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Sequential sound therapy, which uses wide-band white noise distinguished by some unique characteristics, is applied in the treatment of tinnitus. Currently, tinnitus treatment involving the application of sounds is being performed according to a protocol defined as tinnitus retraining therapy (TRT) [1-6], which consists basically of the application of white noise of an intensity inferior to that of tinnitus to permit a patient's habituation to and decreased perception of tinnitus.
TRT, which is being performed worldwide, is considered a conceptual methodology that has helped to standardize the treatment of tinnitus.
The neurophysiological model is structured as a net composed of five aspects: the generation, detection, emotional aspects, and perception of, and the aversive reaction to tinnitus.
Therapeutic counseling for tinnitus should primarily address a patient's understanding of the condition. Sound therapy is created using noises from three sources, such as natural sounds from a patient's environment, sound amplification of earphones, and generators of white noise of a lower intensity than the patient's tinnitus. Sequential sound therapy applies the two tinnitus treatments that use sounds as if they are total masking and partial masking, incorporates an intermediate step - limit masking - for interconnection, and is adapted to each individual patient and so that it can be administered in either a public health system or in private medical practice.
The application of sequential sound therapy comprises three steps: It begins with total masking (white noise more intense than tinnitus), proceeds to limit masking (white noise of an intensity similar to that of tinnitus), and culminates in partial masking (white noise less intense than tinnitus). Twenty-six patients, 21 of whom were women (median age, 69 years) and 5 of whom were men (median age, 63 years), gave their informed consent to be entered into the study.
Aside from anamnesis focused on discerning information about tinnitus [10], complementary tests that were carried out in all patients were otoscopy, tympanometry, tonal audiometry (bony and air auditory thresholds, discomfort thresholds, and pain thresholds), logo-audiometry (thresholds of voice detection, word detection, perception, understanding, and discomfort), and tinnitometry (tinnitus measurement).
In patients treated by means of either sequential sound therapy or TRT, the sound generators used were Siemens (Germany) model TCI and TCI COMBI, the latter incorporating earphones. During the first month of adaptation, in patients with tinnitus but without hearing loss, the sound generator was adapted for total masking (level 3 or 4) for 6 hours per day - 2 hours in the morning, 2 hours at noon, and 2 hours in the afternoon.
During month 2 of adaptation, in patients with tinnitus but without hearing loss, the sound generator was graduated to level 2 for a 6-hour daily span selected by the patient.
In the third month of adaptation, control patients received treatment personalized according to time and masking type. The various types of tinnitus identified in the 26 patients studied are detailed in Table 1.
A total of 38 sound generators, of which 34 incorporated earphones, were adapted initially to the 26 patients treated by means of sequential sound therapy. In the 15 control group patients treated by means of TRT, 30 sound generators with incorporated earphones were adapted binaurally. Tympanometry was normal in 19 patients (73%) of patients, being smooth or plane in the remaining patients for medial ear problems. In every one of the 26 patients treated by means of sequential sound therapy, a subjective, quantitative improvement was obtained according to the THI answered by both a patient and his or her cohabitant. The perception of tinnitus diminished in all patients treated with sequential sound therapy: in six patients from the moment of adaptation, in one patient after 15 days of treatment, in two patients at 1 month of adaptation, in three patients at 2 months, in one patient at 3 months, in four patients at 4 months, and in three patient at 6 months. Three patients, once their perception of tinnitus had decreased, experienced periods of increased tinnitus perception again that were related to stressful situations.
Sequential sound therapy is an original methodology being described here for the first time. In our 26 patients, tinnitus was prevalent in the left ear, coinciding with other published results in which the left ear is the most frequently affected [12-14]. The most common complaint in patients treated by TRT - that is, the presence of two noises instead of one - contributed to these patients' abandonment of therapy.
The evolution of masking in sequential sound therapy is described as a chain of three links: the first link being total masking, the second being partial masking, and the third being sequential sound therapy. The therapeutic masking of tinnitus began in 1969 in Germany, where Feldmann [17] began to mask tinnitus in a total way, as much homolaterally as contralaterally and using different spectra of noises: wide-band, narrow-band, and pure-tone. Many patients whom we subjected to TRT with the application of sounds less intense than their tinnitus did not experience improvement. This model features a #10 battery with 150 hours of battery life, a soft free-field dome, a micro-poly tube, and a miniature OTE case. The Tranquil Simplicity II OTE is one of many models designed and developed by the company that helps to reduce the symptoms of Tinnitus or ringing in the ears. For more information about hearing devices, tinnitus products, and General Hearing Instruments, Inc. Reach out to the author: contact and available social following information is listed in the top-right of all news releases. The professionals at Advanced Hearing Aid Clinic and Advanced Hearing and Balance Institute believe that a comprehensive understanding of tinnitus will help individuals explore treatment options, learn new coping skills, and feel more positive about the future.
Most cases of tinnitus are subjective, meaning that only the person who suffers from tinnitus can hear it. However, there have been documented cases of objective tinnitus, where sounds can actually be heard from the ear. Tinnitus can occur in one or both ears, constantly or intermittently, perceived to be occurring inside or outside the ear(s), be progressive, pulsing, or vary in intensity or pitch.
Feelings of pressure (aural fullness) or pain in or around the ears may accompany tinnitus.
Tinnitus can be very mild during the daytime but more noticeable in quieter situations (quiet room or bedtime), as daytime activities and surrounding sounds can act as a distraction and serve to mask or partially mask tinnitus.
The occurrence and intensity of tinnitus may vary depending on several factors such as stress, diet, and noise exposure.
It is estimated that 25 million Americans experience tinnitus to some degree on an ongoing basis. The Canadian Tinnitus Association has estimated that 360,000 Canadians are annoyed by their tinnitus, and that approximately 150,000 find that tinnitus seriously impairs the quality of affected individual's lives.
The Canadian Academy of Audiology estimates that 10 to 15% of Canadians suffer from tinnitus (approximately 3 million) with 20% of these individuals seeking help for their condition because their tinnitus is so severe that it is debilitating (approximately 600,000 individuals). Tinnitus can be a symptom of a condition that is related to many forms of hearing loss, or it may exist without hearing loss. Atherosclerosis is a large buildup of cholesterol and other fatty deposits in major blood vessels close to your middle and inner ear.
Although there are many theories about how sounds in the ears or head are produced, the exact process is not fully understood.
When healthy, the hairs on top of the hair cells move as a result of the pressure of sound waves moving through the fluid in the inner ear.
Since tinnitus is a symptom, the first step in finding some form of resolution should be to try to determine or diagnose the underlying cause. Our doctoral level audiologists have taken post-graduate training in tinnitus and tinnitus management. Our clinics have one of the most comprehensive protocols for tinnitus assessments in Canada.
The first test involves conventional pure tone testing to determine if there is a hearing loss. One of our Audiologists will also perform tests of residual inhibition to try to determine what treatment method would be most beneficial to you. Auditory brainstem response testing can be done to rule out tumours on the vestibular nerve. Typically, once a comprehensive evaluation has been performed, most individuals who suffer from tinnitus feel reassured and find it somewhat easier to adjust and adapt to the tinnitus.
Not all Canadian Audiologists are trained in tinnitus and hyperacusis management or the most recent therapeutic interventions. If you work in loud noise or partake in loud recreational noise, wear ear effective ear protection.
As you can see below, there are a variety of types of hearing protection - all purpose, or custom that may be appropriate. Deep breathing, hypnosis, biofeedback, systematic relaxation, therapeutic massage, yoga, and some forms of physical exercise such as swimming or walking can reduce tension, stimulate endorphins, and promote better sleep. Alternative approaches (naturopathy, acupuncture, vitamin, and mineral supplements) have been of limited use in treating or reducing tinnitus.
The methodology is described, as are the differences from and similarities to tinnitus retraining therapy. Other types of tinnitus treatment using sounds have been described that involve the total masking of tinnitus by the application of white noise of an intensity greater than that of tinnitus [7-9]. The fundamentals of TRT are (1) the neurophysiological model, (2) therapeutic counseling, and (3) sound therapy. To assist a patient in understanding tinnitus, counseling must attempt to demystify by explaining (1) the physiology (thereby making the patient aware of all the implied mechanisms of this condition), (2) the necessity to control aversive reactions to eliminate suffering, and (3) the details of each step of treatment. Passage from one type of masking to another depends on the obtained result and on the treated patient's opinion about the success of adapting white noise to the individual's tinnitus experience. The predominant pathological findings were arterial hypertension in five patients, diabetes in three, obesity in two, a cerebrovascular accident in one, and acoustic traumatism in another.
All these thresholds are useful during adaptation of the sound generators and the earphones.


Adaptation of the sound generators and the earphones were undertaken with attention paid to each patient's intrinsic tinnitus characteristics and to whether a patient experienced any hearing loss or deafness. In patients with tinnitus and hearing loss, sound generators with earphones were used for 6 hours per day - 2 hours in the morning, 2 hours at midday, and 2 hours in the afternoon. In general, treatment was applied monthly except for necessities expressed by each patient.
Light or moderate hearing loss occurred in 25 patients (96%), a single patient retaining audition within the normal range. One such patient experienced increased tinnitus perception in connection with a cerebrovascular accident suffered by his wife.
This therapeutic approach consists of a three-step sequential application of the white noise of tinnitus, first for a total masking effect, next as a limited masking effect and, finally, for partial masking. Monaural adaptation is carried out in sequential sound therapy for psychological and economic reasons. The flow diagram in Figure 1 depicts a guide to clinical practice that reflects the medical procedures and audio-prosthetics that are integral to our treatment of tinnitus. Flow diagram depicting a guide to clinical practice that reflects the medical procedures and audio-prosthetics integral to our (total) treatment of tinnitus. In both groups of patients, therapy involved similarly generated sounds and was administered by the same personnel (otorhinolaryngologist and audio-prosthetist).
This problem was not encountered among patients treated with sequential sound therapy; rather, patients felt a sense of well-being when they did not hear their tinnitus and had normal audition from the beginning of the treatment. Later, in 1977, Vernon [18] of the United States made important contributions to the development of this technique known currently as TRT. Since 1998, we have undertaken to develop a different methodology in which sounds are applied in a sequential way.
Otorhinolaryngology Service, Specialties Center Doctor Fleming, Virgin of the Rocio University Hospital. Tinnitus is a perception of sound in the ears or the head when no external sound source is present. While the perception of tinnitus is real, there is no external sound corresponding to the patient's perception of sound, and thus tinnitus is classified as a phantom auditory perception. Individuals with more severe cases of tinnitus may find it difficult to hear, work, or sleep. Increased activity in the absence of daytime sounds can seem to make the tinnitus louder although the intensity doesn't actually vary.
Individuals may report similar characteristics of tinnitus but may be affected by it in a significantly different manner.
Almost every individual has, at one time or another, experienced brief episodes of mild ringing or other sounds in the ear. The blood vessels lose some elasticity and therefore the ability to flex and expand with each heartbeat.
The most widely accepted theory, when tinnitus occurs with hearing loss, is damage in the cochlea. Microscopic hairs form a fringe on the surface of each auditory cell (Outer Hair Cells-OHC and Inner Hair Cells-IHC).
Both the inner and outer hair cells are connected to the auditory nerve through the basilar membrane. They are unable to hold their charge and leak random electrical impulses to the brain where it is interpreted as noise.
A comprehensive medical examination can rule out causative factors related to blood pressure, kidney function, drug intake, diet and allergies. Our Audiologists will perform an otoscopic examination of your ear canals to ensure there is no wax or debris buildup in the ear canals.
We will assess your middle ear system to ensure your eardrums and attached middle ear bones are functioning appropriately. Individuals with mild tinnitus or longstanding tinnitus that is not life-affecting generally do not require intervention or treatment. This improvement is not the result of physical changes, as damage to the auditory system that has been measured is typically permanent and irreversible. Tinnitus can be aggravated by excessive noise, nicotine, caffeine, tonic water that contains quinine, alcohol, and excessive doses of aspirin. Noise- induced hearing loss may occur by a one-time exposure to a loud sound or by repeated exposure to loud sounds over an extended period of time.
In a quiet setting such as the bedroom at night, the use of a noise generator may be beneficial.
If the tinnitus is accompanied by hearing loss, hearing aids are an effective way to deal with tinnitus. In fact, there has not been one scientific study to date that has shown long standing efficacy in the reduction of tinnitus with alternative approaches such as illustrated below. All patients began the treatment regimen by means of sound generators, according to the sequential sound therapy protocol, during the year 2002 and part of 2003. In patients with tinnitus and without hearing loss, sound generators were adapted, whereas in patients with tinnitus and hearing loss, sound generators with incorporated earphones were adapted.
The function of the sound generator in this group graduated to level 3 or 4 during 2 hours of each day that proved to be most tranquil.
In patients with tinnitus and hearing loss, the sound generator incorporating earphones was applied in the earphone function for as much time daily as desired by each patient, except for a 2-hour daily span during which a patient could choose the masking level of the sound generator without earphones. Thereafter, patients in the control group received treatment at 3 months, biannually, and annually according to the results obtained in each case. In patients with unilateral tinnitus, monaural adaptation was performed in the ear in which the patient suffered the tinnitus. The intensity of tinnitus varied between 1 and 15 dB above the air threshold of audition, even in the same patient. Six patients no longer perceived their tinnitus - one patient after 15 days of adaptation, three patients after the first month, and two patients after the 3-month adaptation using only the earphone function, thereafter not needing the function of a sound generator.
Passage from one masking type to another in a given patient depends on the result obtained in that patient and on the patient's assessment of the regulation of his or her tinnitus by this method. A decreased perception of tinnitus is said to have occurred when the tinnitus ceases to bother a patient; this decreased perception is known objectively because the patient passes from level 3 or 4 to level 2 or 1 in the sound generator.
We define tinnitus as a noise that the patient hears that it is causing him or her to suffer. The otorhinolaryngologist provides medical counsel in relation to the sound therapy, and the audio-prosthetist provides audio-prosthetic counsel relative to adaptation and its control.
Treatment can be provided as an aspect of a national health system or as a service covered by health insurance companies or extended through private clinics. Evaluation of the outcomes of therapy is carried out by means of the tinnitus handicap inventory as answered by both the patient and his or her cohabitant. However, all 26 tinnitus patients treated with sequential sound therapy experienced improvement, and none left the treatment group, whereas among the 15 control patients treated with TRT, only 33% registered improvement, and 53% abandoned sound therapy. Hazell [19], together with Wood, contributed to the benefits of total masking in this therapeutic modality. In developing this approach, we relied on prior knowledge of masking, both total and partial, and added to this limit masking. Neuropsychological model of tinnitus: Dependence of the minimal masking level on treatment outcome.
Tinnitus retraining therapy (TRT) as a method for treatment of tinnitus and hyperacusis patients. Chronic complex tinnitus: Therapeutic results of in-patient treatment in a tinnitus clinic. Homolateral and contralateral masking of subjective tinnitus by broad spectrum noise, narrow spectrum noise and pure tones.
Neurophysiological model of tinnitus: Dependence of the minimal masking level on treatment outcome.
It offers the same great sound generator technology, as the original Tranquil Simplicity, but now adds a second low frequency pink noise.
Since, 1985, the company has been designing and developing therapy devices and other hearing related products.
Most of the individuals that seek help suffer from constant tinnitus-24 hours a day for seven days a week. Although tinnitus does not cause hearing loss, tinnitus can interfere with one's communicative ability.
Tinnitus can also be extremely loud to the point where the individual may hear nothing else. The severity of tinnitus is related directly to an individual's reaction to, and perception of the tinnitus. Pawel Jastreboff estimates that approximately 17% of the world's population suffers from tinnitus which causes significant suffering in 4% of the general population.


It is estimated that 10 to 15% of adults have prolonged tinnitus and seek medical intervention (Heller, 2003).
Less common causes include a non-malignant tumour on the vestibular nerve (vestibular schwannoma), a fixation of the middle ear bones, or other relatively rare medical conditions. This causes the blood flow to become more forceful and turbulent, making it easier for the ear to detect heart beats.
Depending upon the movement of the cochlear fluids from sound stimulation, different hair fibers are put into motion. The nerves that carry impulses to the brain are adjacent to the base of the hair cells but are not quite embedded into the basilar membrane. Unfortunately, the cause of tinnitus cannot often be identified, so, in some cases, the tinnitus itself may need to be treated.
We will need a complete list of current and past medications and an in-depth description of the tinnitus, including when it happens, and what seems to make it worse. Otoacoustic emissions testing will be done to assess the integrity of the cochlea (assess outer hair cell function) as damage to the cochlea typically can be detected before hearing loss is found with conventional testing. Nicotine and caffeine constrict the blood vessels which increases the speed of blood flow through the veins and arteries.
Thirty-eight generators of sounds were adapted for use in this therapy and, of these, 34 incorporated an earphone. The control group was composed of 15 patients, 11 women (median age, 66 years) and 4 men (median age, 63 years). In both groups of patients, if a patient was unable to sleep owing to tinnitus, the sound generator was used at level 3 or 4 throughout the night as well. If a patient could not sleep at night, he or she was permitted the use of the sound generator during the entire night.
Adaptation was carried out monaurally in unilateral tinnitus and binaurally in bilateral tinnitus.
After the adaptation, either immediately or after some delay, the tinnitus generally appeared in the opposite ear from that in which tinnitus originally was present (Table 3). Similarly, but to a lesser degree, the tinnitus frequency varied for a given patient, being distributed throughout 8 9% of the area of acute frequencies. In the 15 control patients treated by means of TRT, subjective, quantitative improvement was obtained in 33% (n = 5), and 53% left the study (n = 8). In a third patient, increased tinnitus perception occurred on several occasions in connection with personality dysfunctions.
Other authors who used TRT in their patients found improvement rates varied widely, ranging between 23% and 88% [10]. Once the benefits of total tinnitus masking were well-known, the technique continued to be perfected.
According to the American Tinnitus Association (ATA), there are approximately 50 million people who experience mild to severe symptoms.
To further promote the advancement of hearing technology, the company funds extensive research projects with professionals and universities. Other forms of sound are described as hissing, roaring, pulsing, whooshing, chirping, whistling, rushing, booming, and clicking have also been described by individuals that suffer from tinnitus.
Until recently, tinnitus has not received sufficient attention, either in clinical practice or in research. Studies have shown that tinnitus is more prevalent in females than males under the age of 50. Tinnitus may result from age-related hearing loss (presbycusis typically begins after the age of 55), ear injury, or a physiological condition. High blood pressure, including hypertension and factors that increase blood pressure such as stress, alcohol, and caffeine, may make tinnitus more noticeable. Many researchers believe that when the structure of the hair cell collapses, random stimulation of the auditory pathways occurs. The movements of these hairs cause the auditory cell to discharge electricity to the auditory nerve, which is connected to the auditory center of the brain. 90% of the nerves derive from the inner hair cells (despite the fact that they are smaller in number).
Alcohol increases the force of blood by dilating the blood vessels which causes greater blood flow, especially in the inner ear area. The effects of loud noises may exacerbate tinnitus in addition to further damaging hearing.
The noise generator creates a soothing surf, waterfall or rainfall sound that should be used at a level slightly below the level of the tinnitus. Auditory re-training uses sound generators that are set to a level that is below the intensity of the tinnitus (just audible and not masking the tinnitus). The results of sequential sound therapy in our 26 patients were compared with the results of tinnitus retraining therapy in 15 patients treated during the years 2000 and 2001. The perception and evaluation of tinnitus occur in cortical areas, and the aversive reaction to tinnitus emanates from the autonomic nervous system. The predominant pathological findings in this group were arterial hypertension in four patients, diabetes in two, and obesity in one. Control patients generally were treated biweekly during the second month, although such treatment was personalized to the needs of the individual patient. When the tinnitus appeared in the opposite ear, adaptation of another sound generator was made for this ear. On the basis of work published by Hazell and colleagues in 1985 [20], various authors built on the foundation of the application of noises less intense than a patient's tinnitus to obtain positive results [21,22]. Outcomes using this methodology have improved substantially over those obtained with only total masking or partial masking. Over 12 million people in that group will require medical attention, devices, and therapy to cope with this affliction.
General Hearing offices are located at 175 Brookhollow Esplanade in Harahan, LA 70123-5101. The brain translates these electrical impulses into sounds which we recognize and understand.
Each inner hair cell has approximately 10 nerve endings attached to it which results in approximately 30,000 nerve fibers that transmit the electrical equivalents of the sound waves to the brain. When used for an extended period of time, it induces subconscious habituation so that the tinnitus is not perceived as an intrusive or disturbing presence.
Satisfactory results obtained with sequential sound therapy totaled 100%, whereas only 33% of subjects treated with tinnitus retraining therapy obtained satisfactory results. The control group began the treatment regimen with white noise by means of sound generators, according to the TRT protocol, during the years 2000 and 2001. In fact, any matter that causes hypersensitivity in a patient can fix his or her attention on the noise and cause that patient to begin suffering. We conclude that the effectiveness of sequential sound therapy has surpassed that of TRT in the treatment of tinnitus, by modifying the application of white noise to the patient and integrating medication, surgery, adaptation, and human behavior during the entire treatment process until improvement of tinnitus is achieved.
They are also proud to provide devices to the men and women who have served America in the armed forces, working with Veteran Affairs to provide the product to military troops returning from war. While individuals may enjoy these sounds in nature, they are certainly more bothersome when they are coming from one's own ears or head. Pawel Jastreboff estimates that 40% of individuals that suffer from tinnitus, have accompanying hyperacusis. Until recently, tinnitus did not receive sufficient attention, either in clinical practice or in research. Narrowing of the carotid artery or jugular vein can result in turbulent blood flow and head noises.
The stressful nature of some occupations can contribute to tinnitus, increase the severity of existing tinnitus, increase the individual's reaction to the severity of tinnitus, and hinder coping mechanisms.
Other symptoms are caused by diabetes, dental problems, thyroid disorders, and some medications. While the perception of tinnitus is very real, there is no external sound corresponding to the patients' perception of sound; thus, tinnitus can be classified as a phantom auditory perception.
Malformation of capillaries, also called arteriovenous malformations, can occur in the connections between arteries and veins which can result in head noise.
Our Audiologists will be happy to discuss the most appropriate custom protection for the noise levels to which you are exposed. In addition, no patient receiving sequential sound therapy has left the treatment protocol, whereas 53% of patients receiving tinnitus retraining therapy abandoned the treatment protocol. Tinnitus may accompany a number of other symptoms such as a feeling of pressure in the ears, unsteadiness, and dizziness.



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