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Hearing aids for the treatment of tinnitus
Abstract
Clinical evidence shows that the use of hearing aids in tinnitus patients provides two benefits: it makes the patient less aware of the tinnitus and it improves communication by reducing the annoying sensation that sounds and voices are masked by the tinnitus. Hearing loss reduces stimulation from external sounds resulting in increased awareness of tinnitus and deprivation of input may change the function of structures of the auditory pathways. Tinnitus is often caused by expression of neural plasticity evoked by deprivation of auditory input. With hearing aid amplification, external sounds can provide sufficient activation of the auditory nervous system to reduce the tinnitus perception and it may elicit expression of neural plasticity that can reprogram the auditory nervous system and thereby have a long-term beneficial effect on tinnitus by restoring neural function. To obtain the best results, hearing aids should be fitted to both ears, use an open ear aid with the widest amplification band, and disabled noise reducing controls. In some cases a combination device would be preferable. The conditions required in order to obtain good results include not only the use of devices, but above all, their adaptation to the needs of the single patient, by counseling and customization. Wearing the hearing aid must become second nature to the patient even though it is only one element of the therapy.
... One such possible confounder is age. Neuroplastic reorganization in response to hearing aid amplification is assumed to be one of the reasons why hearing aid use is associated with tinnitus relief [12], but neuroplasticity decreases with increasing age [13], meaning that older tinnitus patients could hypothetically have lower odds of experiencing tinnitus mitigation with hearing aid amplification. Another hypothesis on why hearing aid amplification could result in milder tinnitus is that the amplified sounds could mask tinnitus and ease communication difficulties, which in turn would decrease tinnitus annoyance [12]. ...
... Neuroplastic reorganization in response to hearing aid amplification is assumed to be one of the reasons why hearing aid use is associated with tinnitus relief [12], but neuroplasticity decreases with increasing age [13], meaning that older tinnitus patients could hypothetically have lower odds of experiencing tinnitus mitigation with hearing aid amplification. Another hypothesis on why hearing aid amplification could result in milder tinnitus is that the amplified sounds could mask tinnitus and ease communication difficulties, which in turn would decrease tinnitus annoyance [12]. If so, it is plausible that individuals with greater hearing impairment experience greater tinnitus mitigation with hearing aids. ...
... However, comparing hearing status between the study sample of Suzuki et al. [21] and other studies is challenged by Suzuki and colleagues calculating PTAs using the formula that Japan's Act on Welfare of Physically Disabled Persons grading system of hearing impairment is based on. Compared to the formula that the World Health Organization (WHO) grading system [12] is based on, i.e., the following: PTA = ((HT at 0.5 kHz) + (HT at 1 kHz) + (HT at 2 kHz) + (HT at 4 kHz))/4 (1) which is used by most other studies, the Japanese formula omits HT at 4 kHz and counts HT at 1 kHz twice. Taken together, these studies do not provide clear clues as to whether or not hearing aids tend to mitigate tinnitus distress in patients with subclinical hearing impairment. ...
There is a consensus among tinnitus experts to not recommend hearing aids for tinnitus patients with subclinical hearing impairment. However, this notion is arbitrary, as no previous study has compared the treatment effect of hearing aids on tinnitus distress in patients with and without clinical hearing impairment. In this article, we investigate whether tinnitus patients with clinical and subclinical hearing impairment differ in terms of tinnitus mitigation after hearing aid fitting. Twenty-seven tinnitus patients with either clinical (n = 13) or subclinical (n = 14) hearing impairment were fitted with hearing aids. All participants filled out the tinnitus functional index (TFI) before hearing aid fitting and after 3 months of hearing aid use. Clinically meaningful reductions in tinnitus distress (−13 TFI points or more) were seen in both groups, and the difference in tinnitus mitigation between tinnitus patients with clinical (mean TFI reduction = 17.0 points) and subclinical hearing impairment (mean TFI reduction = 16.9 points) was not statistically significant (p = 0.991). Group differences on the suspected confounding factors of age, sex, time since tinnitus debut, tinnitus distress (TFI score) at baseline, and treatment adherence were statistically insignificant. In light of this, we argue that clinical hearing impairment is not required to achieve meaningful tinnitus mitigation with hearing aids, and that hearing aids could be recommended for tinnitus patients with subclinical hearing impairment.
... Together, these findings suggest that the restoration of peripheral auditory input might reduce tinnitus distress. Two mechanisms have been suggested to cause the benefits of hearing aid (HA) amplification: First, it makes patients pay less attention to their tinnitus, and second, it amplifies sounds and voices, such that the interfering effect of tinnitus on other sounds is less dominant [21]. Thus, the HAs might help the habituation process, where one's emotional reaction to and awareness of tinnitus is gradually reduced by reducing the attention paid to tinnitus. ...
... Thus, the HAs might help the habituation process, where one's emotional reaction to and awareness of tinnitus is gradually reduced by reducing the attention paid to tinnitus. Furthermore, since tinnitus very often co-exists with hearing loss, the sensory deprivation caused by hearing loss can lead to neural changes and/or neuronal hyperactivity in the auditory pathway [21] whereas these changes can be reversed with sound stimulation. It has therefore been proposed that HAs may help restore normal or close-to-normal neural activity in the auditory pathway by inducing plasticity [21]. ...
... Furthermore, since tinnitus very often co-exists with hearing loss, the sensory deprivation caused by hearing loss can lead to neural changes and/or neuronal hyperactivity in the auditory pathway [21] whereas these changes can be reversed with sound stimulation. It has therefore been proposed that HAs may help restore normal or close-to-normal neural activity in the auditory pathway by inducing plasticity [21]. ...
This study investigated the effect of broadband amplification (125 Hz to 10 kHz) as tinnitus treatment for participants with high-frequency hearing loss and compared these effects with an active placebo condition using band-limited amplification (125 Hz to 3–4 kHz). A double-blinded crossover study. Twenty-three participants with high-frequency (≥3 kHz) hearing loss and chronic tinnitus were included in the study, and 17 completed the full treatment protocol. Two different hearing aid treatments were provided for 3 months each: Broadband amplification provided gain in the frequency range from 125 Hz to 10 kHz and band-limited amplification only provided gain in the low-frequency range (≤3–4 kHz). The effect of the two treatments on tinnitus distress was evaluated with the Tinnitus Handicap Inventory (THI) and the Tinnitus Functional Index (TFI) questionnaires. The effect of the treatment on tinnitus loudness was evaluated with a visual analog scale (VAS) for loudness and a psychoacoustic loudness measure. Furthermore, the tinnitus annoyance was evaluated with a VAS for annoyance. The tinnitus pitch was evaluated based on the tinnitus likeness spectrum. A statistically significant difference was found between the two treatment groups (broadband vs. band-limited amplification) for the treatment-related change in THI and TFI with respect to the baseline. Furthermore, a statistically significant difference was found between the two treatment conditions for the annoyance measure. Regarding the loudness measure, no statistically significant differences were found between the treatments, although there was a trend towards a lower VAS-based loudness measure resulting from the broadband amplification. No changes were observed in the tinnitus pitch between the different conditions. Overall, the results from the present study suggest that tinnitus patients with high-frequency hearing loss can experience a decrease in tinnitus-related distress and annoyance from high-frequency amplification.
... 5 Amplified sound which emanates from hearing aids, acts as a masker. 6 This reduces awareness on tinnitus directly and reduces stress indirectly, 7 which in turn lower drivers gain adaptation or inhibition. 8 Modifications in the settings of hearing aids add a meaningful approach to tinnitus relief. ...
... 11 The fitting of open ear devices in the treatment of tinnitus is useful. 7 The compression threshold set as low as 30 dB SPL in hearing aids alleviates tinnitus. 7 Switching off the noise reduction circuit and changing the directional sensitivity of the microphone to omnidirectional lead to tinnitus relief. ...
... 7 The compression threshold set as low as 30 dB SPL in hearing aids alleviates tinnitus. 7 Switching off the noise reduction circuit and changing the directional sensitivity of the microphone to omnidirectional lead to tinnitus relief. 12 The features explained above in the hearing aid enhance the ambient noise and results in tinnitus relief, but induces annoyance when listening. ...
Objectives:
The objective of the study is to compare amplification strategies on tinnitus relief. A repeated measure research design was used to determine the best strategy that provides a significant relief on tinnitus and improvements in speech perception.
Methods:
We recruited 20 participants in the age range of 30-60 years (mean age = 47.95 years) having mild to moderately severe sloping sensorineural hearing loss with continuous tonal tinnitus. We grouped the participants into mild and severe, based on the scores obtained in the Tinnitus Handicap Inventory. We evaluated tinnitus pitch and loudness using the adaptive method. Besides, we assessed signal to noise ratio 50 (SNR 50) from each of the programs. We carried out a paired comparison method to determine the best strategy among the 3 in which the maximum preference score was obtained on tinnitus relief by a test hearing aid programmed with 3 programs.
Results:
Each group of participants significantly preferred the strategy for the gain in hearing aid set at tinnitus pitch on tinnitus. However, there was no significant difference between the SNR 50 scores in the 3 gain settings.
Conclusion:
An additional gain set at tinnitus pitch after alleviating hearing loss by the prescriptive method was found to be the best strategy for effective masking of tinnitus and that led to tinnitus relief without compromising speech perception.
... Disentangling cause and effect is further complicated by differences between studies in terms of technical aspects of the hearing aid treatments, such as prescribed gain (McNeill et al., 2012;Shekhawat et al., 2013), frequency range (Del Bo and Ambrosetti, 2007;Moffat et al., 2009;Schaette et al., 2010), laterality (Del Bo and Ambrosetti, 2007;Trotter and Donaldson, 2008), and the use of advanced signal processing features such as digital noise reduction (Del Bo and Ambrosetti, 2007). For example, Schaette et al. (2010) suggested that a hearing aid is most effective in reducing symptoms if the tinnitus pitch falls within the amplified bandwidth. ...
... Disentangling cause and effect is further complicated by differences between studies in terms of technical aspects of the hearing aid treatments, such as prescribed gain (McNeill et al., 2012;Shekhawat et al., 2013), frequency range (Del Bo and Ambrosetti, 2007;Moffat et al., 2009;Schaette et al., 2010), laterality (Del Bo and Ambrosetti, 2007;Trotter and Donaldson, 2008), and the use of advanced signal processing features such as digital noise reduction (Del Bo and Ambrosetti, 2007). For example, Schaette et al. (2010) suggested that a hearing aid is most effective in reducing symptoms if the tinnitus pitch falls within the amplified bandwidth. ...
... Disentangling cause and effect is further complicated by differences between studies in terms of technical aspects of the hearing aid treatments, such as prescribed gain (McNeill et al., 2012;Shekhawat et al., 2013), frequency range (Del Bo and Ambrosetti, 2007;Moffat et al., 2009;Schaette et al., 2010), laterality (Del Bo and Ambrosetti, 2007;Trotter and Donaldson, 2008), and the use of advanced signal processing features such as digital noise reduction (Del Bo and Ambrosetti, 2007). For example, Schaette et al. (2010) suggested that a hearing aid is most effective in reducing symptoms if the tinnitus pitch falls within the amplified bandwidth. ...
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.
... Hearing aids have been found to improve individuals' hearing ability, as measured by self-report [16] or audiological data (e.g., speech-reception threshold in noise [17]). Further, hearing aids appear to ameliorate some forms of chronic tinnitus [18][19][20][21]-potentially through reducing tinnitus awareness via an enhanced perception of external auditory input [22] or, for some patients, through psychological processes such as enhanced experiences of self-efficacy, control, or social inclusion. ...
... The study joins previous research on self-reported symptom-relief following hearing aid fittings in patients with hearing loss [19,20,47] with possible mechanisms involving enhancements of individuals' tonal environments [21,48,49], tinnitus masking [19], reduced tinnitus awareness and improved communication opportunities [22] or possible psychological effects such as, for some patients, enhanced senses of self-efficacy, control, or social inclusion. In the present study, the majority of participants (68%) wore the hearing aids between 5.25 and 13.41 h/day, which is broadly consistent with the previously reported times in the literature (e.g., 3.67-11.93 ...
Background:
The psychological effects of hearing aids and auditory training are underinvestigated.
Objective:
To assess the short- and long-term effects of an industry-developed auditory training on tinnitus-related distress, perceived stress, and psychological epiphenomena in patients with chronic tinnitus and mild-to-moderate hearing loss.
Method:
One-hundred-seventy-seven gender-stratified patients were randomized to an immediate [IIG] or delayed [DIG] intervention group. Following binaural hearing aid fitting, participants completed a CD-enhanced 14-days self-study program. Applying a randomized-controlled cross-over design, psychological measures were obtained at four times: pre-treatment/wait [IIG: t1; DIG: wait], post-treatment/pre-treatment [IIG: t2; DIG: t1], follow-up/post-treatment [IIG: t3; DIG: t2], and follow-up [DIG: t3]. Between- and within-group analyses investigated treatment-related effects and their stability at a 70-day follow-up.
Results:
Overall, distress symptom severity was mild. Unlike the DIG, the IIG showed significant improvements in tinnitus-related distress. Some psychological epiphenomena, notably anxiety, slightly improved in both groups. Within-group analyses demonstrated the stability of the tinnitus-distress-related effects, alongside uncontrolled improvements of perceived stress and mood-related symptoms at follow-up.
Conclusions:
The investigated hearing therapy lastingly improves tinnitus-related distress in mildly distressed patients with chronic tinnitus and mild-to-moderate hearing loss. Beneficial psychological knock-on effects deserve further investigation.
... Current theories about the origins of tinnitus and the associated emotional distress suggest that the perception of tinnitus may result, at least partly, from the peripheral attenuation of auditory input; this attenuation increases central auditory system activity from the dorsal cochlear nucleus to the auditory cortex and couples with the limbic system via collateral connections with the thalamus and other structures [20]. Thalamic stimulation results in the release of neurotransmitters, including epinephrine, to produce an autonomic nervous system response associated with stress [21]. ...
... If possible, hearing aids should be prescribed for both the ears as this enables a better understanding of verbal messages and spatial localization. These two elements are important in activating the entire acoustic nerve system [21]. Further research is required to determine whether such a mechanism is involved in patients who show improvements in THI scores after wearing hearing aids on the side contralateral to the tinnitus-affected side. ...
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.
... 3 Studies on plasticity have also suggested that an increase in the auditory stimulus provided by external sound amplification through the masking effect can induce secondary plasticity, helping to decrease the discomfort associated with tinnitus. 4 There is a significant correlation between tinnitus and hearing loss in 85-96%. 5 Therefore, attenuation of tinnitus may be achieved by restoration of hearing by surgery or amplification by hearing aid. ...
... 16 Del Bo et al suggested two mechanisms for how tinnitus can be improved by hearing restoration. 4 First, an increased level of ambient noise perceived after hearing restoration induces partial or complete masking of tinnitus, and second, the changes in the auditory nervous system caused by the deprivation of stimulus can be reversed by appropriate sound stimulation. Improvement in tinnitus after tympanoplasty has been reported positively in the literature. ...
p> Background: Researches suggest middle ear surgery might improve tinnitus after tympanoplasty. Purpose of this study was to investigate association between pre-operative air-bone gap (ABG) and tinnitus-outcome after tympanoplasty type I.
Methods: 100 patients with tinnitus having more than 6 months of symptoms of chronic suppurative otitis media (CSOM) that were refractory to medical treatment were included in study. All patients were evaluated through otoendoscopy, pure-tone audiometry, questionnaire-based survey using the visual analogue scale (VAS) and tinnitus handicap inventory (THI) for tinnitus symptoms before and 4 months after tympanoplasty. Influence of preoperative bone conduction (BC), preoperative air-bone-gap and postoperative air-bone-gap on tinnitus outcome post-operatively was calculated.
Results: Patients were divided into two groups based on preoperative BC of <25 dB or >25 dB. Postoperative improvement of tinnitus in both groups showed statistical significance. Patients whose preoperative air-bone-gap was <15 dB showed no improvement in postoperative tinnitus using VAS (p=0.887) and THI (p=0.801). Patients whose preoperative air-bone-gap was >15 dB showed significant improvement in postoperative tinnitus using VAS (p<0.01) and THI (p=0.015). Postoperative change in tinnitus showed significance compared with preoperative tinnitus using VAS (p=0.006). Correlation between reduction in VAS score and air-bone-gap (p=0.201) or between reduction in THI score and air-bone-gap (p=0.270) was not significant.
Conclusions: Preoperative ABG can be a predictor of tinnitus outcome after tympanoplasty in CSOM with tinnitus.
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... Nesta pesquisa, a maior parte dos pacientes apresentou zumbido unilateral, perda auditiva bilateral, do tipo neurossensorial, e recebeu próteses auditivas para uso em ambas as orelhas. Estudo prévio indicou que os resultados clínicos são melhores nos pacientes que recebem amplificação bilateral se comparados àqueles que recebem a estimulação acústica em apenas uma orelha (19) . ...
... Na primeira avaliação, o incômodo era classificado como intenso para a maior parte dos pacientes; após o uso de prótese auditiva, tornou-se leve. Os valores constatados no questionário são semelhantes aos obtidos por outros estudos, após um mês de amplificação (17,19) . Também se verificou relação direta entre a pontuação do questionário e o tempo de uso do aparelho, ou seja, quanto mais tempo o paciente utiliza a prótese auditiva diariamente, mais reduz a queixa de incômodo, demostrando o quanto o uso de tal tecnologia beneficia os sujeitos acometidos pelo zumbido. ...
Objetivo
Verificar benefícios do uso de próteses auditivas na autopercepção do zumbido em adultos e idosos sem experiência prévia de amplificação.
Métodos
O estudo incluiu indivíduos de ambos os sexos, com queixa de zumbido, acompanhados em hospital público. Aplicaram-se os seguintes exames e instrumentos para mensurar o zumbido e determinar o seu incômodo: pesquisa do pitch e loudness, Escala Visual Analógica (EVA), pesquisa do nível mínimo de mascaramento, inibição residual e Tinnitus Handicap Inventory (THI). As avaliações foram realizadas em duas etapas: antes da adaptação das próteses auditivas e após um mês de uso dos aparelhos.
Resultados
Dos 20 indivíduos participantes, 60% eram idosos. Verificou-se diferença na autopercepção do zumbido pré e pós-protetização, medido pelas escalas THI e EVA. Também se observaram diferenças nas medidas psicoacústicas, com exceção do pitch, antes e após a amplificação. Além disso, houve correlação entre o tempo de zumbido e a idade com os escores finais do THI.
Conclusão
O uso de próteses auditivas reduziu o incômodo provocado pelo zumbido, com alteração nas medidas psicoaústicas e no impacto na qualidade de vida.
... About 80% of people with clinically significant tinnitus have hearing loss (Davis & El Rafaie, 2000), and it has been reported that 50 to 70% of individuals with hearing loss report tinnitus as well (Del & Ambrosetti, 2007;Jastreboff & Jastreboff, 2003a;Sheldrake & Jastreboff, 2004). Because of observations such as these, for many decades, hearing aids have been commonly prescribed for the relief of tinnitus with the first such report published in 1947 (Saltzman & Ersner,1947). ...
... Because of observations such as these, for many decades, hearing aids have been commonly prescribed for the relief of tinnitus with the first such report published in 1947 (Saltzman & Ersner,1947). The reports of effectiveness of hearing aids alone for tinnitus have been quite varied, from stating that they lack effectiveness to reports of up to 50% of patients experiencing some relief while using them (Del & Ambrosetti, 2007;Searchfield, 2005;Sheldrake & Jastreboff, 2004;Trotter & Donaldson, 2008). Creating an additional challenge for utilizing hearing aids for tinnitus management, decreased sound tolerance affects a significant proportion of tinnitus patients as well (Jastreboff & Jastreboff, 2004). ...
The role of hearing aids in tinnitus treatment and outline of their optimal programming and use for tinnitus patients
... Several hypotheses have been proposed to explain the possible mechanism of tinnitus improvement associated with the use of HAs (Del Bo and Ambrosetti, 2007). For example, HAs have been suggested to be beneficial for tinnitus patients by helping the brain to distinguish between true sounds and tinnitus, decreasing annoyance by partial masking of tinnitus using augmented environmental sounds, and enhancing the ability to cope with tinnitus by reducing communication stress (Del Bo and Ambrosetti, 2007;Shekhawat et al., 2013). ...
... Several hypotheses have been proposed to explain the possible mechanism of tinnitus improvement associated with the use of HAs (Del Bo and Ambrosetti, 2007). For example, HAs have been suggested to be beneficial for tinnitus patients by helping the brain to distinguish between true sounds and tinnitus, decreasing annoyance by partial masking of tinnitus using augmented environmental sounds, and enhancing the ability to cope with tinnitus by reducing communication stress (Del Bo and Ambrosetti, 2007;Shekhawat et al., 2013). In addition, the neurophysiological rationale of HAs usage suggested that sound amplification by HAs may restore the activity of auditory neurons and cortical activity (Gabriel et al., 2006;Norena and Eggermont, 2006), and therefore may lead to neuroplastic changes of the auditory pathway and neural correlates related to the generation of tinnitus. ...
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.
... It has also been suggested that hearing aids reduce tinnitus awareness, and thereby stress [109], and reduce central auditory gain [152] and homeostatic hyperactivity [177], implicating them in tinnitus. It has been hypothesised [109] that increasing bandwidth (the frequency range of sounds amplified) may improve effectiveness. ...
... It has also been suggested that hearing aids reduce tinnitus awareness, and thereby stress [109], and reduce central auditory gain [152] and homeostatic hyperactivity [177], implicating them in tinnitus. It has been hypothesised [109] that increasing bandwidth (the frequency range of sounds amplified) may improve effectiveness. Combination hearing aids (including amplification and sound generator in the same device) are another option for patients who may benefit from both amplification and passive sound stimulation. ...
... Similarly, variations in hearing loss can result in increased tinnitus-related distress [21,23]. Nevertheless, in aforementioned cases, on one hand, the use of hearing aids and cochlear implants can reduce tinnitus symptoms [24][25][26]. While to offset tinnitusassociated predicaments of hearing loss, the hearing protection, enhancement, and testing apps are designed for the users to: (1) assess tinnitus symptoms, (2) reduce tinnitusrelated disabilities of hearing processes in daily life, and (3) reduce the likelihood of tinnitus development. ...
Modern mobile devices are mainstream and ubiquitous devices. The widespread adoption of mobile devices has resulted in surge of mobile applications (apps) hosted on marketplaces (app stores) of several mobile platforms. Besides other benefits, these apps are also applied in healthcare-related and medical use, for instance, in case of tinnitus, where tinnitus disorder is associated with the perception of ringing sound without external sound source. In particular, for tinnitus, these apps allow provision of tinnitus-related relief, self-help, and general management. The collective aim of this chapter is to foster and report on Mobile Health (mHealth) solutions, in particular mobile apps within the tinnitus context. First, this chapter provides an up-to-date overview of existing mHealth apps available for major mobile platforms. Second, this chapter provides deep insights into quality and effectiveness of said mobile apps for tinnitus treatment and management. Finally, this chapter provides discussions in relation to the tinnitus-related mHealth apps.
... As hearing loss is a common comorbidity of tinnitus (Baguley et al., 2013), hearing aids are frequently used for the management of tinnitus (Surr et al., 1999;Kochkin and Tyler, 2008;Trotter and Donaldson, 2008;Searchfield et al., 2010). It has been discussed that the beneficial effects on tinnitus from hearing aids may be related to amplified volume of external sounds which may mask the tinnitus sound or refocus attention on alternative auditory stimuli that are unrelated to the tinnitus sound (Del Bo and Ambrosetti, 2007;Hoare et al., 2014a). Nonetheless, there is not sufficient evidence to support or refute the hypothesis that hearing aids are beneficial as a standard treatment for tinnitus (Hoare et al., 2014a;Sereda et al., 2018). ...
Introduction
Combination devices offering both amplification and sound therapy are commonly used in tinnitus management. However, there is insufficient evidence supporting the relationship between sound therapy and tinnitus outcomes. The aim of this study was to explore longitudinal effects of sound therapy on tinnitus-related distress using a combination device.
Method
Twenty participants with mild to moderate tinnitus related distress were fitted with combination devices that included three sound-therapy programs. The sound-therapy programs were selected by the participants from the available sounds offered in the combination device. The sounds comprised fractal music, nature sounds and combinations of the two. Participants were asked to wear the devices for 12 months and to complete questionnaires related to tinnitus distress at baseline and 1, 2, 4, 6, and 12 months after starting the treatment. Additionally, at 2, 4, 6, and 12 months, the device log data capturing information about amplification and sound-therapy use were collected.
Results
Tinnitus handicap inventory (THI), tinnitus functional index (TFI), tinnitus awareness and annoyance decreased following the device fitting. This improvement plateaued at 4 months. The degrees of improvement in THI, TFI and tinnitus annoyance were correlated with daily hours of sound-therapy use but not with daily hours of amplification-only or total device use.
Conclusions
A combination sound therapy consisting of therapy sounds, amplification as needed, and counseling was associated with a reduction in tinnitus-related distress. A future randomized controlled trial should be conducted to allow for detangling the effect of sound therapy from effects of amplification, counseling, placebo, and time itself, and to investigate the predictors of sound-therapy benefit and use.
... Hearing aids have often been reported to provide secondary benefit for tinnitus management. [96][97][98][99][100][101] The first hearing aids to incorporate built-in sound generators intended to provide relief from tinnitus were called "combination instruments," though most hearing aids now employ Bluetooth streaming of sound files from mobile phones. Studies had failed to demonstrate combination instruments were more effective than hearing aids alone for tinnitus management. ...
The Veterans Affairs (VA) Rehabilitation Research & Development (RR&D) National Center for Rehabilitative Auditory Research (NCRAR) was first funded by the RR&D Service in 1997 and has been funded continuously since that time. The overall purpose of the NCRAR is to “improve the quality of life of Veterans and others with hearing and balance problems through clinical research, technology development, and education that leads to better patient care” ( www.ncrar.research.va.gov ). An important component of the research conducted at the NCRAR has been a focus on clinical and rehabilitative aspects of tinnitus. Multiple investigators have received grants to conduct tinnitus research and the present article provides an overview of this research from the NCRAR's inception through 2021.
... Second, we see a significantly lower best response center frequency of the noise in this study compared to the first pilot study (cf. Figure 6C). If this finding is consistent in follow-up studies, it makes it easier to stimulate in the long term, e.g., with specifically adapted hearing aids with noise generators (Del Bo and Ambrosetti, 2007). As these stimulation frequencies would be just at the edge of the significant HL of the patient collective (cf. Figure 3C), they should be soft enough to be adjusted correctly and not harmful in any way for the patients' hearing. ...
Recently, we proposed a model of tinnitus development based on a physiological mechanism of permanent optimization of information transfer from the auditory periphery to the central nervous system by means of neuronal stochastic resonance utilizing neuronal noise to be added to the cochlear input, thereby improving hearing thresholds. In this view, tinnitus is a byproduct of this added neuronal activity. Interestingly, in healthy subjects auditory thresholds can also be improved by adding external, near-threshold acoustic noise. Based on these two findings and a pilot study we hypostatized that tinnitus loudness (TL) might be reduced, if the internally generated neuronal noise is substituted by externally provided individually adapted acoustic noise. In the present study, we extended the data base of the first pilot and further optimized our approach using a more fine-grained adaptation of the presented noise to the patients’ audiometric data. We presented different spectrally filtered near-threshold noises (−2 dB to +6 dB HL, 2 dB steps) for 40 s each to 24 patients with tonal tinnitus and a hearing deficit not exceeding 40 dB. After each presentation, the effect of the noise on the perceived TL was obtained by patient’s response to a 5-scale question. In 21 out of 24 patients (13 women) TL was successfully subjectively attenuated during acoustic near-threshold stimulation using noise spectrally centered half an octave below the individual’s tinnitus pitch (TP). Six patients reported complete subjective silencing of their tinnitus percept during stimulation. Acoustic noise is able to reduce TL, but the TP has to be taken into account. Based on our findings, we speculate about a possible future treatment of tinnitus by near-threshold bandpass filtered acoustic noise stimulation, which could be implemented in hearing aids with noise generators.
... 12 The rationale to use amplification and sound therapy for tinnitus management from the perceptual and psychological viewpoint is that this has been seen to impact tinnitus perception as they enable masking by ambient noise, reduce attention to tinnitus, and improve communication and quality of life. 13 Also, an argument can be made from the neurophysiological viewpoint that sound could prevent maladaptive neuroplastic changes resulting from cochlear insults. 14 However, due to the heterogeneous nature of hearing loss as well as tinnitus, it would be ideal to examine what kind of patients, based on their hearing loss and tinnitus characteristics, could benefit from amplification and sound therapy. ...
Background:
The heterogeneity of tinnitus perception and its impact necessitates a tailor-made management approach in everyone. The current study examined the effects of residual inhibition in combined amplification and sound therapy in individuals with tinnitus and coexisting hearing loss.
Methods:
A retrospective analysis was performed on patients with tinnitus and coexisting hearing loss between 2016 and 2019. A total of 72 patients provided with combined amplification and sound therapy were divided into 3 groups based on residual inhibition: (i) complete residual inhibition, (ii) partial residual inhibition, and (iii) negative residual inhibition. Tinnitus severity was measured using the Tinnitus Functional Index before treatment and 1 and 6 months after the intervention. A multilevel mixed-effects model was used to examine the treatment effects including both the main and interaction effects of time and residual inhibition on the tinnitus severity.
Results:
Of the 72 participants, 55 (76%) and 61 (85%) had clinically significant changes (13 points in Tinnitus Functional Index) at 1-month and 6-month postintervention, respectively. In the complete, partial, and negative residual inhibition groups, the reduction in tinnitus impact was 100%, 78%, and 74%, respectively. A multilevel mixed model analysis showed that the main effects of time and residual inhibition along with their interaction were significant.
Conclusions:
The study results suggest that combined amplification and sound therapy is beneficial in individuals with tinnitus and coexisting hearing loss in reducing their tinnitus severity, and this benefit was more in individuals with complete residual inhibition. However, these results need to be further confirmed by controlled trials.
... Although the evidence for the use of hearing aids alone for tinnitus management is limited, 40 41 hearing aids may for some reduce the tinnitus percept and aid communication difficulties. 42 Ensuring hearing loss is addressed in addition to the provision of ICBT may lead to more optimal outcomes for those with coexisting hearing loss. ...
Objectives
The current study examined predictors of outcomes of internet-based cognitive–behavioural therapy (ICBT) for individuals with tinnitus.
Design
Secondary analysis of intervention studies.
Setting
Internet-based guided tinnitus intervention provided in the UK.
Participants
228 individuals who underwent ICBT.
Interventions
ICBT.
Primary and secondary outcome measures
The key predictor variables included demographic, tinnitus, hearing-related and treatment-related variables as well as clinical factors (eg, anxiety, depression, insomnia), which can have an impact on the treatment outcome. A 13-point reduction in Tinnitus Functional Index (TFI) scores has been defined as a successful outcome.
Results
Of the 228 subjects who were included in the study, 65% had a successful ICBT outcome. As per the univariate analysis, participants with a master’s degree or above had the highest odds of having a larger reduction in tinnitus severity (OR 3.47; 95% CI 1.32 to 12.51), compared with the participants who had education only up to high school or less. Additionally, the baseline tinnitus severity was found to be a significant variable (OR 2.65; 95% CI 1.50 to 4.67) contributing to a successful outcome with the intervention. Both linear and logistic regression models have identified education level and baseline tinnitus severity to be significant predictor variables contributing to a reduction in tinnitus severity post-ICBT. As per the linear regression model, participants who had received disability allowance had shown a 25.3-point lower TFI reduction compared with those who did not experience a decrease in their workload due to tinnitus after adjusting for baseline tinnitus severity and their education level.
Conclusions
Predictors of intervention outcome can be used as a means of triaging patients to the most suited form of treatment to achieve optimal outcomes and to make healthcare savings. Future studies should consider including a heterogeneous group of participants as well as other predictor variables not included in the current study.
ClinicalTrial.gov Registration: NCT02370810 (completed); NCT02665975 (completed)
... The results of bilateral or unilateral amplification in patients with both tinnitus and hearing loss have varied (Del Bo & Ambrosetti 2007, Totter & Donaldsson 2008, Parazzini et al., 2011. ...
... [13,14] There is minimal high-level evidence for the efficacy of hearing aids for tinnitus in systematic reviews, although it has been suggested that hearing aids reduce tinnitus awareness, and thereby stress, and reduce central auditory gain. [15] Small casecontrol studies have shown the efficacy of cochlear implantation in patients with unilateral deafness and persistent, bothersome tinnitus. Hence, larger studies are necessary to confirm these findings. ...
Tinnitus is one of the annoying disorders which can significantly impair patient's quality of life and productivity. Although it is not a life threatening disease, but it results into emotional distress, cognitive distress, intrusiveness, auditory and perceptual difficulties, sleep disturbances, and various somatic complaints. Its incidence and prevalence are enhancing day by day. Various pharmacological agents including anticonvulsants, anxiolytics, antidepressants, muscle relaxants etc. are presently used or trialed for its pacification, but there is little evidence of their benefit over harm. The role of invasive and non-invasive Neurostimulation treatments, supposed to be very effective, are also little known. The introduction of Hearing aids and cochlear implantation are also not very much conclusive. No evidence of a significant change in the subjective loudness of tinnitus has been noticed with Cognitive behavioural treatment. In this way, there is a need for making an availability of uniformly accepted, broadly effective treatments capable of drastically decreasing the loudness and impact of tinnitus and withstanding systematic replication. This article is for serving the very purpose. Here, an effort has been made to present the remedial procedures and regimen for the alleviation of tinnitus described in Ayurveda, an ancient healing science of India. In Ayurveda, tinnitus has been delineated in the name of Karnanada. The article also brings about several case studies and clinical studies on tinnitus carried out at different centres/Institutes of Ayurveda.
... In the first case, psychological interventions such as cognitive behavioural therapy (CBT) would be relevant and should focus on reducing the negative impact of tinnitus and on improving overall mental health (Hesser et al., 2011). In the second case, audiological management would be relevant, potentially focusing on the improvement of hearing with carefully fitted hearing aids (Del Bo and Ambrosetti, 2007). In addition, failing to differentiate tinnitus subphenotypes with distinct degrees of hearing loss might affect results of research studies investigating tinnitus mechanisms as previously suggested (Vanneste and De Ridder, 2016). ...
Clinical management of tinnitus is rather challenging and there is yet no cure for most tinnitus cases. It is speculated that tinnitus heterogeneity is hindering progress in scientific understanding and development of treatments. Phenotyping (i.e., assessment of observable characteristics) and subphenotyping (i.e., subgrouping based on differences in observable characteristics) are important for studying heterogeneous conditions like tinnitus. Identifying and defining clinically relevant tinnitus subphenotypes could help achieve transformational advances in the field. This dissertation reports the application of several advanced methodological approaches and has two main aims. The first aim is to contribute to an international standardisation of tinnitus assessment relevant for tinnitus phenotypic profiling and subphenotyping. The second aim is to further our understanding of tinnitus heterogeneity by investigating the presence of robust subphenotypes, consistent across multiple independent datasets. Two chapters focus on the first aim. Chapter 2 reviews the literature, summarises current knowledge on tinnitus subphenotypes and identifies research gaps. It also summarises methods used so far and presents a novel framework of variable concepts that have been used for tinnitus subphenotyping. Chapter 3 describes the development of a self-report questionnaire intended to be used as a standard for tinnitus phenotyping. This questionnaire was developed through an international collaboration with tinnitus researchers from many centres. The questionnaire is already translated into 9 languages (Albanian, Dutch, French, German, Greek, Italian, Polish, Spanish, and Swedish) and is being used by multiple research teams as a tool for standardised tinnitus assessment. The second aim is addressed in Chapters 4 and 5. Chapter 4 provides a detailed description of three tinnitus-specific datasets that were subsequently analysed in Chapter 5, and highlights commonalities and differences in the studied populations and the collected variables. Chapter 5 describes a novel data-driven approach for discovering tinnitus subphenotypes. This Chapter reports on a comprehensive unsupervised machine learning methodology applied to the three datasets. Findings indicate that this method was able to identify robust tinnitus subphenotypic patterns. Finally, Chapter 6 relates the overall findings to the wider context of the published literature and presents suggestions and recommendations for future research. Age, sex, hearing ability, problems with sounds, symptoms of depression, and mandible problems were highlighted as important variables for tinnitus subphenotyping and should be considered for assessment in future tinnitus studies. Overall, this work provides a basis for standardised tinnitus assessment in future studies and gives novel insights into the characteristics of tinnitus subphenotypes.
... Although there are a number of treatment options for subjective tinnitus, including hearing aids (HA) (Del Bo and Ambrosetti, 2007), cochlear implants (CI) (Ramos Macias et al., 2015), drug therapies (Richardson et al., 2012), transcranial magnetic stimulation (TMS) (Piccirillo, 2016) and electrode implantation AC (ACEI) (De Ridder et al., 2007), none of them completely eliminates tinnitus. According to the analysis above, two strategies should be considered in the management of subjective tinnitus: restoring cortical input and eliminating pathological hyperactivity. ...
Subjective tinnitus is the most common type of tinnitus, which is the manifestation of pathological activities in the brain. It happens in a substantial portion of the general population and brings significant burden to the society. Severe subjective tinnitus can lead to depression and insomnia and severely affects patients’ quality of life. However, due to poor understanding of its etiology and pathogenesis, treatment of subjective tinnitus is remains challenging. In recent decades, a growing number of studies have shown that subjective tinnitus is related to lesion-induced neural plasticity of auditory and non-auditory central systems. This article reviews cellular mechanisms of neural plasticity in subjective tinnitus to provide further understanding of its pathogenesis.
... Auditory input is decreased in subjects with hearing impairment, and consequently neural firing rate and neural synchrony increases, resulting in the plastic reorganization of the auditory cortex, with subsequently sustained awareness of tinnitus [3,15]. Increasing the external auditory input with hearing devices can induce secondary plasticity and decrease the patients' perception of tinnitus [17][18][19]. ...
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.
... Hearing aids (HAs) have been used for tinnitus management for more than 60 years (1), as it was thought that hearing aids may act as maskers to decrease tinnitus awareness and could facilitate better communication and reduce stress. It has also been suggested that the increased level of environmental sounds may reduce the contrast between tinnitus and silence caused by hearing loss, making tinnitus less intrusive, and less annoying (2,3). Additionally, compensation for peripheral hearing deficit could theoretically normalize the elevated central gain or hyperactivity or maladaptive neural plastic changes (3)(4)(5). ...
Introduction:
Hearing aids (HAs) with frequency lowering have been used for high-frequency hearing loss (HFHL), but their effects on tinnitus relief have not been studied extensively. This randomized double-blind trial was performed to investigate and compare tinnitus suppression effects of conventional type HAs and frequency-lowering HAs in patients with HFHL.
Methods:
A total of 114 patients were randomized into three groups: conventional HA using wide dynamic range compression, HA with frequency translation, and HA with linear frequency transposition. Participants wore HAs for 3 months and then discontinued their use. The final evaluation was performed at 3 months after cessation of wearing HA (6 mo after the initial visit). The Tinnitus Handicap Inventory (THI) score and additional variables, such as matched tinnitus loudness and visual analog scale scores of subjectively perceived tinnitus loudness, daily awareness, and annoyance, were measured at the initial visit and at 3- and 6-month follow-ups.
Results:
THI score and most of the additional outcomes were significantly improved at 3 and 6 months (3 mo after HA removal) compared with their initial values in all three groups. The incidence rates of patients with improvements in the THI score by 20% or more were 71.0, 72.7, and 74.3% at 3 months, and 54.8, 51.6, and 59.4% at 6 months for the three groups, respectively. There were no significant differences in primary or additional variables between hearing aid types at either 3 or 6 months.
Conclusion:
This is a consolidated standards of reporting trials-guided study providing direct evidence for tinnitus suppression effects of HA alone, without accompanying counseling or any other treatments, which lasted for at least 3 months after patients stopped using HAs. HAs effectively suppressed tinnitus in patients with HFHL regardless of the amplification strategy type.
... However, it is unclear whether the lack of energy in the tinnitus frequency band was effective in reducing tinnitus loudness. In contrast, some studies that used a hearing aid reported that an amplification of the background sound was effective for the reduction of tinnitus loudness, based on the auditory cortex reorganization [16][17][18][19] . In summary, regarding tinnitus sounds in acoustic therapy for TRT, there are roughly two contrasting modification approaches, and they contain no energy (notched) or more energy (amplified) in the tinnitus frequency region. ...
Objectives:
In this study, our aim was to use environmental sounds amplified in the frequency region corresponding to the tinnitus frequency of individual patients and apply them as sound therapy in tinnitus retraining therapy (TRT). In this pilot study, we 1) investigated the unpleasantness of processed environmental sounds using the amplification, attenuation, and removal in different frequency regions; 2) compared the unpleasantness of processed sounds for older and younger groups of participants; and 3) determined the amplification level appropriate for a clinical test.
Materials and methods:
We processed the sound of a river with three types of modification (amplified, attenuated, and notched) at a one-octave width of seven central frequencies, in the range 250-8000 Hz. Amplified and attenuated sounds were processed with five positive gains (+6, +12, +15.6, +18, and +20 dB) and two negative gains (-6 and -12 dB). Twenty-three older participants and 23 younger participants rated the unpleasantness of sounds using a visual analog scale.
Results:
We found that, in the older group, there was no difference in unpleasantness among the three modifications. Older participants rated the level of unpleasantness as lower than younger participants for processed sounds in the high-frequency region. There were no marked differences among the amplification levels in the group of older participants.
Conclusion:
Based on the results, we decided that our clinical study would target older patients who had a tinnitus frequency over 4000 Hz and would compare the effect of an amplified sound with a 20 dB gain at the frequency corresponding to individual tinnitus with notched sound.
... If the hearing loss developed rapidly, and hearing aid recommended shortly after that, there will be practical difficulties in the use of hearing aids. If the hearing loss incurred gradually or congenital, can expect some difficulties, which implies a longer period of adjustment to the regular counseling [11]. About 70% of people with hearing loss have tinnitus, accompanying, and unpleasant symptom that by their presence exacerbates already present impairment of hearing and interfere with mood (depression) and emotions (anxiety). ...
Auditory stimulation is one of the most widely used management options for tinnitus and a part of many tinnitus management programmes. Auditory treatments for tinnitus can amplify, modulate, or convert sound to compensate for hearing impairment, or produce sound to achieve a therapeutic effect. While many treatments aim to make tinnitus less audible, auditory stimulation can also provide distraction from tinnitus, promote relaxation, promote habituation, and reverse maladaptive tinnitus-related changes in brain activity. There is limited evidence from controlled trials for the effectiveness of auditory treatments and the decision to offer such treatment is usually based on the clinical experience and patient preferences. This chapter provides an overview of the role and mechanisms of action of the available auditory stimulation options, including hearing aids, sound generators, combination hearing aids, acoustic CR® neuromodulation, modified music, and cochlear implants. A summary of clinical guideline recommendations and a review of the empirical evidence for the use of auditory treatments for tinnitus is provided, together with recommendations for further research and clinical practice.
This essay examines tinnitus in Samuel Beckett’s Embers as a hidden audiological disability that informs the core soundscape of the radio drama. Henry’s tinnitus as an invisible condition replaces his voice and transforms into a dramatic and personal anchor, one that parodies conventional radiophonic narratives by explicating how the tics of his ears propel his sonic narrative. Henry’s radiographic quest for silence is not betrayed by the phantom sound or the tic in his ears, or his troupe of phantom characters, but rather by his failure to appreciate, reveal, and prove his disability to his hearing audience. To this end, the article assays and expands key concepts in social understanding of audiological disabilities such as ‘dysconscious audism’, and ‘impaired consciousness’, to address a phonocentric culture that either suppresses or normalizes such otological disorders by disregarding them as invisible personal matters rather than a debilitating handicap.
Background: Tinnitus is often difficult to treat because it is closely related to hearing loss, central nervous system disorders, and emotional problems. Although various drug treatments have been attempted for patients with tinnitus, there is no drug that has been clearly proven to be effective. On the other hand, there are some studies showing the effectiveness of various non-pharmacological treatments for tinnitus.Current Concepts: Tinnitus is classified into subjective and objective tinnitus. Representative non-pharmacological treatments for chronic subjective tinnitus include sound therapy, hearing aids or implantable hearing rehabilitation devices, tinnitus retraining therapy, neuropsychiatric therapy, and neuromodulatory treatment. When objective tinnitus does not improve with conservative treatment, surgical treatment can be selected depending on the cause. Acupuncture treatment for tinnitus is not recommended due to lack of evidence on its effectiveness and safety.Discussion and Conclusion: Despite many studies, the mechanisms of tinnitus remain unknown. Thus, it is difficult to cure the cause of tinnitus. Because subjective responses to tinnitus vary according to the patient’s psychological state, a variety of approaches would be needed for the treatment of tinnitus.
Sound therapy using hearing aids has recently been performed for patients with chronic tinnitus also manifesting hearing loss. The aim of this study was to report the effectiveness of our sound therapy with appropriate hearing aid fitting and auditory rehabilitation, called the “Utsunomiya method,” in patients with chronic tinnitus. A total of 95 patients with chronic tinnitus with a pre-treatment Tinnitus Handicap Inventory (THI) score of at least 18 who had received hearing aids were included in this study. The average pre-treatment THI score was 55±24, with a significant decrease to 22±23 at 3 months after treatment, and a minimum of 14±18 by a year. The THI score reduction rate was 75%, and 92% of all cases showed a THI score decrease of 20 or more or a drop of the score to below 16. There was no significant difference in the percent decrease of the THI score between the bilateral and unilateral tinnitus groups. Patients with a left-right difference in hearing of 20dBHL or more tended to have a higher percent reduction of the THI score as compared to those with a difference in hearing of less than 20dBHL. The results of this study suggest that acoustic therapy with hearing aids is an effective treatment for chronic tinnitus patients with hearing loss.
Purpose:
The effect of hearing aids (HAs) and educational counseling (EC) or their combination on tinnitus is ambiguous. This study aimed to investigate whether the combined use of HAs and EC is more effective than EC alone on tinnitus relief.
Method:
A total of 72 adults with chronic, bothersome tinnitus and coexisting sensorineural hearing loss completed at least 1-month and 3-month follow-up. After receiving EC and HA prescriptions, 21 participants selected to purchase HAs (i.e., the HA + EC group), whereas the remaining 51 refused to use HAs despite recommendations (i.e., the EC group). Tinnitus severity was measured by Tinnitus Handicap Inventory (THI), Tinnitus Evaluation Questionnaire (TEQ), and Visual Analog Scale (VAS) for loudness. The primary outcome measure was THI, and tinnitus relief was defined as a 20-point or more reduction in THI. A generalized linear mixed model was used to confirm that the heterogeneity in baseline characteristics between groups did not interfere with the results.
Results:
The THI, TEQ, and VAS scores decreased significantly after treatments, and both groups yielded a similar trend of reduction. There were no significant differences in the incidence of tinnitus relief and time-to-event curves between the two groups. In addition, the length of follow-up did not affect treatment effectiveness.
Conclusion:
There was insufficient evidence to support the superiority of the combined use of HA and EC for tinnitus over EC with no device.
Background and Objectives Tinnitus retraining therapy (TRT) is one of the most effective treatment methods for tinnitus. This study aimed to evaluate the treatment response to TRT in tinnitus patients with hearing loss and to analyze an additive treatment effect of an hearing aid.Subjects and Method In this retrospective observational case-control study, we reviewed the medical records of the 80 patients who were diagnosed with sensorineural tinnitus with mild to moderate hearing loss and managed by TRT. The changes of tinnitus after TRT with or without hearing aids were measured by the questionnaire of visual analog scale (VAS) and the Tinnitus Handicap Inventory (THI) at 3, 6, 12, and 24 months after the treatment. Subjects were divided into two groups according to patients’ hearing aided condition: non-hearing aided TRT group (NHAG, n=40) and hearing aided TRT group (HAG, n=40). Treatment responses to TRT from both groups were also compared.Results All VAS scores of loudness, awareness, annoyance and effect on life of tinnitus, and THI scores were significantly decreased in both groups at 1-year follow-up period ( p <0.001). None of the delta scores of VAS and THI showed significant differences between two groups at 1-year follow-up period.Conclusion TRT turned out to be an effective treatment modality for tinnitus patients with mild to moderate hearing loss. Directive counseling with environmental sound therapy seems to be effective enough to improve patients’ symptom of tinnitus. There was no significant additive effect of hearing aids in the treatment of tinnitus following TRT during the study period; nevertheless, patients using hearing aids showed the tendency of better control of their relevant symptoms. A long-term follow-up study using a larger group should be conducted in the future.
Szumy uszne to złożone (nie tylko słuchowe) zaburzenie, któremu bardzo często towarzyszą problemy natury poznawczo-emocjonalnej. Pomimo iż szumy stanowią coraz większy problem społeczny, wciąż nie do końca poznany jest mechanizm ich powstawania. Ze względu na złożoną naturę zaburzenia nadal nie ma standardów diagnostycznych oraz w pełni skutecznych metod terapii szumów usznych. Niniejsza praca prezentuje przegląd wybranych niespecyficznych technik stosowanych w leczeniu szumów usznych, takich jak: techniki wykorzystujące zjawisko habituacji, terapia poznawczo-behawioralna (ang. Cognitive Behavioral Therapy, CBT), metody relaksacyjne oraz techniki związane z neuromodulacją i zmianą aktywności neuronalnej, takie jak: przezczaszkowa stymulacja prądem stałym (ang. transcranial Direct Current Stimulation, tDCS), przezczaszkowa powtarzana stymulacja magnetyczna (ang. Transcranial Magnetic Stimulation, TMS) czy neurofeedback.
Purpose
The purpose of the present meta-analysis is to explore the potential effects of objective verification of hearing aid amplification on tinnitus-related outcomes.
Method
Twenty-seven studies reporting tinnitus outcomes pre and post hearing aid fitting were identified through a systematic literature search. From these studies, data from 1,400 participants were included in the present meta-analysis. Studies were divided into subgroups based on whether they had reported performing objective verification of the participants' hearing aid amplification or not. Outcome measures were tinnitus distress and tinnitus loudness.
Results
Meta-analyses of all included studies indicated verified amplification to result in significantly enhanced reduction of tinnitus loudness ( p < .00001), while the enhanced reduction of tinnitus distress only approached statistical significance ( p = .07). However, when excluding an outlier from the subgroup of studies using unverified amplification, individuals receiving verified amplification showed significantly greater reduction of tinnitus distress ( p = .02). In addition, analyses of longitudinal effects revealed that the reductions of tinnitus distress decreased over time among individuals receiving unverified amplification but increased over time among individuals receiving verified amplification.
Conclusions
The present meta-analysis indicates verified hearing aid amplification to be superior to unverified amplification in terms of reduction of tinnitus loudness and distress. The longitudinal increase of mitigation of tinnitus distress with verified amplification only may reflect improved neural reorganization and/or better adherence to hearing aid use, with verified compared to unverified amplification. Due to the low cost of hearing aid verification compared to the high societal cost of tinnitus, objective verification of hearing aid amplification for tinnitus patients is recommended.
Objective
To review current information about diagnosis and management of tinnitus aiming to identify opportunities for achieving a cost-effective, efficient, evidence-based approach that meets the needs of tinnitus sufferers.
Data Sources
PubMed/MEDLINE.
Review Methods
In total, 249 relevant published reports were reviewed. Pertinent keywords and MeSH terms identified reports via PubMed and EMBASE. Acknowledged experts were consulted on ways to improve tinnitus management.
Conclusions
There may be opportunities to improve evaluation and management of patients with tinnitus using modern modes of communication and a multidisciplinary therapeutic approach.
Implications for Practice
Tinnitus can adversely affect quality of life while being time-consuming and costly to evaluate and manage. Based on both personal experience and the reports of others, patients with tinnitus who choose to see a physician primarily want to know two things: (1) that the tinnitus that is so distressing will not remain at the same level of severity forever and (2) that something can be done to help cope with the tinnitus that is so annoying. Recent advancements in internet communications, social media, information technology, artificial intelligence, machine learning, holistic medical care, mind-body integrative health care, and multidisciplinary approaches in medical therapeutics may be possibly making new ways of meeting the needs of patients with tinnitus.
ARTICLE INFO ABSTRACT The effect of Tinnitus noise in a individuals ear is a very cumbersome. It affects in patients suffering from hearing loss. Tinnitus a squeaky or flat sound which occurs internally without any external stimulation or any external sound exposure. It occurs after a sudden or a continuous exposure to a very high intensity sound, due to ototoxicity, Noise exposure and aging. There are various treatments for Tinnitus to improve their quality of life. One of them is being use of amplification devices. Hearing aids were used both for masking and hearing. This study is to compare which type of hearing aid (Digital or Analog) gives a better performance in reducing tinnitus respectively. A total of 40 participants within the age range of 16-75 years have been considered, all of them had undergone the routine audiological procedure and was diagnosed across mild-severe sensori-neural hearing loss. 20 participants have been prescribed with digital hearing aids while 20 have been prescribed with analog hearing aids. Tinnitus Handicap Inventory (THI) had been administered. Analysis on users of before hearing aid application and after use of hearing aid for 6 months and changes were done. Results shown significant difference when compared across pre and post for both the groups respectively and No significant difference when compared across the two populations.
Background:
Sound therapy is a clinically common method of tinnitus management. Various forms of sound therapy have been developed, but there are controversies regarding the selection criteria and the efficacy of different forms of sound therapy in the clinic. Our goal was to review the types and forms of sound therapy and our understanding of how the different characteristics of tinnitus patients influence their curative effects so as to provide a reference for personalized choice of tinnitus sound therapy.
Method:
Using an established methodological framework, a search of six databases including PubMed identified 43 records that met our inclusion criteria. The search strategy used the following key words: tinnitus AND (acoustic OR sound OR music) AND (treatment OR therapy OR management OR intervention OR measure).
Results:
There are various forms of sound therapy, and most of them show positive therapeutic effects. The effect of customized sound therapy is generally better than that of non-customized sound therapy, and patients with more severe initial tinnitus respond better to sound therapy.
Conclusion:
Sound therapy can effectively suppress tinnitus, at least in some patients. However, there is a lack of randomized controlled trials to identify effective management strategies. Further studies are needed to identify the most effective form of sound therapy for individualized therapy, and large, multicenter, long-term follow-up studies are still needed in order to develop more effective and targeted sound-therapy protocols. In addition, it is necessary to analyze the characteristics of individual tinnitus patients and to unify the assessment criteria of tinnitus.
Objective:
The aim of this study was to evaluate both audiological and tinnitus related results in patients with tinnitus undergoing ossicular chain reconstruction (OCR) for ossicular chain injury.
Methods:
Between January 2015 and January 2019, patients who underwent OCR due to ossicular chain pathology and developed tinnitus symptoms were included in the study group. Middle ear pathologies were standardized using the middle ear risk index (MERI) scoring system and the tinnitus handicap inventory (THI) was used to determine the severity of tinnitus. The surgical methods used for reconstruction were partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP), depending on the patient's pathology.
Results:
The study group consisted of 43 patients aged between 34 and 65 years. Mean MERI score of the patients was 6.42 ± 2.52. When assessed categorically, 18.6% of the study group was identified in the 'mild', 46.5% were in the 'moderate', and 34.5% were in the 'severe' MERI category. Patients in the TORP group and those who were undergoing second session OCR had higher MERI and preop THI scores. Post-operative tinnitus levels were higher in patients who had OCR in the second session and were in the severe risk group. The ABG and tinnitus scores of patients were found to improve with OCR. In patients who underwent TORP, both ABG and tinnitus scores decreased significantly. Whereas, in patients who underwent PORP, only ABG values decreased significantly. After OCR, both ABG value and tinnitus scores significantly decreased compared to pre-operative results. ABG recovery rate was 100% in the study group.
Conclusion:
It can be said that OCR positively changes both audiological parameters and tinnitus levels in ossicular chain pathologies.
Background: Counselling, stress reduction and sound stimulation have been effective in the management of tinnitus.
Aim of the work: It was to investigate the effectiveness of counselling and amplification and sound stimulation (Zen tones of fractal music) technology for hearing impaired patients suffering from tinnitus.
Methods: This study included 40 hearing impaired subjects with tinnitus, divided into two groups: Both received counselling for 2 months then amplification for 4 months. The study group had their hearing aids with Zen program activated.
Results: Post-counselling, none of the cases or controls showed improvement >20 points in the total tinnitus handicap inventory (THI) score. Only 20% of the study group and 15% of the controls showed improved tinnitus severity. Only one of the study group showed improvement in the tinnitus functional index (TFI) > 13 points. After hearing aids, 80% of the study group showed improvement in the tinnitus severity degree compared to 60% of the controls. And 20% improved ≥20 points in the total THI score, compared to none of the controls. Half of the study group improved in the TFI >13 points, compared to only 10% of the controls, and this was statistically significant. After 6 months, both groups showed comparable improvement in THI tinnitus severity degree: But 60% of the study group and only 15% of the controls improved ≥20 points in total THI score and this difference was statistically significant. And (85%) of the study group improved >13 points in total TFI score following both counselling and hearing aid fitting, compared to 50% of the controls, and this was statistically significant.
Conclusion: Counselling alone had no significant effect on tinnitus improvement in the hearing-impaired patients. The combined approach of counselling and amplification resulted in remarkable improvement. And added music resulted in greater improvements, but was more effective when the loudness of the perceived tinnitus was weaker.
Purpose: The purpose of this study was to determine to compare the effects of sound therapy depending on air- and bone-conduction transducers (ACT and BCT). Methods: Participants were twenty adults who have diagnosed as subjective tinnitus in this study. All participants conducted a sound therapy using the level of mixing point for three months. Participants were randomly assigned to different groups, such as the ACT group, or BCT group. To identify the effects of sound therapy, Korean tinnitus primary function questionnaire (K-TPFQ) and visual analogue scale (VAS) were administered at pre- and post-treatment (3 months) sessions. Results: In a result of mixed model analysis of variance, all subcategories for VAS showed significant decrements of scores to the measurement session (pre- vs. post-session), but there was no different between groups. Also, the overall and all subcategories for K-TPFQ showed significant decrements of scores to the measurement session (prevs. post-session), but there was no different between groups. Conclusion: As a result of this study, the sound therapy using portable hearing devices with transducers is effective for subjective tinnitus sufferers. Because the transducer type does not significantly affect effectiveness of the sound therapy, therefore, audiologists or hearing professionals may recommend transducers, which the tinnitus sufferer prefers when they consider sound therapy.
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.
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.
Background: A suggested solution to suppress tinnitus is to restore the normal sensory input. This is based on the auditory deprivation hypothesis. It is known that hearing aids can provide sufficient activation of the auditory nervous system and reduce tinnitus in subjects with mild to moderate hearing loss and that cochlear implantation can reduce tinnitus in subjects with severe to profound hearing loss. This applies to subjects with single-sided deafness (SSD) or bilateral hearing loss.
Aim: To investigate if electric-acoustic stimulation (EAS) can reduce severe tinnitus in a subject with residual hearing in the ipsilateral ear and contralateral normal hearing (high-frequency SSD) by restoring the auditory input.
Methods: Tinnitus reduction was investigated for 1 year after implantation in a subject with high-frequency SSD, who uses EAS, and was compared to 11 subjects with a cochlear implant (CI) with SSD. The Visual Analogue Scale (VAS) and the Tinnitus Questionnaire (TQ) were administered pre-operatively and at 1, 3, 6, and 12 months after implantation.
Results: Significant tinnitus reduction was observed 1 month after implantation on the VAS in the subjects with SSD using a CI. Tinnitus reduction was also observed in the subject with high-frequency SSD using EAS. A further decrease was observed 3 months after implantation. The TQ and VAS scores remained stable up to 1 year after implantation.
Conclusion: A CI can significantly reduce ipsilateral severe tinnitus in a subject with SSD. Ipsilateral severe tinnitus can also be reduced using EAS in subjects with high-frequency SSD.
Remarkable progress in hearing aid technologies has been made in the recent past. The sound clarity of devices has improved significantly, considering that reduction of background noise remained a major issue with earlier-generation devices. The current-generation hearing aids enable noise reduction, speech enhancement, more comfortable enjoyment of music, and most recently, amplification to 10-12 kHz. In this review, I shall review the history of hearing aids and changes in hearing aids over the years, cover solutions to various problems, as well as the historical changes of hearing aids by some manufacturers. For this purpose, I draw on our ongoing evaluation of 2468 patients fitted with hearing aids from 2001 to 2016. A comparison of the three histograms of our patients divided by age group from 2001-2008, 2001-2015 and 2001-2016 reflects an aging society that will require special care, for example, in relation to hearing loss and tinnitus, which can be met with the currently available hearing-aid technologies.
The neurophysiological model of tinnitus postulates that many systems in the brain are involved in tin-nitus and decreased sound tolerance, with the auditory system playing a secondary role. Stress is on the role of the limbic and autonomic nervous systems , subconscious processing of information, subconscious learning, and creation and extinction of conditioned reflexes. The model is based on general neurophysiology and behavioral neuroscience. A clear distinction is made between tinnitus perception and tinnitus-evoked reactions (eg, annoyance, anxiety, depression, difficulty concentrating). Tinnitus as a problem arises from sustained activation of the limbic and autonomic nervous systems , particularly of the sympathetic part of the autonomic nervous system. Tinnitus is defined as a phantom auditory perception , 1 that is, perception of the sound without corresponding acoustic or mechanical correlates in the cochlea. In other words, tinnitus results exclusively from perception of an activity within the nervous system (the tinnitus-related neuronal activity) and is not related to any external or internal auditory stimulus. As presented in this chapter, the model is sufficiently general to encompass the perception of and reaction to tinnitus and external sounds. Issues related to decreased tolerance to external sounds are discussed in Chapter 2, "Decreased Sound Tolerance," and are only briefly alluded to in this chapter. The description of the model focuses on the functional interactions of the various systems in the brain rather than on their anatomic components. The model, however, remains the same as described previously. Although the specific mechanisms responsible for emergence of tinnitus-related neuronal activity are irrelevant for the model, it is customary and convenient to delineate the potential mechanisms generating the tinnitus-related neuronal activity and tinnitus perception while discussing tinnitus. Therefore, the discordant dysfunction theory 1,4 is briefly outlined here. The discordant dysfunction theory postulates that tin-nitus-related neuronal activity is generated in the dorsal cochlear nucleus as a result of disinhibition caused by the decreased or absent signal from type II auditory nerve fibers resulting from damaged or dys-functional outer hair cells (OHCs), whereas inner hair cells (IHCs) are still functioning reasonably well. Each part of the cochlear basilar membrane with local damage to the OHCs will serve as a source for tinni-tus-related neuronal activity, with the strength of the signal depending on the difference in functional properties between OHCs and IHCs located on this particular part of the basilar membrane. If there is only one area with discordant dysfunction of OHCs and IHCs, the individual will perceive tonal tinnitus. In typical cases of complex tinnitus sound perception, the final tinnitus signal is composed of signals created at many locations. This signal is further enhanced in the subconscious part of the auditory pathways and is finally perceived at a high cortical level. Recent experimental data support the discordant dysfunction theory by showing that tinnitus is related to damage to OHCs but not IHCs or hearing loss. 5
This study was undertaken to assess long-term changes in tinnitus severity exhibited by patients who purchased and used ear-level devices (hearing aids or sound generators).
Patients were evaluated and treated within a comprehensive tinnitus management program. Follow-up questionnaires were mailed to patients 6 to 48 months after their initial appointment.
Follow-up questionnaires from 150 patients were reviewed. Fifty patients purchased and used hearing aids, 50 patients purchased and used in-the-ear sound generators for an average of 18 months after their initial appointment; 50 patients did not use ear-level devices. At follow-up, all 3 groups of patients exhibited significant reductions in Tinnitus Severity Index scores and self-rated tinnitus loudness. Patients who used ear-level devices reported greater improvement than patients who did not use hearing aids or sound generators.
Ear-level devices such as hearing aids or sound generators can help a significant number of patients who experience chronic tinnitus. Both types of devices reduce patients' perception of tinnitus and can facilitate habituation to the symptom. Amplification provides additional benefits of improved hearing and communication.
Objective
To evaluate the response of tinnitus in Ménière’s disease patients (MD) using the Tinnitus Retraining Therapy (TRT). This management includes a wide cognitive medical counselling and natural or prosthetic sound therapies (hearing aid or noise generator).
Design
Descriptive prospective study (EBM level 3).
Patients
Twenty-five patients diagnosed as definitive MD (AAO-HNS 95 criteria) were enrolled in our tinnitus protocol.
Main outcome measures
El objetivo del trabajo es diseñar un modelo computadorizado tridimensional del conducto auditivo externo humano. Nos basamos en el método de los elementos finitos, que consiste en dividir un determinado recinto espacial en una malla de elementos simples conectados entre sí por nodos, asociando después a cada elemento ecuaciones que definen sus características físicas. Al resolver las ecuaciones resultantes se logra reproducir la realidad mediante una ejecución numérica computadorizada. El modelo reproduce las características acústicas y mecánicas del conducto auditivo externo humano, lo que nos permitirá, tras acoplarlo a un modelo del oído medio, conocer la respuesta de ambos sistemas ante una excitación sonora, sin necesidad de acudir a mediciones reales o modelos biológicos. El desarrollo de este modelo computadorizado permite conocer las características mecanoacústicas del conducto, lo que facilita la comprensión de la fisiología de esta porción externa del órgano de la audición.
Results
Seventy-three percent of the patients improved their tinnitus after 6 months of treatment (p<0.05). THI scores were reduced from the initial 47% to 24% (p<0.05) and EVA from 6.6 to 5.2 (p<0.05). After 12 months, the response was slightly worse: 68% improved according to their self-evaluation (p<0.05), THI score reached 20% (p<0.05) but EVA did not improve significantly (6.4). Patients that refused prosthesis adaptation (hearing aid or noise generator) did not improved and the THI score (48%) and EVA score (6.6) did not change.
Conclusions
TRT has proved to be an effective method for tinnitus treatment in MD that improves patient’s self-evaluation, tinnitus loudness and handicap scores. Individualized medical counselling and an exhaustive prosthesis adaptation are crucial to guarantee satisfactory results.
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.
Two hundred four subjects supplied with binaural hearing aids through the British National National Health Service were surveyed by means of a postal questionnaire regarding their use of, attitudes of, and satisfaction with the two aids. The majority were using both aids regularly and extensively, and with high levels of satisfaction. Background noise was identified as the acoustic environment creating the greatest difficulty. Wind noise especially was a problem, although a few subjects had devised ways of coping. Significantly better attitudes within the family were reported by the good users, but it was not possible to establish which was cause and which effect. Binaural aids were reported as being significantly better than monaural aids in reducing the problems associated with tinnitus, which was present in almost half the subjects surveyed. Undoubtedly the majority of the patients reviewed believed that their auditory performance, social competence, and personal enjoyment of life were enhanced since changing to binaural aids.
Several studies in the U.S.A. have shown that tinnitus aurium can be reduced by use of maskers or hearing aids. Contrary to the noise of tinnitus, that produced by the masker or hearing aid is localised outside the ear and is less troublesome to most people. Comparing the benefits of both methods (masker against hearing aid) a study of 108 patients with tinnitus aurium was carried out. A group of 58 suitable patients were provided either with tinnitus maskers or with hearing aids for a few weeks. Satisfactory masking was achieved in about 50 per cent of those using hearing aids whereas this was achieved in only 10 per cent using tinnitus maskers.
An electrical tinnitus suppressor, which was developed at Hokkaido University, was implanted in a female tinnitus patient. She had suffered from bilateral chronic otitis media and her bilateral hearing was seriously impaired. The electrical tinnitus suppressor consists of a stimulator, a coil inside the plastic hearing aid case and an implanted coil in the mastoid. The auditory nerve is stimulated at home twice. Using the system, her hearing ability and emotion improved in addition to tinnitus suppression. Her hearing level and tinnitus also improved in the ear contralateral to the stimulated side.
This study assessed the effects of hearing aids on the perception of tinnitus using the Tinnitus Handicap Inventory (THI). THI benefit scores (unaided-aided) were examined in relation to hearing aid benefit as measured with the Abbreviated Profile of Hearing Aid Benefit (APHAB) inventory. The THI benefit was also related to the users' ratings of overall satisfaction with their hearing aids. Thirty-four novice hearing aid users with complaints of hearing loss and tinnitus participated in the study. Outcome measures were obtained 6 weeks after the hearing aid fittings. The results showed that hearing aid use reduced tinnitus handicap significantly, but, typically, the effect was small. The association between overall satisfaction ratings and THI benefit scores was weak. In contrast, the overall satisfaction ratings were strongly related to benefit on the speech subscales (average of Ease of Communication, Reverberation, and Background Noise) but not on the Aversiveness subscale of the APHAB. The weak relationship observed between THI benefit and benefit on the speech subscales of the APHAB suggested that the two inventories were not redundant. The results of the study suggest that the THI can make a useful contribution to the overall profile of hearing aid benefit for new hearing aid users with tinnitus.
Abbreviations: AA&SC = Army Audiology and Speech Center, APHAB = Abbreviated Profile of Hearing Aid Benefit, AV = Aversiveness of Sounds subscale, BN = Background Noise subscale, C = Catastrophic subscale, cd = critical difference, E = Emotional subscale, EC = Ease of Communication subscale, E = Emotional subscale, F = functional subscale, RV = Reverberation subscale, THI = Tinnitus Handicap Inventory
The BAHA is the only cochlea stimulator in clinical use using bone conduction as the mode of stimulation. Sound transmitted through bone conduction is a natural way of hearing and the fundamentals of bone conduction are presented. The simple but important procedure has been refined and is presented in some detail. As the BAHA is approved by the Food and Drug Administration for children, aspects relevant for this age group will be addressed. The future includes semi-implantable BAHA, percutaneous electrical coupling, and a BAHA for tinnitus suppression.
As part of a quality of life study, 84 patients who received multichannel intra-cochlear cochlear implants (CIs) were evaluated regarding tinnitus problems by a questionnaire. As controls, 60 hearing aid (HA) users and 35 non-operated CI candidates were used. The prevalence of tinnitus in the CI group was 70%, and that of troublesome tinnitus was 35%. In the two other groups, the prevalences of tinnitus were 40% (HA) and 74% (non-CI). Twenty-three per cent of HA users and 51% of non-operated CI candidates had troublesome tinnitus. CIs were found to be superior to HAs in reducing tinnitus, 54% of the CI patients with tinnitus experiencing a reduction in tinnitus when using a CI. In the other two groups, 4% of HA users and 23% of non-operated CI candidates experienced a reduction in tinnitus when using an HA. Eight per cent of the CI patients with tinnitus experienced an increase in tinnitus when using their implant. Not having paid employment was independently associated with troublesome tinnitus in all three groups.
Application of high-rate pulse trains (e.g., 4800 pps) to the cochlea may represent an effective treatment of tinnitus.
Tinnitus is a widespread clinical problem with multiple treatments but no cure. A cure for tinnitus would restore the perception of silence. One plausible hypothesis for the origin of tinnitus associated with sensorineural hearing loss is that it is due to loss or alteration of the normal spontaneous activity in the deafferented regions of the cochlea. Electrical stimulation of the cochlea with 5000-pps pulse trains can produce spontaneous-like patterns of spike activity in the auditory nerve.
Eleven volunteer human subjects with bothersome tinnitus and high-frequency sensorineural hearing loss underwent myringotomy and temporary placement of a round window electrode. High-rate pulse train stimuli were presented at various stimulus intensities and tinnitus, and stimulus perception were scaled by the subject. Three cochlear implant recipients with tinnitus in the implanted ear underwent similar stimulation.
Five of 11 (45%) of transtympanic subjects showed substantial or complete tinnitus suppression with either no perception or only a transient perception of the stimulus. Three showed tinnitus suppression only in association with the perception of the stimulus. Three showed no effects on tinnitus. A similar pattern of responses was seen in the cochlear implant subjects.
Although the study lacked an ideal placebo control, the results are promising and support further research to develop a clinically useful intervention for this troubling disorder.
Several studies have already demonstrated that patients with steeply sloping hearing loss of cochlear origin exhibit an improvement in frequency discrimination performance at or around the cut-off frequency. This enhancement cannot be explained in terms of peripheral mechanisms and should rather be interpreted in terms of central reorganization: i.e., injury-induced cortical plasticity. However, the reversibility and time course of such reorganization has not yet been described. The main goal of the present study was therefore to investigate the occurrence of rehabilitation plasticity associated with hearing-aid fitting in human subjects. Nine subjects with steeply sloping hearing loss and who were candidates for auditory rehabilitation were tested. Discrimination-limen-for-frequency (DLF) enhancement was investigated at the frequency with the best DLF (bDLF) for each individual subject before and during auditory rehabilitation (at 1 month, 3 months and 6 months). From 1 month on, frequency discrimination performance decreased significantly at the bDLF frequency, while remaining stable at other frequencies. This normalization may reflect a new central reorganization reversing the initial injury-induced changes in the cortical map. A correlation between subject's age and alteration in DLF at 1 month was also found, suggesting that plasticity operates faster in younger patients.
To evaluate the response of tinnitus in Meniere's disease patients (MD) using the Tinnitus Retraining Therapy (TRT). This management includes a wide cognitive medical counselling and natural or prosthetic sound therapies (hearing aid or noise generator).
Descriptive prospective study (EBM level 3).
Twenty-five patients diagnosed as definitive MD (AAO-HNS 95 criteria) were enrolled in our tinnitus protocol. Main outcome measures: Tinnitus changes were reported according to patient's self-evaluation, a visual analogue scale on tinnitus intensity (EVA) and the Tinnitus Handicap Inventory (THI).
Seventy-three percent of the patients improved their tinnitus after 6 months of treatment (p < 0.05). THI scores were reduced from the initial 47% to 24% (p < 0.05) and EVA from 6.6 to 5.2 (p < 0.05). After 12 months, the response was slightly worse: 68% improved according to their self-evaluation (p < 0.05), THI score reached 20% (p < 0.05) but EVA did not improve significantly (6.4). Patients that refused prosthesis adaptation (hearing aid or noise generator) did not improved and the THI score (48%) and EVA score (6.6) did not change.
TRT has proved to be an effective method for tinnitus treatment in MD that improves patient's self-evaluation, tinnitus loudness and handicap scores. Individualized medical counselling and an exhaustive prosthesis adaptation are crucial to guarantee satisfactory results.
The aim of this study is to describe tinnitus epidemiological characteristics in Ménière's disease (MD), the prognosis and its interaction with other MD symptoms. It is a descriptive transversal study. One hundred two MD patients were referred to a tinnitus clinic. Tinnitus was evaluated according to psychoacoustical tinnitogram, visual analogue scale, and tinnitus handicap inventory (THI). All patients were diagnosed with definitive MD (following AAO-HNS' 95 criteria). Pitch was more commonly identified in low and medium frequencies. Psychoacoustical intensity was matched in 12.7 dB. The visual analogue scale showed a value of 7.1, while THI score reached an average of 49%. Compared with other aetiologies (acoustic trauma, otosclerosis), MD showed a statistical difference in tinnitus severity parameters (P<0.05). Tinnitus increased VAS and THI score as a function of duration and bilateral disease (P<0.01). We found a statistical association (P<0.05) between tinnitus intensity and worse hearing loss or hyperacusis, but it was not influenced by number of vertigo spells. Higher MD stage increased tinnitus intensity and handicap. Tinnitus in MD patients referred to our tinnitus clinic presents a high intensity and handicap levels and represents the most troublesome symptom. Severity is influenced by the longer duration of the disease, the bilateral affection, hearing impairment or hyperacusis and a higher MD stage.
Noise-induced hearing loss induces reorganization of the tonotopic map in cat auditory cortex and increases spontaneous firing rate and neural synchrony. We showed previously that keeping cats after noise trauma in an acoustic environment enriched in high frequencies prevents tonotopic map reorganization. Here, we show the effects of low-frequency and high-frequency enriched acoustic environments on spontaneous firing rate and neural synchrony. Exposed cats placed in the quiet environment and in the low-frequency enriched acoustic environment showed increased spontaneous firing rate and synchrony of firing. In contrast, exposed cats placed in the high-frequency enriched acoustic environment did not show significant differences in spontaneous firing rate or synchrony compared with normal hearing controls. This is interpreted as an absence of putative neural signs of tinnitus.
Tinnitus, the perception of a sound in the absence of acoustic stimulation, is often associated with hearing loss. Animal studies indicate that hearing loss through cochlear damage can lead to behavioral signs of tinnitus that are correlated with pathologically increased spontaneous firing rates, or hyperactivity, of neurons in the auditory pathway. Mechanisms that lead to the development of this hyperactivity, however, have remained unclear. We address this question by using a computational model of auditory nerve fibers and downstream auditory neurons. The key idea is that mean firing rates of these neurons are stabilized through a homeostatic plasticity mechanism. This homeostatic compensation can give rise to hyperactivity in the model neurons if the healthy ratio between mean and spontaneous firing rate of the auditory nerve is decreased, for example through a loss of outer hair cells or damage to hair cell stereocilia. Homeostasis can also amplify non-auditory inputs, which then contribute to hyperactivity. Our computational model predicts how appropriate additional acoustic stimulation can reverse the development of such hyperactivity, which could provide a new basis for treatment strategies.
Chronic tinnitus is often accompanied by a hearing impairment, but it is still unknown whether hearing loss can actually cause tinnitus. The association between the pitch of the tinnitus sensation and the audiogram edge in patients with high-frequency hearing loss suggests a functional relation, but a large fraction of patients with hearing loss does not present symptoms of tinnitus. We therefore, investigated how the occurrence of tinnitus is related to the shape of the audiogram. We analyzed a sample where all patients had noise-induced hearing loss, containing 30 patients without tinnitus, 24 patients with tone-like tinnitus, and 17 patients with noise-like tinnitus. All patients had moderate to severe high-frequency hearing loss, and only minor to moderate hearing loss at low frequencies. We found that tinnitus patients had less overall hearing loss than patients without tinnitus. Moreover, the maximum steepness of the audiogram was higher in patients with tinnitus (-52.9+/-1.9 dB/octave) compared to patients without tinnitus (-43.1+/-2.4 dB/octave). Differences in overall hearing loss and maximum steepness between tone-like and noise-like tinnitus were not significant. For tone-like tinnitus, there was a clear association between the tinnitus pitch and the edge of the audiogram, with tinnitus pitch being on average 1.48+/-0.12 octaves above the audiogram edge frequency, and 0.81+/-0.1 octaves above the frequency with the steepest slope. Our results suggest that the occurrence of tinnitus is promoted by a steep audiogram slope. A steep slope leads to abrupt discontinuities in the activity along the tonotopic axis of the auditory system, which could be misinterpreted as sound.
Evidence has accumulated in the last decade that the dorsal cochlear nucleus (DCN) may be an important site in the etiology of tinnitus. This evidence comes from a combination of studies conducted in animals and humans. This paper will review the key findings, as follows. 1) Direct electrical stimulation of the DCN leads to changes in the loudness of tinnitus. This suggests that the loudness of tinnitus may be linked to changes in the level of neural activity in the DCN. 2) Exposure to tinnitus inducers, such as intense sound or cisplatin, causes neural activity in the DCN to become chronically elevated, a condition known as neuronal hyperactivity. 3) This hyperactivity is very similar to the activity that is evoked in the DCN by sound stimulation, suggesting that the hyperactivity represents a code that signals the presence of sound, even when there is no longer any sound stimulus. 4) Noise-induced hyperactivity in the DCN is correlated with tinnitus. Behavioral studies have demonstrated that animals exposed to the same intense sound that causes hyperactivity in the DCN develop tinnitus-like percepts. The correlation between the level of hyperactivity and the behavioral index of tinnitus was found to be statistically significant. 5) The DCN is a polysensory integration center, and electrophysiological studies have shown that both spontaneous activity and hyperactivity of neurons in the DCN can be modulated by stimulation of certain ipsilateral cranial nerves, such as the sensory branch of the trigeminal nerve. This ipsilateral modulation of DCN activity offers a plausible explanation of how tinnitus, when perceived on one side, can be modulated by certain manipulations of the head and neck on the side ipsilateral to the tinnitus, but rarely on the contralateral side. 6) The DCN exhibits various forms of neuronal plasticity that parallel the various forms of plasticity that characterize tinnitus. These findings collectively strengthen the view that the DCN may be a key structure that should be included as a target of anti-tinnitus treatment.
Sound stimulation via bone conduction for tinnitus relief: a pilot study
- Holgers
Digital instruments for tinnitus management: mixing point identification and thresholds-adjusted noise
- Searchfield
Epidemiology of hearing impairment
- Davis
Role of hearing aids in management of tinnitus
- Sheldrake