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Author: admin | 24.11.2015 | Category: Ginkgo Biloba Tinnitus

The results from this clinical study strongly support the use of Widex Zen Therapy in tinnitus patient management. Previous reported investigations of hearing aids containing fractal tones1-6 have yielded favorable results in reducing the tinnitus annoyance or handicap for patients with significant tinnitus.
Derived from these findings and subsequent research, Widex introduced a new tinnitus management approach called “Widex Zen Therapy” in 2012.7 The overall objective of Widex Zen Therapy (WZT) is to ensure that the tinnitus does not negatively impact the patient’s quality of life. 4) Relaxation strategy program, highlighted by relaxation exercises and sleep management strategies.
The appropriate components constituting the therapeutic intervention are tailored for each individual in accordance with the audiologic evaluation and the patient’s reaction to the tinnitus. 2) to investigate how subjects employ the hearing aids and the acoustic (fractal tones or filtered noise) options. Two tinnitus clinics participated in the data collection (Hearing and Tinnitus Center Tinnitus Clinic in New York and Canadian Tinnitus and Hyperacusis Centre in Whitby, Ontario, Canada).
Subjects were given a comprehensive audiologic and tinnitus evaluation by trained tinnitus clinicians at the two clinical sites. All subjects had significant tinnitus distress (THI >18) when they enrolled in the clinical study with a mean THI score of 51, ranging from 20 to 96. Instructional counseling was similar to that provided in Tinnitus Retraining Treatment (TRT)11 directive counseling. The choice of the particular model (which varied from the high end 440 to the entry level 110) was based on the individual patient’s needs and economic considerations. There are five Zen fractal tone styles available that vary in their tempo, pitch, dynamic range, and chord. Zen Program A utilized the “Aqua” setting that has proven to be the most popular fractal tone style. Subjects were instructed on hearing aid use, including how to access the various Zen programs and how to adjust the volume. The mean TFI baseline score was 53 (range 20 to 82), while the final TFI mean score improved to 25 (range 0 to 62). Individual subject scores for the baseline and 6 months after WZT are shown in Figures 3 (THI) and 4 (TFI).
Symbols falling below these diagonal dashed lines reflect clinically significant relief from tinnitus on these two scales. A secondary objective of this study was to ascertain individual preferences and wearing habits for the hearing aids and programs.
The majority (80%) of subjects selected “Aqua style with microphone on” as their Zen A program.
Figure 6 shows the mean percentage of time use for amplification versus the three Zen programs.
Additionally, 74% and 75% of subjects achieved clinically significant changes in their THI and TFI scores, respectively. Although it is not possible to determine the relative contribution of each WZT component to the reduction of tinnitus handicap and quality of life improvement, it is interesting to note that the degree of improvement (in terms of THI and TFI reduction) was slightly greater (though not statistically significant) for the subjects receiving the more comprehensive cognitive behavioral intervention and relaxation exercises. Future clinical studies would be useful to lend support to these findings and to determine the longer-term efficacy of this treatment.
Earlier this month it was National Tinnitus Awareness Week so we thought we would give you a little bit of information about tinnitus. If you are worried that you have tinnitus please do not be alarmed, it is not an illness or disease of any kind, it is merely something occurring within your own auditory canals. The British Tinnitus Association run many groups and have lots of information about how to deal with tinnitus including support groups and contact details.
If you would like to donate to the British Tinnitus Association then please text TINN15?4 to 70070. A look at the long-term effectiveness of an integrated tinnitus management approach (WZT) and the pattern of amplification and sound therapy use among primary tinnitus patients once successful remediation of symptoms is achieved. Habituation is classically defined as the process of adapting to a stimulus through repeated exposure.
The attentional processes involve perceptual filters that determine which sensory perceptions are brought to our conscious attention. The vast majority of tinnitus patients present at least some degree of hearing loss, fueling the theory that the central auditory nervous system responds to the hearing deficit by increasing its gain, further adding to the perception of tinnitus. The use of music has been shown to reduce stress hormones.10 Physiological and behavioral reactions to tinnitus can be mitigated through the use of music. Hearing aids with either noise generators or some kind of music have become popular in tinnitus management. Consequently, there is a growing consensus that a multifaceted individualized approach to tinnitus management is more likely to result in the best outcomes.
In addition, WZT incorporates the use of fractal (commercially termed Zen) tones and broadband amplification characterized by an extremely low compression kneepoint, relaxation exercises, and sleep management.
The effectiveness of WZT in several studies has been reported,1,18-19 but none of these investigations have indicated the effectiveness or usage characteristics beyond a 6-month period. All participants were given a comprehensive audiologic and tinnitus evaluation including the Tinnitus Handicap Inventory (THI),20 Tinnitus Functional Index (TFI),21 and Widex Tinnitus Intake questionnaire.17 Participants were required to have cognitive, comprehension, and manual dexterity abilities sufficient for treatment, and all subjects paid for the tinnitus treatment for up to 12 months post hearing aid fitting.
Additionally, all subjects were fit with Widex Dream or Clear hearing aids containing fractal (Zen) tones. Even though the initial fitting met most subjects’ needs, some required individual modifications in their Zen + programming. Subjects were instructed to use the devices during their waking hours when hearing and communication were essential.
Figure 3 depicts the relationship between TFI baseline and 12-month post WZT for individual subjects. Figure 5 shows the mean use (in time percentage) of the Zen + programs as well as the amplification alone (the “Master” program) program. Datalogging also revealed that the Zen A (Aqua + microphone on) and Zen B (Aqua and noise plus microphone on) programs were the most frequently used programs.
The use of Zen C (noise only plus microphone on) was very limited, varying from 9-12% during the 12 months. The fact that all 19 of the subjects achieved clinically significant improvements when comparing TFI scores from baseline to each of the follow-up visit scores, including those obtained at the 12-month visit, would seem to provide an unequivocal answer to that question. Unfortunately, it is impossible to determine whether the overall use of amplification increased, because even during the 48% of time in which amplification-alone wasn’t being used at the 12-month visit, 17 out of 19 subjects were still utilizing Zen + programs that contained amplification.
2) Even though subjects had achieved an acceptable resolution of their tinnitus, they still recognized, and in some cases achieved, an even greater appreciation for the benefits received from amplification—either by assisting their hearing or by continuing to minimize their tinnitus distress. Results from myriad investigations leave little doubt that WZT is an effective approach to tinnitus management. The inverse relationship between the use of Zen programs versus amplification-alone over time suggests that patients (even those whose primary complaint was tinnitus, rather than hearing loss) perceive a continued benefit for using amplification for improving their hearing, and possibly for tinnitus relief, even post habituation or successful resolution. Meikle MB, Henry JA, Griest SE, Stewart BJ, Abrams HB, McArdle R, Myers PJ, Newman CW, Sandridge S, Turk DC, Folmer RL, Frederick EJ, House JW, Jacobson GP, Kinney SE, Martin WH, Nagler SM, Reich GE, Searchfield G, Sweetow R, Vernon JA. Cervical spine manipulation is valuable for alleviation of tinnitus to improved brain function! 2 - Spinal manipulation of the neck improves brain equilibrium function and motor function in patients with neck pain. 4 - As Jefferson Park Spine Specialists proudly offers Cox Technic as the preferred form of spinal manipulation in this chiropractic practice, the federally funded biomechanics study of its effect on the disc pressures in the neck shows that it reduces intradiscal pressures!
So contact Jefferson Park Spine Specialists if you have a stiff neck or neck pain or arm pain or any of these neck-related conditions.
Our method at Jefferson Park Spine Specialists centers on chiropractic wellness as well as alleviation of pain, especially spine pain and its related conditions.
The data revealed substantial positive adjustment to tinnitus, as measured by the TFI and THI, evident within the first 2 months of treatment, with further (albeit not statistically significant) changes occurring through 6 months. It appears that a combination of fractal tones (generated by hearing aids), amplification, and counseling have great potential for tinnitus patient management. The more severe and negative the tinnitus reaction, the more components listed above will be added in the individualized program. The mean tinnitus loudness was 6 (on a 10-point scale) and the tinnitus pitch was 7 (on a 10-point scale). Subjects participating in the study were patients who visited the clinics to seek tinnitus management.
In addition, adjustment-based cognitive behavioral intervention (explained below) and relaxation exercises were applied for those individuals demonstrating more severe negative reactions to their tinnitus.
All subjects received detailed instructional counseling related to the hearing loss and tinnitus.

The objectives were to provide the patient with an understanding of the habituation process and to help the patient reclassify the tinnitus. Because many clinicians feel instructional counseling alone is not adequate to address the emotional consequences of tinnitus, including fear, anxiety, and depression,12 WZT recommends adjustment-based counseling or Cognitive Behavioral Intervention (CBI) to help the patient identify barriers to achieving natural habituation. All subjects were fit bilaterally with Widex Dream hearing aids with True Input Technology that remain undistorted at the input stage with inputs as high as 113 dB SPL. All of the hearing aids were programmed to have four memories; a “master” (amplification only) program, and three “Zen” programs, as explained below. The Zen programs use fractal (Zen) tones that are generated by a semi-random recursive algorithm.
In addition, fine-tuning adjustments of each style can be made to its pitch, tempo, and volume by the clinicians.
They were told that the fractal tones should be audible, but soft enough to not interfere with conversational speech. The use of relaxation exercises was given to patients to break the vicious cycle of tinnitus and stress. Mean Tinnitus Handicap Inventory (THI) and Tinnitus Functional Index (TFI) scores at baseline, 2 and 6 months.
Individual subject Tinnitus Handicap Inventory (THI) baseline and 6 months post Widex Zen Therapy scores for 23 subjects (one subject was missing the THI at baseline). Individual subject Tinnitus Functional Index (TFI) baseline and 6 months post Widex Zen Therapy scores for the 24 subjects.
Inspection of individual subject data revealed that 74% of subjects obtained a clinically significant change in THI scores, and 75% of the subjects had clinically significant changes in TFI scores.
In addition, the degree of improvement (in terms of THI and TFI reduction) was slightly greater (though not statistically significant) for the subjects receiving the more comprehensive cognitive behavioral intervention and relaxation exercises. Choice of styles and microphone settings for Zen A, Zen B, and Zen C programs at the initial fitting.
About two-thirds (65%) of the subjects selected “Aqua + microphone off” as their Zen B program. Percentage (time) of use of amplification only (Master program), Zen A, Zen B, and Zen C at the 2 and 6 month visits.
The average use of amplification only (the Master program) was 50%, and the average use of the three Zen programs combined was 50% also. The data revealed substantial positive adjustment to tinnitus (as measured by the TFI and THI) evident within the first 2 months of treatment, with further (albeit not statistically significant) changes occurring through 6 months. While other tinnitus treatments have reported similar success,16 the speed in which the WZT treatment achieved these changes is particularly impressive and vital, considering the importance of early success in maintaining motivation for tinnitus patients. It is also relevant to note that WZT is one of the few current tinnitus treatments utilizing amplification in addition to other sound therapy options. In addition, investigations focusing on and delineating the individual components of WZT would help understand how each component contributes to the process. When tinnitus habituation occurs, either the perception of the tinnitus, or the reaction to the tinnitus, is greatly, if not fully, diminished.2 In this article, habituation will be regarded as substantial and meaningful lessening of the negative reaction to the tinnitus as defined by clinically significant reductions in subjective distress scores. The reaction to it varies from a minor annoyance to one that can significantly and negatively impact one’s quality of life. In clinically significant tinnitus, these filters determine that attention should be applied to the specific patterns of neural activity associated with the tinnitus.3,4 The engagement of the autonomic system and amygdala leads to further increases in the sensitivity of the auditory system and reinforcement of the attentional filters, creating further increase in tinnitus loudness and awareness, which in turn increases the level of stress.
A limitation of the use of popular music, however, is the chance that these stimuli can attract excessive attention to both the music and the tinnitus.
Most tinnitus strategies employed over the past two decades consist of a combination of directive (instructional) counseling and acoustic stimulation (either noise, amplification, or a combination of the two).
There is also an option to include broadband noise in addition to, or in lieu of, the Zen tones. A total of 20 subjects were initially enrolled in this cohort study conducted at the ENT Associates of South Florida in Boca Raton, Fla. The hearing loss varied from mild to moderately severe, and the average hearing thresholds of the subjects are shown in Figure 1. Clinicians participating in this investigation had considerable experience in tinnitus patient management and were familiar with the fitting of Widex hearing aids and Zen programming.
The specific models chosen ranged from models 110 to 440, and were selected based on the joint decision of the patient and clinician taking in audiologic as well as economic considerations.
Zen + B (noise) or Zen noise (C) were only recommended if the clients experienced periods where the tinnitus was very bothersome.
Although turning off the microphone in the Zen+ programs was an option, only two subjects chose to do so. They were further taught that the Zen fractal tones should be audible, but relatively soft and that the tones should not interfere with conversational speech. The TFI and THI were administered at baseline, as well as at 2, 4, 6, 9, and 12 months post-treatment.
The TFI was chosen because of its extremely strong psychometric evidence and multiple domain clinical relevance.
Individual subject Tinnitus Functional Index (TFI) baseline and 12 month post Widex Zen Therapy scores for the 19 subjects.
Note that, at the 2-month visit, the three Zen + programs were used 73% of the time, but amplification-alone was only used an average of 27% of the time. Therefore, one can confidently say that, as habituation (or resolution of the tinnitus distress) increased, the need for additional sound therapy beyond amplification decreased—though subjects continued to use amplification.
It is of particular importance to note that clinically significant changes were found at the 2-month visit for all of the subjects on the TFI. One way to approach this issue is to compare the pattern of fractal tone, noise, and amplification-only usage at the 6-month follow-up, since 15 of 19 subjects (79%) achieved clinical resolution of their tinnitus distress (<20 on the TFI) by that visit, to the 12-month follow-up visit. The exceptions were the 2 subjects who chose to turn off the microphone in Program C at the onset of the project. This is particularly relevant considering the fact that 17 of the 19 subjects originally presented with primary complaints of tinnitus, rather than hearing difficulty. As seen in earlier studies, when given the choice between listening to sound therapy containing fractal tones versus programs containing noise, the overwhelming majority (as reflected by comparing usage of Zen A vs Zen C) choose fractal tones.
However, the excellent results obtained in this study are certainly, in part, related to the expertise of the clinicians. Further studies are needed to determine the relative contribution of each of the WZT components (including the undisputed importance of counseling), but until these data are available, it seems prudent to utilize the multiple counseling and sound therapy tools offered in an integrated approach like WZT. The Tinnitus Functional Index: Development of a new clinical measure for chronic, intrusive tinnitus.
A comparison of benefit and economic value between two sound therapy tinnitus management options. Sweetow, PhD, is Professor of Otolaryngology and former Director of Audiology at the University of California, San Francisco (UCSF); Melodi Fehl, MA, is a Clinical Audiologist and Patti Ramos, AuD, is Director of Audiology and Rehabilitative Services at ENT Associates of South Florida in Boca Raton, Fla. The research documentation continues to grow about the benefits of cervical spine manipulation. We administer in depth care for back pain, neck pain, headaches, shoulder pain, arm pain, leg pain, and injuries to the body from a car accident, sports injury or other cause. The average (mean) reduction in THI scores was 30 points (23 points after only 2 months) and was 28 points in TFI scores (25.5 points after only 2 months). A total of 32 subjects were initially enrolled, but only 24 subjects completed the data collection. Only 6 of the subjects indicated having received previous tinnitus management such as counseling, chiropractic adjustment, medication, dental treatment, Neuromonics,10 and hearing aids. The initial Widex Intake Questionnaire, THI, TFI measures, and the clinician’s observation of the subjects were used to determine which components of Widex Zen Therapy were utilized during the treatment. Table 2 shows the number of subjects receiving the various WZT components in the clinical trial. In addition, the relationship between impaired hearing and tinnitus perception, as well as the reasons why there is commonly an emotional connection established in the brain between the limbic system, autonomic nervous system, and the auditory cortex, was explained.
This intervention utilizes segments of the programs and tools used by psychologists and clinicians who provide comprehensive Cognitive Behavioral Therapy. These instruments have wide dynamic range compression (WDRC) with compression thresholds as low as 0 dB HL, adaptive multichannel directional microphones, noise reduction, active feedback cancellation, inter-ear communication, and data logging. The four normal-hearing subjects had their hearing aids programmed as if they had a 15 dB hearing loss in order to ensure audibility of the Zen programs. The fractal tones are harmonically related but vary in tonality, intensity, or tempo over time. Each Zen setting was programmed in accordance with the hearing loss (based on the Sensogram) to assure audibility of the tones.

They were further advised to avoid frequent volume changes and to use the Zen programs as much as needed for tinnitus and relaxation management and to avoid silence when possible. Tinnitus measures and hearing aid data logging information were collected at baseline, 2 and 6 months.
The solid line represents equivalent baseline vs final (post treatment) scores while the dashed line represents the 20-point benefit score considered clinically significant.
The solid line represents equivalent baseline vs final (post treatment) scores while the dashed line represents the 13-point benefit score required for clinical efforts to be considered clinically significant. Given the high prevalence of hearing loss (often too mild to clearly warrant the necessity for hearing aids), the benefit of using amplification is an added value. Treatment of tinnitus with a customized acoustic neural stimulus: a controlled clinical study. A critical analysis of the directive counseling as a component of tinnitus retraining therapy. The condition typically involves multiple neuro-plastic changes to sites producing auditory, attentional, and emotional processes of the brain. The mechanisms of emotional disturbance associated with tinnitus define the “reaction” to hearing the tinnitus sound, as opposed to the “perception” of the sound. Auditory fractal tones utilize harmonic but unpredictable musical relationships, and are generated by a recursive process where the algorithm is applied multiple times to process its previous output.
Widex Zen Therapy extends these approaches by additionally incorporating cognitive behavioral interventions in the form of adjustment-based counseling designed to identify the unwanted thoughts and behaviors hindering natural habituation, challenge their validity, and replace them with alternative and logical thoughts and behaviors. The approach is individualized, in that the necessary components of WZT are determined after a comprehensive evaluation of the tinnitus and the patient’s reaction.
All but one (19 subjects, 11 females and 8 males with a mean age of 65, ranging from 49 to 86) completed the study. The Widex Intake Questionnaire, TFI, THI, and the clinician’s observation of the subjects were used to determine which WZT components were employed. The hearing aids had wide dynamic range compression (WDRC), compression thresholds as low as 0 dB HL, adaptive multichannel directional microphone, noise reduction, active feedback cancellation, data logging, and inter-ear capabilities. Thus, the volume was to be set so that the annoyance level of the tinnitus would just begin to decrease. Hearing aid datalog records were accessed at these time intervals to ascertain hearing aid use both during the therapeutic effort to induce habituation and after. Any symbol falling below this diagonal line suggests some degree of reduction in tinnitus distress.
The mean use of hearing aids, including amplification and Zen programs, was 8 hours during the 12-month course of this investigation.
By the end of the study (ie, 10 months later), however, the combined use of the Zen programs had decreased to 47%, while the amplification-alone usage increased to 53%.
While the effectiveness of an integrated approach like WZT has been repeatedly shown in studies cited earlier, none of those studies looked at the longer-term effects lasting out to 1 year post therapy onset. Moreover, 17 of 19 subjects (91%) had TFI scores suggesting their tinnitus was no longer clinically significant by the conclusion of the 12-month study. The data showed that the combined use of the three Zen + programs decreased from 56% to 48% (compared to 73% at the 2-month visit), while the use of the amplification-alone (Master) program progressively increased from 44% to 52% (compared to 27% at the 2-month visit). This has been shown in other studies as well,11,12,14 and is likely due to the inherent relaxing qualities of the Zen tones.
It is not realistic to expect the 100% success found in this project to be found in the real world.
And Jefferson Park Spine Specialists is well-trained to safe, gentle, controlled chiropractic spinal manipulation to the neck for our Cleveland patients’ good! A case report of a patient who reports tinnitus in both ears, headaches, blurred vision, restricted temporomandibular joint (TMJ) movements, and neck tightness was treated for 2.5 months and 10 treatments. Combined with a motor sequence learning task, cervical spine manipulation restored these neck pain patients to the cerebellar function of healthy people. Patients with herniated discs in the neck with radiculopathy (arm pain, numbness, tingling) want to consider treatment before surgery.
Cleveland chiropractic care in the form of Cox Technic at Jefferson Park Spine Specialists is effective. The other 8 subjects kept the hearing aids but were excluded from the final data analysis because they did not return for the 6-month follow-up.
Twenty of the 24 subjects reported having had tinnitus for more than 1 year, and 18 reported having bilateral tinnitus. However, CBI does not require the same intensive therapeutic approach, which would be beyond the expertise of many hearing care professionals and would require a greater time commitment than can be reasonably expected.
Subjects with hearing loss were instructed to use the devices during waking hours where hearing and communication were essential. The tones (which sound somewhat like wind chimes) are generated while incorporating the properties of music that are proven to be most relaxing.1,2,7 Thus, they are meant to be pleasant and are not associated with music that the listener may hold in memory. Zen Programs B and C were only recommended if the subjects experienced periods where the tinnitus was very bothersome.
In addition, data logging revealed that the Zen A and Zen C programs were used more frequently than the Zen B program.
Seventeen of the subjects initially presented to the clinic with a primary complaint of tinnitus, rather than hearing difficulty. All subjects were given instructional counseling, relaxation exercises including progressive muscle relaxation (PMR), deep breathing and guided imagery, and sleep suggestions.
A more detailed explanation of the Zen programming is available.17 Subjects were advised to not adjust the Zen volume unless deemed necessary by environmental conditions. The number of sessions necessary to accomplish a successful outcome varied and was defined by a clinically significant reduction in THI and TFI scores, or achievement of a non-significant score (< 20 for the TFI or less than 18 for the THI) for two consecutive visits, as well as a subjective report that tinnitus awareness, or tinnitus disturbance, or quality of life was no longer an issue negatively impacted by the tinnitus. A reduction of 13 points is considered clinically significant on the TFI.21 The dashed line represents the 13-point benefit score considered clinically significant. This decrease may be related to the fact that subjects had their tinnitus distress reduced over time and no longer felt the need to use fractal tones and noise as frequently as they did during the first 2 months of sound therapy.
Not unexpectedly, there was a trend for the subjects least affected at baseline to also show the least amount of improvement. This implies that, as resolution was achieved, subjects tended to utilize the Zen programs, particularly those containing noise (B and C), less frequently while increasing their reliance on amplification-only. This point underscores the importance of offering multiple sound therapy options, such as a variety of fractal tone styles and adjustable bandwidth noises, to those patients (approximately 10% in this study) who may prefer acoustic stimuli other than fractal tones.
If surgery is chosen, research shows that getting treatment after surgery produces significantly greater improvement in neck pain.
We pride ourselves on being patient-oriented and responsive to your needs be they about insurance filing or appointment making or your health and healing. During this phase, the clinicians help the patient identify the unwanted thoughts and behaviors hindering natural habituation, challenge their validity, and help the patient replace them with alternative and logical thoughts and behaviors.13 Basically, the intervention’s objective is to help the patient recognize that it is not the tinnitus itself that produces these beliefs, it is the patient’s reaction to tinnitus. The overall aim of Widex Zen Therapy is to ensure that the tinnitus does not negatively impact the patient’s quality of life, as opposed to reducing the loudness level or production of the tinnitus. All but 7 subjects had experienced tinnitus for more than 1 year, and all but 4 reported tinnitus in both ears.
Additional counseling in the form of cognitive behavioral intervention was applied when the clinicians believed appropriate.
Subjects who showed clinically and significantly improvements didn’t require all the planned sessions; however, the THI, TFI, and datalogging measures were still collected as planned.
Symbols falling below the diagonal dashed line reflect clinically significant relief from tinnitus. The usage of Zen A (fractal tones) decreased somewhat, but this reduction was not statistically significant. The duration of tinnitus, location, and quality reported by the subjects are shown in Table 1.
In addition, 15 of the 19 subjects’ final TFI were below the 20-point score considered clinically significant. In addition, it should be noted that the final mean TFI score was 11.76, a tinnitus distress score considered clinically insignificant.

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Comments to “Tinnitus 2 months jobs”

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