Article

Clinical Guide for Audiologic Tinnitus Management I

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Abstract

This article is the first of 2 that present basic guidelines for audiologists to provide clinical management of tinnitus. The method, termed audiologic tinnitus management (ATM), was developed to incorporate management strategies that can be implemented most efficiently by audiologists. Development of ATM has been drawn from the clinical and research experience of the authors and numerous audiologists. Certain elements of ATM are adapted from the methods of tinnitus masking and tinnitus retraining therapy. Procedures are described in the present article for performing the intake assessment, while the companion article (J. A. Henry, T. L. Zaugg, & M. A. Schechter, 2005) describes treatment methodology. Development of ATM has resulted in defined procedures to conduct a basic tinnitus assessment that includes written questionnaires, an intake interview, audiologic evaluation, and a psychoacoustic assessment of tinnitus perceptual characteristics. If patients report a sound tolerance problem (hyperacusis), loudness discomfort levels are measured at audiometric frequencies. There are special procedures for selecting hearing aids, ear-level noise generators, combination devices (noise generator and hearing aid combined), and personal listening devices (i.e., portable radios and tape, CD, and MP3 players). This article explains each of these assessment components in detail. Adoption of the ATM assessment protocol by audiologists can contribute to the establishment of uniform procedures for the clinical management of tinnitus patients.

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... For tinnitus pitch matching, a two-alternative forced-choice procedure and octave confusion test using stimuli presented at 10 dB SL was performed in the contralateral ear to avoid confusion between the tinnitus perception and external auditory stimulus. [41][42][43] Stimuli were pure tones or narrow band noises respectively for subjectively perceived tonal-or noise-like tinnitus. Tinnitus pitch matching could be performed in half-octave frequencies between 0.125 and 16 kHz. ...
... Subsequently, tinnitus loudness (in dB SL) was matched using 1 dB steps relative to the ipsilateral hearing threshold at the pitch-matched frequency. The difference between the hearing threshold and this loudness match was recorded in dB SL. 43 Tinnitus loudness could not be determined in one patient because of the severity of hearing loss. Tinnitus pitch and loudness match was repeated until the external auditory stimulus resembled the tinnitus with a score of at least 7 out of 10 using a visual analogue scale. ...
... White noise was presented binaurally for patients with bilateral or central tinnitus, and monaurally for those with unilateral tinnitus. 43 Tinnitus was not maskable in eight patients including the one case in which tinnitus loudness could not be determined. ...
Article
Objectives: Chronic tinnitus is associated with reduced auditory input, which results in changes in the central auditory system. This study aimed to examine the relationship between tinnitus pitch and parameters of audiometry and distortion product otoacoustic emissions. For audiometry, the parameters represented the edge frequency of hearing loss, the frequency of maximum hearing loss and the frequency range of hearing loss. For distortion product otoacoustic emissions, the parameters were the frequency of lowest distortion product otoacoustic emission amplitudes and the frequency range of reduced distortion product otoacoustic emissions. Method: Sixty-seven patients (45 males, 22 females) with subjective chronic tinnitus, aged 18 to 73 years, were included. Results: No correlation was found between tinnitus pitch and parameters of audiometry and distortion product otoacoustic emissions. However, tinnitus pitch fell mostly within the frequency range of hearing loss. Conclusion: The current study seems to confirm the relationship between tinnitus pitch and the frequency range of hearing loss, thus supporting the homeostatic plasticity model.
... Schecklmann M., 1 Lehner A., 1 Kreuzer P.M., 1 Poeppl T.B., 1 Background: Tinnitus is a consequence of neuroplastic alterations along the auditory pathway. The main models of tinnitus are based on maladaptation in inhibitory mechanisms resulting in neural hyperactivity, i.e., reduced feed-forward inhibition and lateral inhibition. ...
... Schecklmann M., 1 Lehner A., 1 Kreuzer P.M., 1 Poeppl T.B., 1 Background: Tinnitus is a consequence of neuroplastic alterations along the auditory pathway. The main models of tinnitus are based on maladaptation in inhibitory mechanisms resulting in neural hyperactivity, i.e., reduced feed-forward inhibition and lateral inhibition. ...
... Schecklmann M., 1 Lehner A., 1 Kreuzer P.M., 1 Poeppl T.B., 1 Background: Tinnitus is a consequence of neuroplastic alterations along the auditory pathway. The main models of tinnitus are based on maladaptation in inhibitory mechanisms resulting in neural hyperactivity, i.e., reduced feed-forward inhibition and lateral inhibition. ...
... Speech reception threshold was performed using the CIDW1 spondee word list and speech discrimination testing was conducted using the NAL word list. 5. Psychoacoustical measurements of tinnitus were performed through headphones using the AC40 audiometer. These consisted of tinnitus pitchand loudness-matching procedures as these measures aid in documenting the nature and severity of the tinnitus, as well as facilitating appropriate use of acoustical therapy and evaluation of treatment effects (Henry et al., 2005). Firstly, a noise band centred at the frequency of 1 kHz and a tone at 1 kHz was presented in an alternating fashion, at 20 dB SL (Bauer & Brozoski, 2006). ...
... If the individual matched their tinnitus to a noise band, comparative noise bands were presented, beginning at 2 kHz. This 2AFC procedure was continued until there was a frequency reversal (Henry et al., 2005). The final frequency selected was confirmed by an octave confusion test, whereby the selected tone was compared with a tone one octave higher. ...
... The pitch matching results are very useful in counselling a tinnitus sufferer. Pitch match is also useful for the selection and fitting of tinnitus maskers (Henry et al., 2005). Hence, tinnitus pitch characteristics in patients with TMD may need to be investigated further, using a larger sample of participants, with the use of extended high-frequency testing. ...
Article
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Background: Tinnitus is one of the otologic symptoms commonly reported to be associated with temporomandibular disorder (TMD), and questions regarding its nature and cause continue to plague the clinical and research community. Objectives: The current pilot study aimed to investigate the clinical signs and symptoms of presenting tinnitus in a group of individuals with TMD (group A), and compare them with a group with tinnitus but without TMD (group B). Twenty participants were included in the study, 10 from each group. Methods: All participants underwent basic audiological as well as ear, nose and throat (ENT) evaluations to establish group A and group B. For tinnitus assessment, all participants completed a tinnitus survey questionnaire, and their tinnitus was evaluated using tinnitus matching procedures. Results: Findings revealed clinically relevant differences in attributes of tinnitus in patients with and without TMD. Most of the participants in group A matched their tinnitus to a 6 000 Hz tone or noise, at lower intensity levels than participants in group B, although these results were not statistically significant. Participants in group A associated their tinnitus with a single sound whereas some participants in group B associated it with more than one sound. More participants in group B reported the duration of their tinnitus as constant. Conclusions: Tinnitus may occur in patients with TMD, and be of high frequency. This highlights the importance of thorough assessment for patients with tinnitus as this might have implications for diagnosis and management.
... 10,11 Questions are asked to establish characteristics, such as tinnitus type, location and onset, and psychoacoustic measurements of tinnitus pitch, loudness and maskability are performed. 9,12 Several studies, however, have reported minimal or even absent relationships between the tinnitus characteristics and its perceived severity. 7,[13][14][15][16][17] Some authors have reported that factors other than the audiological characteristics of tinnitus are important for explaining differences in perceived tinnitus severity among patients. ...
... Depending on these characteristics, tinnitus pitch matching was performed using pure tone, narrow band noise or white noise. The stimulus was presented in one ear at an intensity of 10 dB SL. 12,31 The pitchmatching procedure consisted of a two-alternative forced choice procedure and a test for octave confusion. 12,31 Tinnitus was matched to half-octave frequencies between 0.125 and 20 kHz. ...
... The stimulus was presented in one ear at an intensity of 10 dB SL. 12,31 The pitchmatching procedure consisted of a two-alternative forced choice procedure and a test for octave confusion. 12,31 Tinnitus was matched to half-octave frequencies between 0.125 and 20 kHz. ...
Article
Objective: This study aimed to determine the characteristics of tinnitus and tinnitus-related variables and explore their possible relationship with tinnitus-related handicap. Methods: Eighty-one patients with chronic tinnitus were included. The study protocol measured hearing status, tinnitus pitch, loudness, maskability and loudness discomfort levels. All patients filled in the Tinnitus Sample Case History Questionnaire, the Hyperacusis Questionnaire and the Tinnitus Handicap Inventory. The relationship of each variable with the Tinnitus Handicap Inventory score was evaluated by univariate and multivariate analyses. Results: Five univariables were associated with the Tinnitus Handicap Inventory score: loudness discomfort level, subjective tinnitus loudness, tinnitus awareness, noise intolerance and Hyperacusis Questionnaire score. Multiple regression analysis showed that the Hyperacusis Questionnaire score and tinnitus awareness were independently associated with the Tinnitus Handicap Inventory score. Conclusion: Hyperacusis and tinnitus awareness were independently associated with the Tinnitus Handicap Inventory score. Questionnaires on tinnitus and hyperacusis are especially suited to providing additional insight into tinnitus-related handicap and are therefore useful for evaluating tinnitus patients.
... Schecklmann M., 1 Lehner A., 1 Kreuzer P.M., 1 Poeppl T.B., 1 Background: Tinnitus is a consequence of neuroplastic alterations along the auditory pathway. The main models of tinnitus are based on maladaptation in inhibitory mechanisms resulting in neural hyperactivity, i.e., reduced feed-forward inhibition and lateral inhibition. ...
... Schecklmann M., 1 Lehner A., 1 Kreuzer P.M., 1 Poeppl T.B., 1 Background: Tinnitus is a consequence of neuroplastic alterations along the auditory pathway. The main models of tinnitus are based on maladaptation in inhibitory mechanisms resulting in neural hyperactivity, i.e., reduced feed-forward inhibition and lateral inhibition. ...
... Schecklmann M., 1 Lehner A., 1 Kreuzer P.M., 1 Poeppl T.B., 1 Background: Tinnitus is a consequence of neuroplastic alterations along the auditory pathway. The main models of tinnitus are based on maladaptation in inhibitory mechanisms resulting in neural hyperactivity, i.e., reduced feed-forward inhibition and lateral inhibition. ...
... Sound therapy has been established in clinical practice and can be applied in several therapeutic approaches, such as: Tinnitus Retraining Therapy -TRT and Tinnitus Activities Treatment -TAT (10,11,12) . These approaches associate sound therapy with counseling, which consists of basic information about tinnitus, hearing loss, attention and habituation. ...
... Although there is no consensus on the treatment of tinnitus, the use of HAs is embedded in different therapeutic approaches, such as masking therapy (stable sound stimulus emission); TRT (tinnitus habituation therapy, based on the neurophysiological Figure 2. Degree of annoyance of tinnitus in initial assessment and final evaluation model); TAT (counseling, considering differences and individual needs) (10,11,12) , which act on habituation, partial or total masking of tinnitus and help decrease symptom perception (14) . ...
Article
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Introduction Tinnitus has often been reported associated with auditory complaints. Purpose To verify the applicability of the speech-language and hearing pathologist orientation associated with the use of hearing aids (HAs) in the reduction of the tinnitus sensation. Methods Patients with tinnitus associated with hearing loss were selected. The study was developed in two stages: initial evaluation - after patient referral for HA adaptation and final evaluation - after three months of effective use of HAs. The groups were divided into three groups: Group A (8 individuals adapted to HA without orientation for tinnitus), Group B (8 individuals adapted with HA with verbal orientation for tinnitus), and Group C (8 individuals adapted to HA with verbal orientation associated with tinnitus support material). The sample responded to the Tinnitus Handicap Inventory (THI) at the first moment and after three months of effective use of the HA to measure a handicap modification for symptoms in its total score and in the three domains. For statistical analysis, applied tests were performed, adopting a level of significance less than 5%. Results All groups presented improvement in tinnitus, and better results were observed when the patient received guidance regarding tinnitus. In addition, it was observed that there was significant difference between the groups for only one emotional domain of the THI, in which group C presented better results than groups A and B (p<0.05). Conclusion The spech-language and hearing therapist orientation associated with the use of hearing aids may favor the reduction of tinnitus sensation. Clinical trials 4939
... It causes various emotional reactions that may affect the quality of life in different manners. 3 Measurement, quantification, and description of tinnitus depend on the Keywords ► tinnitus ► subjective ► auditory processing disorder ► auditory pathway disorders ► central ...
... Measures of tinnitus include tinnitus pitch and loudness matching. 3,11 Tinnitus matching was performed in the nontinnitus ear when tinnitus was unilateral and in the better ear when tinnitus was bilateral. 12 ...
Article
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Introduction Cochlear or neural mechanisms of tinnitus generation may affect auditory temporal resolution in tinnitus patients even with normal audiometry. Thus, studying the correlation between tinnitus characteristics and auditory temporal resolution in subjects with tinnitus may help in proper modification of tinnitus management strategy. Objective This study aims to examine the relationship between the psychoacoustic measures of tinnitus and the auditory temporal resolution in subjects with normal audiometry. Methods Two normal hearing groups with ages ranging from 20 to 45 years were involved: control group of 15 adults (30 ears) without tinnitus and study group of 15 adults (24 ears) with tinnitus. Subjective scaling of annoyance and sleep disturbance caused by tinnitus, basic audiological evaluation, tinnitus psychoacoustic measures and Gaps in Noise test were performed. Data from both groups were compared using independent sample t-test. Psychoacoustic measures of tinnitus and Gaps in Noise test parameters of the tinnitus group were correlated with Pearson's correlation coefficient. Results Significantly higher hearing threshold, higher approximate threshold and lower correct Gaps in Noise scores were observed in tinnitus ears. There was no significant correlation between psychoacoustic measures of tinnitus and Gaps in Noise test parameters of the tinnitus group. Conclusion Auditory temporal resolution impairment was found in tinnitus patients, which could be attributed to cochlear impairment or altered neural firing within the auditory pathway. It is recommended to include temporal resolution testing in the tinnitus evaluation battery to provide a proper management planning.
... This scale is a survey with 25 items and divided into three subscales: functional, catastrophic, and emotional, with a total score ranging from 0 to 100. It grades five tinnitus severity categories: slight (0-16); mild (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36); moderate (38-56); severe (58-76); and catastrophic (78-100). Psychoacoustic characteristics of tinnitus, including its loudness and pitch, were measured using the standard clinical method by presenting sounds similar to those described by the patient [27,28]. ...
... It grades five tinnitus severity categories: slight (0-16); mild (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36); moderate (38-56); severe (58-76); and catastrophic (78-100). Psychoacoustic characteristics of tinnitus, including its loudness and pitch, were measured using the standard clinical method by presenting sounds similar to those described by the patient [27,28]. All patients underwent a familiarization procedure before the test. ...
Article
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Both tinnitus and headache are very prevalent conditions in the general population, with bidirectional co-occurrence of them. A number of studies revealed a high prevalence of headache in tinnitus patients; however, most of them used self-reported symptoms, questionnaires, or health databases and were retrospective. The aim of this study was to evaluate the prevalence of different types of headache in a cohort of tinnitus patients and to assess the influence of headache on tinnitus parameters, focusing on appropriate headache and tinnitus diagnosis verified by clinical examination. This prospective study involved 286 patients diagnosed with subjective non-pulsating tinnitus. Patients' clinical information was thoroughly assessed by the multidisciplinary team, including tinnitus characteristics and severity according to the Tinnitus Handicap Inventory (THI), loudness assessed by the Visual Analogue Scale (VAS), audiometry, type of headache diagnosed according to the third edition of the International Classification of Headache Disorders, severity of headache assessed by the Numeric Rating Scale (NRS), and impact of headache using the Headache Impact Test (HIT). In total, 141 (49.3%) tinnitus patients were diagnosed with headache, most of them with tension-type headache or migraine. They were significantly younger; mostly women; had bilateral tinnitus, vertigo, and depression more frequently; and had hearing loss less frequently as compared with the non-headache group. In total, 82 (58.16%) patients had the same localization of tinnitus and headache. Younger age, female gender, higher tinnitus burden measured by THI, and coexistence of hearing loss were independent variables connected with the occurrence of headache in the tinnitus group. According to our study, headaches impact tinnitus on many different levels and may be an important co-factor for tinnitus subtyping. We recommend screening for headache coexistence in all tinnitus patients.
... The upshot of such comparisons is clear: tinnitus distress is complex, arises from a variety of sources both physical and psychological, and in severe cases will be most reasonably addressed through the collaboration of audiologists and otolaryngologists with psychologists and other mental health providers. The need for such care also provides the basis for the effective triage program that forms the first stage of progressive tinnitus management (Henry, Zaugg, & Schechter, 2005;Henry, Zaugg, Myers, & Schechter, 2008). Referral options should include interdisciplinary or polytrauma teams designed to offer patients with multiple injuries and related symptoms the comprehensive resources their care requires. ...
Article
Full-text available
Tinnitus has the potential to influence a wide range of routine and important activities in a person's life. It can impair sleep, communication, concentration, and in severe cases can be affected by depression, anxiety, and other mental health issues. Perhaps more important, tinnitus may influence the patient's psychological state; its bidirectional effects, although well established, often challenge patients and providers across a variety of clinical settings. Management of tinnitus requires audiologists to be adept at communicating and supporting coping strategies that may include, but should not be limited to, patient-centered counseling and delivery of sound therapy or hearing aids. In the short term, patient care may benefit from interprofessional collaborations and effective referral networks. In the long term, the inclusion of tinnitus clinic rotations, classes, and interprofessional opportunities for students in Audiology programs should provide AuD students the experiences and competencies to provide for patients with tinnitus.
... Le rapport du patient est une partie essentielle de l'évaluation clinique de l'acouphène (Henry, Zaugg, & Schechter, 2005). Toutefois, considérant les influences de l'expérience et du contexte sur celui-ci, il semble important que cette mesure soit jointe à d'autres afin d'établir le meilleur portrait clinique possible. ...
... The tinnitus patients had all normal hearing with a maximum of 20 dB loss in any of the frequencies tested. To exclude the patients with hyperacusis, the Loudness Discomfort Level Test was performed for each patient, strictly according to the previously published clinical protocol [Henry et al., 2005]. Two sets of measurements were obtained, and the second set was reported. ...
Article
This exploratory study determined the activation pattern in nonauditory brain areas in response to acoustic, emotionally positive, negative or neutral stimuli presented to tinnitus patients and control subjects. Ten patients with chronic tinnitus and without measurable hearing loss and 13 matched control subjects were included in the study and subjected to fMRI with a 1.5-tesla scanner. During the scanning procedure, acoustic stimuli of different emotional value were presented to the subjects. Statistical analyses were performed using statistical parametric mapping (SPM 99). The activation pattern induced by emotionally loaded acoustic stimuli differed significantly within and between both groups tested, depending on the kind of stimuli used. Within-group differences included the limbic system, prefrontal regions, temporal association cortices and striatal regions. Tinnitus patients had a pronounced involvement of limbic regions involved in the processing of chimes (positive stimulus) and neutral words (neutral stimulus), strongly suggesting improperly functioning inhibitory mechanisms that were functioning well in the control subjects. This study supports the hypothesis about the existence of a tinnitus-specific brain network. Such a network could respond to any acoustic stimuli by activating limbic areas involved in stress reactivity and emotional processing and by reducing activation of areas responsible for attention and acoustic filtering (thalamus, frontal regions), possibly reinforcing negative effects of tinnitus.
... However, such approaches often take a longer time period (such as 18 months) to achieve its intended effect. Significant improvements in tinnitus symptoms have been reported in less than six months for patients with Neuromonics [23,[39][40][41][42][43][44]; Widex Zen [30,33] and Widex Zen Therapy [34]. The current approach achieved also significant improvements in a short period of time. ...
... His loudness discomfort levels (LDLs) were measured in 5 dB steps using the protocol recommended by Henry and Zaugg. 20 The stimuli were pure tones presented at octave frequencies from 250Hz through 8000Hz and male talker running speech (the first author, whose arithmetic mean fo was 129.8 Hz as measured with the Kay Visipitch Model 5105 voice analyzer). HP's LDLs were normal (100+dB) for tones from 2000 Hz through 8000 Hz. ...
Article
Background: Hyperacusis is the difference in dB between a normal threshold of audibility for a stimulus and the dB level at which that stimulus becomes intolerably loud. Some persons with autism exhibit symptoms of hyperacusis possibly attributable to phobias to auditory stimuli. Desensitization procedures have been used as a treatment for phobias and appear a promising treatment for patients with autism and hyperacusis. Methods: Our participant was a 26 year old male previously diagnosed Asperger's syndrome who presented with hyperacusis to low-pitched voices and a concomitant vocal disorder manifesting mainly as high vocal pitch. Despite not fully accepting treatment goals he agreed to treatment in our clinic. A systematic auditory desensitization program was employed to treat hyperacusis, including use of recorded male voices, musical instruments, and environmental sounds. In addition, a modified vocal re-education therapy program was also employed which included instruction on easy onset of phonation, biofeedback, ergonomic progressive imagery relaxation techniques and home exercises to reduce vocal hyperfunction and promote phonatorily efficient breath-stream management. Results: Initial, 7 month, and 13 month hyperacusis measures and voice evaluations were conducted. Hyperacusis evaluations showed our participant's hyperacusis for lower-frequency tones improved by up to 30 dB bilaterally and his hyperacusis for running speech improved 40 dB improved in the right ear and 35 dB in the left ear. His vocal pitch, measured as fundamental vocal frequency, improved from 404.471Hz to 280.78Hz. Conclusions: Our systematic auditory desensitization program decreased our participant's hyperacusis and our modified vocal re-education therapy (VRT) program lowered his vocal pitch. However, the results did not generalize beyond the clinic. The latter may be attributable to our participant's unwillingness to fully accept treatment goals, which may serve as a caveat to future clinicians to consider prognosis prior to making treatment decisions.
... (NHS Scotland, 2006). 5. TRI flowchart ( Biesinger et al., 2010). 6. Clinical guide for audiologic tinnitus management: Assessment and Clinical guide for audiologic tinnitus management: Assessment ( Henry et al., 2005a) and Treatment ( Henry et al., 2005b). 7. Adult Tinnitus Management Clinical Practice Recommendation ( Henry et al., 2015). ...
Article
Background: Though clinical guidelines for assessment and treatment of chronic subjective tinnitus do exist, a comprehensive review of those guidelines has not been performed. The objective of this review was to identify current clinical guidelines, and compare their recommendations for the assessment and treatment of subjective tinnitus in adults. Method: We systematically searched a range of sources for clinical guidelines (as defined by the Institute of Medicine, United States) for the assessment and/or treatment of subjective tinnitus in adults. No restrictions on language or year of publication were applied to guidelines. Results: Clinical guidelines from Denmark, Germany, Sweden, The Netherlands, and the United States were included in the review. There was a high level of consistency across the guidelines with regard to recommendations for audiometric assessment, physical examination, use of a validated questionnaire(s) to assess tinnitus related distress, and referral to a psychologist when required. Cognitive behavioral treatment for tinnitus related distress, use of hearing aids in instances of hearing loss and recommendations against the use of medicines were consistent across the included guidelines. Differences between the guidelines centered on the use of imaging in assessment procedures and sound therapy as a form of treatment for tinnitus distress respectively. Conclusion: Given the level of commonality across tinnitus guidelines from different countries the development of a European guideline for the assessment and treatment of subjective tinnitus in adults seems feasible. This guideline would have the potential to benefit the large number of clinicians in countries where clinical guidelines do not yet exist, and would support standardization of treatment for patients across Europe.
... However, the pitch and complexity of the tinnitus, masking level, and acceptance of wearable maskers were not different between the two groups. Tinnitus assessment and management techniques, such as Progressive Audiological Tinnitus Management (PATM; Henry, Zaugg, & Schechter, 2005a, 2005b or Tinnitus Retraining Therapy (TRT; Jastreboff & Jastreboff, 2000), are important components of audiological services for the mTBI population, and audiologists should work with other professionals to encourage referrals to audiology clinics for these patients. ...
Article
The rates of concussion or mild traumatic brain injury (mTBI) are increasing, and audiology is one of the many fields in which increased attention is being paid to this major public health concern. Though many individuals recover rapidly from mTBI, a significant number of these individuals continue to experience debilitating problems for months and years after injury. Auditory problems such as tinnitus, dizziness, and difficulty processing auditory information are among the common long-term symptoms reported. In this article, the author reviews mechanisms of possible injury and the evidence for peripheral and central auditory problems following mTBI. In addition, the author considers the potential influences of cognitive and psychological factors on the auditory problems reported in this population. Although there is a need for further research, audiologists have an important role as part of a team of professionals in the diagnosis and rehabilitation of long-term problems following mTBI.
... The details of such an assessment, including an intake interview, audiological evaluation, and psychoacoustic assessment, have been described by Henry and coauthors. 305 There is consensus, however, that the relationship between tinnitus sensation and its impact on an individual is weak. 306 Several useful questionnaires are available to assess the distress, disability, and handicap encountered by those with tinnitus, and several of these have demonstrated internal consistency and good test-retest reliability (see review by Newman and Sandridge 306 ). ...
Article
The mission of the National Institute for Occupational Safety and Health (NIOSH) is to generate new knowledge in the field of occupational safety and health and to transfer that knowledge into practice for the betterment of workers. Since its establishment in 1970, NIOSH has provided national and world leadership in efforts to prevent occupational hearing loss. In 1996, NIOSH established the National Occupational Research Agenda (NORA). Because occupational hearing loss is one of the most common occupational illnesses among American workers, it was identified as a priority research area, and a NORA Hearing Loss Team was established. The NORA Hearing Loss Team was composed of representatives from industry, academia, labor, professional organizations, and other governmental agencies. The team was tasked with developing a national research agenda for the prevention of occupational hearing loss. Each team member contributed to the original draft, which continued to evolve over time. The current document represents the culmination of several years of deliberation and revision with the goal of identifying needed research to prevent occupational hearing loss. This is Part 1 of the document, outlining research needs on the mechanisms and consequences of occupational exposure to noise and other ototoxicants.
... This measurement is often necessary because tinnitus patients tend to confuse hearing problems with tinnitus problem. Therefore, the THS is an efficient screening tool that allows clinicians to differentiate which of the three problems (tinnitus, hearing, and/or hyperacusis) is most troublesome to the patient [37,38]. A total score of 3 or more on the tinnitus portion of the survey may suggest a need for clinical intervention [38][39][40][41]. ...
Article
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Purpose. Tinnitus and sleep disturbance are prevalent in veterans, and a better understanding of their relationship can help with tinnitus treatment. Materials and Methods. Retrospective chart review of 94 veterans seen in audiology clinic between 2010 and 2013 is presented. Results. The mean age was 62 years, and 93 of 94 veterans were males. The majority (96%) had hearing loss. The positive predictive value of the ESS for sleep disorder was 97% and the negative predictive value was 100%. Veterans with a Tinnitus Handicap Inventory (THI) score ≥38 had significantly higher Epworth Sleepiness Scale (ESS) scores compared to those with THI score <38 ( P = 0.006 ). The former had a significantly higher incidence of PTSD, anxiety, and sleep disorder. A subgroup of patients had normal sleep despite rising THI scores. Bilateral tinnitus, vertigo, and anxiety were found to be predictors of sleep disturbance. Conclusions. The ESS can be used as a tool in the initial assessment of sleep disorders in veterans with tinnitus. Higher tinnitus handicap severity is significantly associated with greater sleep disturbance. Optimal management of tinnitus may require concomitant treatment of sleep disorder, PTSD, anxiety, and depression.
... Perceptual attributes of tinnitus (pitch, loudness) are recommended as part of patient symptom documentation [1]. Psychoacoustic measures can be used to predict tinnitus malingerers [2], and are essential to the prescription of some sound-based interventions (e.g. ...
Article
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The ability to reproducibly match tinnitus loudness and pitch is important to research and clinical management. Here we examine agreement and reliability of tinnitus loudness matching and pitch likeness ratings when using a computer-based method to measure the tinnitus spectrum and estimate a dominant tinnitus pitch, using tonal or narrowband sounds. Group level data indicated a significant effect of time between test session 1 and 2 for loudness matching, likely procedural or perceptual learning, which needs to be accounted in study design. Pitch likeness rating across multiple frequencies appeared inherently more variable and with no systematic effect of time. Dominant pitch estimates reached a level of clinical acceptability when sessions were spaced two weeks apart. However when dominant tinnitus pitch assessments were separated by three months, acceptable agreement was achieved only for group mean data, not for individual estimates. This has implications for prescription of some sound-based interventions that rely on accurate measures of individual dominant tinnitus pitch.
... The American Speech-Language-Hearing Association includes tinnitus management in its scope of practice for audiologists [16], which is justified for many reasons [17][18]. Audiologists were therefore the primary providers of the intervention for this study. ...
Article
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Tinnitus is the most prevalent service-connected disability awarded to Veterans. However, clinical protocols for management of tinnitus have been inconsistent across Department of Veterans Affairs (VA) medical centers. A study was funded to develop and pilot test a protocol to provide tinnitus services consistently across VA audiology clinics. Drawing on a series of prior VA and external research projects, a clinical model was formulated, supporting materials in multimedia were developed, and a pilot study was conducted. Five hierarchical levels of care were defined and labeled the Progressive Audiologic Tinnitus Management (PATM) model. The model facilitates access to medical services for tinnitus and includes detailed protocols for evaluation, education, and counseling of patients. Patients at each level of care have the option to "progress" to the next level of PATM if further services are required. Clinical procedures were defined for each level and materials were produced for audiologists and patients. The PATM model was then piloted with clinical patients at the James A. Haley Veterans' Hospital (JAHVH) in Tampa, Florida. Throughout the pilot study, feedback from patients and clinicians was carefully noted. Training materials for audiologists, incorporation of the protocol into clinic activities, and patient outcomes were evaluated. The model was implemented within the JAHVH Audiology Clinic and to assist Veterans with tinnitus management. The most notable finding was how little tinnitus-specific intervention was required for the majority of patients. This finding supports a clinical model that offers stepped-care ("progressive") levels of care until tinnitus management is achieved by the patient.
... Over the past few decades, hearing aids have been developed with an integrated sound generator as an alternative to enhance the treatment of tinnitus in patients with associated hearing loss (Henry, Zaugg, & Schechter, 2005). However, neither a well-established protocol nor sufficient scientific evidence exists to support the superiority of the combined use of tools over conventional amplification. ...
Article
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Hearing aids with an integrated sound generator have been used to enhance the treatment of tinnitus. The main aim of this study was to verify whether the combined use of amplification and sound generator is more effective than conventional amplification alone in reducing tinnitus annoyance by means of the use of a new hearing aid with an integrated sound generator. A total of 49 patients underwent a blind randomized clinical trial. Tinnitus annoyance was measured by Tinnitus Handicap Inventory and numerical scales, and psychoacoustic measures of tinnitus were also performed. The sound generator was set at the lowest intensity capable of providing relief from tinnitus. Results showed that 62.5% of the patients presented a reduction in tinnitus annoyance in the combined fitting group and in the group with amplification alone, 78% showed a reduction. This difference between the groups was not statistically significant.
... Folmer and Carroll (2006) stated that hearing aids may help reduce the perceived loudness of tinnitus and severity. As cited by Henry, Zaugg & Schechter (2005), Vernon (1992) noted this could be accomplished by the amplification of external sounds or by the instruments internal noise floor thus partially masking the perception of tinnitus. ...
Article
The aim of this critical review is to examine the literature regarding the effectiveness of hearing aids in the reduction of tinnitus perception. Study designs include: mixed (between and within) measures (pre-post test), between groups and single group pre-post test. Current research suggests the fitting of hearing aids not only benefit a person's hearing loss but helps in the reduction of tinnitus that often accompany the loss. This finding may persuade those individuals not willing to accept a hearing aid to support their hearing loss to be prescribed with a hearing aid to help reduce tinnitus perception.
... However, the pitch and complexity of the tinnitus, masking level, and acceptance of wearable maskers were not different between the two groups. Tinnitus assessment and management techniques, such as Progressive Audiological Tinnitus Management (PATM; Henry, Zaugg, & Schechter, 2005a, 2005b or Tinnitus Retraining Therapy (TRT; Jastreboff & Jastreboff, 2000), are important components of audiological services for the mTBI population, and audiologists should work with other professionals to encourage referrals to audiology clinics for these patients. ...
... Another important way to assess tinnitus is with the help of various questionnaires as tinnitus is a subjective symptom. Questionnaires can be both written and verbal and are useful in the assessment process (Henry & Zaugg, 2005). Self-report questionnaires elucidate the effect that tinnitus has on the individual"s daily life. ...
... En 2005, Henry A ; Zaugg T. et Schechter M. ont publié un guide clinique de l'évaluation de l'acouphène à travers une méthode appelée ATM : Audiologic Tinnitus Management [52]. Elle a été développée dans le but d'établir une procédure uniforme que les audiologistes, aux ...
Thesis
La détermination des caractéristiques psychoacoustiques des acouphènes est un sujet étudié depuis le début du XXe siècle à travers diverses méthodes de mesure par comparaison. Cependant, FELDMANN innove en 1969 en élaborant le principe de l’ « Audiogrammemasking ». En se basant sur cette méthode, ce travail propose de combiner l’audiométrie automatique de BEKESY afin d’établir une courbe du seuil tonal liminaire, avec une CPAR réalisée à partir du « signal acouphène » en tant que son test ; mesurant ainsi sa sélectivité propre par effet de masque. Sur ce postulat, Yves LASRY a élaboré un prototype logiciel nommé « TinniSweep ». Le but de cette étude est donc de tenter de rendre compte du potentiel de cette méthode. Afin d’étoffer le sujet, il a semblé nécessaire de passer en revue les différents aspects physiologiques, psychologiques et psychoacoustiques que comporte l’acouphène ; ainsi que d’établir un état des lieux des logiciels d’acouphénométrie existants, rappelant également les trois principes fondateurs cités précédemment.
... New advances in research offer the possibility to detect tinnitus objectively by using imaging techniques 21,22 or magnetoencephalography. 23 These techniques are promising but cannot yet be used in clinical practice as none has been shown to work. Table 31-1 lists the methods used to evaluate tinnitus (adapted from [24][25][26][27] ). ...
Chapter
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General information about tinnitus and decreased sound tolerance, hyperacusis, misophonia, with outline of the neurophysiological model of tinnitus and Tinnitus Retraining Therapy
... This may be due to focus of TRT is on reducing distress by addressing a person's maladaptive appraisal, avoidance, selective attention, and other psychological mechanisms that leads to distress regarding tinnitus. 20 Findings were similar in all those studies, which revealed that no significant change in subjective loudness of tinnitus was found when compared to a control group, but a significant reduction of tinnitus distress both when compared to a wait-list control group and to another intervention. [21][22][23][24] ...
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p class="abstract"> Background: Since last one decade there were no such studies done in India on the efficacy of tinnitus retraining therapy (TRT) on tinnitus treatment. Here, in this study we try to find out whether TRT is an effective tool than tinnitus masking as a treatment procedure of tinnitus in Indian context. Methods: A total of 60 participants (with no prior history of presence of hearing loss) were divided into two groups. Group 1 was consisted of 30 subjects provided tinnitus masking using relief app at the ease of their home environment for 2 months. Group 2 was consisted of another 30 subjects have been provided tinnitus retraining therapy (TRT) for 2months (60 sessions). The design is experimental design. The study was carried out in eight phases. Results: The findings of this study suggested that both the tinnitus masking therapy as well as TRT helped tinnitus sufferers to improve after 60 days of therapy continuation at initial stage. But a significant marked difference was found in terms of performance in participants from group 2 who had undergone TRT i.e., they performed very well after one month of post transfer therapeutic sessions than those who had undergone tinnitus masking therapy. Conclusions: The findings of this study are suggestive of that TRT is more effective than tinnitus masking therapy in tinnitus individuals even after one month of stopping therapy sessions. It also suggests that TRT has a long-term effect on tinnitus management than tinnitus masking.</p
... 5 Audiology training is focused on the clinical application of the science of hearing; although skills acquired in this training are applicable to tinnitus, 5 there seems to be limited training in degree programs specific to tinnitus. 6 Piskosz 7 suggested that the two highest hurdles for clinicians to overcome in establishing a tinnitus clinic were insufficient education and establishing a protocol. Tyler et al 8 believed that audiologists had the building blocks for tinnitus practice but might feel anxious in undertaking this work because of the extra demands of tinnitus patients. ...
Article
Introduction: Tinnitus assessment and management is an important component of audiology. The benefits of continuing education (CE) workshops in the field of tinnitus have not been published. This study evaluated the outcomes of a workshop centered around a Sound Therapy and Aural Rehabilitation for Tinnitus (START) framework. Our hypotheses were that a CE workshop would (1) be useful, (2) improve clinician's knowledge and willingness to undertake tinnitus practice, and (3) result in learners using knowledge gained in their practice. Methods: Twenty-five participants attending a 3-day tinnitus workshop were invited to complete an evaluation immediately and 3 months after the workshop's completion. The workshop consisted of seminars and practical sessions. The pedagogical approaches employed were experiential (theory building, reflection, and testing) and community of practice (shared experiences). Results: Participants reported on a 5-point Likert scale (1 = not useful-5 = excellent) a high level of satisfaction both immediately after the workshop (ratings of usefulness: mean, 4.8; SD, 0.4; willingness to practice: 4.6; SD. 0.6; ability to manage: 4.6; SD, 0.5; all "excellent" ratings) and 3 months later (ratings of usefulness: mean, 4.2; SD, 0.9, "very useful;" willingness to practice: 4.6; SD, 0.6, "excellent;" ability to manage: 4.1; SD. 0.5, "very useful"). Open-ended questions indicated participants made changes in their practice that reflected material provided in the CE. Conclusion: The workshop was successful in improving knowledge and confidence of audiologists in undertaking tinnitus assessment and management, but the need for ongoing support and supervision was a common theme.
... Depuis le début des années 1980, les appareils auditifs sont équipés de générateur de bruit dans le but d'améliorer la prise en charge des acouphènes (Henry, Zaugg, & Schechter, 2005). Les audioprothésistes ont aujourd'hui la possibilité de proposer une grande diversité de bruits à leurs patients. ...
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Background: Audiologists, globally, are generally challenged when assessing and creating intervention plans to help patients suffering from tinnitus. Tinnitus is very common among individuals and may significantly affect one’s quality of life, especially if not addressed by health care professionals. In South Africa, there seems to be limited published studies regarding the current practices of tinnitus management by audiologists. This is mainly because of limited training and a lack of guidelines and strategies for the management of tinnitus. In particular, some participants reported being unfamiliar on how to approach the identification of tinnitus and difficulty is also encountered when counselling tinnitus patients. Aim: The aim of this study was to describe the preparedness, perspectives and practices of audiologists who manage adult patients with tinnitus. Method: Two hundred and forty-three registered Health Professions Council of South Africa (HPCSA) participants were involved in the study by responding to an electronic questionnaire survey. Data were collected online from Survey Monkey and were exported to Statistical Packages for the Social Sciences (SPSS) (Version 23) for statistical analysis. Data were analysed using descriptive and inferential statistics. Closed-ended questions were analysed within a quantitative framework and thematic analysis for open-ended questions that were descriptively quantified. Results: The results of the study are presented according to the objectives. Approximately 44% of participants (44.3%) disagreed that the undergraduate university training had sufficiently prepared them to manage adult patients with tinnitus. Very few (12.3%) had the opportunity to attend specialist training on how to assess patients with tinnitus. Similarly, only 11.6% received any specialist training with regard to tinnitus intervention. With regard to its overall management, 49.4% felt adequately informed in the assessment of patients with tinnitus, while a further 39.2% rated their experience as being limited with regard to tinnitus intervention. There is no statistical significance relationship between participants’ years of experience and tinnitus intervention (p = 0.075). Most participants did not follow any standard guidelines for its management. Some participants (26.8%) reported that further education and training are required in the overall management of patients with tinnitus, while a further 17.7% required training in all areas of tinnitus. Conclusion: The feedback relating to the study suggests that overall management of tinnitus seems to be a challenge among South African audiologists, irrespective of their years of experience. Audiologists in the study perceived that tinnitus services are limited mainly because of a lack of or limited knowledge, training and guidelines, these being affected by contextual restraints.
Article
Telehealth, or the delivery of healthcare services from a distance, has historically been used to provide care to underserved populations and to those unable to visit a healthcare center. During the ongoing global COVID-19 pandemic, some providers of tinnitus healthcare services incorporated telehealth into their clinical protocols to allow for continued care for their patients while adhering to social distancing guidelines and safety measures. Bothersome tinnitus can negatively impact one's quality of life. Telehealth has been instrumental in treating this debilitating problem in a time when in-person care has not been easily available. The case of a patient with tinnitus is examined to demonstrate the use of a hybrid delivery model utilizing telehealth and in-person interactions to assess and manage her bothersome tinnitus. In-person services were used for audiological assessments and fitting of treatment devices, while telehealth was utilized for counseling, education, and remote programming of her treatment devices. This combined approach, which has allowed the patient to continue receiving care safely during the pandemic, can be continued for future care. Telehealth offers several advantages to patients and providers alike. While the COVID-19 pandemic will hopefully come to an end, telehealth services for tinnitus management may be here to stay.
Article
Purpose Tinnitus is reported by millions of Americans and is significantly problematic for many people. Commonly, individuals suffering from tinnitus report disturbances in the areas of sleep, hearing, emotional well-being, and so forth. This case report presents the evaluation and treatment of an adult female with severe tinnitus and multiple relevant comorbidities. This case includes the onset, evaluation, and management of significantly bothersome tinnitus in a 60-year-old woman. Tinnitus was first reported after she was treated with an Epley maneuver intended to resolve benign paroxysmal positional vertigo. An evaluation of tinnitus (including a comprehensive audiometric evaluation, an assessment of the impact of tinnitus on her life, and psychoacoustic measures of tinnitus perception) was completed. The tinnitus was reported to have a severely negative impact on her overall health, mental state, and quality of life. Method This patient opted to manage her tinnitus with a combination of pharmaceuticals, sound therapy, and education (the latter two in the form of tinnitus retraining therapy). Results The course of her active treatment spanned approximately 18 months, and, at the completion of her treatment, she demonstrated significant improvements in all areas of her life that had been impacted by tinnitus. She has become an active advocate for tinnitus management and has made herself available as a resource for other individuals who are struggling to cope with intrusive tinnitus. Conclusion Tinnitus retraining therapy is a treatment option that may significantly improve the quality of life of individuals suffering from severely bothersome tinnitus.
Article
Individuals complaining of tinnitus often attribute hearing problems to the tinnitus. In such cases some (or all) of their reported "tinnitus distress" may in fact be caused by trouble communicating due to hearing problems. We developed the Tinnitus and Hearing Survey (THS) as a tool to rapidly differentiate hearing problems from tinnitus problems. For two of our research studies, we administered the THS twice (mean of 16.5 days between tests) to 67 participants who did not receive intervention. These data allow for measures of statistical validation of the THS. Reliability of the THS was good to excellent regarding internal consistency (α = 0.86-0.94), test-retest reliability (r = 0.76-0.83), and convergent validity between the Tinnitus Handicap Inventory and the A (Tinnitus) subscale of the THS (r = 0.78). Factor analysis confirmed that the two subscales, A (Tinnitus) and B (Hearing), have strong internal structure, explaining 71.7% of the total variance and low correlation with each other (r = 0.46), resulting in a small amount of shared variance (21%). These results provide evidence that the THS is statistically validated and reliable for use in assisting patients and clinicians in quickly (and collaboratively) determining if intervention for tinnitus is appropriate.
Article
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The effective management of tinnitus should start with an accurate diagnosis, but no concensus has been developed in Korea concerning how to measure the features of tinnitus. This study surveyed otologists in the training hospitals and hospitals specialized in otologic care in Korea to identify the current status in the assessment of patients with tinnitus.
Article
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.
Article
Tinnitus is described as the perception of any sound or noise in the absence of real acoustic stimulation. Numerous investigations have been tried for this potentially debilitating, heterogeneous symptom. The authors overview the current concepts of the management of the suffering tinnitus patients. The review contains modern views on the mechanisms of generation, etiology and pathogenesis of tinnitus. Classifications for practical management of patients are presented. The review of medical and physical methods of therapy and rehabilitation of a tinnitus patients given. The review includes the most clinically reliable and common methods of treatment and rehabilitation.
Chapter
Tinnitus suffering might be understood as a function of tinnitus-related distress, which is a reaction to negative stressors and leads to a very negative and aversive state, when processes of adaptation to stressors and the efforts thereto have failed to return the organism to calmness of homeostasis. This chapter will provide an overview of this phenomenon. To provide a framework for the treatment avenues that are typically designed to relieve tinnitus-related distress, several concepts such as stress, distress, and tinnitus suffering are presented. Furthermore, an overview of theoretical frameworks in which the psychological mechanisms are predicted by these models is presented. Finally, different treatment approaches will be described, and some of the most commonly used instruments used to assess tinnitus-related distress and associated variables will be presented.
Article
Purpose Functional imaging is often used to try to elucidate the pathophysiological mechanism of tinnitus. Residual inhibition, the temporary suppression of tinnitus after application of a masking noise, could be an interesting technique to modulate tinnitus perception in functional imaging paradigms. The purposes of this study were to primarily assess reproducibility of the (partial) positive residual inhibition response duration in patients with tinnitus and to explore its utility in experimental designs. Method Patients with tinnitus exhibiting a (partial) positive residual inhibition response or tinnitus reduction after a 1-min white noise presentation were selected from a broad consulting tinnitus population. In 27 patients, this response was tested 4 times: twice during initial testing and twice during a retest of the psychoacoustic tinnitus measures, 4–8 weeks after initial consultation. In 17 patients with stable residual inhibition responses, reproducibility of response duration, the duration of tinnitus reduction up to pretesting state, was analyzed. Results Initial testing showed a residual inhibition duration of 29.5 s on average. Test–retest reproducibility of response duration was shown to be reliable with an ICC(3, 4) of .871 (95% CI [0.733, 0.948]) and a standard error of measurement of 6.64 s. Conclusions This study indicates the good test–retest reproducibility of residual inhibition duration in our subset of 17 patients with stable (partial) positive residual inhibition. Residual inhibition is, therefore, a technique that can potentially be used for temporary tinnitus manipulation in experimental paradigms to unravel tinnitus pathophysiology.
Article
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Introduction Cochlear or neural mechanisms of tinnitus generation may affect auditory temporal resolution in tinnitus patients even with normal audiometry. Thus, studying the correlation between tinnitus characteristics and auditory temporal resolution in subjects with tinnitus may help in proper modification of tinnitus management strategy. Objective This study aims to examine the relationship between the psychoacoustic measures of tinnitus and the auditory temporal resolution in subjects with normal audiometry. Methods Two normal hearing groups with ages ranging from 20 to 45 years were involved: control group of 15 adults (30 ears) without tinnitus and study group of 15 adults (24 ears) with tinnitus. Subjective scaling of annoyance and sleep disturbance caused by tinnitus, basic audiological evaluation, tinnitus psychoacoustic measures and Gaps in Noise test were performed. Data from both groups were compared using independent sample t-test. Psychoacoustic measures of tinnitus and Gaps in Noise test parameters of the tinnitus group were correlated with Pearson’s correlation coefficient. Results Significantly higher hearing threshold, higher approximate threshold and lower correct Gaps in Noise scores were observed in tinnitus ears. There was no significant correlation between psychoacoustic measures of tinnitus and Gaps in Noise test parameters of the tinnitus group. Conclusion Auditory temporal resolution impairment was found in tinnitus patients, which could be attributed to cochlear impairment or altered neural firing within the auditory pathway. It is recommended to include temporal resolution testing in the tinnitus evaluation battery to provide a proper management planning.
Article
Importance Current individualized sound therapies for tinnitus rely on tinnitus pitch assessment, which is commonly derived from the standard clinical 2-alternative forced-choice (2-AFC) approach driven by the examiner. However, this method is limited by lack of individual test-retest reliability and focuses on a single rather than multiple tinnitus frequencies. Objective To assess individual test-retest reliability of the 2-AFC, with a single final frequency (and corresponding loudness), and the tinnitus likeness rating (TLR), with the participant exposed to the entire audible frequency spectrum, from which 3 dominant frequencies and corresponding loudness were extracted. Design, Setting, and Participants In this case series, participants with tinnitus underwent testing twice with both methods at a 1-month interval by experienced clinicians from January 6 through March 17, 2017. Each clinician tested each patient only once at visit 1 or 2 in a university audiology training setting with standardized equipment and was blind to previous assessment. Participants with bilateral or unilateral chronic tinnitus for longer than 6 months, in good health, without total deafness in either ear, and without cerumen in the ear canal were recruited through advertisements (community and clinics) and word of mouth (volunteer sample). The audiologists were likewise participants in the planned comparison between TLR and 2-AFC in the test-retest measures. Main Outcomes and Measures Test-retest concordance with 95% CIs for each method, calculated as the proportion of participants with the same final frequency between the 2 visits (2-AFC) or with at least 1 concordant dominant frequency (TLR) as well as loudness differences of no greater than 10 dB. Results The study sample included 31 participants (55% men; mean [SD] age, 50.7 [13.7] years). For TLR, 26 of 31 participants had at least 1 concordant dominant frequency between the 2 visits (proportion, 0.84; 95% CI, 0.66-0.95), whereas for 2-AFC, 7 of 31 participants had a concordant final tinnitus pitch in either ear (proportion, 0.23; 95% CI, 0.10-0.41). Loudness reliability followed the same pattern, with more concordant loudness levels in the TLR (proportion, 0.73; 95% CI, 0.52-0.88) than in the 2-AFC (proportion, 0.40; 95% CI, 0.05-0.85). Mean time taken to complete the tests was less than 15 minutes, and general appreciation by participants with tinnitus and audiologists were overall similar for both. Conclusions and Relevance Superior test-retest concordance can be demonstrated at the individual level using the several dominant frequencies extracted from the patient-centered TLR.
Article
Objective: The objective of this study was to evaluate the feasibility of the Chinese (Mandarin) Tinnitus Handicap Inventory (THI-C) by comparing patient-reported and clinician-interviewed outcomes and to raise awareness of the difficulties in using adapted international test measures. Design: All patients were required to first complete the THI-C independently. Then, clinicians conducted a face-to-face interview, explained the exact meaning of each item and re-evaluated every item based on the patient's descriptions. During this process, patients were encouraged to make comments about each item. Both the self-administered and clinician-interviewed scores were recorded and compared. Study sample: A total of 178 patients who reported tinnitus as a primary complaint were included. Results: Among these patients, 88 (49.4%) completed the questionnaire independently, while 79 (44.4%) patients experienced difficulty in understanding at least one item. The difference between the self-administered and clinician-interviewed scores was statistically significant (p < 0.01). Conclusions: The feasibility of the THI-C is limited unless a revision is made. Follow-up studies are needed for validation when a newly translated self-administered questionnaire is put into use. In addition to semantic equivalence and idiomatic equivalence, experiential equivalence and conceptual equivalence should also be fully considered during the translation process.
Article
Clinical decision-making strategies used to promote tinnitus relief vary widely depending upon the burden tinnitus places on an individual. This paper will discuss a care path for managing patients with tinnitus using an interprofessional collaborate model.
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Current clinical assessment of tinnitus relies mainly on self-report. Psychoacoustic assessment of tinnitus pitch and loudness are recommended but methods yield variable results. Herein, we investigated the proposition that a previously validated fixed laboratory based method (Touchscreen) and a newly developed clinically relevant portable prototype (Stand-alone) yield comparable results in the assessment of psychoacoustic tinnitus pitch and loudness. Participants with tinnitus [N = 15, 7 with normal hearing and 8 with hearing loss (HL)] and participants simulating tinnitus (simulators, N = 15) were instructed to rate the likeness of pure tones (250—16 kHz) to their tinnitus pitch and match their loudness using both methods presented in a counterbalanced order. Results indicate that simulators rated their " tinnitus " at lower frequencies and at louder levels (~10 dB) compared to tinnitus participants. Tinnitus subgroups (with vs. without HL) differed in their predominant tinnitus pitch (i.e., lower in the tinnitus with HL subgroups), but not in their loudness matching in decibel SL. Loudness at the predominant pitch was identified as a factor yielding significant sensitivity and specificity in discriminating between the two groups of participants. Importantly, despite differences in the devices' physical presentations, likeness and loudness ratings were globally consistent between the two methods and, moreover, highly reproducible from one method to the other in both groups. All in all, both methods yielded robust tinnitus data in less than 12 min, with the Stand-alone having the advantage of not being dependent of learning effects, being user-friendly, and being adapted to the audiogram of each patient to further reduce testing time.
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Background: Though clinical guidelines for assessment and treatment of chronic subjective tinnitus do exist, a comprehensive review of those guidelines has not been performed. The objective of this review was to identify current clinical guidelines, and compare their recommendations for the assessment and treatment of subjective tinnitus in adults. Method: We systematically searched a range of sources for clinical guidelines (as defined by the Institute of Medicine, United States) for the assessment and/or treatment of subjective tinnitus in adults. No restrictions on language or year of publication were applied to guidelines. Results: Clinical guidelines from Denmark, Germany, Sweden, The Netherlands, and the United States were included in the review. There was a high level of consistency across the guidelines with regard to recommendations for audiometric assessment, physical examination, use of a validated questionnaire(s) to assess tinnitus related distress, and referral to a psychologist when required. Cognitive behavioral treatment for tinnitus related distress, use of hearing aids in instances of hearing loss and recommendations against the use of medicines were consistent across the included guidelines. Differences between the guidelines centered on the use of imaging in assessment procedures and sound therapy as a form of treatment for tinnitus distress respectively. Conclusion: Given the level of commonality across tinnitus guidelines from different countries the development of a European guideline for the assessment and treatment of subjective tinnitus in adults seems feasible. This guideline would have the potential to benefit the large number of clinicians in countries where clinical guidelines do not yet exist, and would support standardization of treatment for patients across Europe.
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Regarding the high prevalence of vitamin D (25(OH)D) deficiency in the population and its possible association with ear diseases, we aimed to investigate the 25(OH)Dserum level in patients with subjective, nonpulsating tinnitus and its effect on tinnitus severity. The study included 201 tinnitus patients and 99 controls. Patient clinical information, including tinnitus characteristics and severity according to Tinnitus Handicap Inventory (THI), loudness assessed by Visual Analogue Scale (VAS), audiometry, and the blood level of vitamin D, was recorded. The level of 25(OH)D in tinnitus patients was significantly decreased compared with the controls (19.86 ± 7.53 and 27.43 ± 8.85 ng/ml, respectively; P value < 0.0001). More patients in the tinnitus group were deficient in vitamin D, compared with the controls (50.7% vs. 22.2% respectively, p < 0.0001). Tinnitus patients with a lower serum level of 25(OH)D (�15 ng/dl) were significantly younger, had a higher degree of tinnitus severity measured with THI and VAS scales, had higher triglyceride and TSH levels, and a lower HDL level compared with individuals who had higher 25(OH)D level (>15 ng/dl). There was a strong correlation between the 25(OH)D level and THI. Our findings suggest that a large proportion of tinnitus patients suffers from vitamin D deficiency and that the vitamin D level correlates with tinnitus impact. We recommend a vitamin D assessment for all tinnitus patients.
Article
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The main objective of Tinnitus Retraining Therapy (TRT) is habituation of activation of the autonomic nervous system, evoked by signals present in the auditory pathways. Sound therapy aims at decreasing the strength of these signals. The same systems in the brain are involved in tinnitus and decreased sound tolerance, and the same basic neurophysiological mechanisms are utilised for decreasing the tinnitusrelated neuronal activity and, in case of hyperacusis, abnormally enhanced activity induced by external sounds. The similarity of TRT treatment between tinnitus and misophonia is even closer, as in both situations the goal is to achieve extinction of functional connections between the auditory and the limbic and autonomic nervous systems. The increased gain within the auditory pathways that are presumably responsible for hyperacusis could enhance the tinnitus signal, thus it is possible to expect coexistence of tinnitus and hyperacusis, and the predisposition of hyperacusis patients to develop tinnitus. As such, for some patients tinnitus and hyperacusis may be considered the double manifestation of the same internal phenomenon.
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Phantom auditory perception--tinnitus--is a symptom of many pathologies. Although there are a number of theories postulating certain mechanisms of its generation, none have been proven yet. This paper analyses the phenomenon of tinnitus from the point of view of general neurophysiology. Existing theories and their extrapolation are presented, together with some new potential mechanisms of tinnitus generation, encompassing the involvement of calcium and calcium channels in cochlear function, with implications for malfunction and aging of the auditory and vestibular systems. It is hypothesized that most tinnitus results from the perception of abnormal activity, defined as activity which cannot be induced by any combination of external sounds. Moreover, it is hypothesized that signal recognition and classification circuits, working on holographic or neuronal network-like representation, are involved in the perception of tinnitus and are subject to plastic modification. Furthermore, it is proposed that all levels of the nervous system, to varying degrees, are involved in tinnitus manifestation. These concepts are used to unravel the inexplicable, unique features of tinnitus and its masking. Some clinical implications of these theories are suggested.
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Two separate factor analyses were conducted on various self-rated complaints about tinnitus and related neuro-otological symptoms, together with audiometric measurements of tinnitus 'intensity' (masking level and loudness matching levels). Two general tinnitus complaint factors were identified, i.e. 'intrusiveness of tinnitus' and 'distress due to tinnitus'. 3 specific tinnitus complaint factors were also found, i.e. 'sleep disturbance', 'medication use' and 'interference with passive auditory entertainments'. Other neuro-otological symptoms and the audiometric measures did not load on these factors. An exception was provided by loudness matches at 1 kHz, which had a small loading on the 'intrusiveness of tinnitus' factor. Self-rated loudness had a high loading on this factor. Otherwise, the loudness (either self-rated or determined by loudness matching) was unrelated to complaint dimensions. The clinical implications of the multifactorial nature of tinnitus complaint behaviour are considered.
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To develop a self-report tinnitus handicap measure that is brief, easy to administer and interpret, broad in scope, and psychometrically robust. A standardization study of a self-report tinnitus handicap measure was conducted to determine its internal consistency reliability and convergent and construct validity. Audiology clinics in tertiary care centers in two sites. In the first investigation, 84 patients reporting tinnitus as their primary complaint or secondary to hearing loss completed the 45-item alpha version of the Tinnitus Handicap Inventory (THI). In the second investigation, 66 subjects also reporting tinnitus completed the 25-item beta version. Convergent validity was assessed using another measure of perceived tinnitus handicap (Tinnitus Handicap Questionnaire). Construct validity was assessed using the Beck Depression Inventory, Modified Somatic Perception Questionnaire, symptom rating scales (annoyance, sleep disruption, depression, and concentration), and perceived tinnitus pitch and loudness judgments. From the alpha version of the THI, we derived a 25-item beta version with the items grouped into functional, emotional, and catastrophic subscales. The total scale yielded excellent internal consistency reliability (Cronbach's alpha = .93). No significant age or gender effects were seen. Weak correlations were observed between the THI and the Beck Depression Inventory, Modified Somatic Perception Questionnaire, and pitch and loudness judgments. Significant correlations were found between the THI and the symptom rating scales. The THI is a self-report measure that can be used in a busy clinical practice to quantify the impact of tinnitus on daily living.
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The aim of this paper is to provide information about the neurophysiologic model of tinnitus and Tinnitus Retraining Therapy (TRT). With this overview of the model and therapy, professionals may discern with this basic foundation of knowledge whether they wish to pursue learning and subsequently implement TRT in their practice. This paper provides an overview only and is insufficient for the implementation of TRT. Abbreviations: DPOAE = distortion product otoacoustic emission, IHC = inner hair cells, LDL = loudness discomfort level, OHC = outer hair cells, THT = Tinnitus Habituation Therapy, TRT = Tinnitus Retraining Therapy
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Clinical management for patients complaining of severe tinnitus has improved dramatically in the last 25 years. During that period of time, various methods of treatment have been introduced and are being used with varying degrees of success. One method that has received considerable attention is tinnitus retraining therapy (TRT). This method is being practiced by hundreds of clinicians worldwide, and retrospective clinical data indicate that TRT has been effective for the majority of patients. This article provides a guide for clinicians to evaluate their patients for treatment with TRT. Included in this guide is the expanded version of the TRT initial interview and specific instructions for the clinician administering the interview.
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The diagnosis of “classic” Meniere’s disease is easy to make. Unfortunately, Meniere’s disease is a diagnosis of exclusion and many disease entities can mimic Meniere’s disease. Thus, it is essential to eliminate other possible etiologie agents for complaints that could be related to Meniere’s disease before making this diagnosis. This article evaluates the differential diagnosis in Meniere’s disease.
Article
Tinnitus Retraining Therapy (TRT) helps tinnitus patients by offering the possibility of successful habituation of tinnitus-induced reactions and the habituation of tinnitus perception. TRT presumably induces and sustains plastic changes in the neuronal networks within the auditory system, and its connection with the limbic and autonomic nervous systems, but it does not remove the tinnitus signal. Reports from a number of centers around the world indicate high levels of effectiveness of this method. There is still an ongoing discussion regarding TRT's efficacy and the relative contribution of its components. This article attempts to summarize the basis of TRT and its foundations on the neurophysiologic model of tinnitus. Additionally, some questions and concerns related to the method are addressed.
Article
Hyperacusis is a well known phenomenon consisting of a collapse of loudness tolerance. The following generalisations can be made: (1) Hyperacusis is not heightened hearing sensitivity (hearing thresholds are not better than normal); (2) hyperacusis is often accompanied by tinnitus; (3) the severity of hyperacusis is usually inversely proportional to the pitch of the offending noise; (4) perhaps most important, overprotection of the ears is a natural reaction of hyperacusic patients but it must be avoided as it progressively exacerbates hyperacusis. A testing procedure, which involves determining loudness discomfort levels at a number if frequencies, will be described and typical data will be presented. Successful treatment for hyperacusis involves two components: First, training patients to use sound level meters to distinguish between truly damaging sound levels versus those which simply sound too loud; and second, instructing them in the use of a desensitisation program which involves listening to pink noise for several hours daily, starting at a low sound level and progressively increasing it over a period of several months. A new type of protective hearing device will also be described which allows the wearer to avoid loud sounds while preventing over-protection of the ears. When using the device, known as the Star 2001, hyperacusis patients are able to go out and about without fear of encountering loud sounds.The theoretical basis for hyperacusis is not yet known but a potential neural mechanism will be discussed.
Article
A vexing problem in audiology has been the modification of sound tolerance. Sound intolerance and restricted dynamic ranges are common conditions that audiologists encounter daily in the hearing-impaired population, especially in the fitting of hearing aids. To date, no clinical protocol has proven to be successful for modifying sound tolerance among the hearing-impaired population. This report describes the use of low-level, broadband sound in a habituation-based treatment protocol termed Tinnitus Retraining Therapy (TRT). Over the past decade, TRT has become increasingly popular as an intervention for severe tinnitus and hyperacusis. One of the primary treatment effects from TRT is that over the course of the intervention the patient's loudness discomfort level (LDL) thresholds routinely shift to higher levels. Ostensibly, the resulting higher LDL thresholds reflect treatment effects associated with the resetting of a plastic and adaptive auditory gain process that somehow regulates the supra-threshold sensitivity of the auditory system in response to chronic changes in the sound input from the auditory periphery to the central auditory pathways. Tinnitus patients with significant hearing losses and sound tolerance problems respond successfully to TRT and, as a consequence, their LDL thresholds are usually elevated (improved) and, concomitantly, their dynamic ranges are expanded. Many of these patients, who before the TRT intervention could not tolerate amplified sound, then have been able to make a comfortable transition into appropriate amplification after treatment. In principle, TRT would seem to offer a viable intervention strategy for modifying sound tolerance in the general hearing-impaired population. If so, then the clinical applications of TRT principles may extend well beyond the treatment of tinnitus and hyperacusis.
Article
This study compared the effectiveness of pulsed tones (200 ms on/200 ms off) and continuous tones (1 to 2 s) for measuring thresholds in patients with tinnitus. Sixty veterans with tonal tinnitus and a history consistent with noise-induced hearing loss participated. Half were assigned to a pulsed-tone group; half were assigned to a continuous-tone group. Air-conduction thresholds were measured twice for each patient in a single session for octave intervals between 250 Hz and 4000 Hz. Results indicated no significant difference between groups for test-retest differences, but overall more presentations were required to measure thresholds with continuous tones than with pulsed tones at 4000 Hz. Moreover, the continuous-tone group had, on average, more false-positive responses than the pulsed-tone group. This study supports the clinical belief that pulsed tones are preferred over continuous tones for measuring thresholds for persons with tinnitus.
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Article
The subjective nature of tinnitus is not the only feature which imposes difficulties upon the identification of tinnitus. The patients who must provide information about their tinnitus are greatly handicapped in this task and for the simple reason that there is very little vocabulary available to them. Thus it is not only important that the clinician listen very carefully to the patient but it is increasingly important that standardized tests be used to identify, measure and classify tinnitus.
Article
The symptom of tinnitus is likely shared by several underlying pathologies. It is funda-mental to the investigation and treatment of tinnitus to be able to reliably quantify different types of tinnitus. In one experi-ment we required patients to increase the level of a broadband noise until it just masked their tinnitus. Regardless of where in the head they perceive their tinnitus, in most patients the minimum level (in sound pressure level or sensation level) required to mask the tinnitus is similar in both ears. In a few other patients, the tinnitus cannot be masked or requires high levels in the contra-lateral ear. We have found this masking procedure valuable in measuring tinnitus following the administration of tocainide. In some patients the tocainide seemed to reduce the magnitude of the tinnitus (required lower masker levels to mask the tinnitus) whereas in others there was some evidence that the tinnitus got worse (higher masker levels were required). In another experiment, we quantified tinnitus percep-tion following the termination of a masker. Several different patterns were evident. After the termination of the masker, the tinnitus either (a) returned to normal immediately, (b) returned immediately but was at a softer loudness, (c) was absent for a time before gradually returning to normal, (d) was absent for a time before abruptly returning to normal, or (e) was louder than normal before gradually returning to normal. Increasing masker duration and masker level prolonged the effects.
Article
The psychometric properties of a tinnitus handicap questionnaire are reported. There were two phases in this study. In Phase I, 87 questions were administered to 100 tinnitus patients. From their responses, 59 items that were either redundant, insensitive, or had low item-total correlations were eliminated. In Phase II, the resulting 27-item questionnaire was administered to 319 patients. Fifty-three of these patients also completed psychological and psychophysical measures that were used to validate the questionnaire. A factor analysis of patients' responses revealed a three-factor structure. These three factors appeared to reflect the physical, emotional, and social consequences of tinnitus (Factor 1), hearing ability of the patient (Factor 2), and the patients' view of tinnitus (Factor 3). Although the 27-item questionnaire had high internal consistency reliability and validity as reflected by correlations with life satisfaction and depression scales, it is recommended that only the items on the Factor 1 and the Factor 2 subscales be scored because of the low internal consistency reliability of the Factor 3 subscale. This questionnaire can be used to compare a patient's tinnitus handicap with the norm, identify specific areas of handicaps, and to monitor a patient's progress with particular treatment programs.
Article
There is scant literature relating to tinnitus in children. This may be due in part to the inability of the child to differentiate normal from abnormal, and also adults failing to communicate adequately with children to allow them to describe their observed symptoms. One hundred and two children with severe to profound hearing loss between six to seventeen years of age were questioned as to the presence of tinnitus. The 24 children (23 per cent) who reported tinnitus, also completed a questionnaire, and were interviewed about their symptoms and then were compared to the non-tinnitus children regarding hearing level, age, sex and aetiology of the deafness. No significant difference was found between the two groups. This study documents that tinnitus does exist in a significant number of children with severe to profound deafness and addresses the problem involved in its description and assessment.
Article
Three thousand six hundred randomly selected adults in the city of Gothenburg (425,000 inhabitants) stratified by age and gender, were questioned by mail concerning tinnitus. We received 66% useful answers, 14.2% suffered from tinnitus 'often' or 'always'. Tinnitus was more common in males than in females. Tinnitus was much more common in the left than in the right ear. 2.4% of the whole population suffered from the worst severity degree, 'tinnitus plagues me all day'. Tinnitus was clearly more common with hearing loss than with subjectively normal hearing. Sleep disturbances were common and increased with tinnitus severity. A majority of the questioned subjects wanted further examination and treatment.
Article
A new procedure is described for measuring loudness discomfort levels (LDLs) for the purpose of selecting SSPL90 characteristics of hearing aids. The person is seated in sound field wearing a high-output hearing aid (with a known amount of 2 cm3 coupler gain) connected to a personal earmold. The loudness of frequency-specific signals is rated from a series of loudness category descriptors. The LDL is defined in terms of SPL developed in a 2 cm3 coupler, thus making selection of SSPL90 from hearing aid specification sheets practical. Experiments on LDL stability over time and validation of the SSPL90 selection are reported.
Article
Despite the availability of several management procedures for tinnitus, many audiologists seem reluctant to engage in long-term rehabilitation of patients. Tinnitus patients are somewhat similar to chronic pain patients in that both groups suffer from intractable symptoms. A technique which has been effectively utilized in helping pain patients cope with their problems is cognitive-behavioral therapy. This approach can be applied with considerable success to tinnitus patients with the emphasis placed on treating the patient's reaction to tinnitus rather than the tinnitus itself. To accomplish this, maladaptive behaviors and thought patterns must be identified and then systematically altered via a program specifically designed for the individual. This procedure is analogous to many precepts governing aural rehabilitation.
Article
A comparison of threshold variation among patients with sensorineural hearing loss and accompanying tinnitus in relation to plused and continuous tone threshold determination was reported. The results indicated that both types of signals obtained comparable threshold levels at all audiometric frequencies tested, and did not vary by more than 1.6 dB. The greatest variation in threshold occurred at those frequencies which corresponds to the reported tinnitus. The latter was observed for 5 patients and did not exceed 5 dB. All threshold variations were within the acceptable criterion of ±5 dB. The majority of patients reported high-pitched tinnitus, and most frequently matched their tinnitus to 3 000 Hz. Over two-thirds of both normal and tinnitus subjects preferred to listen to pulsed tones as opposed to continuous tones during threshold determination. The data obtained from this study did not confirm the assumption that significantly lower threshold are obtained with pulsed tones among patients with tinnitus, although the use of pulsed tones appears to facilitate patient responsiveness.
Article
Tinnitus can be masked by broad band noise, narrow band noise and pure tones. The levels necessary for masking form characteristic patterns, which can be classified in five types. Unilateral tinnitus can usually also be inhibited by stimulation of the contralateral ear. When using interrupted stimuli inhibition is effective also in the intervals up to a certain length, dependent on various parameters. Les acouphènes peuvent ětre masqués par des bruits à bandes larges, des bruits à bandes étroites et des sons purs. Les intensités nécessaires pour le masquage des bourdonnements donnent des courbes de masque caractéristiques. Elles peuvent ětre différenciées en cinq types. Les acouphènes unilatéraux peuvent ětre aussi inhibés par une stimulation acoustique de l'oreille contro-latérale. En émettant des stimuli interrompus, l'inhibition est aussi effective dans les intervalles jusqu'à une certaine durée dépendante de divers paramètres.
Children attending ENT and audiology clinics and a further group interviewed in the partially hearing units of their schools have been questioned about tinnitus. A total of 79 children reported tinnitus during the course of the study. A wide variety of descriptions were given. Only 10 of the subjects found the symptom annoying. Only 17 of them could say when their tinnitus began. Of a group of 66 children with secretory otitis media, 43.9% reported tinnitus, while amongst 44 children with sensorineural hearing loss the incidence was 29.5%. Tinnitus is a common phenomenon in children with ear disease, but it is seldom reported spontaneously.
Article
This report has provided a brief survey of the Tinnitus Clinic population as it appeared near the end of 1981, when 1806 patients had been seen. That number is probably sufficient to provide satisfactory statistical reliability for the observations cited here. It should be mentioned that the Tinnitus Clinic has continued to accumulate cases, at the approximate rate of 30 per month, and at this writing the total number of patients seen to date is over 2300. The data obtained from the first 1806 patients were collected under conditions that were not as homogeneous as those prevailing now, in that standardized testing equipment was not available until January 1979, and testing techniques were continuing to be revised even after that time. In addition a major revision of the patient questionnaires was undertaken late in 1981, with the result that much more detailed information is being obtained than was formerly possible using the old questionnaire format. Thus, we can anticipate that the next such survey of the Tinnitus Clinic population will offer considerably expanded and more detailed types of observations than those presented here.
Article
Ninety-seven members of a tinnitus self-help group were asked to list the difficulties that they had as a result of their tinnitus. Seventy-two replies were returned from 22 men and 48 women (sex not reported in two cases) whose average age was 61 years. Tinnitus was associated with hearing difficulties in 53%, effects on lifestyle in 93%, effects on general health in 56%, and emotional difficulties in 70% of the sample. Getting to sleep was the most frequently mentioned difficulty, and many respondents indicated that they experienced depression, annoyance, and insecurity. The clinical application of this open-ended questionnaire are discussed.
Article
The most prominent pitch of tinnitus was measured in 10 subjects with sensorineural tinnitus. The pitch was determined with three different psychophysical procedures in the ear ipsilateral to the tinnitus; an Adaptive Method (Bracketing), a Method of Limits (ascending and descending), and the Method of Adjustment. Each procedure involved equating the pitch of a pure tone to the most prominent tinnitus pitch, and was repeated seven times on each subject. Although there was no statistically significant difference for the means and standard deviations among the different methods for the group data, there were some large differences in a few individuals. Many of the subjects produced pitch matches that covered a range of 1 octave, whereas others showed better consistency. The Method of Limits took longer to perform and resulted in more octave confusions than the other two methods. The Adaptive Method was also repeated five times for each subject in the ear contralateral to the tinnitus. Two subjects produced a tinnitus pitch match that was over 1/2 octave lower in the contralateral ear. We recommend that tinnitus pitch be measured in the ipsilateral ear with either the Method of Adjustment or the Adaptive Method. Because some patients are unreliable in their pitch matching we suggest repeating the match seven to nine times.
Article
Masking of tinnitus by acoustic stimuli, especially the residual inhibition, which extends beyond the duration of the masking stimulus, is a dynamic process with an individual time course. Various methods for measuring residual inhibition of short, medium and long duration are presented, and their typical results are discussed.
Article
With care to provide properly chosen masking sounds, masking can help in 60-80% of clinically significant tinnitus cases. There is no universal masker; instead, an individual evaluation of each patient's tinnitus must be performed in order to match the masking sounds to the patient's audiogram and the spectral characteristics of the tinnitus. Successful long-term masking can usually be achieved in patients for whom (1) hearing impairment is not excessive. (2) the tinnitus frequency, FT, can be reliably located, and (3) the tinnitus can be completely masked by a band of noise at or near FT at a low sensation level. Such patients often experience residual inhibition (temporary suppression of tinnitus upon cessation of masking) which may accumulate with sustained use of masking, in some cases becoming permanent. Long-term masking is difficult or impossible for patients whose hearing is so impaired they cannot hear the masker, or those for whom the masking sounds must be presented at unacceptably loud levels to obtain adequate coverage of the tinnitus. There is a great need for additional work to determine what factors influence the effectiveness of masking, in order to improve our ability to provide appropriate masking stimuli even for the difficult cases.
Article
The diagnosis of "classic" Meniere's disease is easy to make. Unfortunately, Meniere's disease is a diagnosis of exclusion and many disease entities can mimic Meniere's disease. Thus, it is essential to eliminate other possible etiologic agents for complaints that could be related to Meniere's disease before making this diagnosis. This article evaluates the differential diagnosis in Meniere's disease.
Article
Loudness balance techniques are commonly employed to match the loudness of tinnitus using either pulsed or continuous tones; however, it is not known whether the tone duration affects the observed loudness matches. In this study, hearing thresholds and tinnitus loudness matches were measured in 26 subjects with chronic tinnitus using both pulsed and continuous tones. Subjects' thresholds and loudness matches were determined at 11 frequencies between 0.5 and 10 kHz. No significant differences were found between pulsed versus continuous measures, either for thresholds or for loudness matches. There were, however, nine subjects (34.5% of the group) who showed relatively large differences (> or =10 dB) at one or more test frequencies. These "outlier" values did not show systematic trends; some were positive, some negative. In conclusion, studies employing group data appear to be comparable if group sizes are sufficiently large (e.g., > or =25 subjects). Studies employing smaller numbers of subjects may, however, be vulnerable to potential positive or negative biases introduced by one or more outliers.
Article
Repeated tinnitus loudness matches (LMs) were obtained to determine response reliability using a computer-automated technique with two procedural variations, fixed or random step sizes, to increase output level during the initial ascending series of tones at each frequency. Twenty subjects with stable, tonal tinnitus were evaluated with both methods during each of two sessions. Response instructions were displayed on a portable computer, and a pen device was used to make response choices that appeared on the touch-sensitive video monitor. For each method, hearing thresholds and LMs were obtained, with 1-dB resolution, at 1/3-octave frequencies from 1 to 16 kHz. Analyses revealed reliability of LMs to be equivalent between methods. LM data are reported in both dB SPL and dB SL, with the SPL values providing greater reliability both within and between sessions (all r's ≥ .889, p's ≤ .0001). Abbreviations: ANOVA = analysis of variance, LAN = local area network, LM = loudness match
Article
This report reviews research from the 1930s to the present that has extended our understanding by investigating the characteristics of tinnitus that can be studied using psychoacoustic techniques. Studies of tinnitus masking and residual inhibition began in the 1970s, leading to the therapeutic use of tinnitus masking and a consequent increase in research devoted to tinnitus measurement. In 1981, the CIBA Foundation symposium on tinnitus advocated general adoption of four tinnitus measures: (1) pitch, (2) loudness, (3) maskability, and (4) residual inhibition. Since then, psychoacoustic research into all four topics has proliferated, yielding many valuable insights and controversies concerning the details of measurement techniques. A consensus has emerged that neither the loudness nor other psychoacoustic measures of tinnitus bear a consistent relation to the severity or perceived loudness of tinnitus. Nevertheless, quantification is needed in clinical trials of proposed treatments and in a variety of other types of tinnitus research. Standardization of techniques for specifying the acoustic parameters of tinnitus thus continues to be an important research goal. Abbreviations: ABLB = alternating binaural loudness balance, DL = difference limen, FCDS = forced-choice double staircase, MML = minimum masking level, PLU = personal loudness unit, Rl = residual inhibition
Article
To investigate the effects of insomnia on tinnitus severity and to determine how this relationship may evolve with the passage of time. Questionnaires were mailed to patients before their initial appointment at the Oregon Health Sciences University Tinnitus Clinic between 1994 and 1997. These questionnaires requested information pertaining to insomnia, tinnitus severity, and loudness. During their initial appointment, patients received counseling, education, and reassurance about tinnitus; audiometric and tinnitus evaluations; and treatment recommendations. Follow-up questionnaires were mailed to 350 patients 1 to 4 years (mean = 2.3 yr) after their initial appointment at the clinic. One hundred seventy-four patients (130 men, 44 women; mean age 55.9 yr) returned follow-up questionnaires. Although many of these patients improved in both sleep interference and tinnitus severity, a significant number (43) reported on the follow-up questionnaire that they continued to have difficulty sleeping. Reported loudness and severity of tinnitus were significantly greater for this group than for groups of patients who reported that they never or only sometimes have difficulty sleeping. The relationship between sleep disturbance and tinnitus severity became more pronounced with the passage of time. Insomnia is associated with greater perceived loudness and severity of tinnitus. These findings underscore the importance of identification and successful treatment of insomnia for patients with tinnitus.
Article
Tinnitus has been much researched within adult populations with consideration of prevalence as well as the impact of tinnitus on individual's lives. Although the literature highlights the prevalence of tinnitus in children, there is little information on its effects from a psychological perspective. This small-scale preliminary study looked at 24 children (50% with normal hearing and 50% with a hearing loss) who presented to the Psychology Department with troublesome tinnitus. In line with adult studies, preliminary results suggested that tinnitus can have as marked an effect on children's lives as it is reported to have on adults. Insomnia, emotional distress, listening and attention difficulties are the main psychological factors associated with tinnitus in children. These, in turn, may have an effect upon their school performance. Differences were found between children with normal hearing and those with some degree of hearing loss. Overall, children with normal hearing found tinnitus more troublesome and presented with higher levels of anxiety than those with some level of hearing impairment. The present study suggests that children who complain of tinnitus should be taken seriously. In terms of management, individual intervention packages were found to be useful in alleviating anxiety and other associated factors. Recommendations are made on areas for future research.
Article
Clinical assessment of the perceptual characteristics of tinnitus usually includes an attempt to match the pitch of tinnitus to a pure tone. A standardized clinical protocol for tinnitus pitch matching does not yet exist, and there is a history of unsuccessful attempts to obtain such measures reliably. The present study was designed to evaluate new protocols for identifying the perceived pitch of tinnitus, with the objectives of reducing testing time and improving test-retest reliability. Two protocols ("Octave" and "Binary") were developed, each of which was patterned after the testing procedure previously developed at the Oregon Tinnitus Clinic and used to assess thousands of tinnitus patients. Both protocols use computer-automation to conduct testing; the protocols differ according to their specific testing algorithms. Twenty subjects with nonfluctuating tinnitus were each tested over two sessions. Results of testing revealed that both protocols could obtain pitch matches within 20 to 25 min. Reliability of responses was good for some subjects but not others, and the Binary protocol generally provided more reliable results.
Article
Two methods for treating tinnitus are compared. Tinnitus masking has been used for over 25 years, and although this method is used in clinics around the world, there are many misconceptions regarding the proper protocol for its clinical application. Tinnitus retraining therapy has been used clinically for over 12 years and has received considerable international attention. Although these methods are distinctive in their basic approach to tinnitus management, certain aspects of treatment appear similar. These aspects of treatment have created considerableconfusion and controversy, especially regarding the use of "sound therapy" as a basic component of treatment. It is the objective of this article to clarify the major differences that exist between these two forms of treatment.
Article
Audiology clinics are increasingly being asked to provide tinnitus treatment services to patients who are severely distressed by tinnitus. It is unclear what levels of tinnitus care are available at different audiology clinics across the nation. Some clinics have staff who are experienced with the tinnitus masking technique or with tinnitus retraining therapy (TRT), whereas other clinics may limit their care to the provision of hearing aids. This article is an attempt to provide some basic information for those clinicians who would like to provide at least a minimum level of care for their tinnitus patients using the tinnitus masking approach. The most important requirement is a commitment by the clinician to assemble some basic resources and to structure the clinical schedule so that adequate time is available for historical review, evaluation, trial and selection of devices, and tinnitus counseling. A minimum set of measurements is recommended for inclusion in the tinnitus evaluation process. This informal review summarizes a variety of clinical observations culled from years of direct patient care experience. A tinnitus questionnaire is provided to help clinicians review potentially relevant issues.
Article
Effective tinnitus relief can be achieved in a large percentage of patients using appropriately selected wearable devices that provide masking of the tinnitus. Guidelines are presented for selecting between three types of devices for that purpose: (1) tinnitus maskers; (2) hearing aids; and (3) tinnitus instruments (units that combine hearing aid and masker in the same case). For patients whose tinnitus cannot be masked, oral administration of alprazolam may be an effective alternative, which should be done with the knowledge and cooperation of the patient's primary care physician. Dosages and guidelines for administering alprazolam are presented.
Article
Clinical measurement of tinnitus is necessary for (1) establishing adequate diagnostic information, (2) selection of appropriate treatment, and (3) quantitative documentation of treatment effects. This article describes standardized methods for measuring tinnitus pitch, loudness, maskability, and residual inhibition. These methods have been used in the Tinnitus Clinic, Oregon Health & Science University, since the 1970s. Summary data for all four measures, obtained from over 1600 Tinnitus Clinic patients, are presented here in tabular form to demonstrate the nature and range of variability within the tinnitus patient population.
Article
It has been estimated that 15% of the population in the United States has tinnitus which lasts greater than 5 minutes. It has also been estimated that 155 million patients have previously sought care for this symptom. It is clear that the incidence of tinnitus increases with age and by 70 years of age at least 25 to 30% of patients experience tinnitus constantly. In addition, noise exposure and noise induced sensorineural hearing loss are most often seen in tinnitus patients. Furthermore, of interest to the physician, 94% of patients who have sought medical care have not been offered treatment for their tinnitus, rather they have been informed that nothing could be done for them, and they should "live with it".