus (Surr et al., 1999;Shekhawat et al., 2013). ...
Although hearing aids (HAs) are sometimes efficacious in abating tinnitus, the precise mechanism underlying their effect is unclear and predictors of symptom improvement have not been determined. Here, we examined the correlation between the amount of tinnitus improvement and pre-HA quantitative electroencephalography (qEEG) findings to investigate cortical predictors of improvement after wearing HAs. QEEG data of thirty-three patients with debilitating tinnitus were retrospectively correlated with the percentage improvements in tinnitus handicap inventory and the numerical rating scale scores of tinnitus. Activation of brain areas involved in the default mode network (DMN; inferior parietal lobule, parahippocampus, and posterior cingulate cortex) were found to be a negative predictor of improvement in tinnitus-related distress after wearing HAs. In addition, higher pre-HA cortical power at the medial auditory processing system or higher functional connectivity of the lateral/medial auditory pathway to the DMN was found to serve as a positive prognostic indicator with regard to improvement of tinnitus-related distress. In addition, insufficient activity of the pre-treatment noise canceling system tended to be a negative predictor of tinnitus perception improvement after wearing HAs. The current study may serve as a milestone toward a pre-HAs prediction strategy for tinnitus improvements in subjects with hearing loss and severe tinnitus.
... Several studies noted tinnitus relief in individuals using total or partial masking delivered by sound generators (Hazell et al., 1985;Jastreboff & Hazell, 1993;Tyler & Bentler, 1987;Vernon & Meikle, 2000;Vernon & Schleuning, 1978). These studies further demonstrated that large differences exist among patients, notably the desired intensity and frequency range of background sounds to provide tinnitus relief (Surr, Montgomery, & Mueller, 1985;Tyler & Bentler, 1987;Tyler, 1995;Vernon & Meikle, 2000;Vernon & Schleuning, 1978). These observations have led to the provision of background sound therapy embedded in hearing aids and the availability of different sound options and connectivity for patients with acoustic hearing (e.g., pure tones, broadband noises, fractal tones). ...
Background Electrical stimulation of the cochlea to treat tinnitus has been explored for decades. However, few studies have investigated the most salient programming parameters for tinnitus suppression in cochlear implant (CI) patients.
Purpose The purpose of this study was to review the available CI programming parameters for tinnitus suppression and to consider possible clinical research designs for selecting the optimal programming parameters for CI patients.
Results Across research studies, the optimal parameters vary significantly and are often based on data fromonly a fewparticipants. Electrical stimulation using lowand high rates, different electrode numbers, and low T-levels were helpful in suppressing tinnitus, although more research is needed from a greater number of CI patients. Possible designs for evaluating these parameters in a clinical setting are presented.
Conclusions Programming a CI to reduce the prominence of tinnitus is complex, and audiologists should consider adjusting CI parameters systematically for CI patients with bothersome tinnitus.
... Near all patients with tinnitus have with some hearing loss, so devices like hearing aids are often an important first step in tinnitus. Surr et al. [4], reported that approximately half of those who use hearing aids to treat tinnitus receive. Recently, a survey revealed that two out three tinnitus patients reported hearing aids helped with their tinnitus [5]. ...
Although tinnitus is not curable, but many researchers have shown that sound therapy could greatly reduce people’s sensational level of tinnitus. Most sound therapy devices can produce many different types of sounds to help ease tinnitus. The mechanism behind this therapy is complicated and contains many subtypes that will likely require a different approach. Hearing aids also plays an important role in sound therapy, which involves both the psychological and physiological perspective. Additionally, there are many companies today that have the technology to aid people with sound therapy. In conclusion, sound therapy can be effective for patients with tinnitus, more research is needed in the future.
... Audiologists have always known that sounds could modify the tinnitus nature [73][74][75][76]. However, there is no consensus yet about how to quantify the effectiveness of acoustic therapies for tinnitus treatment [77][78][79]. ...
Subjective tinnitus is a complex symptom that has no effective treatment up to now. Several acoustic therapies such as retraining therapy, auditory discrimination therapy, enriched acoustic environment and binaural therapy have been proposed to induce habituation and/or diminution of the tinnitus perception. The effect of the auditory stimulus in use is not, however, well understood yet. At present, the effectiveness of the acoustic therapies on patients suffering from tinnitus is only monitored via visual analog scales or questionnaires, what could not reflect accurately the patient evolution.
It is well known that neuroimaging techniques are widely applied to monitor neural activity for diagnosing brain disorders, and predicting treatment outcome success. From those techniques, Electroencephalography (EEG) has become the most commonly used method since it gives an insight into the temporal behavior of neural oscillations, and it is relatively a low-cost and low-maintenance system in comparison to other techniques. EEG signals are modulated by the internal communication between neural networks, and the inter-communication among those networks. As is hypothesized that subjective tinnitus is the result of increased neural synchrony and spontaneous firing rates in the auditory system, EEG analysis may be an objective method to monitor the effect of acoustic therapies for tinnitus.
In this paper, the state-of-the-art on acoustic therapies for tinnitus, and recent advances on the follow-up treatment based on EEG analysis is discussed. In general, this paper outlines evidence showing that EEG signal processing offers to investigate (1) internal communication in neural nodes (absolute and relative power), (2) inter-communication of neural nodes (coherence), (3) time-frequency analysis with high resolution in both low and high frequencies (Fourier and Wavelet analysis), (4) rate at which neural information is being produced (entropy), (5) genesis of abnormal neural synchrony on the basis of biophysical assumptions (source localization) or statistical evaluations (PCA and ICA), and (6) level of neural synchrony over time (ERD/ERS maps).
... As early as 1947, Saltzman and Ersner reported that patients with tinnitus benefited from the use of HAs [5], and the efficacy of this approach has been confirmed by other studies. Surr et al. reported that approximately 50% of patients with HAs experienced relief from tinnitus [6], and Folmer and Caroll reported the improvement of tinnitus with HAs in 70% of participants [7]. In 2008, Trotter et al. reported a 25-year study examining the effects of HAs on tinnitus [8], in which 350 of 826 patients with HAs (42.4%) reportedly showed effective suppression of tinnitus. ...
Objectives
Tinnitus is a common symptom among patients with hearing loss, and many studies have reported successful tinnitus suppression with hearing devices. Active middle ear implantation of the Vibrant Soundbridge (VSB) is a good alternative to existing hearing devices. This study evaluated the effects of VSB implantation on tinnitus and sought to identify the main audiological factor that affects tinnitus suppression.
Methods
The study participants were 16 adults who had tinnitus with sensorineural hearing loss, and who underwent VSB implantations. Pure-tone audiometry; word recognition test; tinnitus handicap inventory (THI); and visual analog scale (VAS) assessment of loudness, awareness, and annoyance were performed before and 12 months after surgery. Changes in hearing threshold, word recognition scores (WRS), THI scores, and VAS scores were analyzed.
Results
VAS scores for loudness (mean difference: 1.9, 95% CI: 0.6, 3.1), awareness (mean difference: 1.6, 95% CI: 0.4, 2.8), and annoyance (mean difference: 1.7, 95% CI: 0.7, 2.8) showed significant improvements from baseline to 12 months after surgery. In addition, THI scores showed a significant decrease (mean difference: 13.8, 95% CI: 2.9, 24.9). The average hearing threshold level, WRS, and most comfortable level (MCL) also showed significant improvements at 12 months after surgery (mean difference: 17.3, 95% CI: 13.3, 21.3; mean difference: −7.6, 95% CI: −15.1, −0.1; mean difference: 26.3, 95% CI: 22.9, 29.6, respectively). Among the aforementioned factors, changes in MCL were best correlated with those in THI scores (mean difference: 2.55, 95% CI: 0.90, 4.21).
Conclusion
A VSB implant is beneficial to subjects with tinnitus accompanied by sensorineural hearing loss. The changes in THI scores best correlated with those in MCL. This improvement may represent a masking effect that contributes to tinnitus suppression in patients with VSB implants.
... It is a well-established fact that hearing aid is a common rehabilitative tool for tinnitus relief. Surr et al. (1985) surveyed the effect of amplification on tinnitus management from 200 naïve hearing aid users who had tinnitus. About 62% of them reported a total or partial relief from tinnitus while using hearing aids. ...
To investigate how much gain variation is required from prescription to effect tinnitus percept, and if this revised prescription affects speech recognition. Twenty participants who experienced catastrophic tinnitus even after fitted with hearing aid were included. Participants were grouped based on their tinnitus pitch and the prescriptive formula used to fit hearing aid. They were evaluated for handicap from tinnitus using Tinnitus Handicap Inventory (THI). Hearing aid was programmed using either NAL- NL2 or DSL (I/o) v5 prescriptive formula and gain at tinnitus pitch was adjusted till the tinnitus get suppressed. SNR 50 was determined soon after fitted with hearing aid and 30 days of hearing aid use. Further, THI and international outcome inventory for hearing aid (IOI-HA) were determined after 30 days of hearing aid use. A significant higher gain adjustment was needed at tinnitus pitch to reduce tinnitus precept using NAL- NL2 than DSL (I/o) v5 prescriptive formula. Further, SNR 50 was not affected by either tinnitus pitch or revised prescription formulas. However, SNR 50 improved after 30 days of hearing aid use. A 76% of the participants’ experienced habituation to perception after 30 days of hearing aid use, 10% had slight, 10% had mild, and 4% had a moderate degree of tinnitus on THI. On IOA-HA, 96% (N=19) of participants have reported satisfactory, and 4% (N=1) reported moderate benefit from hearing aid. Irrespective of prescriptive formula adjusting gain at tinnitus pitch is an efficient method to reduce tinnitus symptoms and improve speech perception. Keywords: Amplification, Hearing loss, Tinnitus, Speech perception, Hearing aid
... Several studies noted tinnitus relief in individuals using total or partial masking delivered by sound generators (Hazell et al., 1985;Jastreboff & Hazell, 1993;Tyler & Bentler, 1987;Vernon & Meikle, 2000;Vernon & Schleuning, 1978). These studies further demonstrated that large differences exist among patients, notably the desired intensity and frequency range of background sounds to provide tinnitus relief (Surr, Montgomery, & Mueller, 1985;Tyler & Bentler, 1987;Tyler, 1995;Vernon & Meikle, 2000;Vernon & Schleuning, 1978). These observations have led to the provision of background sound therapy embedded in hearing aids and the availability of different sound options and connectivity for patients with acoustic hearing (e.g., pure tones, broadband noises, fractal tones). ...
Purpose
The use of acoustic stimuli to reduce the prominence of tinnitus has been used for decades. Counseling and tinnitus sound therapy options are not currently widespread for cochlear implant (CI) users. The goal of this study was to determine whether tinnitus therapy sounds created for individuals with acoustic hearing may also benefit CI users.
Method
Sixteen sounds from the ReSound Relief app (Version 3.0) were selected for the study. Sixteen participants were asked to rate the overall acceptability of each sound and to write the description of the sound they perceived. Sounds were streamed from an Apple™ iPod (6th generation) to the CI using a Cochlear™ Wireless Mini Microphone 2+. Thirteen participants then completed a 5-min trial where they rated their pretrial and posttrial tinnitus and the acceptability of a subset of preferred sounds. Ten out of these 13 participants completed a 2-week home trial with a preferred sound after which they answered an online tinnitus questionnaire and rated the effectiveness of the sound therapy.
Results
Individual differences were large. Results from the 5-min trial showed that sounds perceived as rain, music, and waves were rated the most acceptable. For all of the participants, the posttrial tinnitus loudness rating was lower than the pretrial rating, with some participants experiencing greater difference in their tinnitus loudness than others. At the end of the 2-week home trial, 3 of 10 participants rated the effectiveness of sound therapy 70% or higher.
Conclusion
The results suggest that the use of tinnitus therapy sounds delivered through a CI can be acceptable and provides relief for some tinnitus sufferers.
... A bout 10-15% of the adult population experiences chronic tinnitus (Hoffman and Reed, 2004), of whom about one in five has a problem that would warrant tinnitus-specific clinical services (Davis and Refaie, 2000). Hearing aids (HAs) have long been a mainstay tool for providing relief from tinnitus (Saltzman and Ersner, 1947;Surr et al, 1985;Melin et al, 1987). However, controlled clinical studies evaluating the effectiveness of hearing devices for tinnitus management are limited (Shekhawat et al, 2013). ...
Background:
Whereas hearing aids have long been considered effective for providing relief from tinnitus, controlled clinical studies evaluating this premise have been very limited.
Purpose:
The purpose of this study was to systematically determine the relative efficacy of conventional receiver-in-the-canal hearing aids (HA), the same hearing aids with a sound generator (HA+SG), and extended-wear, deep fit hearing aids (EWHA), to provide relief from tinnitus through a randomized controlled trial. Each of these ear-level devices was a product of Phonak, LLC.
Research design:
Participants were randomized to HA, HA+SG, or EWHA and wore bilaterally fit devices for about 4 months. Fittings, adjustments, and follow-up appointments were conducted to comply with company guidelines and to ensure that all participants attended appointments on the same schedule. At 4-5 months, participants returned to complete final outcome measures, which concluded their study participation.
Study sample:
Participants were 55 individuals (mean age: 63.1 years) with mild to moderately-severe hearing loss who: (a) did not currently use hearing aids; (b) reported tinnitus that was sufficiently bothersome to warrant intervention; and (c) were suitable candidates for each of the study devices.
Data collection and analysis:
The primary outcome measure was the Tinnitus Functional Index (TFI). Secondary outcome measures included hearing-specific questionnaires and the Quick Speech in Noise test (QuickSIN). The goal of the analysis was to evaluate efficacy of the EWHA and HA+SG devices versus the HA standard device.
Results:
There were 18 participants in each of the HA and EWHA groups and 19 in the HA+SG group. Gender, age, and baseline TFI severity were balanced across treatment groups. Nearly all participants had a reduction in tinnitus symptoms during the study. The average TFI change (improvement) from baseline was 21 points in the HA group, 31 points in the EWHA group, and 33 points in the HA+SG group. A "clinically significant" improvement in reaction to tinnitus (at least 13-point reduction in TFI score) was seen by 67% of HA, 82% of EWHA, and 79% of HA+SG participants. There were no statistically significant differences in the extent to which the devices reduced TFI scores. Likewise, the hearing-specific questionnaires and QuickSIN showed improvements following use of the hearing aids but these improvements did not differ across device groups.
Conclusions:
There is insufficient evidence to conclude that any of these devices offers greater relief from tinnitus than any other one tested. However, all devices appear to offer some improvement in the functional effects of tinnitus.
... There is a long history of the benefits of hearing aids (HAs) for individuals with tinnitus (e.g., Kuk & Peeters, 2008;Melin, Scott, Lindberg, & Lyttkens, 1987;Moffat et al., 2009;Saltzman & Ersner, 1947;Searchfield, 2006;Stacey, 1980;Surr, Montgomery, & Mueller, 1985;Trotter & Donaldson, 2008;. Indeed, most HA users report benefits to their tinnitus (Kochkin & Tyler, 2008). ...
Purpose
The aim of this study was to measure the progression of benefits to individuals with tinnitus from providing informational counseling, hearing aids, a brief tinnitus activities treatment and Zen therapy.
Method
Several magnitude estimation scales and tinnitus handicap scales were administered for the duration of the study to 20 participants.
Results
Results indicated that all participants benefited from this sequential approach of providing different components of this tinnitus treatment. Large benefits were observed following the tinnitus activities treatment and the Zen treatments.
Conclusion
We conclude that the progressive approach of treatment demonstrated here should be of benefit to most individuals with tinnitus and that the Widex Zen sound therapy is a worthwhile treatment for many tinnitus sufferers.
... Audiologists have always known that sounds could interfere with tinnitus [8][9][10][11], though there is no consensus on how to measure the effectiveness of the outcomes of tinnitus treatments so that they remain inconclusive [12][13][14]. ...
Cochrane reviews indicate there is very limited support for all forms of sound therapy and cognitive behavioral therapy has the strongest support. American Academy of Otolaryngology (AAO) recently published some guidelines which recommends Cognitive Behavioral Therapy (CBT) for tinnitus intervention, and only indicates that sound therapy should be considered an “option” for intervention.
Nevertheless, acoustic therapy could lead to cause changes in the tinnitus perception and has been appreciated by the affected people for years. In the last decades, the use of sound or sound enrichment has become a central part of many tinnitus management programs used by audiologists, whether the intention was to mask tinnitus, suppress tinnitus, or interrupt the tinnitus generating neural activity.
Several acoustic therapies have been developed and implemented in the last 40 years, but how can we determine which one is the most effective? We can determine the effects based on the results reported in many research studies, but in those studies are many factors that differ from one study to another, like in-ear medical devices used to apply acoustic therapy for tinnitus treatment.
In this article, we review and analyze the different types of in-ear medical devices used in the most recently acoustic therapies in treatments against tinnitus, allowing us to identify the pros and cons. By our analysis, an optimal medical device could be characterized to enhance the application of acoustic therapies and in consequence the global results of the sound therapies that already exist. In this review, it was considered acoustic therapies, the technology implemented in medical devices and the clinical needs.
... There are several ways in which hearing aids can benefit tinnitus patients (Coles, 1985) including: 1) Psychological benefit through hearing improvement, 2) diverting attention away from hearing and tinnitus, 3) through understanding that hearing loss is responsible for communication difficulties rather than tinnitus, 4) audibility of ambient noise and hearing aid circuit noise diminishing tinnitus awareness and 5) hearing aid counselling promoting tinnitus understanding. Past research has shown hearing aids to be reasonably successful in managing tinnitus (Surr et al., 1985), with approximately 50% experiencing tinnitus reduction 1-8 weeks subsequent to fitting of the device(s). ...
Tinnitus (the phantom perception of sound) often accompanies hearing loss. Two common methods for managing tinnitus are masking (Vernon and Meikle, 2000) and auditory habituation therapy (Jastreboff, 2000). Hearing aids are often used to amplify ambient sounds in these therapies. Digital hearing aids have recently become available that allow a great deal of flexibility in fitting hearing losses and potentially, managing tinnitus. This study is the first to compare the relative merits of two prescriptive procedures (DSL [i/o] and NAL-NL1) for tinnitus management. The study was undertaken to help determine whether one hearing aid setting is appropriate for both hearing loss and tinnitus management, or whether separate amplification strategies are required for each purpose. Changes in perception of tinnitus were determined in 15 subjects using visual analogue rating scales in conjunction with various hearing aid settings. The preferred setting for tinnitus management was also compared to those providing optimal speech discrimination using tests of audibility and speech quality. No statistically significant differences were seen in tinnitus and noise mixing point; the analogue rating scale scores for the prescriptive procedure used. However, DSL [i/o] with a low compression knee-point was found to result in the greatest reduction in tinnitus awareness in 80% (n = 12) of subjects. Although the preferred DSL [i/o] setting interfered most with tinnitus audibility, analogue rating scale scores for noise annoyance indicated DSL [i/o] caused statistically significant greater annoyance to environmental sound than NAL-NL1.
No statistically significant differences were noted for analogue rating scale scores for speech quality and intelligibility, prescriptive procedure used or knee-point. This suggests that either NAL-NL1 or DSL [i/o] prescriptions are suitable for maintaining speech quality and intelligibility. However, using the Speech in Noise (SIN) test, it was determined that the NAL-NL1 prescriptive procedure resulted in higher word recognition scores than the prescriptive procedure that interfered most with tinnitus, indicating that a prescription optimised to reduce tinnitus awareness resulted in poorer ability to hear speech in noise.
It is suggested that tinnitus therapy using amplification may best be achieved through the use of a multi-programmable aid. One program should be optimised for communication and a separate one should be optimised for tinnitus reduction. A prescriptive procedure, tailored for management of tinnitus through amplification of ambient noise, should be investigated further. Modern digital signal processing instruments allow for a range of combinations of hearing aid settings, the ramifications of such processing for tinnitus management, should be explored.
... 25,26 Survey and case control studies have shown that tinnitus patients gain relief from the symptoms by the consistent use of hearing aids. 27,28 In addition, a broader range of patients with milder degrees of hearing loss can become successful hearing aid users due to the increased use of open-fit hearing aid. This can benefit tinnitus sufferers who previously were not interested in amplification. ...
Despite the high prevalence of hearing impairment in the elderly, the rate of hearing aid use is still low. The objectives of this study were to report the nation-wide prevalence of hearing aid use in the Korean population and to determine the associated factors with hearing aid use utilizing a nationally representative data set.
We obtained data from the 2010 to 2012 Korea National Health and Nutrition Examination Surveys, which were cross-sectional surveys of the civilian, noninstitutionalized population of the Republic of Korea at age ≥40 years (N = 12,709). A field survey team performed interviews as well as physical examinations. Hearing aid use was assessed using an interviewer-administered questionnaire and pure-tone audiometry was administered for all participants in a sound-attenuating booth. Prevalence of hearing aid acquisition and regular use were calculated in participants who reported perceived hearing loss and who have bilateral hearing thresholds exceeding the 40 dB hearing level. Multivariable analyses were used to examine the associated factors with hearing aid use.
The prevalence of hearing aid acquisition and regular use was 17.4% and 12.6%, respectively, in South Korea. Increased hearing threshold (OR 1.05, 95% CI 1.03–1.07), severe perceived hearing loss (OR 10.73, 95% CI 4.52–25.46), annoying tinnitus (OR 3.30, 95% CI 1.61–6.74), balance problems (OR 0.39, 95% CI 0.18–0.86), and myopia (OR 0.30, 95% CI 0.12–0.76) were associated factors of regular use of hearing aids.
The prevalence of hearing aid use in Korea is relatively low. Finding relevant factors of hearing aid use could provide further insight in setting up hearing-rehabilitation strategy for the elderly with significant hearing loss.
... Hearing aids are used to compensate for hearing loss and the lack of auditory input in the impaired frequency range. In addition to improved hearing function, they have shown in clinical practice beneficial effects on tinnitus complaints in a subgroup of patients (Surr et al., 1985;Del Bo and Ambrosetti, 2007;Searchfield, 2007). Amplification of sound by hearing aids cannot restore auditory input in case of complete inner hair cell loss in a given frequency range. ...
Tinnitus activities treatment (TAT) is a holistic approach to tinnitus management that includes listening to the patient, understanding the patient’s needs, and providing comprehensive counseling to address their concerns. We use three principles including picture-based counseling on tinnitus and related problems, coping strategies and homework to practice activities learned in the session, and sound therapy using partial masking. TAT was developed in the 1980s by Dr. Richard Tyler at the University of Iowa and since has been implemented worldwide by many audiologists and clinicians. The content for TAT includes four areas that are largely impacted by tinnitus: thoughts and emotions, hearing and communication, sleep, and concentration. The picture-based materials provide helpful illustrations of difficult concepts on tinnitus and the hearing mechanism, though the presentation can be modified to include relevant information for the patient. Before providing therapy using TAT, we suggest administering the Tinnitus Primary Functions Questionnaire that evaluates tinnitus in these four areas. The outcomes from the questionnaire can be used to determine the sessions that are relevant for the patient and to document treatment effectiveness as therapy progresses. TAT uses a collaborative approach that nurtures patient expectations and provides a sense of hope.
Background:
There has been a growing interest in the provision of smartphone- or internet-based tinnitus management. Studies have shown a positive impact of the smartphone applications on tinnitus symptoms. However, research into a relatively long-term effect of these applications on tinnitus relief as well as sound preferences has been sparse. This study explored the potential benefit of a tinnitus application in tinnitus relief over a period of six months.
Methods:
Twenty-two participants with subjective tinnitus were enrolled in the study. Puretone audiometry, tinnitus pitch and loudness matching, stress assessment, and questionnaires were completed at the initial visit and three and six months after the first visit. The participants used the tinnitus application for six months.
Results:
A significant reduction in subjective tinnitus loudness and annoyance and subjective stress level was observed. The Tinnitus Handicap Inventory scores were also significantly decreased after six months. The participants also reported high satisfaction with the application. Music and environmental sounds were the most preferred sound stimuli.
Conclusions:
The findings of this study demonstrate the potential benefit of the tinnitus application for tinnitus improvement.
Although the technical challenge has increased, along with the complexity of accessing the cochlea and electrode array insertion following the introduction of cochlear implant surgery in individuals with inner ear malformations and potentially useable residual natural hearing, CI surgery remains an operation that is generally safe and associated with very few lasting complications. Initial concerns about a negative effect upon balance function, especially in bilaterally implanted young children, have not materialized. In fact, there is increasing interest in the potential beneficial effect upon overall balance function. Likewise, the effect of cochlear implantation is more likely to be positive than to exacerbate intrusive tinnitus. Salvaging extruding receiver-stimulator packages continues to be a rare but significant challenge, which can often result in explantation (leaving the electrode array in the cochlea as a ‘spacer’) and reimplantation several months later when the inflammation has settled. It remains the responsibility of the operating surgeon to provide the patient and/or family with a detailed explanation of the potential risks of cochlear implantation, wherever possible illustrating the level of risk with their own surgical data.
Cochlear Implant (CI) has reached its maturity after 35 years of extensive research and developmental activities by the CI manufacturers in collaboration with clinicians from across the world. The impact resistance of the implant stimulator case plays a critical role in the reliability of the device, and over time, the ceramic-based stimulator case has transformed into a titanium-based stimulator case offering the highest impact resistance. Diametrically designed MRI-compatible implant magnet would enable trouble-free MRI procedures without the need for the surgical removal of the magnet. The intracochlear electrode arrays have seen a tremendous evolution more toward flexible and slimmer design enabling them to preserve the intracochlear structures. The audio processor is the one that has undergone continuous changes as it started from the body-worn type to a single unit processor recently. Signal processing strategies as well have seen changes over time which started with simultaneous multichannel analog stimulation to channel-specific sequential stimulation that resulted in power consumption and better hearing experience by the CI users.KeywordsAudio processorElectrode arrayImplant magnetImplant stimulator caseSignal processing strategy
Device-based clinical treatments for tinnitus are predominantly sound based and include ear-level sound generators, hearing aids, cochlear implants, and tinnitus treatment devices. They are intended for patients with bothersome tinnitus. Bothersome tinnitus is characterized by problems with sleep, concentration, and mood. Most people with bothersome tinnitus have hearing loss and would benefit from amplification; however, not all patients are willing to use hearing aids. Tinnitus treatment devices are available to assist those who are not good candidates for amplification, and include devices used while sleeping and devices used for specified periods during the day.
Background:
Tinnitus affects 10% to 15% of the adult population, with about 20% of these experiencing symptoms that negatively affect quality of life. In England alone there are an estimated ¾ million general practice consultations every year where the primary complaint is tinnitus, equating to a major burden on healthcare services. Clinical management strategies include education and advice, relaxation therapy, tinnitus retraining therapy (TRT), cognitive behavioural therapy (CBT), sound enrichment using ear-level sound generators or hearing aids, and drug therapies to manage co-morbid symptoms such as insomnia, anxiety or depression. Hearing aids, sound generators and combination devices (amplification and sound generation within one device) are a component of many tinnitus management programmes and together with information and advice are a first line of management in audiology departments for someone who has tinnitus.
Objectives:
To assess the effects of sound therapy (using amplification devices and/or sound generators) for tinnitus in adults.
Search methods:
The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL, via the Cochrane Register of Studies); Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 23 July 2018.
Selection criteria:
Randomised controlled trials (RCTs) recruiting adults with acute or chronic subjective idiopathic tinnitus. We included studies where the intervention involved hearing aids, sound generators or combination hearing aids and compared them to waiting list control, placebo or education/information only with no device. We also included studies comparing hearing aids to sound generators, combination hearing aids to hearing aids, and combination hearing aids to sound generators.
Data collection and analysis:
We used the standard methodological procedures expected by Cochrane. Our primary outcomes were tinnitus symptom severity as measured as a global score on multi-item tinnitus questionnaire and significant adverse effects as indicated by an increase in self-reported tinnitus loudness. Our secondary outcomes were depressive symptoms, symptoms of generalised anxiety, health-related quality of life and adverse effects associated with wearing the device such as pain, discomfort, tenderness or skin irritation, or ear infections. We used GRADE to assess the quality of evidence for each outcome; this is indicated in italics.
Main results:
This review included eight studies (with a total of 590 participants). Seven studies investigated the effects of hearing aids, four combination hearing aids and three sound generators. Seven studies were parallel-group RCTs and one had a cross-over design. In general, risk of bias was unclear due to lack of detail about sequence generation and allocation concealment. There was also little or no use of blinding.No data for our outcomes were available for any of our three main comparisons (comparing hearing aids, sound generators and combination devices with a waiting list control group, placebo or education/information only). Data for our additional comparisons (comparing these devices with each other) were also few, with limited potential for data pooling.Hearing aid only versus sound generator device onlyOne study compared patients fitted with sound generators versus those fitted with hearing aids and found no difference between them in their effects on our primary outcome, tinnitus symptom severity measured with the Tinnitus Handicap Inventory (THI) at 3, 6 or 12 months (low-quality evidence). The use of both types of device was associated with a clinically significant reduction in tinnitus symptom severity.Combination hearing aid versus hearing aid onlyThree studies compared combination hearing aids with hearing aids and measured tinnitus symptom severity using the THI or Tinnitus Functional Index. When we pooled the data we found no difference between them (standardised mean difference -0.15, 95% confidence interval -0.52 to 0.22; three studies; 114 participants) (low-quality evidence). The use of both types of device was again associated with a clinically significant reduction in tinnitus symptom severity.Adverse effects were not assessed in any of the included studies.None of the studies measured the secondary outcomes of depressive symptoms or depression, anxiety symptoms or generalised anxiety, or health-related quality of life as measured by a validated instrument, nor the newly developed core outcomes tinnitus intrusiveness, ability to ignore, concentration, quality of sleep and sense of control.
Authors' conclusions:
There is no evidence to support the superiority of sound therapy for tinnitus over waiting list control, placebo or education/information with no device. There is insufficient evidence to support the superiority or inferiority of any of the sound therapy options (hearing aid, sound generator or combination hearing aid) over each other. The quality of evidence for the reported outcomes, assessed using GRADE, was low. Using a combination device, hearing aid or sound generator might result in little or no difference in tinnitus symptom severity.Future research into the effectiveness of sound therapy in patients with tinnitus should use rigorous methodology. Randomisation and blinding should be of the highest quality, given the subjective nature of tinnitus and the strong likelihood of a placebo response. The CONSORT statement should be used in the design and reporting of future studies. We also recommend the use of validated, patient-centred outcome measures for research in the field of tinnitus.
Sound therapies are a common component of treatments for tinnitus and hyperacusis. The original idea was to partially or completely mask tinnitus with broadband noise delivered by sound generators or hearing aids, for a few hours each day. Over several months, many patients reported that their tinnitus became quieter or easier to bear, and that loud sounds became less aversive. However, it wasn't always clear that these benefits could be attributed to sound therapy rather than to other aspects of treatment, such as counseling or hearing aid use, and not all patients reported benefits. During the past few decades, many other sound stimuli have been tried, including tones, noise bands, music, and nature sounds. These sounds have been filtered in relation to the tinnitus pitch, adjusted for hearing loss, amplitude-modulated, and recently paired with electrical nerve stimulation. Many of our ideas about the neural underpinnings of tinnitus and hyperacusis come from animal models. However, studies of sound treatments in animals with putative tinnitus or hyperacusis have been rare. Clinical sound therapy trials are emerging, but outcomes typically remain modest, and few patients achieve complete remission of tinnitus or hyperacusis, unless the underlying hearing loss is treated with hearing aids or implants, in which case success rates are higher. More studies are needed, on both animal models and human subjects, to further explore the rationales for the various sound therapy options reviewed here, and to optimally tailor sounds and treatment approaches to individual patients, so that maximum benefits can be obtained.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of sound therapy (using amplification devices and/or sound generators) for tinnitus in adults.
Many patients with tinnitus have noticed that their tinnitus varies in severity in different acoustical environments. Tinnitus is more intrusive and bothersome in silent environments, while being less severe in sound-enriched environments, suggesting that therapeutic strategies using sound (sound therapy) may be effective for the relief of tinnitus. Sound therapy has been developed together with directed counseling as tinnitus retraining therapy (TRT), based on the neurophysiological model of tinnitus. The effectiveness of sound therapy using hearing aids is still under investigation, but it has been suggested that it is effective in about 80% of the patients. In this manuscript, we present a review of sound therapy for tinnitus using hearing aids.
Chronic subjective tinnitus is an auditory phantom phenomenon characterized by abnormal neuronal synchrony in the central auditory system. As shown computationally, acoustic coordinated reset (CR) neuromodulation causes a long-lasting desynchronization of pathological synchrony by downregulating abnormal synaptic connectivity. In a previous proof of concept study acoustic CR neuromodulation, employing stimulation tone patterns tailored to the dominant tinnitus frequency, was compared to noisy CR-like stimulation, a CR version significantly detuned by sparing the tinnitus-related pitch range and including substantial random variability of the tone spacing on the frequency axis. Both stimulation protocols caused an acute relief as measured with visual analogue scale scores for tinnitus loudness (VAS-L) and annoyance (VAS-A) in the stimulation-ON condition (i.e. 15min after stimulation onset), but only acoustic CR neuromodulation had sustained long-lasting therapeutic effects after 12weeks of treatment as assessed with VAS-L, VAS-A scores and a tinnitus questionnaire (TQ) in the stimulation-OFF condition (i.e. with patients being off stimulation for at least 2.5h). To understand the source of the long-lasting therapeutic effects, we here study whether acoustic CR neuromodulation has different electrophysiological effects on oscillatory brain activity as compared to noisy CR-like stimulation under stimulation-ON conditions and immediately after cessation of stimulation. To this end, we used a single-blind, single application, cross over design in 18 patients with chronic tonal subjective tinnitus and administered three different 16-minute stimulation protocols: acoustic CR neuromodulation, noisy CR-like stimulation and low frequency range (LFR) stimulation, a CR type stimulation with deliberately detuned pitch and repetition rate of stimulation tones, as control stimulation. We measured VAS-L and VAS-A scores together with spontaneous EEG activity pre-, during- and post-stimulation. Under stimulation-ON conditions acoustic CR neuromodulation and noisy CR-like stimulation had similar effects: a reduction of VAS-L and VAS-A scores together with a decrease of auditory delta power and an increase of auditory alpha and gamma power, without significant differences. In contrast, LFR stimulation had significantly weaker EEG effects and no significant clinical effects under stimulation-ON conditions. The distinguishing feature between acoustic CR neuromodulation and noisy CR-like stimulation were the electrophysiological after-effects.
The first important feature about tinnitus is that it is a symptom of a given cause (or disease). As for any disease, a prerequisite in developing any therapeutic approach to treat the causes of tinnitus is the understanding of these causes. When the cause of a cold is known (microbial infection) it is then straightforward to treat it with appropriate means (antibiotic). In parallel, the symptoms of the cold (fever, runny nose, muscle aches) can also be treated to prevent discomfort accompanying the cold.
Tinnitus is the perception of sound in absence of any external acoustic stimuli. It may lead to significant reductions of quality of life especially by affective comorbidities. Tinnitus is difficult to treat but this should not lead to feelings of helplessness in therapists. In contrary, there is a multitude of general treatment options at hand which can be integrated in daily therapeutic routine quite easily. General treatment options for chronic tinnitus range from counseling, cognitive behavioral therapy, neurofeedback and neuromodulatory techniques to pharmacological treatment, which may especially be suitable in targeting tinnitus-associated symptoms like sleeping disorders and attentional deficits. Awareness of psychiatrists and neurologist about tinnitus is considered to be vital both because of the growing evidence for a decisive role of the central nervous system in the pathophysiology of chronic tinnitus and its comorbid associations with neuropsychiatric core symptoms like depressive disorders and anxiety.
Patient preference for monaural versus binaural hearing aids was studied to evaluate the subjective differences noted between these two types of fittings. Subjects were 30 patients with bilateral hearing impairment who were being fit with amplification for the first time. Subjects wore both monaural and binaural hearing aids for controlled periods of 1 hr each and 2 days each. This was followed by an additional 3 days during which the fittings were alternated at the subjects' own discretion. Subjects reported preferences and subjective differences after each experimental phase. Interviews were conducted 3 months after participation in the study to determine actual hearing aid use. Binaural amplification was preferred by 90% of the subjects for consistently similar reasons. Results also suggest that consistency of preferences throughout an initial trial period may be predictive of successful adjustment to and use of amplification. Findings indicate that the routine practice of fitting monaural hearing aids may not provide optimum fittings for many patients.
A follow-up study of two groups of tinnitus patients was conducted in an attempt to evaluate the tinnitus masking program. Results are discussed separately for a group of patients seen during the first three years of the program (1976 through 1978) and during the last year (1979). These results suggest an improvement in the management of the tinnitus patient and support this procedure as a viable technique in providing relief for selected tinnitus patients.
Results from tinnitus evaluations and follow-up questionnaires were used in an effort to assess the efficacy of tinnitus masking units as a means of providing active and/or passive relief for patients experiencing problematical tinnitus. Nine of 34 patients (26%) who were felt to be candidates for masking units reported that they were receiving some form of relief from their tinnitus.