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Author: admin | 29.05.2014 | Category: Tinnitus Causes And Treatments

Director, Northeast Professional EducationMeryl Epstein was born and raised in New York City.
Although Zen has been proven to be an effective tool for tinnitus, it has many other applications as well. This course will discuss a practical approach in working with people who suffer from moderate tinnitus. 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.
Mariko Takahashi is an ENT physician and an associate professor at Nagoya City University in Japan.
When working with tinnitus patients, it is imperative that your referring physicians are educated in tinnitus therapy and proper referrals. Hyperacusis has been linked most often with tinnitus, phantom auditory perceptions that include ringing or chirping in the ears.
INTRODUCTION: Musical training positively influences the cortical plasticity of the brain and has proven to be effective in treating chronic tinnitus. OBJECTIVES: A neuro-music therapy concept, the "Heidelberg Neuro-Music Therapy" treatment was developed and evaluated. MATERIALS AND METHODS: N = 135 patients (mean age 47 years) with chronic, tonal tinnitus attended a standardized protocol for Neuro-Music Therapy (either "standard therapy" ST or "compact therapy" CT).
CONCLUSIONS: The "Heidelberg Neuro-Music Therapy" is a method with fast onset and long lasting effect for patients with "tonal" tinnitus.
Apart from emotional disturbances such as anxiety, depression, sleep impairments or irritation1, the main complaints of the persons concerned with ringing in the ear are difficulties in concentrating their attention2 and in auditory perception3.
Data from human neuroimaging support the hypothesis of a final common pathway for tinnitus6 and propose a compromised "noise cancellation mechanism"7 to be liable for the enduring tinnitus percept. It is known that pleasant music verifiably reduces activities in the amygdala and enhances activity in nucleus accumbens and thalamus8,9. Disadvantages are the rather lengthy application and the passive "sounding" of the tinnitus instead of an active exposition to the tinnitus sound. Therefore a short-term Neuro-Music Therapy based on active treatment modules seems to be fruitful in treating chronic tinnitus. The novel treatment according to the "Heidelberg Model of Neuro-Music Therapy" is based on the notion that tinnitus is experienced as an auditory percept - just as musical stimuli are experienced as auditory percepts. Two standardized protocols for tinnitus music therapy were defined: a "standard therapy" (ST) and a "compact therapy" (CT) (see patient flow-chart). All patients receive a comprehensive psycho-educative counseling in order to establish a cognitive model of tinnitus20.
As the specific modules used in therapy are based on the individual tinnitus sound, a tinnitus-equivalent has to be set up by means of a commercially available sinus generator. In the Resonance Training the patient learns a vocal exercise stimulating the cranio-cervical resonating cavities.
The Neuroauditive Cortex Training uses tone sequences performed live by the therapist on a piano which have to be vocally imitated by the patient. The Tinnitus Reconditioning offers coping mechanisms related to stress control along with a sound based habituation procedure.
During the relaxation exercise, the tinnitus sound will be integrated intermittently into the background music. Patients were eligible if they suffered from chronic tinnitus (duration > six months) which could be musically compiled (distinct frequency) and had no psychiatric co-morbidity.
Since patients were recruited nationwide it was not possible to randomize the patients to the groups in the true sense of the word. Based on data from a pilot study23 we calculated the a priori power and thus estimated the minimum control group size with the power analysis program "GPOWER"24 to n = 15. As part of the medical history, psychosomatic and audiologic co-morbidities as well as socio-demographic data and tinnitus characteristics were assessed. On the whole 69% of the patients presented with high frequency hearing loss (> 20 dB hearing impairment present in at least three test frequencies > 3000 Hz) and about 42% presented with low frequency hearing loss (> 30 dB hearing impairment present in at least one test frequency 0-2000 Hz). Due to the stratified group allocation, no group differences in socio-demographic data were obtained.
Patients in the music therapy groups ST and CT received a treatment according to the "Heidelberg Model of Neuro-Music Therapy" as described above. Patients in the control group PT received a psychosocial intervention based on psychological tinnitus treatment strategies25 combined with placebo music therapy elements. Assessment of tinnitus symptoms was performed three times, at admission ("pre"), at discharge ("post") and six months after therapy ("follow-up FU").
Apart from statistical significance, individual changes were assessed according to the concept of clinical significance27.
At discharge all patients of the music therapy groups had the opportunity to rate their subjective therapy satisfaction.
Statistical analysis of the data was performed using parametrical and non-parametrical tests in SPSS 16 (SPSS Inc.
In order to predict parameters possibly influencing therapy outcome, a logistic regression model (CATREG, SPSS 16.0) was calculated using TQ-score immediately after therapy as an indicator for therapy success as a dependent variable. Analysis of TQ scores revealed a highly statistically significant reduction pre-post (p p =.913).
The overall reduction in the music therapy groups can be explained by significant changes in distinct sub-scales of the TQ, especially of "E = emotional problems" (p p p p p >.05). According to the concept of "clinical significance", more than 80% of the patients the music therapy groups (ST and CT) achieved a reliable reduction in their tinnitus scores from admission to discharge and could thus be categorized as "responder".
On a subjective level, 67% of the patients treated with music therapy regarded their symptoms as "better", 22% observed no change and 11% stated to be worse off. Apart from immediate therapy-related effects, there could be other factors influencing therapy outcome ("moderator variables"). In order to set the results in the context of existing therapies, a psychologically based treatment group was used as control group. Animal models 29 as well as results from research on tinnitus treatments30 suggest the use of very specific stimuli, i.e. The "Heidelberg Model of Neuro-Music Therapy" on the other hand integrates some well known psychological techniques and strategies in order to reduce the tinnitus sensitivity by means of an immediate exploration of the tinnitus sounds by the patient. The rather low positive feedback rate of the Neuroauditive Cortex Training (only about a quarter of the patients rated this module as helpful) might have been due to the wording during the therapy.
The Resonance Training is a purely vocal exercise that stimulates the auditory pathway by means of somatosensory innervations and enables the patients to control their tinnitus perception.
It is known that there are manifold cross-modalities in processing somatosensory and auditory stimuli 35. The Neuroauditive Cortex Training contains a detailed "intonation-training" with purpose-built musical stimuli, based on the individual tinnitus frequency in order to increase the patients" discriminative abilities and enhance their attentive skills. In chronic tinnitus characteristic auditory cortical reorganizations are traceable, which seem to be frequency specific 40,41.
Tinnitus Reconditioninghas distinct features in that it combines musical distractors with psychophysiological relaxation and imagination of mental well-being.
Since the application of the "well-being image" is linked to acoustic stimuli (relaxation music, tinnitus equivalent sound), the connection "well-being image - relaxation - tinnitus reduction" can be explained in terms of classical conditioning 46. The neurological basis seems to be in an endogenous system located in the medial temporal lobe system (MTLS) 6 and the reticular formation (RF) 47. On the whole, music therapy is a method with short duration, fast onset and long lasting effect for patients with "tonal" tinnitus and light to moderate tinnitus severity (Figure 1 and 2). Paper submitted to the RBCMS-SGP (Publishing Management System) on April 1, 2012; and accepted on August,16, 2012. Imagine putting your headphones on to listen to your favourite music and instead hearing a constant whooshing noise. Even with the volume turned up all she could hear from her left ear was a rushing sound that never faded away. Janice Dyson relief from Tinnitus Janice, 63, a retired library assistant, started to notice the noise after she fell ill with a totally unrelated spinal problem and was given powerful drugs. Doctors suspect, although they cannot be sure, that some of the medicines she received may have triggered the debilitating problem. Audiological tests showed some slight hearing loss and Janice was fitted with a hearing aid and a device that generated a€?white noisea€? to try to mask the sound of the tinnitus. It didna€™t work though and in desperation she contacted The Tinnitus Clinic in Birmingham for help. The sound enrichment component of the therapy is designed to provide ad hoc control over the patienta€™s tinnitus awareness with a long-term goal of bringing about perceptual habituation to the tinnitus signal. Our audiologist at The Tinnitus Clinic, Rugina Begum says: a€?Janicea€™s sound enrichment was set up to match her tinnitus. If your symptoms are similar to Janice Dyson's, contact us to book your Initial Assessment.
Our video explains the neurological causes of tonal tinnitus and how audiologists at The Tinnitus Clinic are able to treat it with a pioneering therapy known as Acoustic CR® Neuromodulation. The Tinnitus Clinic is the leading provider of the latest evidence-based tinnitus treatments in the UK. Misophonia is a rare and poorly-understood condition, sometimes called soft sound sensitivity syndrome, or 4S. Typical triggers include mouth noises, such as eating, chewing, breathing, lip smacking, licking, whistling, or the sound of certain speech sounds. Decreased sound tolerance must be considered in the context of overall health status and may be a symptom of a variety of medical and psychological problems. The most effective treatment almost always follows an accurate evidence-based medical, audiological and psychological diagnosis. Our office, as well as most other pioneers who treat misophonia, have concluded that a multi-disciplinary treatment approach appears as the best option, and, in most cases, is essential for progress. In addition to being preceded by a thorough evaluation, we provide counseling for the patient and family members to understand the condition and how it should be treated. You are welcome to contact us to schedule an initial appointment for a Misophonia Assessment and Consultation, and auditory testing.
This course will review case studies using Zen in unique ways, including cases on sleep management and issues with concentration. It will review a treatment plan and modifications when looking at real world scenarios to accommodate for individual lifestyle and occupational needs and challenges. 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. 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).
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. Heidelberg Neuro-Music Therapy for chronic-tonal tinnitus - treatment outline and psychometric evaluation.
But more than 80% of the music therapy patients (both ST and CT) revealed a reliable improvement ("responder") compared to 44% in the PT group. A number of potential working factors accounting for the treatment success are highlighted. The main reason seems to be the permanent awareness of the tinnitus and the diminished ability to habituate to the sounds4. According to these assumptions, the tinnitus sounds originate from lesions in the auditory pathways.


Therefore the patients shall be enabled to actively control the sounds in order to reorganize the underlying neuronal mechanisms maintaining the tinnitus17. The overall therapeutic dose rate (500 minutes of therapy) was equal just as were the intervention modules (including the counseling).
The aim is not to reproduce a psychometrical pitch-matched tone but rather a sound that is subjectively equivalent to the patients" "ear sounds".
A systematic and targeted training of inaccurately intonated musical sounds enables the patients to exert influence on their auditory processes since they learn to actively filter out irrelevant information and to concentrate on relevant acoustic stimuli.
By means of music as calming background stimulus, the balance between the activity of the sympathetic and the parasympathetic branches of the autonomic nervous system shall be restored. The volume is adapted to the individual hearing level compensating for a potential hearing deficit. The therapy concept was announced by press releases (newspapers and magazines, radio and TV) and offered to patients at the outpatient department of the local ENT-clinic of the university hospital. The therapy was designed as group intervention with five weekly sessions a 90 minutes and an additional individual counselling (50 minutes) leading to therapy duration of 500 minutes equal to the music therapy intervention. The main outcome criteria were the absolute scores of the German version of the tinnitus questionnaire ("Tinnitus-Fragebogen", abbreviated "TQ") by Goebel and Hiller26 as well as the relative decrease in TQ scores. They had to answer three specific questions a) "Was your tinnitus percept changed by the music therapy?" (Answers: worsened - unaffected - improved) and b) "Which elements from therapy did you consider helpful?" (open question).
In the logistic regression demographic, therapy and tinnitus related factors were entered in the model to define those factors that are associated with tinnitus and may therefore contribute to therapy success.
Therefore there is an urge for a short term therapy with preferably minimal effort but long lasting effect. In terms of treatment outcome this group was target underperforming since just less than half of the patients achieved the desired symptom reduction. At the core of the "Heidelberg Model of Neuro-Music Therapy", the patients are actively "confronted" with their individual tinnitus sounds and are told to deal with their tinnitus explicitly instead of trying to take no notice of the tinnitus. These modules enhance the self-determination and the control beliefs of the patients since they learn techniques in order to actively influence their tinnitus. The patients possibly did not know the scientific label of the intervention thus the answers in the feedback-sheet were blurred because the patients could not label this intervention. One specific of the "Heidelberg Model of Neuro-Music Therapy" is the establishment of a tinnitus-equivalent sound. Many patients can voluntarily change the percept of their tinnitus by for example teeth clenching, pressure on the occiput, forehead, vertex and temples, head turning and shoulder abductions 36. Frequency discrimination training may interrupt the cortical representations that are generating tinnitus 42,43. This module increases the auditory filtering and supports a modified emotional processing of the tinnitus sound.
The MTLS is suspected to be responsible for the establishment of a "tinnitus memory" similar to the pain memory. Further studies are needed in order to evaluate which elements of the music therapy contribute most to the overall effect and to scrutinize the proposed working factors of the modules. The treatment of tinnitus related psychological distress is part of the music therapy concept, though the duration is very short and music therapy presents a focal therapy and no in-depth psychotherapy will be possible. University Hospital for Ear, Nose, and Throat - University of Heidelberg - Heidelberg - Germany. Tinnitus outpatient department - German Center for Music Therapy Research - Heidelberg - Germany. Thata€™s how it sounded to Janice Dyson every time she wanted to use her iPod to relax to some much-loved tunes.
Soon it started to disrupt her sleep, damage her concentration and severely affect her mood.
White noise is a bit like the a€?statica€? sound on a radio when ita€™s not tuned into a station properly. Experts there suggested Tinnitus Desensitisation Therapy TM, involving counselling sessions combined with a€?sound enrichmenta€? to gain greater control over her tinnitus. We offer a highly personalised service and a commitment to audiological best practices to significantly reduce your tinnitus symptoms and hearing loss.
Pawel Jastreboff, whom I directly trained under, as part of his updated published research on Tinnitus Retraining Therapy (TRT). It typically begins with a sudden onset after some emotionally significant event associated with exposure to a first trigger sound, activating a strong emotional and behavioral reaction.
Most often, reactions begin in response only to particular individuals, usually parents or siblings. Some of these include tinnitus, hyperacusis, hearing loss, family relation problems, depression, anxiety, autism or brain injury. This includes following an appropriate therapy, such as the Misophonia Management Protocol, Tinnitus Retraining Therapy for misophonia, or Reverse-Progressive Masking Therapy for misophonia.
We and our audiology and psychological colleagues, view misophonia a family affair because most triggers are experienced during family interactions. 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. Pawel Jastreboff, now at Emory University in Georgia, and Jonathan Hazell, The Tinnitus and Hyperacusis Centre in London, of a strong correlation between the two conditions that helped ignite the recent surge in scientific interest in reduced sound tolerance. Tinnitus distress was assessed using the German version of the Tinnitus-Questionnaire (TQ) at admission, at discharge and six months after therapy.
Therapy impact seems to be lasting since TQ scores remained stable until follow-up at six months. For that reason the predominant wish of the patients is to get rid of the "annoying" and "intrusive" sounds5 and to regain confidence in their sense of hearing.
Usually these sounds should be blocked off by feedback connections from limbic regions before reaching the auditory cortex. Musically based interventions11,12,13 also have proven to be highly effective in treating chronic tinnitus - possibly by correcting tinnitus evoking neuronal mechanisms14. If they could actively influence their tinnitus, their control beliefs will rise and thus let down the strains15. Purpose-built music therapeutic interventions were merged to modules and integrated into a standardized manual. During the interval between the sessions, the patients have to exercise themselves in Resonance Training for three minutes every hour. For this purpose, before the training session starts, the patients have to set the background music to a convenient level such that they can easily listen to the music while still being able to follow verbal instructions from the therapist. Only patients coming from the proximity of Heidelberg were allocated in a randomized way (computer generated) either to the ST group or the PT group.
The regression analysis reveals a highly significant relationship between the tinnitus score and the independent variables (p 2= 0.43).
The proposed therapy concept "Heidelberg Model of Neuro-Music Therapy" seems to be a potential completion of the therapy spectrum. Given that this group received also placebo music therapeutic elements (active listening to preselected musical pieces) and an individual counseling, it seems reasonable to argue that the positive and long lasting effect of the music therapy according to the "Heidelberg Model of Neuro-Music Therapy" is due to the far more specific and active musical training aiming directly at the individual tinnitus sound. There exists a variety of procedures using a combination of counseling and acoustic stimulation. In doing so, the duration of the therapy does not exceed ten weeks (standard therapy) and can even be compacted to five days (compact therapy). Many patients stated though that they would enjoy singing or listening to music subsequent to the therapy.
Levine 37 proposed interactions between auditory perception and somatosensory input at the dorsal cochlear nucleus. Experimental data indicate that it is more efficient to train at normal hearing frequencies rather than in the region of hearing loss or tinnitus frequency 44,45. Biocybernetics of attention in the tinnitus decompensation: An integrative multiscale modeling approach. Development and psychometric adequacy of the screening version of the tinnitus handicap inventory. Final common pathway for tinnitus: theoretical and clinical implications of neuroanatomical substrates. Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotion. The rewards of music listening: response and physiological connectivity of the mesolimbic system.
Auditive stimulation therapy as an intervention in subacute and chronic tinnitus: a prospective observational study. A multi-centre study on the long-term benefits of tinnitus management using Neuromonics Tinnitus Treatment.
Listening to tailor-made notched music reduces tinnitus loudness and tinnitus-related auditory cortex activity. A cognitive model of tinnitus and hyperacusis; a clinical tool for patient information, appeasement and assessment. Musiktherapie bei Tinnitus: Interdisziplinare Pilotstudie zur Uberprufung des Heidelberger Modells. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research.
Enriched acoustic environment after noise trauma reduces hearing loss and prevents cortical map reorganization. Treatment of tinnitus with a customized, dynamic acoustic neural stimulus: underlying principles and clinical efficacy.
Cross-modal interactions of auditory and somatic inputs in the brainstem and midbrain and their imbalance in tinnitus and deafness. The effect of a new treatment based on somatosensory stimulation in a group of patients with somatically related tinnitus. Auditory discrimination training for tinnitus treatment: the effect of different paradigms. Auditory perceptual learning at normal hearing frequencies affects changes in tinnitus intrusiveness and percept. Tinnitus suppression by low-rate electric stimulation and its electrophysiological mechanisms. Classical conditioning as the basis for the effective treatment of tinnitus-related distress. The dorsal cochlear nucleus as a participant in the auditory, attentional and emotional components of tinnitus. Without it I dona€™t know what might have happened, I really feel for people who are told there is nothing that can be done.a€? she says. Misophonia also occurs as a secondary symptom accompanying tinnitus or hyperacusis, usually associated with a condition of hearing loss, auditory damage or head trauma.
Because multiple forms of decreased sound tolerance may be involved simultaneously, we carefully consider evaluating all conditions, especially hyperacusis.
An essential feature of Misophonia assessment is a detailed clinical interview to differentiate between the types of sound and non-sound triggers that are being reacted to, and the types of reactions. We are qualified to identify key behavioral and family relationship difficulties that may be relevant to the misophonia problem, before, during or as a result of reactions to triggers. Music, on the other hand, is generally not recommended, since it may induce strong emotions, and may attract attention as well (Jastreboff & Hazell, 2004). The western heptatonic musical tonality forms the basis of the active music therapy procedures. The most common side effects are headache and laryngitis if the exercise is not executed properly, either too often, too long or with too much pressure. Group differences of sociodemographic data and audiometric tinnitus characteristics were analyzed with the c2-test or univariate analysis of variance (ANOVA).
About 80% of the patients accomplished a reliable decrease of tinnitus pathology in the course of music therapy and about two thirds of the patients describe their tinnitus symptoms as "improved" after therapy.


Often the musical stimuli are spectrally modulated in order to account for hearing impairments31,32 and are incorporated as a passive means patients have to listen to for rather lengthy intervals (months up to years). The main parts of the therapy consist of active music therapy modules; hence there is no need and no purpose for spectrally changing the music used.
We therefore propose that it is possible to alter the internal tinnitus spectrum by means of the Neuroauditive Cortex Training, which represents a specific perceptual training within the normal hearing frequencies. RF neurons coordinate sensory and motor functions and influence cortical activity via the thalamus. The interview will also determine whether reactions are multi-sensory in nature, involve non-auditory anticipation and visual triggers, and if family relationships are being affected. However, we have seen a number of clinical cases in which neither of the two conventional TRT sound stimuli produced the desired effect.
Mutual stimulation via both the thalamic and paralimbic pathways ultimately lead to tonotopic changes in the auditory cortex7 while reciprocal innervations of the medial temporal lobe system give rise to memory consolidation leading to a paradoxical "tinnitus memory"6. Therefore the Neuro-Music Therapy is indicated only if the patients indentify their tinnitus as "tonal" (sinus tones).
Any psychiatric disorder or ongoing medication with antidepressants or antipsychotic drugs yields to exclusion of the patients. Selection of the musical pieces was based on the individual musical taste and preferences as well as on the emotion evoking impact of the musical pieces. Therapy outcome as assessed by the TQ and the CPT were evaluated using univariate analysis of variance (ANOVA) for repeated measure procedures. This effect was independent of the patient"s treatment allocation to standard therapy or compact therapy.
Additionally, a tinnitus-equivalent sound provides the possibility to deal with the symptoms in an immediate and direct way. Therefore an activation of cranio-cervical and cranio-facial muscles and nerves by means of the Resonance Training might correct the auditory pathway by means of indirect stimulation of the joint "relay-station" cochlear nucleus 36.
Furthermore it is very important to ensure the training regime is intrinsically motivating. Stress is considered to potentiate the severity of tinnitus due to the proposed accompanying reduction and alteration in auditory masking 6. Example of treatment plan checklist for Widex Zen Therapy.AssessmentThe assessment process includes the audiological evaluation as well as other measures of tinnitus disturbance. Meryl is also passionate about participating in leadership programs, cooking as well as international traveling and appreciates being able to explore all of the great things that New York City has to offer in her spare time. According to the results from the regression analysis, there was - apart from tinnitus masking level - no influence of tinnitus characteristics or otological co-symptoms on therapy success. A deliberate regulation of emotional responses towards the tinnitus sounds might enhance gate control mechanisms and restore misdirected "filter functions" of thalamic and limbic areas. Fractal music is described as sequences of tones with no lyrics, which sound something like wind chimes. Predictable without being monotonous, the music sounds familiar, but is not associated directly with music that the listener holds in memory (Sweetow & Jeppesen, 2012).
Nevertheless, the relative reduction and the individual improvement (reliable change index) were independent from the basic TQ-value - therefore also patients with comparatively lower strains still benefit from the therapy in equal measure. Adding the counseling and relaxation pieces becomes more critical as the tinnitus becomes more severe.AmplificationWhat are the ideal characteristics of amplification for your patients, including those with tinnitus? The results were positive, so a larger trial with a total of 91 patients in TRT categories 1 and 2 was initiated. 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. Ericsson (2013) addresses these types of strategies, including cognitive behavioral intervention, which is a successful tool in more severe tinnitus patients that helps to identify the emotional impact of tinnitus and control its impact on quality of life. 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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Comments to “Tinnitus and hyperacusis therapy master class”

  1. Symptom of one more wellness dilemma.
  2. Will cover the price of the moreover, considerably.
  3. Final Though commonly life can typically be lessened by a mixture bothering.
  4. Examination of the ear, a physician can brand of Tegerol may.
  5. The discomfort?associated with ear wax build up between the.


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Children in kindergarten to third, seventh and expertise anxiety and taking deep swallows for the duration of the descent of ascent of a flight. Also.