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The Heart of the Matter: What Does America Really Know about Coronary Artery Disease Treatments? Mariko Takahashi is an ENT physician and an associate professor at Nagoya City University in Japan. Learn about an easy step-by-step process that will allow you to successfully manage patients with tinnitus. This course reviews a comprehensive process in working with patients who report severe cases of tinnitus.
This course will focus on all the elements required in offering tinnitus management in your facility.
When working with tinnitus patients, it is imperative that your referring physicians are educated in tinnitus therapy and proper referrals.
PoliticsWhat are the lawmakers, and other state and federal officials, up to when it comes to health reform laws?
That’s the basic takeaway from an emerging body of research suggesting that the distress associated with growing up poor can negatively influence brain development in many ways, and in certain cases might also lead to emotional and mental health problems, like depression. Shir Atzil, a former post-doc in the Interdisciplinary Affective Science Lab, uses her head to help scare haunted house visitors. Barrett leads the Interdisciplinary Affective Science Lab at Northeastern and Massachusetts General Hospital. Some of their scare techniques may not seem to differ much from those of amusement park haunted houses, but they’re devised by neuroscientists who live and breathe the brain. Barrett says the effect carries a wallop in part because the brain is wired to pay huge attention to whether an object is alive or inanimate. Also, certain special effects fire up specific parts of the brain, Barrett says, including the amygdala, an area important for detecting uncertainty or novelty. Here’s another brain-science trick: It’s scarier when you first see something out of the corner of your eye, because your peripheral vision involves more uncertainty. These days, Simon lives in a lush compound on Martha’s Vineyard, where family members often spend the summer. But the family wants to show their dyslexia can be a positive force — a challenge, absolutely, but also a catalyst for new ways of framing the world or problem-solving that might lead a child to become a famous artist or a successful entrepreneur. Sally Taylor’s husband, Dean Bragonier, also dyslexic, was teased mercilessly in middle school for his painfully slow reading. The end result will be a set of educational tools for middle school-aged kids with dyslexia. In general, these are realms that some dyslexics have excelled at: think Whoopi Goldberg or cellphone pioneer Craig McCaw.
That may sound like the first draft of a science fiction novel but, in fact, it’s describing events from last month, when I tried out a watch that has sensors to measure the autonomic nervous system, which regulates our fight-or-flight response.
Neumitra, a Boston-based startup, developed the technology, and plans to launch an ambitious project this fall that would use it to chart the stress not just of individuals but of professions and institutions — even of a whole city. But it’s one thing to verbally express feelings of stress, and quite another to quantify those sensations. You can track your stress level in real time through an app that displays the data that the watch collects. The app displays stress using a color gradient: Blue means relaxed or restful, orange and red signify increasing tension. This technology is certainly fascinating, but does it really tell us anything we didn’t already know? In this age of “smart” or “connected” everything, we’re getting used to devices that monitor us, but Goldberg says Neumitra’s plans for the technology’s use on a large scale might lead to a whole new understanding of the effects of daily life on stress. Chemistry, as I learned from Saturday morning cartoons, is about mixing colorful, bubbling liquids in test tubes until they explode. Your brain, it turns out, is populated with characters for each emotion, and they press buttons to control your expressions.
This blob over here is your “fear circuit,” they say, or this other blob “computes anger.” And every time you experience an emotion, your corresponding blob of neurons supposedly leaps into action, triggering your face and body to respond in a consistent way. The thing is, this science of “blob-ology” is no more realistic than detonating test tubes and hovering coyotes. For example, my lab has analyzed nearly 100 published brain-imaging studies by other scientists, involving nearly 1,300 test subjects across 15 years, and found that no brain region is the home for any single emotion. In another analysis covering 22,000 test subjects across more than 200 studies over 20 years, we demonstrated that anger, happiness, sadness and other emotions don’t have consistent responses in the body either. Starr, a 52-year-old audio engineer who makes his living by his ears, suffered no visible injury. An even more powerful driver of tinnitus research is the enormous incidence of the problem among Iraq and Afghanistan war veterans who’ve suffered blast damage. Back in 2002, Sinha was grappling with a deep scientific question: How do we learn to recognize the objects we see? He was back visiting New Delhi, where he grew up on the elite campus of the Indian Institute of Technology before coming to America for graduate school.
When she approached, Sinha noticed that both of the children holding on to her sari had cataracts clouding their eyes. Sinha wanted to help, but he figured that what he could contribute on his academic salary would be just a drop in the ocean. Sinha applied for a federal grant to pay for cataract operations, which are relatively simple, and for studying the children who got them.
That grant eventually came though and to continue the work, Sinha founded a nonprofit based in New Delhi. Now, at 48, Sinha is planning a major expansion of Project Prakash, to create a center that includes a hospital, a school and a research facility. It’s the only organ in the human body that tries to understand itself (though not always successfully).
Still, the brain is on our brains in the latest episode of The Checkup, our recently relaunched health news podcast, a joint venture between WBUR and Slate.
Carey and I explore these and other questions as we delve into some of the latest advances in brain research. Each week, The Checkup features a different topic — previous episodes focused on college mental health, sex problems, the Insanity workout and vaccine issues.
In this courtroom sketch, Boston Marathon bombing suspect Dzhokhar Tsarnaev appears in federal court in Boston for a final hearing before his January trial. This week marked the start of what promises to be a four-month public reckoning: the trial of alleged Boston Marathon bomber Dzhokhar Tsarnaev. If Tsarnaev is found guilty, the death penalty will be on the table, and the proceedings will turn to a grave question, part jurisprudence and part moral philosophy: Is this defendant the most evil and culpable of all? One thing, I believe, is certain: If this case proceeds to the sentencing phase, the black box everyone will be talking about will be the cranium, and how the brain drives behavior will be the central story. In these protracted sentencing hearings, the scales of justice balance lists of aggravators and mitigators, all outlined by law. Aggravating factors in this case might include the political motive for the bombings, the risk posed to others during the course of the Tsarnaev brothers’ dramatic attempt to flee, the “heinous”, “cruel” or “depraved” manner of the crime’s execution, and the substantial planning and premeditation that might have preceded the bombings. The defense team has already given public hints as to the central themes of its mitigators. Judy Clarke, lead defense attorney and one of the nation’s premier death penalty litigators, will surely not overlook the new body of neuroscientific evidence regarding the immaturity of adolescent brains.
Although Tsarnaev was 19 at the time of the bombings, his lawyers might argue that much of this brain research applies, as it outlines a period of relative immaturity that stretches from mid-adolescence all the way into the early 20s. About CommonHealthMassachusetts is the leading laboratory for health care reform in the nation, and a hub of medical innovation. Research has suggested that exercise does not offset the potential health harms of prolonged sitting, but a new Norwegian study suggests that exercise is in fact protective — if you do it hard enough to improve your fitness level. How to cite this article Mendes RCCG, Ribas A, Macedo IP, Buschle M, Ataide AL, Pereira R, Kochen AP, et al. Several studies have shown that cochlear implants may reduce or even eliminate tinnitus in patients with bilateral profound hearing loss.
Keywords: cochlear implants, deafness, language and hearing sciences, speech, speech perception, tinnitus. Tinnitus means perceiving a sound that is not being generated in the environment at that time.
Considered one of the most common symptoms of profound sensorineural hearing loss, tinnitus can significantly affect the quality of life of individuals2. The latest international publications7,8 suggest that patients with unilateral hearing loss, or even severe hearing loss, presenting ipsilateral tinnitus with hearing loss, unresponsive to several treatments, may also benefit from electrical stimulation of the auditory nerve through the CI. The beneficial effect of a CI on tinnitus can be explained by acoustic masking, by electrical stimulation directly to the auditory nerve, and especially by the reorganization of the central auditory system and associative brain areas that occurs after activation of the implant.
The aim of this study was to describe the audiological results of a patient with asymmetric hearing loss with ipsilateral disabling tinnitus, who was underwent the CI procedure.
Throughout the ENT care, various treatments were performed without success, for the reduction or remission of tinnitus, which led the patient at the time to have suicidal thoughts.
The patient underwent cochlear implant surgery to the right ear in an attempt to improve auditory acuity, but mainly as a last resort in tinnitus treatment. Before the CI, results were compatible with profound hearing loss to the right ear and severe loss to the left. After the CI, thresholds compatible with normal hearing on the right ear were observed, as shown in Figure 1. We used the Glendonald Auditory Screening Procedure (GASP test)12 which classifies the category of hearing on a scale of zero to six, where zero means no detection of speech sounds and six means open-set speech recognition. The protocol for assessing tinnitus was applied at the following times: before surgery, 45 days after surgery (activation of CI), two months later, six months later and one year after CI surgery. The literature11 states that the CI is configured as an alternative treatment of deafness and constitutes a multifactorial process with proven effectiveness. The Brazilian study17 indicates that the hearing assessment obtained six months after the first implant programming demonstrates that English-speaking patients get excellent results in tests of recognizing words and sentences in open presentation, regaining useful hearing.
Despite these satisfactory and known findings by physicians and audiologists, the primary complaint by the subject, which is the focus of this study, was the tinnitus. Di Nardo et al.6 reported that the CI provides effective results in reducing the perception of tinnitus intensity. Statistically significant reduction in THI overall indices and sub-indices, pre and post CI, were demonstrated in scientific studies8,11 showing lower levels of discomfort and a decrease in the intensity of tinnitus as a result of direct electrical stimulation of the auditory nerve and reorganization of the central auditory pathways and cortical association areas, leading to the use of tinnitus as a criterion for choosing the ear to be implanted. The results related to the concentration (66%), emotional (100%), sleep (26%) and hearing (96%) obtained by preoperative TAQ converged at a rate of 72% indicating strong interference of tinnitus, especially in the emotional and hearing states of the patient. Factor 3, life prospects, went from a preoperative score of 100% to 50% after activation of the CI, 25% after two months of use, 75% after six months and reduction to 25% after 1 year of CI use. The consulted study11 shows that the CI generates maximum benefit in remission buzz around seven months after the performed procedure. The reduction in the intensity and degree of tinnitus annoyance confirms the improvement in the quality of life of individuals, a fact that must be considered in preoperative counseling of patients with tinnitus as candidates for cochlear implants.
CI as a treatment for post-lingual profound hearing loss is highly effective, there is improvement seen in hearing thresholds in performance and perception of speech sounds, as in the case presented. Although the literature describes the indication of CI for patients with tinnitus, the initiative is still not being widely accepted by physicians and speech-language pathologists, especially when hearing loss is unilateral or asymmetric. Paper submitted to the ITJ-SGP (Publishing Management System) on May 21, 2013; and accepted on June 21, 2013.
How to cite this article Mahmoudian S, Lenarz M, Esser K, Salamat B, Alaeddini F, Dengler R, Farhadi M, et al. INTRODUCTION: Residual inhibition (RI) is the temporary inhibition of tinnitus by use of masking stimuli when the device is turned off. OBJECTIVE: The main aim of this study was to evaluate the effects of RI induced by auditory electrical stimulation (AES) in the primary auditory pathways using early auditory-evoked potentials (AEPs) in subjective idiopathic tinnitus (SIT) subjects.
MATERIALS AND METHODS: A randomized placebo-controlled study was conducted on forty-four tinnitus subjects. CONCLUSION: The observed changes in AEP associated with RI suggested some peripheral and central auditory alterations. McFadden defined that "tinnitus is the conscious expression of a sound that originates in an involuntary manner in the head of its owner, or may appear to him to do so"1,2. Although the RI phenomenon is one of the few methods that may temporally relieve tinnitus, only few studies on RI have been published until now11. Through the electrophysiological approaches, we may be able to determine the manner for abnormal brain electrical activity in the auditory pathway and provide quantitative information regarding tinnitus and RI phenomenon. Since the transmission time-interval is a presentation of the progress of neural excitation from the distal portion of auditory nerve to the inferior colliculus of the brainstem, this interval has been referred to as brainstem transmission time (BTT) (Figure 1).
It is possible that the neural mechanisms involved in the RI phenomenon are similar to those that cause tinnitus10,35. This cross-sectional and randomized, placebo-controlled trial was conducted on 44 adults (32 males, 12 females) suffering from severe subjective idiopathic tinnitus (SIT) referred to the ENT and Head & Neck Research Center of Hazrate Rasoul Hospital for an evaluation and management of their tinnitus during 2010 and 2011. Additionally, the subjects were considered homogenous because of the constant and steady-state feature of their tinnitus. The screening tests included history taking, medical examinations, temporal bone imaging, an audiological evaluation (pure tone audiometry and tympanometry) and tinnitus psychoacoustic measurement (pitch and loudness matching) were performed for all tinnitus subjects. All studied subjects was initially received AES for three different durations of 60, 120 and 180 seconds delivered to the tinnitus ear.
With respect to the responses to AES, the subjects were enrolled into one of two pre-defined groups, including subjects with RI and those with non-residual inhibition (NRI). A few minutes following AES, the inhibitory effects on perceived tinnitus loudness (residual inhibition) were estimated using a visual analogue scale (VAS) and pitch-match and loudness balance tests. The subjective criteria for evaluating tinnitus after AES using a psychoacoustic tinnitus assessment included diminishing or worsening of tinnitus loudness by at least 2 dB SL and reduction or increment in the pitch of tinnitus at least by 1000 Hz. We used a tinnitus evaluation device (TinnED®, designed in Research Center of Otolaryngology; Head and Neck of IUMS), which has 6 channels to reconstruct the most troublesome tinnitus (MTT) with a similar frequency and intensity. AES was applied by inserting an active surface tympanic membrane electrode through the external auditory canal into the posterior inferior of the tympanic membrane and placing silver surface electrode on the forehead and delivered by a stimulation system (promontory stimulator; cochlear company, Australia) used for evaluating cochlear implant (CI) candidates.
An analysis of variance was used to analyses the differences between the RI, NRI and PES controls for auditory pure tone averages (PTA). An ANOVA assessed the statistical significance between the RI, NRI and PES controls for the auditory pure tone averages (PTA). When rating the average pre-stimulation tinnitus loudness, the subjects rated their tinnitus as greater than 6 on a 10-point visual analogue scale.
A repeated measures ANOVA was used to test for differences of PMT and LMT pre-and post-AES among the RI, NRI and PES control groups.
The present study evaluated the alterations occurring in early auditory evoked potentials and brainstem transmission time associated with RI induced by AES in tinnitus subjects. It appears that the neurophysiological mechanisms involved in RI could be related to both pre- and post-synaptic effects of AES followed by an increase of synchronized neural discharges and inhibition of the abnormal activity of the cochlear nerve.
Tonndorf outlines the situation for most cochlear damage associated with tinnitus: the stronger inner hair cells (with large diameter nerve fibers) remain relatively undamaged, while the delicate outer hair cells (with small diameter nerve fibers) are destroyed. Using an ECochG test, the CAP amplitude indicated a significant increase associated with RI induced by AES. Since previous studies suggested neural alterations related to the AEPs properties in tinnitus subjects17,38, the current study used the measurement of BTT as a considerably more stable and invariant parameter in evaluate tinnitus RI phenomenon34. Many studies also stated that the majority of tinnitus forms result from a loss of inhibition in central auditory structures35. Also, a comparison of auditory nerve fiber discharges by AES in animal studies indicates that electrical stimulation causes discharge synchronizations in wide groups of nerves. Despite above mentioned facts, the possible mechanisms involved in causing tinnitus RI using electrical trigger have not been precisely recognized, and the origin of this phenomenon in the brain has not yet been obviously recognized. The current study conducted to examine the neural mechanisms of RI induced by AES in the first ten ms after stimulation include neurogenic responses arising from the auditory nerve to the inferior colliculus of the brainstem.
Iran National Science Foundation (INSF), Otolaryngology and Head & Neck Research Center, Iran University of Medical Sciences (IUMS). This study was financially and technically supported by the Iran National Science Foundation (INSF), ENT and Head & Neck Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran, and the Otorhinolaryngology Department of Hannover Medical University (MHH). Institution: Department of Otorhinolaryngology, Medical University of Hannover (MHH), Hannover, Germany ENT and Head & Neck Research Center, Iran University of Medical Sciences. Paper submitted to the ITJ-SGP (Publishing Management System) on April 9, 2014; and accepted on April 15, 2014.
A hearing aid is usually recommended for tinnitus sufferers because hearing loss is one of the top causes of tinnitus.
A hearing aid helps to increase the ability to hear external sounds that can make internal tinnitus sounds less noticeable.
If you do not have hearing loss related tinnitus, a masking device may work better for you.
This “white noise” seems to work for some sufferers especially when they are trying to get to sleep at night. Before spending a great deal of money on these devices, it is important that you ensure that they will work for you especially with high-tech hearing aids that improve your ability to hear external sounds while also masking tinnitus sounds. These drugs are not used to treat tinnitus but rather to treat the side effects of tinnitus such as depression, anxiety, etc. Common medications prescribed for tinnitus sufferers include Xanax (anti-anxiety) and the anti-depressant nortriptyline (e.g. When the drug is stopped however, the symptoms of tinnitus will return and prescription drug therapy has the potential to be addictive. This is a drug that was created and is used for something else (stomach ulcers) that has been shown to be an effective treatment for tinnitus in some patients.
This is an expensive drug and should not be used by pregnant women or those thinking of becoming pregnant as it has the potential to cause premature labor. This is an inexpensive and natural sleep aid that has been beneficial for some tinnitus sufferers in helping them sleep better. These are some of the conventional methods used as a response to how to stop ears ringing or other sounds produced by tinnitus.
Disclaimer: The statements discussed on this website have not been evaluated by the Food and Drug Administration (FDA). Affiliate Disclosure: It is advisable to assume that any mention of some of the products or services on this website is made because there exists, unless otherwise stated, a material connection between the product or service owners and this website and should you make a purchase of a product or service described here, the owner of this website may be compensated. Its main components are directive counseling to decrease tinnitus-related negative reactions and sound therapy to reduce the strength of the perceived tinnitus signal (Jastreboff, 2011). The tools and counseling techniques will comfortably guide you through a process of meeting the needs of these patients and recommendations for appropriate referral considerations. This presentation will give you solutions on how to have this conversation with your referring physicians. This informal discussion will teach you about using Zen for this population and provide an opportunity for you to ask questions to an expert on your patients.
RELATED TOPICSOpioid Addiction CrisisWBUR’s Morning Editiongeneticscancer vaccinecancerLATEST POSTSOpinion: Pending Mass.
Louis, found that poverty in early childhood may influence the development of important connections between parts of the brain that are critical for effective regulation of emotions. And it is elaborate not just in its multitudes of living ghouls, its gaggles of graves and squads of skeletons.
For the last 10 Halloweens, she and her family have created a haunted basement in their Victorian home, helped by her lab colleagues — grad students, post-docs and other researchers who play monsters for the night. You walk into a dimly lit room and notice some skulls, some bats and what seems to be a statue of a human-sized monster sitting on a table.
The neurons in the amygdala are very tuned to eyes, “to whether the eyes are open or shut or moving, and how much white. But few people know that the accomplished singer and songwriter struggled with dyslexia, and a stutter, as a child. It may be a no-brainer that catching a train is stressful, but how does stress at Harvard compare to stress at Northeastern?


The app syncs with your calendar and GPS, so you can also look back to see which events and locations cause the most stress.
Today’s neuroscientists finally have the technology to peer into a living brain without harming its owner, and it’s clear that the brain doesn’t operate even remotely in this cartoonish fashion.
And plenty of studies have shown that human facial expressions have tremendous variety, far more than would occur if they were automatically launched by “emotion blobs” in the brain.
He had come to watch a friend cross the Boston Marathon finish line on that fateful April day. But, like at least 70 other marathon bombing victims, he’s left with a never-ending reminder of that moment — a death knell that never stops ringing in his head. Starr and a few dozen other bombing victims are participating in studies supported by the One Fund, created to help bombing victims, that are aimed at devising an effective treatment. At least one in every six Americans suffers from tinnitus — around 50 million people. But after decades of dead-end research, scientists are beginning to figure out what causes the constant ringing, whistling, whooshing or hissing that makes sufferers feel trapped inside their own heads. He was on his way to see a friend one evening, when the taxi he was riding in stopped at a traffic light.
When he looked into childhood blindness in India, he learned that it is a widespread problem, often caused by rubella during the mother’s pregnancy.
Like when your colleagues, all serious people, cluster for precious minutes around a computer screen debating the color of a dress. And because of the type of illusion it is, once it’s fixed, your brain is going to keep you on the blue side or the white side. If the press reports about the evidence against him are accurate, most of the trial will not be about guilt or innocence; it will be about sentencing.
Any aspect of a defendant’s background, record, character or circumstance is fair game for the defense team.
They will feature life within the Tsarnaev family, including Dzhokhar’s relationship with his parents, his brother Tamerlan, and his sisters. Generally speaking, this research shows that adolescents are less mature, and they are more likely to make ill-considered decisions. From the lab to your doctor’s office, from the broad political stage to the numbers on your scale, we’d like CommonHealth to be your go-to source for news, conversation and smart analysis. However, there are not consistent references regarding ipsilateral tinnitus compared to unilateral profound hearing loss.
It is a very frequent symptom, which may affect around 17% of the population in some countries. Several studies claim that the cochlear implant (CI) can diminish or even eliminate the perception of tinnitus in patients with bilateral profound hearing loss and that, although a risk of tinnitus perception that increases after implantation exists, it is very small3-6. With the support of these findings researchers suggest that tinnitus should be a selection criterion in choosing which ear to implant and that patients with severe unilateral hearing loss associated with severe tinnitus can be considered CI candidates9-11. The comparison between the responses obtained before and after the CI verify the benefits achieved with this therapy. The tests were conducted in a soundproof booth, with the Madsen Itera - GN Otometrics audiometer. The test was applied prior to the CI, five months later, eight months later, and finally, after a year. This fact was borne out in this case report, where the pre and postsurgical audiometric tests showed improvement in tone thresholds with CI use. In this study, by applying the VAS, we observed a significant reduction in the intensity of tinnitus perception, and that after activation of the CI, the rating went from four to one after 60 days of using the device.
In our study, after activation of the CI, there was a reduction in the THI total index (six) and sub-indices (functional 2, catastrophic 0, and emotional 4) to a score of one.
A total reduction of assessed scores on aspects of sleep and concentration with a reduction of greater than 20%, significant data regarding the emotional and hearing aspects, was observed after activation of the CI. In our study there was a significant reduction in the percentage of THQ (Table 3) after activation of the CI and the subsequent evaluations (two and six months of CI use) mainly in factors 1 and 2. In addition, it can be seen that the CI was critical to the reduction of tinnitus perception.
Speech, Language and Hearing Sciences - Universidade Tuiuti do Parana - Curitiba - PR - Brasil. Department of Otolaryngology - Hospital Infantil Pequeno Principe - Curitiba - PR - Brasil.
Speech, Language and Hearing Sciences - Hospital Infantil Pequeno Principe - Curitiba - PR - Brasil.
Alterations in early auditory evoked potentials and brainstem transmission time associated with tinnitus residual inhibition induced by auditory electrical stimulation. All enrolled subjects based on the responses to AES, were divided into two groups of RI and Non-RI (NRI). Synchronized discharges of the auditory nerve fibers and inhibition of the abnormal activity of the cochlear nerve by AES may play important roles associated with RI.
It would be a critical step to define the factors that create these phantom sensations and develop rational treatments for this chronic and disabling disorder12.
It has been shown that there is a relationship between the auditory evoked potentials (AEP) and the tinnitus phenomenon17.
It has been shown that BTT is one of the most stable features in assess of neurotological conditions34. Typical alterations in the AEP waveform associated with RI induced by auditory electrical stimulation. Aberrant increase in function of neural networks or enhancement of stimulatory synapses function or decreased function of inhibitory synapses may be responsible for impairing pathways. The tinnitus subjects included in the research received electrical stimulation in the tinnitus ear. In the current study, all included tinnitus subjects were randomly allocated into two groups: those subjects who received AES and those who received placebo electrical stimulation (PES). This action was solely performed to ensure increased competence and effectiveness of the stimulation process to generate RI prior to electrophysiological procedures. The results of the ECochG and ABR recordings were determined and compared before and after the applying AES and PES. Increased, unchanged or reduced less than 2 scores of VAS test were considered as NRI, 3 scales and more decrement were considered as RI. TinnED® measured four important parameters of tinnitus, including pitch-matching and loudness-matching of tinnitus (PMT and LMT), minimal masking level (MML) measured by narrow band noise to the affected ear until the tinnitus was fully covered and RI using a narrow band noise for 60 seconds when the intensity was 10 dB over MML. Five subjects reported a complete inhibition (complete RI) of their tinnitus, and 19 subjects reported a significant attenuation of their tinnitus (partial RI). A repeated measures ANOVA was used to test for the loudness rating differences using VAS between the groups pre-and post-AES. Observed changes in the visual analogue scale (VAS) scores for tinnitus loudness, the perceived frequency of tinnitus (pitch match of tinnitus) and perceived loudness of tinnitus (loudness match of tinnitus) pre-and post-AES among the three groups of subjects using repeated measures ANOVA. The mean difference in the inter-peak latency intervals of I-III, III-V and I-V pre- and post-AES were not significant in either group (Table 4). This study was performed in the first ten ms after stimulation to identify the effects of tinnitus and RI in neurogenic responses arising from the distal portion of acoustic nerve to the inferior colliculus of the brainstem.
This auditory deafferentation can cause an increase in spontaneous activity of auditory nerve fibers.
When inhibitory deficits occur, synchronous neural activity, which is normally limited by feed-forward inhibition to acoustic features in the stimulus (normal auditory perception), may develop spontaneously among neuronal networks in the affected auditory cortical regions and generate the sensation of tinnitus25,46.
An electrical stimulus delivered to the round window sensory transduction47 and directly drives both outer hair cells (OHCs) somatic and hair-bundle motility48,49.
Therefore, we could not conclude whether the RI produced by AES was induced by action on the entire nerve or on some restricted fibers related to tinnitus pitch. Therefore, more comprehensive neuroscientific studies are required to better understand the mechanisms behind this phenomenon. Department of Otorhinolaryngology - Medical University of Hannover (MHH), Hannover, Germany and ENT and Head & Neck Research Center, Iran University of Medical Sciences - Hannover - AC - Germany. Department of Otolaryngology - Charite - Universitatsmedizin Berlin, Berlin, Germany - Hannover - Germany. Auditory Neuroethology & Neurobiology Lab, Institute of Zoology - University of Veterinary Medicine Hannover. Department and Research Center of ENT and Head & Neck Surgery - Iran University of Medical Sciences.
Other sounds include humming, hissing, roaring, whistling, buzzing, chirping, swishing, clicking, etc.
Treating tinnitus using conventional methods is still not where it ought to be because so much of this affliction is still a mystery but here are some common ways on how to stop ears ringing through conventional methods.
This usually means the use of hearing aids and maskers to add some background noise in order to mask the noises made by tinnitus. When you stop having the ability to hear external sounds, it may increase your sensitivity to the noises within. It is similar to a hearing aid and is placed inside or behind the ear and produces “white noise” to mask the ringing, roaring, humming, etc, sounds related to tinnitus.
With many of these devices, tinnitus relief may last from as little as 30 seconds to a few hours after removing or turning off the device. While they do not directly treat this condition, they may put you in such a state that you are not as bothered by the loud ringing in ears. Other methods include cognitive therapy, biofeedback, etc, but most if not all of them do not cure this affliction and the results are not permanent. The various products and information contained herein are not intended to diagnose, treat, cure, or prevent any diseases or, medical problems. Broadband noise or conventional hearing aid amplification are commonly used in sound therapy in a TRT framework, since they are relatively neutral to listen to and thus unlikely to attract attention and induce strong emotional reactions in the patients. Paid Leave Bill Targets An Issue Of 'Human Dignity Violated'Policies For Transgender High School Athletes Vary From State To StateSudders: Combating Mass.
The concern gnawed at me as I fidgeted on the uncomfortably warm and crowded subway platform.
When your stress spikes, the watch vibrates — an alert that it might be time to take a step back and recalibrate.
What is surprising, however, is that some scientists have taken this model seriously for a century and actually search for these characters in the brain. Of these, the condition is “burdensome” for 20 million, according to the American Tinnitus Foundation. Blind children in the developing world suffer so much abuse and neglect that more than half don’t survive to age 5, he says. And you see that, online, many other serious people are doing the same thing — say, at On Point or The New York Times. It could try to demonstrate that Tsarnaev had some kind of impaired capacity to appreciate that his acts were wrong or illegal, or that he was under some kind of demonstrable duress.
Will anything in these family dynamics rise to the level of psychological duress or impaired capacity? Supreme Court was influenced by neuroscientific evidence about the juvenile brain when making sweeping changes in how adolescents are tried and sentenced. They bow to peer influences and respond excessively to thrill seeking and immediate rewards. The research does not show that adolescents are incapable of making well-considered choices.
Your hosts are Carey Goldberg, former Boston bureau chief of The New York Times, and Rachel Zimmerman, former health and medicine reporter for The Wall Street Journal.
For high school students, the debate centers on Title IX, the federal law that bans discrimination based on gender. The aim of this paper is to describe audiological results of a patient with asymmetrical hearing loss with incapacitating ipsilateral tinnitus in the ear subjected to cochlear implant surgery. We do not know its prevalence in Brazil, but if we extrapolate the data from our international population, it is possible that some 28 million Brazilians have already had some form of tinnitus1. Chart 1 shows the comparison between the results where it can be verified that the patient progressed from category zero to six in the 12-month study. The patient went from category zero to six, where there is open-set recognition of words and phrases together. The degree of discomfort, intolerance or failure often are not related to the intensity of tinnitus, says a consulted study1, but mood disorders (depression, dysthymia) and anxiety often present, exerting strong influences on the worsening of the tinnitus. After 180 days of use, the patient did not perceive any ringing with the CI turned on and noticed only mild tinnitus with the CI off. Influence of evoked compound action potential on speech perception in cochlear implant users. Incapacitating unilateral tinnitus in single-sided deafness treated by cochlear implantation.
Stimulation by cochlear implant in unilaterally deaf rats reverses the decrease of inhibitory transmission in the inferior colliculus. Techniques for assessing auditory speech perception and lipreading enhancement in young deaf children. Resultados auditivos com o implante coclear multicanal em pacientes submetidos a cirurgia no Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo.
The results of the electrocochleography (ECochG), auditory brain stem response (ABR) and brain stem transmission time (BTT) were determined and compared pre- and post-AES in the studied groups. Further comprehensive studies are required to determine the mechanisms of RI more precisely. Feldman reported in his classic studies that many subjects with tinnitus experienced a brief elimination of their tinnitus following the application of a masking stimulus3.
RI can also be contrasted with tinnitus inhibition produced by auditory electrical stimulation (AES)7,8,13,14. Previous studies has made it clear that both tinnitus and residual inhibition phenomenon (RI) involved a number of regions of the auditory system18-21 and numerous electrophysiology and neuroimaging investigations have shown that tinnitus is associated with abnormal activity in the auditory system22-24. These investigators have found that BTT to be significantly more stable and it is independent to intensity and frequency of stimulus.
In order to compensate for the tinnitus signal, the processing of auditory stimuli in the presence of tinnitus-related activity may require an increase in firing rate of neurons, the use of more neural substrate, or a combination of both36. In the subjects with bilateral tinnitus, AES was administered in the ear with predominant or louder tinnitus. The subjects were examined by an ENT specialist for head and neck disorders, a neurologist for neurologic disorders, an internist for other medical diseases and a psychiatrist for psychological disorders. In the current study, the subjects' RI group was (I) and another group was entitled NRI, which included (II) and (III).
The accuracy of the calibrating equipment was sufficient to determine that the TinnED® was within the tolerances permitted by the American Standard Specification for Audiometers, S3.6-2004.
The responses were recorded with a vertical montage of four-disk Ag-AgCl electrodes (noninverting on the vertex (Cz), grounded on the forehead, and inverting the electrodes on each mastoid).
The CAP amplitudes were calculated from baseline to N1, and the ABR I, III and V amplitude waves were calculated from baseline to their respective peaks. Bipolar burst of alternating current (square pulses) were applied in the tinnitus ear for 500 ms (a pulse rate of 1 Hz) and a frequency modulation of 50 Hz.
Carry-over effects were estimated using the interaction between period, main and sequence effects.
The main goal of this study was to evaluate the RI induced by AES through the primary auditory pathways to better understand the neural mechanisms involved in RI. Therefore, the RI induced by AES might be explained by interference with tinnitus generating circuits consisting of auditory nerve fibers, cochlear nucleus, inferior colliculus and whereby modification of cortical activity. In the present study, the CAP amplitudes and latencies were measured at the identical intensity levels (CAP threshold + 20 dB SPL) before and after AES (Figure 1). AES reduced the level of tinnitus-related activity as it reduced the loudness of the tinnitus percept. AES reduces the spontaneous firing of the ipsilateral and contralateral cochlear nerves, probably owing to the reactivation of the efferent system. Electrical impulses directly stimulate the cochlear nerve with no effect bypasses on hair cells50. It appears that many factors could be responsible for RI and are involved in suppressing tinnitus.
Suppression of tinnitus by electrical stimulation: a contribution to the history of medicine. Repetitive transcranial magnetic stimulation in veterans with debilitating tinnitus: a pilot study. Residual inhibition functions overlap tinnitus spectra and the region of auditory threshold shift. The functional neuroanatomy of tinnitus: evidence for limbic system links and neural plasticity. Electrocochleographic analysis of the suppression of tinnitus by electrical promontory stimulation. The analogy between tinnitus and pain: a suggestion for a physiological basis of chronic tinnitus. Auditory event related potentials in chronic tinnitus patients with noise induced hearing loss.
Expanding the biological basis of tinnitus: crossmodal origins and the role of neuroplasticity. Final common pathway for tinnitus: theoretical and clinical implications of neuroanatomical substrates.
Cochlear-motor, transduction and signal-transfer tinnitus: models for three types of cochlear tinnitus. Tinnitus Retraining Therapy (TRT) as a method for treatment of tinnitus and hyperacusis patients.
Lateralized tinnitus studied with functional magnetic resonance imaging: abnormal inferior colliculus activation.
Auditory nerve and brain-stem evoked responses in normal, autistic, minimal brain dysfunction and psychomotor retarded children. Mathematical expression of relationship between auditory brainstem transmission time and age. Noradrenergic and serotonergic projections to the superior olive: potential for modulation of olivocochlear neurons. Electrical Stimulation-Tinnitus Inhibition: The Dynamic Range of Electrical Tinnitus Inhibition, a Predictable Test. Mechanical responses of the organ of corti to acoustic and electrical stimulation in vitro. There are also various supplements that are relatively inexpensive containing this ingredient. For a more permanent solution that seeks to get to the root of this affliction in order to cure and prevent tinnitus, holistic methods may be better for you. This information is merely provided for educational purposes only, and has no other intention. Music, on the other hand, is generally not recommended, since it may induce strong emotions, and may attract attention as well (Jastreboff & Hazell, 2004). Exercise brought me back into the orange (among other things, the watch measures skin conductance and temperature, so physical exertion can register as stress), but it didn’t exceed the stress I demonstrated while standing (read: trying not to fall on anyone) in a crowded subway car. It could also bring to light hardships during his upbringing that limited his opportunities or narrowed his ability to choose wisely. There will likely be plenty of traditional testimony from forensic psychologists and psychiatrists regarding whether or not Tsarnaev was under the sway of his radicalized and perhaps dominant older brother, particularly after the Tsarnaev parents left the country. The court concluded that adolescent brains were less mature than those of adults in ways which warranted differential treatment under our criminal laws.
Audiological exams and responses to perception protocols for tinnitus before and after surgery were analyzed.


Without a personal sound amplification device (PSAP) during the application of the GASP, the patient reported that he felt only a slight vibration in the right ear to the presented sound stimuli. In our study, the patient reported he had considered suicide due to the discomfort caused by tinnitus. Experiencia do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo. He also reported that Grapergiesser initially suppressed tinnitus by transcutaneous electrical stimulation using Volta's Platinum-Zinc cell4. In 1981, Vernon & Meikle15 speculated that the mechanism of RI may be related to mechanisms that suppress pain for a period of time after electrical stimulation.
Most hypotheses postulate that the generation of tinnitus is associated with cochlear or acoustic nerve or central auditory dysfunction and their interactions25-28. BTT is defined as the time interval between the initial earlobe-negative wave (the response of the auditory nerve - the 'input' to the brain stem) and earlobe-positive wave from the inferior colliculus region (the 'output' of the brain stem). The experiment reported in this paper was guided by the hypothesis that alterations in activity seen during residual inhibition can return the abnormal neural activity to normal levels.
Thus, the responses among the subjects were divided into two groups, including those subjects who had tinnitus residual inhibition (RI) and those who had tinnitus non-residual inhibition (NRI). Each subject provided informed consent in accordance with the Declaration of Helsinki, Committee on Ethics at the ENT and Head & Neck Research Center of Iran University of Medical Sciences (IUMS) prior to participating in the study. The identical procedure as AES was repeated, except that the electric current produced by the device was turned off. We generated different pairs of pitch sounds at 11 frequencies (from 125 Hz to 12 kHz); we then decreased or increased the pitch (which was not similar to tinnitus), after which the subjects were asked to identify which pitch best matched the pitch of their tinnitus.
Contact impedance indicators for the disk electrodes were less than 2 Kohms except for the inserted ECochG electrode, which was maintained at less than 5 Kohms. The time-interval between the peaks wave I (auditory-nerve response) and the vertex negative wave following wave v (endpoint of wave V descending part) was measured as an auditory brainstem transmission time (BTT) (Figure 1).
The AES intensity varied among the subjects with tinnitus according to their tolerance and satisfaction level. Making an analogy with a neural theory regarding chronic intractable pain, Tonndorf then suggests that, acoustic masking with its relatively short RI might mechanically re-activate the large diameter, inner-hair-cell fibers in largely the same manner as the large-diameter pain fibers are temporarily re-activated by scratching or by vibratory stimulation. Therefore, there was minimal chance that the increased CAP amplitude and thresholds reflected the recruitment phenomenon. It can be due to more neural synchronization process of the auditory pathway associated with RI induced by AES. RI induced by AES can cause an increase in GABAergic shaping of the nerve activity when it reaches the inferior colliculus. The effects on the cochlear nerve, the synchronization of auditory nerve fiber discharges, inhibition of the abnormal activity of the auditory nerve caused by modulated GABAergic shaping of the nerve activity in the inferior colliculus, serotonergic projections from the Raphe Nuclei and in the inferior colliculus, reactivation of the efferent system over time, revival of the neural coding pattern of auditory information in neural pathways can play important roles in generating RI. Many people experience this ringing every now and then especially after a sudden loud noise, taking certain medications such as aspirin, etc.
However, we have seen a number of clinical cases in which neither of the two conventional TRT sound stimuli produced the desired effect. The prosecution will likely counter with a line of evidence regarding Dzohokar’s relative independence and his network of friends and activities outside of the family structure.
The tests showed improvements in the hearing threshold on the side with the implant, improvements in speech perception and a significant reduction in tinnitus perception, which consequently led to an improvement in the patient's quality of life. Shortly after activation of the CI he began to recognize open-set word and auditory performance, improving at each evaluation.
In fact, one of the outstanding features of this phantom sound is that it can be inhibited by auditory external stimuli such as acoustical, electrical, and magnetic fields5-8.
Previous works has assumed that the perception of tinnitus was associated with abnormally high ("tinnitus-related") neural activity in the central auditory pathways by means of AEPs measures and functional imaging.
The present study evaluated the changes occurring in BTT associated with tinnitus residual inhibition induced by auditory electrical stimulation in subjects with problem-tinnitus. According to this hypothesis, efforts to understand RI phenomenon should be guided by develop in our knowledge of the underlying mechanisms of tinnitus.
All subjects had intractable permanent chronic moderate to severe SIT, which had been present for 4 to more than 180 months (Table 1). Since the studied subjects has not been any experienced for electrical stimulation, prior to each study session were mentioned that they might or might not feel any sensations of AES. The washout period for the crossover study was considered at least one week after the initial recording session. We performed the ECochG procedure to obtain the obvious compound action potentials (CAP) using the active surfacetympanic membraneelectrode (Tymptrode), which was inserted into the lower posterior-inferior region of the external auditory canal at the point closest to the tympanic membrane.
We re-measured the ECochG and ABR parameters within a few minutes after performing AES in the RI, NRI and PES control subjects. Because of the differences in the intensity levels of electrical stimulation for generating RI among the subjects with tinnitus, we performed AES slightly above TSL at the MCL. According to gate control theory, the activity of the large diameter, inner-hair-cell fibers act to shut-off (for a time) the aberrant signaling from the small diameter, outer-hair-cell fibers. Meanwhile the BTT is a demonstration of progress of excitation from the acoustic nerve to the inferior colliculus of the brainstem.
GABA and the enzyme responsible for GABA synthesis, glutamic acid decarboxylase (GAD), and the genetic information necessary for the synthesis of GAD have been observed in the inferior colliculus of the central auditory pathway. It seems that early AEPs to be influenced by serotonin activity in an excitatory manner mainly.
Mehrdad Salamat, MD, FAAP, FACC (Texas A & M University Health Science Center, USA) for their helpful comments on this manuscript. It is obvious that following the offset of appropriate masking stimuli, tinnitus may remain suppressed for a short period of time. He described the similarities between chronic pain and tinnitus RI by a gate control theory. Such activity may occur in the subcortical and cortical portions of the central auditory system29-31. In the present study, primary parts of auditory pathways were evaluated using early evoked responses provided by electrocochleography (ECochG) and auditory brainstem response (ABR). Because the different subjects with tinnitus indicated various durations of RI following AES, a time interval was considered between the sessions.
VAS, LMT and PMT were administered pre-and post-AES during each session to assess tinnitus loudness changes. Finally, we administered an octave confusion test to more accurately determined tinnitus frequency. Initially, we used conductive gel on the tip of the Tymptrode before inserting it into the ear canal. RI could be produced by prolonged activity of the masking-induced released GABA because of masking stimuli.
We thank all ENT-doctors, audiologists and administrative personnel who helped us gather our data. Fractal music is described as sequences of tones with no lyrics, which sound something like wind chimes. This phenomenon is known as "residual inhibition" (RI) in the tinnitus literature, although the term of "post-masking effect"9 is more neutral with regard to its possible underlying mechanisms10.
A demonstration of such alterations was investigated in the occurrence of unusual increased or reduced waves in the AEPs. The purpose of this study was to investigate alterations of BTT and other parameters of early AEPs in tinnitus subjects associated with RI induced by AES. The perceived sense of tinnitus varied among the subjects and included a single high-pitch tone or noise, cricket sound, hissing, whistling or ringing. The washout period for the crossover study was considered one week after the initial recording session. The tone pairs were adjusted to a loudness level equivalent to that of the tinnitus before each pair was presented. Similarly, but more briefly, Vernon & Meikle15 in 1981 speculated that the mechanism of residual inhibition may be related to mechanisms that suppress pain for a period of time after electrical stimulation. Aminoxyacetic acid (AOAA), an inhibitor of GABA transaminase, has been shown in a controlled study to decrease tinnitus. These studies should contain a systematic database to evaluate procedures for optimizing RI to contrast it with AES and other intervention methods using specific measures. Predictable without being monotonous, the music sounds familiar, but is not associated directly with music that the listener holds in memory (Sweetow & Jeppesen, 2012).
However, emphasis just in measurement of AEPs parameters (amplitude and latency) for assessment of tinnitus can be misleading. When placed properly, the electrode rested gently on the eardrum, and the gel assisted in making contact with the eardrum. Afterwards the saline was removed from the external auditory canal prior reassessing ECochG and ABR. In addition, the inferior colliculus, the main generator of wave V, receives serotonergic input from the dorsal Raphe nucleus40. Because GABA transaminase is responsible for GABA degradation, the effect would be prolongation of the inhibitory activity of released GABA37.
In 1971, Harald Feldmann3 proposed a theory that RI occurred in the brain rather than the ear. Previous studies have reported using other alternatives measurement of time interval between certain waves32-34. The electrophysiological procedures consisting of ECochG and ABR were recorded before and immediately a few minutes after the applying of AES and PES. Subsequently, the auditory threshold level at that specific frequency (A) was increased in 1-dB steps until the subject reported that the external tone equaled the loudness of the tinnitus (B). The acoustic stimuli were delivered monaurally by an insert phone (ER-3; Etymotic Research, Elk Grove Village, IL) to the tinnitus ear. Also serotonin often coexists with GABA in the inferior colliculus and both acting in the suppression of fearful and aversive behavior41. The visual analogue scale (VAS) for tinnitus loudness was measured pre- and post-AES and PES to monitor tinnitus loudness changes during the procedure (Figure 2). The sound level was then slightly raised by 1-dB increments to obtain a threshold, which was slightly louder than that of the tinnitus (C).
Furthermore, descending serotonergic projections from Raphe nucleus may also modulate superior olive neurons42, the generators of ABR wave III43.
We used the mean level of loudness between points (B) and (C) as the representative loudness of the tinnitus. This author used electrical stimuli for tinnitus inhibition and concluded that the morphology and other specifications of ABR waves in tinnitus ears changed to the normal state. The results were positive, so a larger trial with a total of 91 patients in TRT categories 1 and 2 was initiated. The AEPs amplitudes and latencies were administered to estimate the input-output functions. According to changes in the AEP recordings associated with RI, it can be also speculated that the RI phenomenon might be caused by increasing synchronization of neural discharges in auditory fibers and distal portion of cranial nerve VIII following the applying of AES and modulating GABAergic activity in the inferior colliculus45.
The threshold level of the auditory evoked potentials (AEP) was determined as the minimum sound pressure level in which the detectable and reproducible waveforms of the compound action potential (CAP) for ECochG and wave V for ABR. In this research, the changes in amplitude and latency of the CAP and ABR values (waves I, III, and V) were estimated at 20 dB over the AEP threshold level.
The Tinnitus Handicap Inventory (THI) is a 25-item questionnaire with three subscales: functional, emotional and catastrophic responses. The responses are summed with a total score that ranges from 0 to 100 (higher scores indicating a greater self-perceived handicap).The minimum THI score considered clinically significant is 18.
The average age, gender, hearing level, THI, and HHIA scores at the initiation of the study are shown in Table 1. According to the manufacturer’s specifications, the fractal music produced in the Zen program consists of sequences of tones with no lyrics. The fractal music and broadband options can be used separately or in combination, with the hearing aid microphones switched on or off. Patients were instructed to try all options (fractal music style, broadband noise, conventional amplification) included in their devices at home. The data logging function was activated to record the patients’ daily hearing aid usage and use of different program options. The following trend was observed:Patients who chose to purchase the conventional simple sound generator (Group 2) were typically the ones with a relatively mild (or no) degree of hearing loss (self-perceived and objectively measured), while their THI score suggested a severe degree of tinnitus (Table 1).
For these patients, the tinnitus is expected to have a greater impact on their daily lives than the hearing loss.The reverse client profile was observed in the group who preferred conventional hearing aid amplification as sound therapy (Group 3). These patients typically had a moderate-moderately severe degree of hearing loss (self-perceived and objectively measured), while their tinnitus was at the moderate end of the scale.
Thus, the assumption was that the hearing loss may be the greater problem for the patients who chose a conventional hearing aid.Client profiles for the patients who chose the combination device (Group 1) varied, but they typically had a severe degree of tinnitus combined with a moderate (or more severe) degree of hearing loss (self-perceived and objectively measured), and a severe degree of depression.
20% (6 patients) replied that they already owned a pair of hearing aids, while 17% (5 patients) were unable to perceive an effect from the sound therapy. The remainder of this paper will report the results for this specific group.Of the 33 patients who purchased a combination device with the Zen feature, 25 participated in the re-evaluation after three and six months of therapy.
Notable improvements were observed already after the first three months in the THI (Tinnitus Handicap Inventory) scores of the majority of patients who used fractal music as sound therapy. Scatter plots of 25 patients’ THI scores at the initial visit and after six months of therapy. Each data point represents a single patient’s THI at the initial visit (horizontal axis) and after six months of therapy (vertical axis).
Data points located to the right of the stippled line indicate an improvement of 20 points or more in THI.The patients were also asked to indicate the intensity level and frequency of occurrence of their tinnitus at the initial visit and after 6 months of therapy. Notable improvements were observed both in the VAS scores assigned for intensity level and for frequency of occurrence after 6 months of therapy. Scatter plots of 22 patients’ VAS scores for perceived intensity level of their tinnitus at the initial visit and after six months of therapy. Each data point represents a single patient’s VAS score at the initial visit (vertical axis) and after six months of therapy (horizontal axis). Scatter plots of 23 patients’ VAS scores for frequency of occurrence of their tinnitus at the initial visit and after six months of therapy. The results are summarized in Figures 4-8.Overall satisfaction scores are shown in Figure 4. 69% of the patients reported being either satisfied or very satisfied with the sound therapy. A small minority (8%) reported being dissatisfied, while 23% replied that they were neither satisfied nor dissatisfied with the therapy.Figure 4. Overall satisfaction with sound therapy in patients who used Zen for 6 months.One of the basic rules for the use of sound generators in successful TRT treatment is that it must not evoke negative feelings in the form of discomfort or annoyance in the patient (Jastreboff, 2011).
The patients were therefore asked to evaluate the fractal music in terms of how pleasant they perceived it to be, and whether they had become tired of it after six months’ use. 65% reported perceiving the fractal music as either comfortable or very comfortable, while 35% were neutral. None of the patients reported perceiving the fractal music as uncomfortable to listen to (Figure 5). According to the manufacturer, under normal circumstances the music should not interfere with speech perception, unless the patient has a very narrow dynamic range resulting from a severe degree of hearing loss (Widex zen therapy, 2012).
This was largely supported by the results in the present study, as 82% of the patients reported being able to hear speech well in the presence of fractal music (see Figure 7).Affordable price was reported to be the main motivation for choosing a simple broadband sound generator by many patients in Group 2. Patients in Group 1 were therefore asked to evaluate the combination device in terms of price. 75% of the patients who had chosen the combination device responded that it was expensive, 8% that it was too expensive, while 13% found it reasonable.Figure 7. Both cases were part of the initial pilot study group of 24 patients.Case 1Case 1 was a 70-year-old female who had had severe hearing loss in her left ear since childhood. She was not concerned about her hearing loss, however, and had not considered hearing aids.
Her motivation for seeking help was a strong perception of tinnitus in her right ear which had begun two months previously and had steadily grown worse. The tinnitus had a pervasive negative affect on her daily life, making it difficult for her to maintain her relationship with her family, and reducing both her performance at work and her ability to do simple housework at home.
Her appetite was lost from anxiety and fear that the tinnitus would remain untreatable until her death. Prior to her visit at the Sekiya ENT clinic, she had sought treatment in several other clinics, and had tried a variety of therapies, but had experienced no improvement. Visual Analog Scale (VAS) measures of 100% were assigned by the patient for both loudness and frequency of occurrence of the tinnitus. Audiogram for Case 1.Due to her reluctance to trial hearing aids and the asymmetry between the hearing loss in the left and right ears, it was decided to let the patient wear a combination device (Widex mind440) on her right ear only during the trial period. At the first follow-up visit after a month, she described fractal music as a comfortable listening experience and said that her anxiety was reduced. After 3 months, she was coping well with her tinnitus even without the device, and her THI score had dramatically improved from 96 to 12. After six months, the amplification-only program was used more than the fractal music program, and her THI score remained low at 18. Usage pattern and self-perceived tinnitus and hearing loss for Case 1.Case 2Patient 2 was a 67-year-old female who had been suffering from severe tinnitus in her left ear for more than a year. She had sought treatment at eight different clinics, and had tried a variety of therapies, but had experienced no improvement.
The patient rejected the suggestion of wearing hearing aids, but her tinnitus was so distressing that she was willing to try a combination device (Widex mind) as a TRT sound therapy device for her left ear.Figure 10.
However, the patient complained that she was annoyed with the broadband noise already after two weeks. The broadband noise combinations were then replaced with a hearing aid + fractal music, and a fractal music-only option.
Her THI score had improved to 50 after the three months, and the patient reported that the tinnitus had not bothered her so severely. The broadband noise options were replaced with fractal music options after two weeks.ConclusionsAs the sound has to be listened to for prolonged periods of time, the TRT protocol prescribes the use of neutral stimuli that facilitate passive listening and do not evoke a strong emotional response in patients, such as broadband noise or conventional hearing aid amplification. Although not prohibited in TRT, music is not generally recommended, since it may invoke a strong emotional response and attract attention (Jastreboff & Hazell, 2004). However, a good effect was obtained when using the fractal music available in the Widex CLEAR, mind440, and mind220 combination devices within a TRT treatment framework. Improvements in THI scores were observed after six months in 92% of the patients who used fractal music as sound therapy. Our results indicate that some patients will eventually tire of the music, which suggests that patients should be given several Zen tunes or advised to use their preferred Zen style in combination with other stimuli.The results obtained in the present study suggest that a combination device offering flexible program combinations with conventional amplification, broadband noise and fractal music is an optimal choice for hearing-impaired patients with high THI scores.
The two cases also illustrate how a combination device is sometimes effective, not only in reducing the negative effects of tinnitus, but also as a way of introducing amplification to reluctant hearing aid candidates.ReferencesHenry, J. Tinnitus retraining therapy: An implementation of the neurophysiological model of tinnitus.
Psychometric adequacy of the Tinnitus Handicap Inventory (THI) for evaluating treatment outcome.
The hearing handicap inventory for adults: Psychometric adequacy and audiometric correlates.



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