Association between tinnitus retraining therapy and a tinnitus control instrument

Objective

Tinnitus retraining therapy (TRT), which is an adaptation therapy for tinnitus based on the neurophysiological model proposed by Jastreboff in 1990,consists of directive counseling and acoustic therapy with a tinnitus control instrument (TCI) or other devices. For the past 5 years, our hospital has administered TRT characterized by the use of a TCI.

Method

In this study, we reviewed the clinical course of patients with tinnitus who presented to our outpatient clinic for tinnitus and hearing loss during the 3-year period from April 2004 to March 2007 and underwent TRT with a TCI. Among 188 patients with tinnitus (105 males and 83 females), 88 patients (51 males and 37 females, excluding dropouts) who purchased a TCI and continued therapy were included in the study.

Results

Significant improvement in Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS) scores was found as early as 1 month of treatment and later compared with those on initial examination, suggesting that TRT with a TCI may be an effective treatment for tinnitus. Among the noises generated by the TCI, the sound pressure output from the TCI was set at just below tinnitus loudness level both of the first adjustment and the second adjustment. Speech noise and white noise were frequently selected, whereas high-frequency noise and pink noise were infrequently selected. Speech noise was most frequently selected at the first adjustment, and the number of patients selecting white noise increased at the second adjustment. The results that we compared the two also revealed that the mean hearing level and tinnitus loudness levels were higher in the white noise group than in the speech noise group, which suggested that the inner ear disorder was more harder in the white noise group. Both the THI score and VAS grade improved after 1 month of treatment in the speech noise group, whereas improvement in these parameters was observed in the white noise group after 6 months of treatment. These results suggest that it took much longer the patients in the white noise group to improve.

Conclusion

: Significant improvement in THI and VAS scores was found as early as 1 month of treatment and later compared with those on initial examination, suggesting that TRT with a TCI may be an effective treatment for tinnitus. It resulted that many patients chose the speech noise or the white noise. And also it was indicated that noise generators set at just below mixing point with tinnitus are more effective. In this study, however, speech noise was often selected probably because of the reduced output at high frequencies and the level of comfort. As white noise produces greater sound volume, patients tended to switch from other therapeutic sound to white noise at the second adjustment. These findings may help administer acoustic therapy in the future.     

Public Health Perspectives on Hearing Loss and Aging Outcomes: Association of Hearing Loss with Physical,Social, and Mental Activity Engagement

This article aims to evaluate a hearing loss intervention versus an aging education intervention on activity engagement in the Aging and Cognitive Health Evaluation in Elders pilot (ACHIEVE-P). Forty adults (70–84 years) with hearing loss recruited from the Atherosclerosis Risk in Communities Study and de novo participated. Participants were randomized 1:1 to a best practices hearing intervention or a successful aging intervention. Hearing was measured with pure-tone audiometry. The Community Healthy Activities Model Program for Seniors questionnaire measured self-reported time engaging in activities at baseline and 6-month follow-up. At baseline, greater hearing loss was associated with reduced time per week on mental activities (−3.0 hours per 10 dB of hearing loss, 95% confidence interval: −5.8, −0.2). Mental activity engagement increased (mean: +1.3 hours, SD = 6.6) for the hearing intervention group but decreased (mean: −1.1 hours, SD = 4.8) for the aging education group (Cohen''s d : 0.41). Hearing loss may be associated with reduced engagement in mental activities. Whether hearing loss treatment impacts activity will be studied in the full-scale ACHIEVE trial.     

声治疗联合劳拉西泮治疗耳鸣的临床研究

目的观察声治疗联合劳拉西泮治疗耳鸣的疗效,并探讨作用机制。方法采用随机、对照、双盲的研究方法,将68例耳鸣患者分为试验组和对照组,每组34例,均予耳鸣咨询和声治疗作为基础治疗,试验组加用劳拉西泮,对照组加用维生素B6,治疗1周后观察近期疗效并停药,继续使用声治疗至2个月观察远期疗效。治疗前后行纯音测听和耳鸣匹配,填写耳鸣问卷(包含耳鸣残疾度量化表)和焦虑自评量表,对结果进行比较。结果用药1周后,试验组患者的耳鸣主观响度评分下降1.2±1.0分,残疾度评分下降14.0±13.5分,焦虑评分下降9.9±7.2分,对照组上述三个指标改善值分别为0.1±1.4、1.3±8.0、3.3±6.1分,两组间差异有统计学意义(P<0.05),且用药后2个月差异仍有统计学意义(P<0.05),三个评价指标的变化呈中度正相关(r=0.378～0.762,P<0.01);两组均未出现严重药物不良反应。结论劳拉西泮结合耳鸣咨询与声治疗可以改善患者的耳鸣症状和焦虑情绪;劳拉西泮治疗耳鸣安全有效。     

Small-Group Counseling in a Modified Tinnitus Retraining Therapy for Chronic Tinnitus

Objectives

The authors have treated chronic tinnitus patients using a combination of a simplified tinnitus retraining therapy (TRT) and medications, which we called modified TRT. In this clinical setting, we have attempted small-group counseling to find a time-effective equivalent of individual counseling. The aim of the present study was to evaluate the effectiveness of small-group counseling by comparing the treatment outcomes between individual and small-group counseling.

Methods

The patients who had distressing chronic tinnitus with normal hearing or mild hearing loss were included. The subjects were placed into the small-group (group 1:4) or the individual (group 1:1) counseling group, and underwent a modified TRT composed of a single session of directive counseling and ambient sound stimulation. In addition, alprazolam (0.25 mg) and ginkgo biloba extract (80 mg) were administered orally to the subjects for 3 months. The 3- and 6- month outcomes were assessed using the follow-up rates and tinnitus severity scores: awareness, tinnitus handicap inventory (THI), loudness, annoyance, and effect on life. The treatment responses were classified as improvement, no changes, and worsening.

Results

Of the total 149 patients (77 in group 1:1; 72 in group 1:4), 104 patients completed the protocol at 3 months, and 55 patients at 6 months. The follow-up rates were similar in both groups. Over the period of 6 months, all scores declined significantly except the loudness score at 3 months in both groups. Treatment responses showed no between-group differences. The success rate based on THI was 70% in group 1:1, and 64% in group 1:4 at 6 months.

Conclusion

The small-group counseling of our modified TRT was comparable to the individual counseling for tinnitus relief. We suggest that this protocol can be implemented effectively in any crowded otolaryngology clinics.     

Clinical practice guidelines for diagnosis and treatment of chronic tinnitus in Japan

Clinical practice guidelines in Japan for tinnitus were published in May 2019. Effective treatment of tinnitus contributes to quality of life and may improve depression, anxiety, and cognitive function. The highest priority of treatment recommended by this guideline involves educational counseling, including an explanation of the mechanisms of tinnitus. Understanding tinnitus pathology has also been reported to be a therapeutically effective educational counseling strategy. Further, explaining how sound therapy such as tinnitus retraining therapy (TRT) works is effective. Psychological and cognitive behavioral therapies may be an option. Here, the hearing aid is coupled with a sound generator in order to administer sound therapy for patients with more-severe symptoms. In Japan, it can be difficult to perform psychotherapy alongside otorhinolaryngology, and exemplary sound therapy is more likely to be carried out. In any case, the purpose of treatment is not to eliminate tinnitus, but rather reduce distress that manifests in response to tinnitus by promoting sensory adaptation. Clinically, the most important subject is not the loudness of tinnitus, but the severity of tinnitus distress.TRT consists of educational counseling and sound therapy. The tinnitus handicap inventory (THI) is used to measure the distress level for tinnitus and to determine treatment priorities. Rehabilitation of tinnitus is important because anxiety and depression are often observed in patients with severe tinnitus.Additionally, drug administration should be avoided. As a surgical treatment, a cochlear implant can affect tinnitus symptoms. It is essential to establish a treatment policy according to the disease condition and degree of distress.     

A revised model of loudness perception applied to cochlear hearing loss

We previously described a model for loudness perception for people with cochlear hearing loss. However, that model is incompatible with our most recent and most satisfactory model of loudness for normal hearing. Here, we describe a loudness model that is applicable to both normal and impaired hearing. In contrast to our earlier model for impaired hearing, the new model correctly predicts: (1) that a sound at absolute threshold has a small but finite loudness; (2) that, for levels very close to the absolute threshold, the rate of growth of loudness is similar for normal ears and ears with cochlear hearing loss; (3) the relation between monaural and binaural threshold and loudness; (4) recent measures of equal-loudness contours. Like the earlier model, the new model can account for the loudness recruitment and reduced loudness summation that are typically associated with cochlear hearing loss.     

Personal experience with tinnitus retraining therapy

We present the results of tinnitus retraining therapy (TRT) in a group of patients suffering from tinnitus and/or hyperacusia. Based on the scores from a specific questionnaire and the Tinnitus Handicap Inventory (THI), the patients were classified into five categories and began therapy according to Jastreboff’s criteria. Depending on the individual case, therapy envisaged counselling sessions, ambient sound enrichment, sound generators and hearing aids. At the end of the 18-month period, therapeutic success was observed in 79% of the patients. The initial numerical values of the scale of the symptoms and the THI seem predictive of treatment outcome. The use of instruments (sound generators) increases the success rate, but the study also demonstrates the effectiveness of counselling and ambient sound enrichment. Failures mainly involved patients with hypacusia who refused to wear hearing aids, as this influenced the effectiveness of ambient sound enrichment and counselling. Paralleling the data in the literature, the results demonstrate the effectiveness of TRT, which cannot be attributed to a placebo effect given the extended duration of treatment.     

Hearing aid saturation and aided loudness discomfort.

Clinical measurements of the loudness discomfort level (LDL) are generally performed while the subject listens to a particular stimulus presented from an audiometer through headphones (AUD-HP). The assumption in clinical practice has been that the sound pressure level (SPL) corresponding to the sensation of loudness discomfort under AUD-HP conditions will be the same as the corresponding to LDL with the hearing aid. This assumption ignores the fact that the distortion produced by a saturating hearing aid could have an influence on the sensation of loudness. To examine these issues, 5 hearing-impaired subjects were each fit with four linear hearing aids, each having a different saturation sound pressure level (SSPL90). Probe-tube microphone measurements of ear canal SPL at LDL were made while the subjects listened to continuous discourse in quiet under aided and AUD-HP conditions. Also using continuous discourse, real-ear coherence measures were made at various output sound pressure levels near LDL. All four hearing aid types produced mean LDLs that were lower than those obtained under AUD-HP conditions. Those hearing aids with higher SSPL90 produced significantly higher LDLs than hearing aids with lower SSPL90. A significant negative correlation was found between real-ear SPL and real-ear coherence. Quality judgments made at LDL indicated that sound quality of hearing aids with higher SSPL90 was preferred to that of hearing aids with lower SSPL90. Possible fitting implications regarding the setting of SSPL90 from AUD-HP LDL measures are discussed.     

Loudness discrimination of speech signals spectrally shaped by a simulated hearing aid.

A discrimination task was used to assess changes in the loudness of speech that accompanied changes in the spectral tilt of a simulated hearing aid's frequency response. Band-limited (0.25-4 kHz) spondaic words were spectrally shaped at comparison tilt-factor values of -6, 0, and +6 dB per octave and delivered monaurally via insert earphone to each of 10 listeners with normal hearing (NH) and 15 listeners with mild-to-moderate sensorineural hearing impairment (HI). Results for the NH listeners indicated that loudness differences among the tilt factors were generally perceptible and that loudness judgments were highly transitive across different tilt-factor comparisons. Loudness differences were also perceptible to many of the HI listeners when they switched among tilt factors. The HI listeners' data showed some evidence of transitivity, but not so much as was shown by the NH listeners. Intersubject variability in the loudness judgments was found to be comparable for the two subject groups. Results of the study are discussed with regard to their implications for hearing aid fitting, with particular emphasis on the "parameter adjustment and selection" fitting procedure (J. Punch & R. Robb, 1992).     

A comparison of sound quality judgments for monaural and binaural hearing aid processed stimuli.

Fifteen adults with bilaterally symmetrical mild and/or moderate sensorineural hearing loss completed a paired-comparison task designed to elicit sound quality preference judgments for monaural/binaural hearing aid processed signals. Three stimuli (speech-in-quiet, speech-in-noise, and music) were recorded separately in three listening environments (audiometric test booth, living room, and a music/lecture hall) through hearing aids placed on a Knowles Electronics Manikin for Acoustics Research. Judgments were made on eight separate sound quality dimensions (brightness, clarity, fullness, loudness, nearness, overall impression, smoothness, and spaciousness) for each of the three stimuli in three listening environments. Results revealed a distinct binaural preference for all eight sound quality dimensions independent of listening environment. Binaural preferences were strongest for overall impression, fullness, and spaciousness. Stimulus type effect was significant only for fullness and spaciousness, where binaural preferences were strongest for speech-in-quiet. After binaural preference data were obtained, subjects ranked each sound quality dimension with respect to its importance for binaural listening relative to monaural. Clarity was ranked highest in importance and brightness was ranked least important. The key to demonstration of improved binaural hearing aid sound quality may be the use of a paired-comparison format.     

Clinical randomized trial study of hearing aids effectiveness in association with Ginkgo biloba extract (EGb 761) on tinnitus improvement

IntroductionTinnitus is defined as the perception of sound without its actual presence in the environment. It has been the subject of a great number of studies, especially considering its consequences on patient's quality of life.ObjectiveThis study aimed to investigate the effect of hearing aids and/or Ginkgo biloba extract EGb 761 on tinnitus in patients with hearing loss.MethodsThis is a trial randomized-controlled treatment, parallel, double-blind, with three-arm. Thirty-three adults subjects were divided into three groups: group 1 — subjects undergoing drug therapy with Ginkgo biloba extract EGb 761; group 2 — individuals fitted with digital hearing aids; group 3 — individuals submitted to drug therapy with Ginkgo biloba extract EGb 761 and using hearing aids. The tinnitus handicap inventory and visual analogue scale were used to evaluate self-perception of tinnitus loudness and severity before treatment and 90 days after treatment.ResultsThis study demonstrated a significant correlation between tinnitus handicap inventory and visual analogue scale, before and after treatment. We observed a significant improvement in self-perception of tinnitus loudness and severity after 90 days of treatment with Ginkgo biloba extract EGb 761 and/or hearing aids. No correlation was found between tinnitus onset time and self-perception of tinnitus loudness and severity. Hearing aids were more effective in patients with a shorter tinnitus onset time and Ginkgo biloba extract was effective regardless of tinnitus duration.ConclusionsIt was possible to prove the effectiveness of the hearing aids and/or Ginkgo biloba extract EGb 761 treatment, which shows success in the control of tinnitus contributing to the improvement of this symptom.     

Effective sound therapy using a hearing aid and educational counseling in patients with chronic tinnitus

ObjectiveThis study aimed to assess the effectiveness of our sound therapy with appropriate hearing aid fitting and periodic hearing aid adjustment in patients with chronic tinnitus.MethodsWe conducted a retrospective study. The study included 490 individuals who received treatment with hearing aids for chronic tinnitus at least for 3 months. To determine the effects of tinnitus on patients’ quality of life, the participants completed a series of questionnaires, including the Tinnitus Handicap Inventory (THI), Visual Analogue Scale (VAS) for loudness and annoyance, and questionnaires of subjective symptom improvement. Data were collected at entry and 3 months and 1 year after treatment initiation.ResultsAll 490 participants completed the questionnaires at 3 months; however, only 312 completed them at 1 year. The mean ± standard deviation THI score before treatment decreased significantly at 3 months (490 participants: 53 ± 25 to 11 ± 16 and 312 participants: 55 ± 24 to 12 ± 16) and 1 year (55 ± 24 to 9 ± 14) (P < 0.01). The mean VAS score for tinnitus loudness before treatment decreased significantly at 3 months (490 participants: 70 ± 22 to 25 ± 27 and 312 participants: 71 ± 22 to 27 ± 26) and 1 year (71 ± 22 to 21 ± 28) (P < 0.01). In addition, the mean VAS score for tinnitus annoyance before treatment decreased significantly at 3 months (490 participants: 75 ± 26 to 20 ± 26 and 312 participants: 75 ± 25 to 23 ± 27) and 1 year (75 ± 25 to 17 ± 26) (P < 0.01). Approximately 80% of patients noticed improvements in their tinnitus annoyance and loudness, as determined by their responses to the questionnaires of subjective symptom improvement.ConclusionThe results of this study suggest that treatment with sound therapy may ameliorate the symptoms of chronic tinnitus associated with hearing loss.     

Screening strategy and time points for newborn hearing re‐screening with high risk factors

ObjectiveTo compare and analyze the pass rate and screening strategy of hearing rescreening for newborns with high risk factors.MethodsRetrospective chart review of high‐risk newborns who failed their initial newborn hearing screen and subsequently underwent secondary hearing tests from June 2011 to June 2018 in Guangzhou Women and Children''s Medical Center were performed.ResultsEight hundred and sixty‐eight newborns with high risk factors were included in the study. The 57‐70 days (83.5%) and 71‐84 days (83.4%) group had the highest pass rate compared with 42‐56 days (75.8%) and < 42 days (68.3%) group. As for different screening strategies, the pass rate of OAE(otoacoustic emissions), AABR (auto auditory brainstem response) and OAE + AABR was the highest in 57–70 days group and 71‐84 days group, respectively. The OAE + AABR had the lowest pass rate compared to the other two modalities. When the pass rate was compared as different risk factors, the 57–70 days and 71–84 days group also had the highest pass rate compared with 42–56 days and < 42 days group and the pass rate had no significant differences among various risk factors group.ConclusionOur results showed that all the pass rate of OAE, AABR and OAE + AABR was the highest in 57–70 days group and 71–84 days group with significant difference, suggesting that the delayed screening time (>57 days) may increase the re‐screening pass rate and reduce anxiety of parents, which is of great significance for clinical work.     

Loudness and annoyance of disturbing sounds – perception by normal hearing subjects

Objective: Sounds in the daily environment may cause loudness and annoyance. The present study investigated the perception of loudness and annoyance for eight different sounds present in a daily sound environment and at nine different levels varying by ±20?dB around the recorded level. The outcomes were related to tests of participants’ auditory and cognitive abilities. Design: The participants undertook auditory and working memory (WM) tests prior to ratings of everyday sounds previously shown to be disturbing for persons with hearing impairment (hearing aid users). Study sample: Twenty-one participants aged between 24 and 71 years, with normal hearing threshold levels. Results: Both perceived loudness and annoyance were primarily driven by the sound level. Sounds emitted from paper were rated as having greater loudness and being more annoying than the other sound sources at the same sound level. Auditory and cognitive abilities did not influence the perception of loudness and annoyance. Conclusions: Loudness and annoyance ratings were mainly driven by sound level. Expectations of a sound seemed to influence the assessment of loudness and annoyance while auditory performance and WM capacity showed no influence on the ratings.     

Wireless Connectivity for People with Hearing Loss: Behavioral Validation of the Smartphone for Remote Microphone Technology

As part of a National Institutes of Health–National Institute on Deafness and Other communication Disorders (NIH-NIDCD)–supported project to develop open-source research and smartphone-based apps for enhancing speech recognition in noise, an app called Smartphone Hearing Aid Research Project Version 2 (SHARP-2) was tested with persons with normal and impaired hearing when using three sets of hearing aids (HAs) with wireless connectivity to an iPhone. Participants were asked to type sentences presented from a speaker in front of them while hearing noise from behind in two conditions, HA alone and HA + SHARP-2 app running on the iPhone. The signal was presented at a constant level of 65 dBA and the signal-to-noise ratio varied from −10 to +10, so that the task was difficult when listening through the bilateral HAs alone. This was important to allow for improvement to be measured when the HAs were connected to the SHARP-2 app on the smartphone. Benefit was achieved for most listeners with all three manufacturer HAs with the greatest improvements recorded for persons with normal (33.56%) and impaired hearing (22.21%) when using the SHARP-2 app with one manufacturer''s made-for-all phones HAs. These results support the continued development of smartphone-based apps as an economical solution for enhancing speech recognition in noise for both persons with normal and impaired hearing.     

Morphology,GluR1 and GRIP-C localization differ in octopus cells of C57BL6 and B6Cast mice

Air conduction (AC) versus bone conduction (BC) loudness balance testing was conducted at frequencies of 0.25, 0.5, 0.75, 1, 2, and 4 kHz for two groups: 23 normal hearing subjects and eight subjects with a mild to moderate pure sensorineural hearing loss. Narrow-band noise was presented interchangeably between earphones and a bone transducer fitted to the subjects. Loudness matching was carried out at each frequency and at the levels 30-80 dB hearing level (HL) (10 dB steps) in the following manner: the sound pressure from the earphones was fixed and the subject adjusted the output level of the bone transducer for equal loudness by bracketing the standard. The results revealed somewhat different loudness functions for AC and BC sound with a 6-10 dB difference in the AC and BC loudness functions for the normal hearing group over the dynamic range 30-80 dB HL at the frequencies 250-750 Hz. At the higher frequencies, 1-4 kHz, the difference was only 4-5 dB over the same dynamic range. Similar results were obtained for the sensorineural hearing-impaired group. The difference between the AC and the BC loudness functions may originate from changes with level of the AC sound path, e.g. contraction of the stapedius muscle, but also distortion from the bone transducer and tactile stimulation could have contributed to the results seen.     

Eficacia del corticoide intratimpánico como tratamiento de rescate en sordera súbita neurosensorial idiopática

IntroductionIdiopathic sudden sensorineural hearing loss (ISSHL) is defined as an abrupt hearing loss of at least 30 dB of unknown cause. The hearing response obtained after intratympanic steroid injection as a salvage treatment after a prior failure of initial systemic steroid treatment was analysed.Material and methodAn observational study was performed on 125 cases of ISSHL who were diagnosed from 2006 to 2014. Sixteen achieved complete recovery after one week according to Siegel's criteria. The remaining 109 cases were analysed in two groups: one that received intratympanic corticosteroid salvage therapy (treatment group) and one that did not (control group). The recovery was analysed after 6 months and 2 years of follow-up.ResultsThe difference between each group at baseline were not statistically significant. After systemic treatment for 7 days, PTA in the control group was 53.13 dB and 66.11 dB in the treatment group (P < .01). After 6 months, the mean PTA improvement was 10.84 dB in the treatment group, and 1.13 dB in the control group, a significant difference (P < .0001). Only 10 cases achieved full hearing recovery after intratympanic corticosteroid salvage therapy, none of the patients did so in the control group.ConclusionIntratympanic corticosteroid rescue for ISSHL acheived hearing improvement for the cases with failure of initial systemic corticosteroid treatment. However, this treatment did not provide complete hearing recovery according to Siegel's criteria in most cases.     

Evaluation of the tinnitus retraining therapy as combined with a cognitive behavioral group therapy

BACKGROUND: The study evaluates the effectiveness of a Tinnitus Retraining Therapy as combined with a cognitive behavioral group therapy. PATIENTS AND METHODS: 95 patients suffering from chronic tinnitus (mean age 49,3 years) were included. 16 of these 95 participants served as a waiting list control group. The participants were divided into 3 treatment groups. Group 1 was fitted with wideband noise generators, group 2 with hearing aids. The 3rd group was not supplied with any device. After a detailed audiological and psychological examination and tinnitus counseling all patients took part in a cognitive behavioral therapy for a period of 3 months. RESULTS: 64,5% of our patients improved significantly after the initial group therapy. In contrast, the patients of the waiting list control group showed no significant improvement. This initial treatment effect could be maintained over the period of control. We were unable to show significant advantages of noise generators as compared to cognitive behavioural group therapy alone. CONCLUSION: The Tinnitus Retraining Therapy combined with a cognitive behavioral group therapy is an effective treatment in patients with chronic tinnitus.