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Hearing aids have become common therapeutic tools in the audi-
ological management of tinnitus (Kochkin & Tyler, 2008). The
potential benefi ts of hearing aids for tinnitus management have
been known since the late 1940s (Saltzman & Ersner, 1947). It is
only fairly recently that the potential physiological origins of tinnitus
(Eggermont & Roberts, 2004) and mechanisms of sound-based
treatments have become clearer (Norena & Eggermont, 2005;
Schaette & Kempter, 2006).
From a perceptual and psychological viewpoint hearing aids
have been presumed to impact tinnitus perception by: (1) improving
quality of life related to hearing diffi culties, (2) reducing attention
to tinnitus, and (3) enabling masking by ambient sound (Coles,
1985). There is also a strong case for a neurophysiological mecha-
nism whereby sound could prevent maladaptive neuroplastic changes
that may result from permanent damage to the peripheral auditory
system (Norena & Eggermont, 2005; Schaette & Kempter, 2006).
The presence of tinnitus is strongly related to the presence of
hearing loss and its pitch often corresponds to the frequency
range neighbouring (Moore et al, 2010), or within the hearing loss
region (Sereda et al, 2011). Following damage to the auditory
peripheral system, plastic changes occur in the central nervous sys-
tem. Cortical tonotopic maps change in response to injury, hear-
ing loss frequencies become over-represented and associated with
synchronous spontaneous activity (Eggermont & Roberts, 2004).
These central changes have been shown to be largely preventable
when animals are raised with auditory stimulation in the areas of
hearing loss (Norena & Eggermont, 2005), and in humans might be
reversed with the use of hearing aids (Schaette & Kempter, 2006).
Hearing aids are commonly used alongside counselling
(Kochkin & Tyler, 2008) and form an important part of treatments
such as tinnitus retraining therapy (Jastreboff & Jastreboff, 2000).
Although hearing aids have been used for many years, and are a
very popular tinnitus treatment tool, there has been less evidence
for their tinnitus effectiveness when compared to some more recent
sound based therapies, for example, the neuromonics tinnitus treat-
ment (Davis et al, 2007, 2008; Hanley & Davis, 2008; Hanley et al,
2008; Henry et al, 2008; Goddard et al, 2009; Jang et al,
2010; Seidman et al, 2010; T á vora-Vieira & Davis, 2010; Távora-
Vieira et al, 2011; Wazen et al, 2011). As hearing aids are used “ off
label ” as tinnitus treatments there have not been many commer-
cial, or regulatory, driving forces for undertaking large randomized
controlled trials. Small scale controlled or uncontrolled studies sug-
gest that hearing aids can have a positive effect on tinnitus handi-
cap or severity. Aside from one study showing that hearing aids
did not improve tinnitus on a visual analogue scale (VAS) (Melin
et al, 1987), all other studies we identifi ed describe some tinnitus
Original Article
Tinnitus pitch, masking, and the effectiveness of hearing aids for
tinnitus therapy
Celene McNeill ∗ , Dayse T á vora-Vieira †,§ , Fadwa Alnafjan ‡ , Grant D. Searchfi eld
#,¶ & David Welch #
∗ Audiology Department, Mcquarie University, Healthy Hearing and Balance Care, Sydney, Australia ,
† Medical Audiology Services, Perth,
Australia, ‡ Audiology Department, Flinders University, Adelaide, Australia ,
# Audiology Department, The University of Auckland, New Zealand ,
¶ Tinnitus Research Initiative, Germany , and § The University of Western Australia, Perth, Australia
Abstract
Objective: To assess the benefi ts of hearing aids on tinnitus according to the tinnitus reaction questionnaire (TRQ; Wilson et al, 1991), to verify whether the degree of masking
provided by the hearing aid infl uenced the TRQ score, to examine whether the matched tinnitus pitch predicted the effectiveness of hearing aids in masking tinnitus, and to determine
whether prescription of high-frequency amplifi cation might be desirable in tinnitus management when tinnitus pitch is high. Design and study sample: A retrospective evaluation
of the clinical outcomes of 70 tinnitus patients fi tted with hearing aids was undertaken. The primary outcome measure was the TRQ, with a secondary subjective measure of tin-
nitus masking. Results: Participants who achieved masking with their hearing aids had greater reduction in TRQ scores. Masking was more likely to be achieved when participants
had good low-frequency hearing and tinnitus pitch fell into the frequency range of the hearing aids. Conclusions: The results support the use of hearing aids for tinnitus management,
and suggest that masking may be a signifi cant contributor to hearing aid success, implying that high-frequency amplifi cation may be effective in high-pitch tinnitus.
Key Words: Hearing aids; tinnitus; masking; pitch match
Correspondence: Celene McNeill, Audiology Department, Mcquarie University, Healthy Hearing and Balance Care, 1204/1 Newland Street, Bondi Junction, Sydney, NSW, 2022,
Australia. E-mail: celene@healthyhearing.com.au
( R e c e i v e d 2 7 N o v e m b e r 2 0 1 1 ; a c c e p t e d 1 0 A u g u s t 2 0 1 2 )
ISSN 1499-2027 print/ISS N 1708-8186 online © 2012 British So ciety of Aud iology, Inter national Societ y of Audiology, and Nor dic Audiological Societ y
DOI : 10.3109 /1499 2027.201 2.7219 34
International Journal of Audiology 2012; 51: 914–919
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For personal use only.
Tinnitus pitch masking 915
improvement with hearing aids. Sheldrake and Hazell (1991) dem-
onstrated small changes on a VAS by the majority of patients. More
recent studies suggest stronger treatment effects: Del Bo et al (2006)
demonstrated a 51% change in Tinnitus Handicap Inventory (THI)
three months following open-fi t hearing aids; Folmer et al (2006)
showed a 33% decrease in the tinnitus severity index following
long term use of hearing aids. Searchfi eld et al (2010) demonstrated
a 37% reduction in tinnitus handicap questionnaire, and Parazzini
et al (2011) demonstrated a 52% change in THI after 12 months of
hearing aid use. A simple review across these results would suggest
that the effectiveness of hearing aids might have improved since
the 1980s. Over this time period there have been very signifi cant
advances in hearing aid techno logy. Trotter and Donaldson (2008)
reported on 25 years of hearing aid use for treating tinnitus and
found that patients reporting a greater than 50% improvement in
tinnitus, increased from 39% (1980 – 1999) to 65% (2000 – 2004)
when digital hearing aids were made available to their patients. Digi-
tal hearing aids offer increased fi tting fl exibility, feedback reduction,
and noise reduction unavailable in their analogue predecessors, but
some of these advanced features may not be benefi cial for tinni-
tus management (Searchfi eld, 2006). Trotter and Donaldson (2008)
believed that the ability to provide more selective amplifi cation of
high frequencies was the single most important factor explaining the
improvement seen with digital hearing aids.
The ability of more modern hearing aids to mask high frequency
tinnitus may be one reason for the improved effect of hearing aids
on tinnitus. However there is not a clear relationship between tin-
nitus pitch and sounds effective in masking it. Unlike masking
of tones, frequencies close to tinnitus pitch are not always the
most effective maskers (Feldman 1971). Feldman (1971) inves-
tigated and then characterized tinnitus into fi ve masking types.
Type 1 (convergent) tinnitus masking occurred when the lowest
sensation of masking was near tinnitus pitch and in the region of
high frequency hearing losses: it occurred in 34% of cases. Type 2
(divergent) tinnitus was seen in 3% of cases as threshold and mask-
ing curves diverge from low to high frequencies, high frequencies
provided less masking. Type 3 (congruence) masking occurred in
32% of cases when any low sensation level sound was equally
effective, independent of tinnitus pitch. Type 4 (distance) mask-
ing occurred in 20% of participants, but only at higher sensation
levels irrespective of frequency. The Type 5 (resistant) masking
occurred for 11% of cases where masking was not possible even
at high intensities. These tinnitus-masking patterns are inconsistent
with masking occurring only at the cochlea, so tinnitus masking
is likely to include a central component. On the other hand, and
even though it has been suggested that sound therapy such as
masking need not contain sounds encompassing the tinnitus pitch
(Penner & Zhang, 1996), recent computational models of tinnitus
(Schaette & Kempter, 2006) and physiological evidence (Norena
& Eggermont, 2005) suggest that stimulation of frequency regions
of hearing loss (and tinnitus) should be important for treatment.
At least two small-scale studies have investigated the value of
hearing aids with extended high-frequency response on tinnitus
(Moffat et al, 2009; Schaette et al, 2010). Moffat et al compared
the effect of conventional amplifi cation to extended high-frequency
amplifi cation on tinnitus loudness up to 30 days following the
hearing aid fi tting. The authors concluded that high-frequency ampli-
fi cation had no effect, but this might have been due to the short
period of hearing aid use (Moffat et al, 2009). Schaette et al (2010)
undertook a similar study in which participants received hearing
aids and sound generators for six months. Those with tinnitus pitch
less than 6 kHz improved on a tinnitus loudness VAS and a tinnitus
questionnaire, while those with tinnitus pitch above 6 kHz did not.
Although it is generally accepted that hearing aids mask tinnitus
perception in many patients, there are currently no clinical tools
available to reliably assess the likelihood of masking occurring.
Audiologists usually recommend hearing aids for the management
of tinnitus on a “ trial and error ” basis. Such a heuristic approach
is not satisfactory for clinicians or patients and a more evidence-
based method is desirable. A prognostic clinical tool is therefore
needed to help the clinician to predict the effects of amplifi cation on
tinnitus perception for an individual before hearing aids are recom-
mended as tinnitus treatment. The pilot results of Schaette (Schaette
et al, 2010) suggest that tinnitus pitch may provide such a tool
when compared to the frequency response of potential hearing aids.
This study aimed to:
Ascertain the benefi ts of hearing aids on tinnitus according to 1.
the Tinnitus Reaction Questionnaire (TRQ) (Wilson, et al,
1991).
Determine whether complete, partial or no masking infl uenced 2.
TRQ scores.
Consider whether tinnitus pitch match could be used to predict 3.
the effect of hearing aids in masking tinnitus perception.
Determine whether high frequency amplifi cation might be 4.
desirable in tinnitus management.
It was hypothesized that hearing aids would be most effective when
their frequency range encompassed an individual ’ s tinnitus pitch.
Methods
This was a retrospective study conducted by reviewing the clinical
records of 70 patients (48 male and 22 female: mean age 55 years,
SD 11 range 21 – 74) who attended Healthy Hearing & Balance Care
in Sydney and Medical Audiology Services in Perth, Australia, for
the management of tinnitus and hearing loss between January 2007
and November 2010. They were not selected on the basis of any
factor other than the presence of hearing loss (ranging from mild
to severe) and a primary or secondary complaint of bothersome
chronic tinnitus. All participants were privately funded.
Audiometry and tinnitus assessment
Pure-tone audiometry (0.25 – 12.5 kHz) was undertaken using a
Madsen Itera and GSI-61 audiometers with Seinheiser HD 200 head-
phones following the modifi ed Hughson-Westlake threshold seeking
method. Tympanometry and acoustic refl exes were used to exclude
middle-ear pathologies. All participants had otologic investigation
to exclude any treatable cause for their hearing losses prior to fi t-
ting hearing aids. Tinnitus pitch was measured in 102 ears prior to
the fi tting of hearing aids in the 70 patients. Tinnitus pitch match
was conducted in a sound proof booth under headphones with the
same equipment used for pure-tone audiometry. Participants were
presented with two 10dB SL pure tones at a time on the ear opposite
to the loudest tinnitus. They were asked to compare the two tones
Abbreviations
TRQ Tinnitus reaction questionnaire
VAS Visual analogue scale
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916 C. McNeill et al.
(e.g. 0.5 and 4 kHz) and identify which tone pitch was more similar
to their tinnitus. The frequency of presented tones was then narrowed
down until they identifi ed the closest match to their tinnitus. The
procedure was repeated three times for consistency of results.
Tinnitus distress was measured using the tinnitus reaction ques-
tionnaire. This tool was chosen due to its validated psychometric
properties to measure tinnitus distress in the Australian tinnitus
population. The TRQ comprises of 26 items that summates a maxi-
mum score of 104 and represents the level of tinnitus disturbance
in daily life (Wilson et al, 1991). The TRQ was administered prior
to and at least three months post hearing aid fi tting. At that time
patients were also asked to report the effect of their hearing aids
on tinnitus perception answering a multiple choice question:
How do you hear your tinnitus with your hearing aid switched
on in your ear?
1. I don ’ t hear the tinnitus at all
2. I hear the tinnitus softer
3. I hear the tinnitus the same
4. I hear the tinnitus louder
Results were subsequently classifi ed (1 ⫽ Total masking, 2 ⫽ Partial
masking, 3 ⫽ No masking). No participants reported experiencing
louder tinnitus.
Hearing aid fi tting
Hearing aids were selected based on patients ’ needs and prefer-
ences amongst the range of Oticon, Phonak, and Widex instruments.
Entry level to advanced hearing aid features were chosen based on
individual needs, hence a range of technology was used. Hearing
aids were fi tted to the hearing loss with no specifi c considerations
to the presence of tinnitus. They were programmed via Noah and
Noah Link equipment using the algorithm prescribed by the manu-
facturers ’ software for the given audiogram. Fittings were verifi ed
with probe microphone measurements using MedRx Avant Real
Ear Measurement equipment.
The frequency response amplifi ed by the hearing aids, as described
by the manufacturers ’ specifi cations, was compared with the
tinnitus pitch and the patients were retrospectively separated in two
groups: patients with tinnitus falling within the hearing aid fre-
quency response and patients with tinnitus falling outside the hearing
aid frequency response. Patients were counselled to use the hearing
aids starting from one hour on the fi rst day building up to full-time
usage. Follow-up was conducted two and four weeks post-fi tting for
fi ne-tuning if required. Tinnitus review was conducted three months
post-fi tting.
Analysis
ANOVA was undertaken using SPSS (PASW Statistics 18). Chi-
squared analysis was undertaken for categorical data. Criteria for
signifi cance was set at ⬍ 0.05 for all tests. Cohen ’ s d was calcu-
lated using an online calculator (http://www.cognitivefl exibility.org/
effectsize/) with corrections for within participant measurements.
Results
Hearing aid fi tting outcome
Participants had change in TRQ from 49.02 (SD 20.90) prior
to hearing aids to 34.08 (SD 17.48) with a Cohen ’ s d effect size
of 1.25 following three months of use. Twenty-six participants
reported that while wearing the hearing aids, their tinnitus was
totally masked, twenty-eight reported partial masking, sixteen
reported no masking, and none reported an increase in loudness of
tinnitus. The TRQ score for those with some masking effect was
similar at baseline (total masking mean TRQ pre 51.9, SD 20.7;
partial masking 53.1, SD 22.3), but the no masking group had a
lower TRQ prior to having the hearing aids (mean TRQ 38.6,
SD 19.5). There was overall improvement in tinnitus (TRQ mean
prior to fi tting 49.3, SD 21.6; mean post-fi tting 28.4, SD 16.8;
Figure 1), but this was not consistent across the masking groups.
There was a reduction in tinnitus after fi tting with hearing aids
for those who experienced masking, but not for those who did
not, as indicated by an interaction between masking group
and time of completing the TRQ (F(2,67) ⫽ 34.786, p ⬍ 0.001;
Figure 2). Three months following the fi tting of the aids the no
masking group ’ s TRQ was similar to baseline (mean 36.1, SD
17.4) but the partial masking group ’ s TRQ score (34.5, SD 16.4)
had reduced, with an even greater reduction in TRQ score for the
total masking group (mean 17.2, SD 10.0). A “ clinically signifi -
cant ” change of 40% or greater in the TRQ (Davis et al, 2007) was
achieved by 51% of all participants. In the total masking group
Figure 1. TRQ score following hearing aid fi tting as a function of
TRQ score prior to fi tting for each participant in the study (N ⫽ 70).
Symbols below the line indicate improved TRQ scores.
Figure 2. Mean TRQ scores (error bars represent ⫾ 1 standard error
of the mean [SE]) for each group prior to and three months post the
fi tting of hearing aids.
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Tinnitus pitch masking 917
100% achieved a 40% or greater improvement, in the partial mask-
ing group 36%, and 0% in the no masking group.
Audiogram
The majority of participants (65) had high-frequency symmetrical
sensorineural hearing loss, three had fl at hearing losses and two
presented with “ cookie bite ” shaped audiograms. The audiograms
were grouped according to masking effect, a signifi cant difference
was found between the groups ’ mean audiograms in the low fre-
quencies (Figure 3). Participants who achieved total masking had
on average more residual hearing at 0.25 and 0.5 kHz compared
to those who achieved partial masking. In addition, the group that
achieved no masking benefi ts had the worst hearing thresholds at
0.25 and 0.5 kHz.
Tinnitus pitch
Pitch matched frequencies for participants in this study were
distributed around a mean pitch of 6.9 kHz, SD 3.4 (Figure 4).
There were differences between masking groups in terms of tinnitus
pitch (F(2,67) ⫽ 4.471, p ⫽ 0.015) (Figure 5). The group that did
not achieve masking with hearing aids had a higher mean tinnitus
pitch (8.0, SD 0.8) than the partial (7.6, SD 0.7) and total masking
groups (5.4, SD 0.6).
Hearing aid frequency amplifi cation
The hearing aids in this study had low frequency limits from 0.1
to 0.5 kHz and varied in high frequency response from 6.6 to
8.9 kHz (Figure 6). The groups differed in the frequency range of
the hearing aids that they were using (F(2,67) ⫽ 4.971, p ⫽ 0.010).
The mean upper frequency limit for the hearing aids used by the
no masking group was 7.2 kHz (SD 0.519), for the partial mask-
ing group: 8 kHz (SD 0.368), and for total masking: 7.645 kHz
(SD 0.847). A higher proportion of those who experienced better
masking had tinnitus within the frequency range of the hearing
aids used (chi-squared (2df) ⫽ 15.087, p ⫽ 0.001) (Figure 7). When
participants were divided between those whose tinnitus pitch fell
within and outside the frequency response range of their aids, a
small difference in effect size were obtained; pitch within aid range:
n ⫽ 36, mean TRQ before 49.64 (SD 22.55), after 23.08 (SD 14.48),
correlation between means 0.51, Cohen ’ s d ⫽ 1.49; pitch outside
aid range: n ⫽ 34, mean TRQ before 49.02 (SD 20.9), after 34.08
(SD 17.48), correlation between means 0.82, Cohen ’ s d ⫽ 1.3.
Discussion
The results of this study suggest that the fi tting of hearing aids
can reduce the audibility of, and improve reaction to, tinnitus.
Overall the fi tting of hearing aids was associated with a Cohen ’ s d
of 1.25, values of 0.8 and greater which are considered large effects.
Patients were divided into three groups following hearing aid fi t-
ting based on self-reported effects on tinnitus audibility (tinnitus
unchanged/not masked, partial masking, and total masking/tinnitus
not audible with aids in). Forty per cent achieved a reduction but
not complete masking of tinnitus, 37% total masking, and 23%
no masking at all. The TRQ for these groups showed progressive
improvement across masking to total masking. Patients whose tin-
nitus pitch fell within the frequency range of their hearing aids
had a larger treatment effect size than those for whom the tinnitus
Figure 3. Mean audiogram (combined ears, error bars represent
⫾ 1 SE) for each group. Values marked with an asterisk indicate
statistically signifi cant differences (p ⬍ 0.05).
Figure 4. The number of participants grouped according to tinnitus
pitch.
Figure 5. Mean tinnitus pitch (error bars represent ⫾ 1 SE) for each
group in the study.
Figure 6. The number of participants grouped according to high
frequency limit of hearing aid response.
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918 C. McNeill et al.
was outside of the frequency range. This is an important fi nding
for discussion as the merits of sound therapy (McKenna & Irwin,
2008) and different levels of therapeutic sound on tinnitus has been
debated (Tyler, 2006).
Despite the popularity of hearing aids in treating tinnitus
(Kochkin & Tyler, 2008) there has been limited good quality
research to support this practice. This study does not “ prove ” that
amplifi cation (as a form of sound therapy) is effective because
assignment of participants to groups was based on the perceived
benefi t of the hearing aids. It must therefore be acknowledged
that the improved perception of tinnitus may have resulted from
some other characteristic of these participants that also made
them more likely to report masking. On the other hand, provision
of hearing aids did contribute to a reported reduction in tinnitus
after three months for many participants, and was not associated
with an increase in tinnitus. Our fi ndings suggest that the difference
in TRQ scores was not due to counselling, which all participants
received, but the effect of masking. Total masking using hearing
aids achieved a greater effect than partial masking and no masking
based on TRQ results. The groups differed in that the no masking
group had a lower TRQ prior to aid fi tting, and these showed no
improvement in tinnitus score, whereas clear improvements were
observed for those who did experience a masking effect.
There has been a longstanding debate as to the most effective
level of sound for tinnitus therapy. When broad-band noise is used
for sound therapy a level at which tinnitus mixes (Jastreboff &
Jastreboff, 2001) or is the lowest effective level (Tyler, 2006) are
usually recommended over total masking. Total masking has been
suggested as being counterproductive to habituation (Jastreboff &
Jastreboff, 2001) and can be uncomfortably loud (Tyler, 2006).
The fi nding that hearing aid users who achieved total masking
had greater benefi t might, at fi rst glance, contradict this. However,
masking through amplifi cation of environmental sound may
represent different mechanisms of action in the auditory pathway
than masking using non-meaningful broad-band noise. Information
in amplifi ed sound may require attention and cognitive functioning
and this might allow tinnitus masking to be achieved at a different
level (Kidd et al, 2002). Personality has been linked to tinnitus
and it is possible that awareness of tinnitus (masking to no-
masking) was not solely reliant on sound-level but was determined
to a large degree by the individuals ’ signal detection criterion
(Welch & Dawes, 2008). It may be that those persons susceptible
to masking are also more likely to adapt to tinnitus; as such mas-
king might simply indicate likelihood of natural accommodation
of tinnitus. The benefi ts may have been due to psychosocial
effects such as improved communication and social interaction,
however, although this was not formally measured, we suspect
that hearing aid satisfaction was similar across the groups and
psychosocial effects on tinnitus would be equivalent. Those par-
ticipants who did not achieve any masking did not show the same
reduction in their TRQ scores compared to those who obtained
partial and total masking. These results challenge the view that
sound therapy has limited benefi t in tinnitus management and
that hearing aid effects on tinnitus are rather due to psychosocial
effects. If this were the case TRQ scores might be expected to be
similar irrespective of the degree of masking.
It is also possible that the reduction in TRQ was not due to a
masking effect but a central plastic reorganization as a consequence
of the degree of neural excitation by sound (Norena & Eggermont,
2005). There is a need for systematic evaluation of the many
potential contributing factors to hearing aid benefi t. Objective
evaluation through functional imaging or auditory evoked poten-
tials may assist in elucidating the physiological cause for behav-
ioural observations.
Not all patients obtained tinnitus masking from the hearing
aids. Our results suggest that successful tinnitus management
with amplifi cation is most likely to occur in the presence of good
low-frequency hearing, with poorer TRQ score, and when tinnitus
pitch falls within the frequency range of the hearing aids chosen.
It is possible that a change in prescribed hearing aid output might
provide better results. Some prescription procedures typically
weight response towards speech frequencies and reduce low fre-
quency gain to prevent upward spread of masking. The DSL pre-
scription procedure (Scollie et al, 2005) which generally provides
greater low and high frequency amplifi cation to NAL-NL1 (Byrne
et al, 2001) may be preferred by tinnitus sufferers (Wise, 2003).
Hearing aid noise reduction strategies, which reduce low frequency
amplifi cation, may also reduce masking effectiveness in individu-
als with low-frequency hearing loss to a greater extent than per-
sons with normal low frequency hearing (not receiving/requiring
low frequency amplifi cation). A greater proportion of hearing aid
users might achieve tinnitus masking if greater emphasis is placed
on amplifi cation of quiet ambient sounds (Searchfi eld, 2006) but
this also must be balanced against potential reduction in hearing
satisfaction. This study did not differentiate effect on the basis of
level of hearing instrument technology; this may be a signifi cant
contributor to success that should be investigated in future studies.
One potential benefi t from more recent technology is extended
high-frequency responses. In this study the hearing aid frequency
response limits were from manufacturer specifi cations reporting
performance in couplers; this may not represent effective amplifi -
cation in the real ear and one study suggests that extended high-
frequency amplifi cation does not provide additional benefi ts in
changing tinnitus percept in the short-term (Moffat et al, 2009).
Predicting hearing aid success on the basis of tinnitus pitch also
requires the accurate measurement of tinnitus pitch. Due to vari-
ability inherent in tinnitus pitch matching from errors such as octave
confusion (Tyler & Conrad-Armes, 1983) repeated measures of pitch,
checking for octave confusion with higher frequencies than standard
audiometers (preferably at or above 16 kHz) are necessary. Such care
is necessary so to avoid artifi cially low matches forced by inability
to compare estimated pitch against higher frequency sounds.
Based on our results we recommend the fi tting of hearing aids for
treatment of tinnitus in patients with hearing loss, and our prognosis
is that better results are achieved when there is:
Figure 7. The percentage of participants with tinnitus pitch falling
within and outside the frequency response of their hearing aids, for
each group.
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Tinnitus pitch masking 919
1. Good low-frequency hearing.
2. Strong reaction to tinnitus.
3. Tinnitus pitch within the fi tting range of the selected hearing aid.
Conclusion
These results indicate that tinnitus pitch match may be a useful
tool to predict the effects of hearing aid fi tting in masking tinnitus.
Based on this study, audiologists should be confi dent to recommend
hearing aids for the treatment of tinnitus perception, especially
when tinnitus pitch falls within the hearing aid frequency response.
Clinicians are encouraged to include tinnitus pitch matches in their
test battery to help with the prognosis of tinnitus treatment by
means of hearing aid fi tting. It should however be noted that treat-
ing tinnitus perception may not necessarily resolve tinnitus distress,
and counselling is an important component of therapy. The mecha-
nisms of hearing aid effects are worth investigating, as our results
would suggest a greater benefi t from total than partial masking. It
was hypothesized that hearing aids would be most effective when
their frequency range encompassed an individual ’ s tinnitus pitch,
the hypothesis was supported, but additional factors such as low
frequency audibility may also contribute to hearing aid success.
Acknowledgements
None.
Declaration of interest: The authors report no confl icts of interest.
The authors alone are responsible for the content and writing of the
paper.
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