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Author: admin | 22.05.2014 | Category: Tinnitus Causes And Treatments

Sound therapy for the treatment of tinnitus can take many forms; however, all forms of sound therapy are intended to alter the tinnitus perception and reactions for clinical benefit. Managing tinnitus has evolved from a highly specialized skill that few treated to something that hearing care professionals (HCPs) must be prepared to address. Clearly the pervasiveness of tinnitus necessitates a primer for HCPs looking to add tinnitus services to their practices, or for those wanting a refresher.
Although there are many forms of tinnitus, the most common form an HCP will encounter is subjective tinnitus.
There is strong evidence to suggest that acoustic therapy can help mitigate the effects of subjective tinnitus.2 Acoustic therapy can occur in many forms, such as fitting the patient with appropriate amplification, modifying advanced signal processing features for the purpose of tinnitus treatment, or following a formal tinnitus protocol.
Sound therapy for tinnitus is defined as any use of sound intended to alter the tinnitus perception and reactions for clinical benefit.
2) Partial masking: The addition of an alternative stimulus to reduce the focus of the patient’s subjective tinnitus on both a conscious (psychological level) and unconscious level (central auditory perception). Both employ the use of broadband noise sound generators, hearing instruments, or combination devices.
The HCP may also give the patient a volume control to adjust the therapy signal independent from the hearing aid microphones. To set the therapy signal according to the TRT protocol, the HCP needs to look for the mixing point: the point where the noise mixes with the tinnitus—without masking it! Setting the noiser according to the Tinnitus Activities Treatment (TAT).3-5 TAT is a treatment for the reaction to tinnitus that also uses counseling, sound therapy, and other activities based on Cognitive Behavioral Therapy (CBT).
To set the therapy signal according to the TAT protocol, the HCP should also use the ascendant technique and stop when the sound is audible and comfortable for the patient. If the amplification of the natural environment isn’t sufficiently reducing the patient’s reaction to tinnitus, a designated hearing instrument program in a mixed mode (microphone+noise) can be activated. Acoustic therapy doesn’t always require a noiser signal in the device or following an established tinnitus treatment protocol. When habituation is the treatment goal, a standard recommendation is to avoid silence.6 However, not all patients are candidates for noise therapy.
Habituation to tinnitus can take between 12 to 18 months even with appropriate sound therapy. This is why counseling should be an essential part of tinnitus treatment, and is featured prominently in most successful therapy programs such as TRT and TAT.
Mental health professionals often specialize in CBT, which is commonly used in treating a patient’s psychological response to tinnitus. Ocean Waves Therapy Signals was introduced in March 2015 as an expanded feature for all Siemens binax products (Figure 2).
Recent research in tinnitus therapy signals suggests that, although the long-term effects of modulated sounds have yet to be determined, they can be considered for use on a case-by-case basis. As discussed in this article, sound therapy for the treatment of tinnitus can take many forms; however, all forms of sound therapy are intended to alter the tinnitus perception and reactions for clinical benefit.
Gisele Munhoes dos Santos, PhD, MD, is an audiologist and Product and Marketing Manager of Sivantos Solucoes Auditivas Ltda, Sao Paulo, Brazil.
A great article and overview for those of us who have not fully ventured into Tinnitus treatments. People with tinnitus often characterize their tinnitus as “ringing in the ears” or a “buzzing sound.” The American Tinnitus Association (ATA) describes it as a subjective noise that only the patient can hear. About 50 million people in the United States experience tinnitus to some degree and, in severe cases, seek medical attention.
HR: Why should hearing care professionals who traditionally focus on hearing impairment get involved in tinnitus? Clint Keifer, AuD: As audiologists, we possess an in-depth understanding of the anatomical, physiological, and psychoacoustical aspects of the auditory system. Wendy Switalski, AuD: In conversations I’ve had as an audiologist and as a consultant to audiologists, it is clear that these conditions coexist for so many of our patients. Clement Sanchez, AuD: Tinnitus can be a problem for those who are hearing impaired and have a hearing loss.
Sanchez: Hearing aids can be very effective if they can reduce the symptoms related to the tinnitus. A clinician can play a vital role in helping the patient deal with the sounds of everyday living, instead of avoiding sounds all together. Switalski: Professionals interested in expanding their services have so many resources available.
Practices may begin by simply offering tinnitus assessment, patient questionnaires, or surveys. Keifer: Ideally, practices would be “full-service,” but in practical terms, it is difficult for any one practice to offer every possible solution.
Sanchez: Assessing tinnitus can be challenging, so clinicians who decide to add a full-service tinnitus treatment plan have a few details to consider.
Aside from my traditional practice, I used to schedule consultation with tinnitus patients 1 day a week and this worked well.
HR: I’ve heard that tinnitus patients can consume huge amounts of practice time and many dispensing professionals are not adequately staffed for that.
Sanchez: Yes, tinnitus patients will need time to express their fears, frustrations, and the discomfort they are experiencing because the sounds they hear are unclear and can be difficult to describe. I would describe the tinnitus consultation as “a mix of charisma and empathy,” where clinicians can focus on gathering the information that can benefit the treatment. The MADSEN Astera2 features a dedicated tinnitus assessment module designed to help clinicians address increased claims for tinnitus and hearing loss disability. The new tinnitus test module we have developed as part of fundamental audiometry in MADSEN Astera2 supports the professional through a series of integrated questionnaires.
Keifer: Tinnitus treatment protocols should not be rigid, but rather they should adapt to the individual. The treatment may also involve retraining strategies, amplification, masking, sound therapy device application, support group attendance, and so forth. Sanchez: In addition, it will entail an in-depth hearing assessment, such as audiometry with UCL, immittance, otoacoustic emissions (OAE), and auditory brainstem response (ABR). The full tinnitus psychoacoustic test battery is designed to improve patient counseling and test precision.
Visualization of the tinnitus on the audiogram is a great experience for a patient who has looked for help for years and may have felt misunderstood at times.


The electronic questionnaires—Tinnitus Functional Index (TFI), Tinnitus Handicap Inventory (THI) and Tinnitus and Hearing Survey (THS)—can be saved in NOAH and are designed to eliminate the need for paper records. The next step is explaining that, for example, a 7 dB tinnitus is quite a small issue that can be managed. Once again, dialogue with other professionals is important and should be considered from the very beginning.
HR: What types of equipment should you consider for your practice when starting up a tinnitus treatment program? Switalski: Having access to the proper audiometer features is important for performing a tinnitus assessment.
Otometrics has developed a dedicated tinnitus management tool for audiologists, which is integrated with our clinical audiometer, the MADSEN Astera2. Do Hearing Aids Help With Tinnitus VRyqXA Click to watch a video presentation on how to cure your tinnitus permanently, and in less than 7 days. The steadily increasing number of people with tinnitus—now approximately 1 out of every 10 Americans—has helped drive the need for HCPs to add tinnitus treatment to their armamentarium of services provided.
This paper provides a general guide on how the tinnitus therapy options available in modern hearing aids can be utilized for acoustic therapy. Besides hearing instrument use for tinnitus relief, numerous methods of sound therapy have been used since tinnitus masking was introduced in the 1970s. Sound therapy is thought to provide relief from tinnitus and reduce the emotional consequences of tinnitus.3-5 Additionally, sound therapy may promote habituation to tinnitus by reducing the contrast between the tinnitus and environmental sound.
Ideally, hearing aids with tinnitus therapy signals should be designed to fit the needs of virtually any established protocol (Figure 1).
The following are suggested protocols for programming the therapy signal according to the more established tinnitus programs, as well as fitting suggestions for those not following a specific tinnitus protocol. The HCP chooses one of the therapy sounds and then adjusts in an ascendant technique by utilizing the Master Gain handle (Figure 1). The majority of tinnitus patients seen by HCPs require a combination treatment for both hearing loss and tinnitus.
Typical set up will include one program with amplification alone and another program with the mixed mode. When treating tinnitus without hearing loss, a noise-only mode without microphone input is appropriate. As mentioned above, amplification alone is a common treatment for tinnitus patients,2,8 and is often the starting recommendation by the HCP. Acoustic therapy with the hearing instrument alone typically involves making environmental sounds more audible for the patient.
In order to use environmental sounds as a natural masking noise for your patient with hearing loss and tinnitus, you many choose to reduce or eliminate some of the noise reduction features. HCPs can choose alternative trigger points for the directional microphone modes and varying levels of directionality. Modern streaming devices like the Siemens easyTek™ connect to virtually any audio device, wirelessly turning a pair of hearing instruments into a personal headset. Because of this, many patients return to their HCP feeling discouraged, frustrated, and desperate. The patient must understand what tinnitus is in order to overcome or avoid the negative associations that inhibit habituation.
An HCP may consider a multi-disciplinary approach to tinnitus treatment where the HCP fits and adjusts the hearing instrument for effective sound therapy and provides only the initial tinnitus counseling. These new modulated therapy signals complement the five static therapy noises which can be chosen from a preset or be customized in up to 20 bands by the HCP. Since the patient’s reaction to the configuration of a particular hearing instrument or sound generating device is subjective, there is no right or wrong combination of features to use when it comes to tinnitus treatment. Hearing aids as an adjunct to counseling: Tinnitus patients who choose amplification do better than those that don’t. MarkeTrak VIII: The prevalence of tinnitus in the United States and the self-reported efficacy of various treatments. Feeling inadequate we HCPs may be the reason many tinnitus sufferers do not have this treatment suggested.
In some cases of objective tinnitus, physicians can identify the symptom with the use of a stethoscope placed on the neck or directly in the ear canal. There is currently no known cure for tinnitus; however, there are advanced devices and treatments today that can help alleviate tinnitus symptoms. Drs Sanchez, Switalski, and Keifer share their thoughts on the benefits of tinnitus assessment, and provide advice to audiologists and hearing care professionals who are interested in adding tinnitus assessment to their practice.
As hearing care professionals, we are skilled in diagnostic, counseling, and rehabilitative approaches to managing auditory disorders. And for some of them, treating the tinnitus is necessary to address the concerns that led them to seek hearing care in the first place. They may have difficulty sleeping, be unable to concentrate, and experience irritability and high stress levels. A hearing aid can amplify soft sounds, which can have a “masking” effect and helps to decrease the contrast between the environmental sounds and the tinnitus. This is an important step to address the patient’s fears and provide supportive tools when the tinnitus is too intense. Today, tinnitus management tools also include sound enrichment devices, sound generation pillows, as well as sound generators like MP3 and relaxing music. Are there different levels at which practices can participate, or should every hearing care practice seek to have a full-service tinnitus treatment plan? They can also provide informational counseling and supplement their fittings with hearing instruments that include features and options for tinnitus relief.
My recommendation would be to offer as many options as possible within the means of the practice and the practitioner. Collaboration with other professionals like ENTs, psychologists, and general practitioners is helpful. Prior to the consultation, patients can fill out questionnaires in the waiting room to avoid external influences during the test. While proper diagnostic testing and quantification measures should be performed for hearing and tinnitus aspects, the treatment options will vary greatly based on the individual and should focus on addressing identifiable needs.
Tinnitus can be viewed as a spectrum disorder where trying a combination of approaches may be necessary.


Highlighted in magnifying glass on lower left is the electronic questionnaires for the TFI, THI, and Tinnitus and Hearing Survey (THS), which saves in NOAH and eliminates the need for paper records. Clinicians should ensure they are working with a subjective tinnitus and characterization via the existing questionnaires, like the Tinnitus Handicap Inventory (THI), Tinnitus Functional Index (TFI), and Tinnitus Handicap Questionnaire (THQ). Testing efficiency and immediate availability of measurement results allow more time for consultation. Test results will provide the professional with information concerning the effect of an external sound on the tinnitus.
A high-resolution audiometer in frequency (1 Hz) and intensity (1 dB) is required to perform a characterization of the tinnitus.
Today’s clinicians and audiologists can now more effectively evaluate the tinnitus and its impact on the lives of their patients.
Don't miss out before they take it down!Ways To Reduce Tinnitus 1ljAsvm Click the link for a medically proven technique to get rid of tinnitus in about 7 days. It also looks at therapy signal alternatives, including the new Ocean Waves Therapy Signals in the Siemens binax devices.
Other drivers include more awareness of the condition than ever, which is tied to a consumer thirst for more information.
This can be done by first decreasing the Master Gain until the therapy signal is no longer audible to the patient, and then increasing the noise level until the patient says the sound is mixed to tinnitus. While the goal here is not to achieve total masking or mixing point, it is acceptable to use total masking if the patient prefers it.
However, as hearing instruments have become more sophisticated, less circuit noise has meant much “quieter” hearing aids. Consider a multi-channel approach of less noise reduction applied in the lower frequencies where “room noise” is typically present. A tinnitus wearer may prefer the hearing instrument stay in an omnidirectional mode to amplify more ambient noise when the tinnitus is more intense.
Once sound therapy has begun, the mental health professional can provide additional counseling and CBT to further support the emotional well-being of the patient. It is recommended that the HCP try different combinations of features at various settings to find what’s right for each patient. With this clinical foundation, few other health professionals are as well suited to help those with tinnitus.
For example, the US Center for Health Statistics estimates that tinnitus was reported by 25% of those who are hearing impaired and have hearing loss. The hearing care professional needs to consider these issues if they want to succeed in managing the hearing loss on top of the tinnitus.
However, it’s important to check the effect of the external sound on the tinnitus before introducing the benefits of wearing a hearing aid to the patient.
Additionally, training from hearing instrument manufacturers and collaborating with colleagues can be valuable. Then be sure to include information that the patient may benefit from—like additional options or resources not offered at your practice.
It is important to consider that treating patients with tinnitus requires the ability to listen and a high degree of patience.
When testing patients with tinnitus, clinicians should consider scheduling a dedicated time just for consultation because it will take longer than usual and the patient is expecting a solution.
For this, I would recommend using an analog visual scale of relief to set the objective from the very beginning. When the patient becomes more comfortable describing their situation, the clinician should then begin to drive the conversation.
Then the follow-up treatment can be done online, where the answers provided previously can help clinicians evaluate the impact of this strategy. This may include education, information, or recommendations for further medical evaluation or treatment by other professionals. Psychoacoustical tests are also important and can include pitch and loudness matching and minimum masking level (MML).
If there is a positive impact, like an attenuation of the perception, a strategy like the TRT (Tinnitus Retraining Therapy) can be considered. In fact, according to the Better Hearing Institute, one-third of all hearing loss related online searches are related to tinnitus.
The amount of noise shaping desired is the primary consideration for these patients, which is often based on the hearing instrument technology level. Additionally, modern hearing instruments automatically reduce background noise with noise reduction algorithms and directional microphones.
In some cases, it may be advantageous to give the patient a second dedicated program where noise reduction is completely eliminated. A quick search in Google Play or the Apple App Store for “Tinnitus,” “Relax,” or “Audio” yield several apps that may help complement your tinnitus therapy program.
The four modulated signals differ primarily in terms of the intensity and frequency of the modulation, or breaking ocean waves.
Good tinnitus resources are needed in every community to bring new exposure and business to your office.
The Tinnitus Clinic at Oregon Health and Science University found that 90% of their patients who have tinnitus also have some degree of hearing loss. If the patient can accept a sound generating strategy, many hearing instrument manufacturers deliver interesting solutions today—with or without an amplifier for the hearing loss. Here, more economic hearing aid models are appropriate, as they often do not feature the sophisticated amplification algorithms necessary for people with hearing loss.
Although these advances improve sound quality and comfort for traditional hearing aid wearers, they may be counterproductive for tinnitus patients. As an alternative to the more artificial and static therapy noises, these new signals were designed to provide a positive, soothing, and stress-relieving listening experience ideal for tinnitus patients who prefer a more natural therapy signal. For example, a clinician may have to wait for the patient to fall asleep using a sound generator pillow. Miracle" Stress Relief with the Healing FUSIONA simple protocol for Stress and Anxiety Relief that can take you out of the "fight-or-flight" and make you a healthier and happier person in 20 min.



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