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Tinnitus Self-help - What should you do when it whistles, rings, roars or drones in your ear? The most important and encouraging information is the fact that tinnitus has a benign cause in 99% of all cases. A look at the long-term effectiveness of an integrated tinnitus management approach (WZT) and the pattern of amplification and sound therapy use among primary tinnitus patients once successful remediation of symptoms is achieved. Habituation is classically defined as the process of adapting to a stimulus through repeated exposure.
The attentional processes involve perceptual filters that determine which sensory perceptions are brought to our conscious attention.
The vast majority of tinnitus patients present at least some degree of hearing loss, fueling the theory that the central auditory nervous system responds to the hearing deficit by increasing its gain, further adding to the perception of tinnitus. The use of music has been shown to reduce stress hormones.10 Physiological and behavioral reactions to tinnitus can be mitigated through the use of music.
Hearing aids with either noise generators or some kind of music have become popular in tinnitus management.
Consequently, there is a growing consensus that a multifaceted individualized approach to tinnitus management is more likely to result in the best outcomes. In addition, WZT incorporates the use of fractal (commercially termed Zen) tones and broadband amplification characterized by an extremely low compression kneepoint, relaxation exercises, and sleep management. The effectiveness of WZT in several studies has been reported,1,18-19 but none of these investigations have indicated the effectiveness or usage characteristics beyond a 6-month period. All participants were given a comprehensive audiologic and tinnitus evaluation including the Tinnitus Handicap Inventory (THI),20 Tinnitus Functional Index (TFI),21 and Widex Tinnitus Intake questionnaire.17 Participants were required to have cognitive, comprehension, and manual dexterity abilities sufficient for treatment, and all subjects paid for the tinnitus treatment for up to 12 months post hearing aid fitting. Additionally, all subjects were fit with Widex Dream or Clear hearing aids containing fractal (Zen) tones. Even though the initial fitting met most subjects’ needs, some required individual modifications in their Zen + programming. Subjects were instructed to use the devices during their waking hours when hearing and communication were essential. Figure 3 depicts the relationship between TFI baseline and 12-month post WZT for individual subjects. Figure 5 shows the mean use (in time percentage) of the Zen + programs as well as the amplification alone (the “Master” program) program. Datalogging also revealed that the Zen A (Aqua + microphone on) and Zen B (Aqua and noise plus microphone on) programs were the most frequently used programs. The use of Zen C (noise only plus microphone on) was very limited, varying from 9-12% during the 12 months. The fact that all 19 of the subjects achieved clinically significant improvements when comparing TFI scores from baseline to each of the follow-up visit scores, including those obtained at the 12-month visit, would seem to provide an unequivocal answer to that question.
Unfortunately, it is impossible to determine whether the overall use of amplification increased, because even during the 48% of time in which amplification-alone wasn’t being used at the 12-month visit, 17 out of 19 subjects were still utilizing Zen + programs that contained amplification. 2) Even though subjects had achieved an acceptable resolution of their tinnitus, they still recognized, and in some cases achieved, an even greater appreciation for the benefits received from amplification—either by assisting their hearing or by continuing to minimize their tinnitus distress.
Results from myriad investigations leave little doubt that WZT is an effective approach to tinnitus management. The inverse relationship between the use of Zen programs versus amplification-alone over time suggests that patients (even those whose primary complaint was tinnitus, rather than hearing loss) perceive a continued benefit for using amplification for improving their hearing, and possibly for tinnitus relief, even post habituation or successful resolution.
Meikle MB, Henry JA, Griest SE, Stewart BJ, Abrams HB, McArdle R, Myers PJ, Newman CW, Sandridge S, Turk DC, Folmer RL, Frederick EJ, House JW, Jacobson GP, Kinney SE, Martin WH, Nagler SM, Reich GE, Searchfield G, Sweetow R, Vernon JA. In collaboration with affected persons and with specialists we are researching and developing new forms of therapy and evaluating their chances of success.
In Step 2 you will receive an overview of the most appropriate of the therapy possibilities. When tinnitus habituation occurs, either the perception of the tinnitus, or the reaction to the tinnitus, is greatly, if not fully, diminished.2 In this article, habituation will be regarded as substantial and meaningful lessening of the negative reaction to the tinnitus as defined by clinically significant reductions in subjective distress scores. The reaction to it varies from a minor annoyance to one that can significantly and negatively impact one’s quality of life. In clinically significant tinnitus, these filters determine that attention should be applied to the specific patterns of neural activity associated with the tinnitus.3,4 The engagement of the autonomic system and amygdala leads to further increases in the sensitivity of the auditory system and reinforcement of the attentional filters, creating further increase in tinnitus loudness and awareness, which in turn increases the level of stress. A limitation of the use of popular music, however, is the chance that these stimuli can attract excessive attention to both the music and the tinnitus. Most tinnitus strategies employed over the past two decades consist of a combination of directive (instructional) counseling and acoustic stimulation (either noise, amplification, or a combination of the two).


There is also an option to include broadband noise in addition to, or in lieu of, the Zen tones.
A total of 20 subjects were initially enrolled in this cohort study conducted at the ENT Associates of South Florida in Boca Raton, Fla. The hearing loss varied from mild to moderately severe, and the average hearing thresholds of the subjects are shown in Figure 1. Clinicians participating in this investigation had considerable experience in tinnitus patient management and were familiar with the fitting of Widex hearing aids and Zen programming. The specific models chosen ranged from models 110 to 440, and were selected based on the joint decision of the patient and clinician taking in audiologic as well as economic considerations. Zen + B (noise) or Zen noise (C) were only recommended if the clients experienced periods where the tinnitus was very bothersome.
Although turning off the microphone in the Zen+ programs was an option, only two subjects chose to do so.
They were further taught that the Zen fractal tones should be audible, but relatively soft and that the tones should not interfere with conversational speech. The TFI and THI were administered at baseline, as well as at 2, 4, 6, 9, and 12 months post-treatment. The TFI was chosen because of its extremely strong psychometric evidence and multiple domain clinical relevance. Individual subject Tinnitus Functional Index (TFI) baseline and 12 month post Widex Zen Therapy scores for the 19 subjects. Note that, at the 2-month visit, the three Zen + programs were used 73% of the time, but amplification-alone was only used an average of 27% of the time.
Therefore, one can confidently say that, as habituation (or resolution of the tinnitus distress) increased, the need for additional sound therapy beyond amplification decreased—though subjects continued to use amplification.
It is of particular importance to note that clinically significant changes were found at the 2-month visit for all of the subjects on the TFI. One way to approach this issue is to compare the pattern of fractal tone, noise, and amplification-only usage at the 6-month follow-up, since 15 of 19 subjects (79%) achieved clinical resolution of their tinnitus distress (<20 on the TFI) by that visit, to the 12-month follow-up visit. The exceptions were the 2 subjects who chose to turn off the microphone in Program C at the onset of the project. This is particularly relevant considering the fact that 17 of the 19 subjects originally presented with primary complaints of tinnitus, rather than hearing difficulty.
As seen in earlier studies, when given the choice between listening to sound therapy containing fractal tones versus programs containing noise, the overwhelming majority (as reflected by comparing usage of Zen A vs Zen C) choose fractal tones.
However, the excellent results obtained in this study are certainly, in part, related to the expertise of the clinicians.
Further studies are needed to determine the relative contribution of each of the WZT components (including the undisputed importance of counseling), but until these data are available, it seems prudent to utilize the multiple counseling and sound therapy tools offered in an integrated approach like WZT.
The Tinnitus Functional Index: Development of a new clinical measure for chronic, intrusive tinnitus. A comparison of benefit and economic value between two sound therapy tinnitus management options. Sweetow, PhD, is Professor of Otolaryngology and former Director of Audiology at the University of California, San Francisco (UCSF); Melodi Fehl, MA, is a Clinical Audiologist and Patti Ramos, AuD, is Director of Audiology and Rehabilitative Services at ENT Associates of South Florida in Boca Raton, Fla. In order to be certain about even the last percent, one should go to an ear, nose and throat specialist. The condition typically involves multiple neuro-plastic changes to sites producing auditory, attentional, and emotional processes of the brain.
The mechanisms of emotional disturbance associated with tinnitus define the “reaction” to hearing the tinnitus sound, as opposed to the “perception” of the sound. Auditory fractal tones utilize harmonic but unpredictable musical relationships, and are generated by a recursive process where the algorithm is applied multiple times to process its previous output. Widex Zen Therapy extends these approaches by additionally incorporating cognitive behavioral interventions in the form of adjustment-based counseling designed to identify the unwanted thoughts and behaviors hindering natural habituation, challenge their validity, and replace them with alternative and logical thoughts and behaviors. The approach is individualized, in that the necessary components of WZT are determined after a comprehensive evaluation of the tinnitus and the patient’s reaction.
All but one (19 subjects, 11 females and 8 males with a mean age of 65, ranging from 49 to 86) completed the study.
The Widex Intake Questionnaire, TFI, THI, and the clinician’s observation of the subjects were used to determine which WZT components were employed.
The hearing aids had wide dynamic range compression (WDRC), compression thresholds as low as 0 dB HL, adaptive multichannel directional microphone, noise reduction, active feedback cancellation, data logging, and inter-ear capabilities.


Thus, the volume was to be set so that the annoyance level of the tinnitus would just begin to decrease. Hearing aid datalog records were accessed at these time intervals to ascertain hearing aid use both during the therapeutic effort to induce habituation and after.
Any symbol falling below this diagonal line suggests some degree of reduction in tinnitus distress. The mean use of hearing aids, including amplification and Zen programs, was 8 hours during the 12-month course of this investigation. By the end of the study (ie, 10 months later), however, the combined use of the Zen programs had decreased to 47%, while the amplification-alone usage increased to 53%.
While the effectiveness of an integrated approach like WZT has been repeatedly shown in studies cited earlier, none of those studies looked at the longer-term effects lasting out to 1 year post therapy onset. Moreover, 17 of 19 subjects (91%) had TFI scores suggesting their tinnitus was no longer clinically significant by the conclusion of the 12-month study. The data showed that the combined use of the three Zen + programs decreased from 56% to 48% (compared to 73% at the 2-month visit), while the use of the amplification-alone (Master) program progressively increased from 44% to 52% (compared to 27% at the 2-month visit). This has been shown in other studies as well,11,12,14 and is likely due to the inherent relaxing qualities of the Zen tones.
It is not realistic to expect the 100% success found in this project to be found in the real world.
If the diagnosis is benign then, medication or surgical treaments will have scarcely any effect here. Seventeen of the subjects initially presented to the clinic with a primary complaint of tinnitus, rather than hearing difficulty.
All subjects were given instructional counseling, relaxation exercises including progressive muscle relaxation (PMR), deep breathing and guided imagery, and sleep suggestions. A more detailed explanation of the Zen programming is available.17 Subjects were advised to not adjust the Zen volume unless deemed necessary by environmental conditions. The number of sessions necessary to accomplish a successful outcome varied and was defined by a clinically significant reduction in THI and TFI scores, or achievement of a non-significant score (< 20 for the TFI or less than 18 for the THI) for two consecutive visits, as well as a subjective report that tinnitus awareness, or tinnitus disturbance, or quality of life was no longer an issue negatively impacted by the tinnitus. A reduction of 13 points is considered clinically significant on the TFI.21 The dashed line represents the 13-point benefit score considered clinically significant.
This decrease may be related to the fact that subjects had their tinnitus distress reduced over time and no longer felt the need to use fractal tones and noise as frequently as they did during the first 2 months of sound therapy.
Not unexpectedly, there was a trend for the subjects least affected at baseline to also show the least amount of improvement. This implies that, as resolution was achieved, subjects tended to utilize the Zen programs, particularly those containing noise (B and C), less frequently while increasing their reliance on amplification-only. This point underscores the importance of offering multiple sound therapy options, such as a variety of fractal tone styles and adjustable bandwidth noises, to those patients (approximately 10% in this study) who may prefer acoustic stimuli other than fractal tones. The overall aim of Widex Zen Therapy is to ensure that the tinnitus does not negatively impact the patient’s quality of life, as opposed to reducing the loudness level or production of the tinnitus.
All but 7 subjects had experienced tinnitus for more than 1 year, and all but 4 reported tinnitus in both ears. Additional counseling in the form of cognitive behavioral intervention was applied when the clinicians believed appropriate. Subjects who showed clinically and significantly improvements didn’t require all the planned sessions; however, the THI, TFI, and datalogging measures were still collected as planned. Symbols falling below the diagonal dashed line reflect clinically significant relief from tinnitus. The usage of Zen A (fractal tones) decreased somewhat, but this reduction was not statistically significant. We will try to advise you objectively and to inform you about the most promising of the treatment possibilities. In addition, 15 of the 19 subjects’ final TFI were below the 20-point score considered clinically significant.
In addition, it should be noted that the final mean TFI score was 11.76, a tinnitus distress score considered clinically insignificant.



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