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Author: admin, 13.09.2013. Category: Treatment For Tinnitus

This study reports on the long-term benefit of ultra-high-frequency masking with the UltraQuiet device.
This study reports on the long-term benefit of ultra-high-frequency masking with the UltraQuiet (UQ) device.
Well accepted is that if maskers overlap in frequency with the tones to be masked, masking is likely to occur, its degree related to masker intensity.
Because tinnitus can usually be masked (at least partially) for some period by a variety of sounds, one commonly used procedure is to assess wide-range masking, termed minimal masking levels (MMLs), using a variety of frequencies, including broad- or narrowband noise [12]. Theoretically, stimulation above the tinnitus frequency may supplement or assist the neurological reprogramming at the cortex and perhaps restore the normal-frequency spatial relationship.
The goal of this study was to evaluate the long-term efficacy of using UltraQuiet high-frequency bone-conduction therapy for treating tinnitus, using pre- and postbehavioral assessment of tinnitus loudness, tinnitus anxiety, and tinnitus severity. Fifteen subjects (3 female, 12 male) with subjective idiopathic tinnitus of the severe disabling type participated in the study. The stimulus was produced using Kyma Version 5 software with a Capybara 320 Sound Computation Engine, and it was recorded on a compact disk (CD). The transducer is a custom-made aluminum ceramic bimorph with a high-frequency limit of some 50 kHz.
The UltraQuiet stimulus parameters, or sound features, were chosen to optimize the activation of auditory cortical neurons.
Classification of masking curve type according to Feldmann's system was applied to the masking data, and we measured loudness discomfort levels at 250-8,000 Hz.
To assess, in a preliminary fashion, the effects of treatment length, we randomly assigned subjects to one of three groups.
Before each stimulation session, subjects completed three outcome measurements: the tinnitus intensity index, the annoyance index, and the tinnitus severity index [1]. The questionnaire results for measures of tinnitus intensity and annoyance were not significantly different over the course of therapy sessions, although a drop in the mean level for each was noted on the last few trials. We examined the relationship among high-frequency MMLs, tinnitus pitch, tinnitus intensity, and Feldmann masking curves. The use of high-frequency bone conduction stimulation using the UltraQuiet therapy system resulted in longterm reduction in tinnitus severity during therapy, and that tinnitus relief lasted for at least 2 months after therapy in most subjects in this study. During posttherapy interviewing, we noted partial masking of the tinnitus by the UltraQuiet system throughout the trial in all patients (although not in every session). Frequency range of stimulation is critical in the auditory cortical reprogramming approach of the UltraQuiet system; however, any reduction in the amount of masking required to eliminate (or partially eliminate) tinnitus also is important.
Alternatively, we could argue that the energy around 6 kHz was predominant in our subjects owing to mild to moderate sensorineural hearing loss.
RI, which refers to a decrease in the perceived intensity of the tinnitus for a time after the masking stops, was first reported by Feldmann [12].
Because the UltraQuiet stimulus generally overlaps with high-frequency tinnitus and the presentation is just above threshold stimulation (~6 dB SL), inhibition should be facilitated. Treating tinnitus patients with the UltraQuiet device is more difficult when their tinnitus is of the severe problematic type.
Problematic tinnitus is most likely related to changes in the auditory pathway and consequent reactions in various areas of the brain.
The authors acknowledge the support of Sound Technique Systems, LLC, in this study and the assistance of Robert Guinta. For people with HFHL, it can be as though someone has removed certain letters from the alphabet in speech. Clearly the best thing to do is to be knowledgeable about the types of causes for hearing loss and how to avoid them. Should the worst occur and you have discovered some hearing loss, there are some options available. While there are treatments available, and there are new breakthroughs happening all the time in the field, the best measures to take are ones of prevention. Caring for the ears is as simple as identifying the hazards and putting measures in place to either avoid or protect from these hazards. When aiming to treat, instead of only protect, The Hearing Loss Pill team has created a post specifically covering all of the available options which include everything from stem cell treatments to cochlear implants. Some data from studies is showing that high frequency hearing loss is actually getting worse in the main population, particularly in the youth. A: Possible causes for HFHL include extreme noise exposure, genetics, aging, ototoxicity, and desease. A: Hearing Aids can take the higher frequency sounds, not heard by someone with HFHL, and lower the frequency one of two ways. Fernanda Acaui Ribeiro Burguetti*, Angela Garcia Peloggia**, Renata Mota Mamede Carvallo***.
Introducao: O zumbido e uma sensacao sonora nao relacionada a uma fonte externa de estimulacao.
INTRODUCAOA coclea, orgao sensorial nobre, pode ser descrita como um analisador de frequencias caracterizado por um conjunto de tres canais justapostos em forma de espira.
People with high-frequency hearing loss in addition to tinnitus may need to wear hearing aids. Natural tinnitus products include herbal remedies, vitamins, minerals, and homeopathic remedies. Non-surgical medical equipment, including hearing aids, tinnitus maskers, and a hand-held, ultrasonic device are other tinnitus products that have brought much-needed relief to people with ringing ears. Surgical procedures for tinnitus are usually appropriate only when there is obvious structural damage causing the condition. Tinnitus is itself not a disease, but rather it is a symptom that can be caused by a range of other conditions. According to modern concepts, the pathogenesis of tinnitus is the theory of self hearing somatic sounds of a body from the existing pathological conditions and of auditory sensations.
Patients often compare it with the noise of the surf, the rustle of leaves, the sound of steam, gurgling or splashing water, and mosquito peep.
Very rarely complain of tinnitus children and almost never – patients with congenital deafness. Tinnitus is not a mandatory symptom of any diseases, but it is known that up to 85% of patients suffering from this condition have registered a hearing loss in the range of 250-8000 Hz.
Tinnitus can be caused by different reasons, and not always regarded as a pathological condition.
Objective tinnitus can be registered using auscultation and other instrumental methods of examination of the patient.
The concept of tinnitus combines violation of socialization, mental disorders, mood caused by noise in the ears. A commercial product, UltraQuiet provides a new form of high-frequency bone conduction therapy. In the case of masking tinnitus by an external noise, this relationship is more the exception than the rule. The masking stimulus is raised in 5-dB steps, and patients are asked whether their tinnitus is still audible. The stimulation must be very high in spectral content to accomplish this above the tinnitus pitch requirement.
Music appears be a more effective tinnitus masker than is noise [19], possibly owing to the involvement of more central and cognitive processes.
The CD recording stimulus consisted of digitally processed music (44.1-kHz sampling rate) with playback in the 10- to 20-kHz range.
Spectrum of the high-frequency bone-conducted stimulation ranges from approximately 6 kHz to 20 kHz.
The transducer is coupled to the skin and held in place with a band, much as are traditional clinical boneconduction transducers. Cortical neurons have been shown to be sensitive to frequency edges, temporal patterns, and frequency or intensity transitions [20].
We presented outcome questionnaires to establish a baseline of functioning; these included the tinnitus intensity index, the annoyance index, and the tinnitus severity index [1,21,22]. No one indicated a poorer result, and those four reporting no change in their tinnitus did indicate improvement on measures of tinnitus intensity or severity after therapy treatment. That is, as a group, the patients with problematic tinnitus indicated a significant reduction in severity over the course of the treatment trials. Effects of high-frequency therapy on three outcome measures - tinnitus severity, intensity, and annoyance - as evaluated by questionnaires completed after each therapy session. For some patients at some frequencies, reductions in MMLs were as high as 25-45 dB in one ear (Fig.
Decrease in the minimum masking levels (MMLs) for the six patients who received brain imaging before and after therapy.
Mean minimum masking levels for all subjects when patient and ear data are collapsed reveals a frequency-specific pattern. Individual variability in this small sample of patients with problematic tinnitus precluded any detailed analysis, but tinnitus intensity ratings exceeding 50 dB were associated with improvement on the overall tinnitus relief questionnaire and were associated with a high-frequency pitch match. Relationship among minimal masking level changes (by frequency), Feldmann masking curve (FMC) types, and pitch and loudness matches in all subjects.
Hearing thresholds before and after therapy generally suggest improvement after therapy; however, the pattern was complex and included elevation in some frequencies.
Threshold was established before each session but, given the problems in detecting a stimulus in the presence of tinnitus (even in skilled hands), the level of UltraQuiet therapy may have been as little as 2-3 dB SL for some patients in some sessions.
Patients in the 10-session group averaged just above "no change," whereas those in the 12- and 14- session groups averaged above "slight improvement." What must be emphasized is that these patients with problematic tinnitus have had limited therapeutic success with other treatment modalities. The tinnitus relief was inferred from a pattern of lower weekly scores on the tinnitus severity scale and reduction in MMLs. Owing to stringent adherence to the protocol approved by the Western Institutional Review Board, we made no effort to increase the stimulation level in an attempt to produce complete masking. All patients had serviceable hearing to 12 kHz, but hearing improvement may have been related to relative frequency sensitivity of the UltraQuiet stimulus. In an individual with hearing loss and tinnitus, RI may last for a few seconds or minutes but can last days or weeks [2,31]. The acceptance of RI over questionnaire data is understandable in an effort to obtain a more "physiological" metric. What effect the increase in stimulation level from 6 dB SL to 12 dB SL would have on the effect of masking, on further reduction in MMLs, and on increased RI remains to be explored. When contrasted to normal controls and tinnitus patients who tolerate their tinnitus, patients with problematic tinnitus showed less habituation in middle latency potentials [36]. The emerging picture is that of an initial insult to the ear or brain (or both) followed by an increase in the tinnitus frequency cortical map, which could increase dyssynchrony-synchrony and loudness and reduce habituation. Department of Otolaryngology, State University of New York, Downstate Medical Center, Brooklyn, and Martha Entenmann Tinnitus Research Center, Forest Hills, New York.
Tinnitus is a condition in which damage to the ear results in sufferers hearing sound or noise that isn?t there.
Hearing deteriorates with age to a certain degree, and this decline can be exacerbated by any number of other factors.
The goal is to become educated on the risks of damaging noises and to minimize any potential hearing loss as we age. These can range from heavy-duty work earmuffs that cover the whole ear to small, inconspicuous plugs for watching bands. HFHL usually impairs the inner ear, which affects how sound is received and transmitted as signals to the brain.
Obviously this plan will differ person to person: a truck driver might identify far different noise hazards than a full-time mother. Frequency transposition, the first option, takes the higher frequency energies and moves them to a lower frequency.
The truth is that most people never do anything with the products they buy, so most of the time, they dona€™t get ANY results. Diferentes procedimentos tem sido adotados para diagnosticar a sua etiologia, sendo que alguns autores relacionam o zumbido a uma disfuncao coclear. Foram determinados os limiares auditivos em dBNA, para as frequencias de 9, 10, 12,5, 14, 16, 18 e 20 kHz para ambos os grupos. Two subgroups were determined: Study Group with twenty eight patients (56 ears) with tinnitus complaint, Control Group with forty-three patients (86 ears) without tinnitus.
Esta ligada a orelha media pela janela oval, por onde a energia mecanica e transmitida aos liquidos da coclea. There are several different types of tinnitus products that may make living with this condition more tolerable. Using a biofeedback machine that monitors muscle tension, temperature, and galvanic skin response, a person learns to control responses to tinnitus. In one trial, more than 80% of patients got relief after receiving intravenous lidocaine and a perfusion of lidocaine and dexamethasone; unfortunately, the relief only lasted about 30 minutes.


A tinnitus masker works by blocking the tinnitus with white noise or other pleasant sounds. Shunts, jugular vein ligation, and 8th nerve surgery have been tried on some patients, but have very limited uses in the treatment of tinnitus. In tinnitus the patient will suffer from sounds and particularly 'ringing' heard in the ear (the word tinnitus actually translates from Latin as ringing) despite there usually being no corresponding sound in reality. There are endogenous somatic sounds that occur during muscle contraction, movement joints, and the bloodstream. It considers that the noise of central origin is more common, but because of low intensity rarely a cause for seeking medical attention and is detected only during purposeful questioning. Objective noise is characterized for those rare diseases in which there is noise audible for outside observer. Subjective tinnitus occurs in all patients who experience a sound, not measurable from the outside. To assess its effectiveness in tinnitus treatment, we selected 15 patients with problematic tinnitus and randomly assigned them to three variations of the medical-audiological tinnitus patient protocol modified for the UltraQuiet study. Logically, high-frequency masking should provide effective relief in persons with severe problematic tinnitus. The UltraQuiet device delivers amplitude-modulated musical-type stimulation in the range of 10-20 kHz suitable for this purpose. We specifically investigated the use of the UltraQuiet device for providing relief, masking, and RI in individuals with problematic tinnitus of the severe disabling type.
The stimulus consisted of synthesized music digitally processed and used to modulate a carrier at 16 kHz. The CD was played through a custom-made amplifier into a piezoelectric bone-conduction transducer. Some energy occurs around 6 kHz, owing to the transducer's fundamental resonance and the high-pass filter slope. In other words, features that are found in speech, music, or amplitudefrequency modulation were incorporated into the stimulus to facilitate auditory cortical activation. Audiological evaluation included pure-tone audiometry, speech audiometry, tinnitus pitch and loudness matching, the measurement of RI, and masking curves to establish MMLs at 250-8,000 Hz using both narrowband and white noise. One week after the last intervention session, we repeated the audiological evaluation and administered the outcome questionnaires to assess any changes. Group 1 received stimulation twice weekly for 2 weeks, stopped the stimulation for 2 weeks, then received stimulation twice weekly for 3 weeks, for a total of 10 sessions. The stimulation lasted 30 minutes for the first session and 1 hour for all succeeding sessions. Some patients indicated more improvement than others, but the trend in all patients was an increase in tinnitus relief. Note the general improvement that lasted for 2 months in approximately one-half of the patients. Tinnitus severity improvement for the group was evident at the second session, gradually increasing through the twelfth session. Clearly the severity is decreasing, with a trend in that direction for anxiety and loudness. The tinnitus pitch match most frequently occurred in the region of the hearing loss but not necessarily at the frequency with the maximal loss.
Dynamic hearing levels appear related to central processes assumed to be active during and after therapy.
Note in Figure 3 that dramatic improvement in tinnitus severity occurs in session 12, as does a modest abatement of tinnitus intensity and annoyance. Four factors likely contributed to long-term tinnitus relief: ultra-high-frequency masking, RI, neurological reprogramming, and habituation. The strategy of using high frequencies at low levels was designed to potentially provide some partial masking but, more important, was designed to aid in tinnitus neurological reprogramming and habituation. This is suggested by the six cohort patients in whom positron emission tomography scans were obtained. High-frequency stimulation, both in the high audiofrequencies (UltraQuiet) [2] and in ultrasonic frequencies [11], have resulted in RI. We observed (by interview at the end of therapy but not by formal testing) RI lasting approximately 5 minutes. The conclusion of Shulman [15] suggests that a brain-imaging index in conjunction with high-frequency audiometry may be the technique of choice in objectively assessing tinnitus relief from auditory therapy if neurological reprogramming and habituation are the essential processes as hypothesized. Cortical reprogramming as a consequence of sensorineural hearing loss has been well established [33, 34].
In view of the degree of improvement and results with the limited number of sessions in our study, a reasonable expectation is improved results with an increased level of stimulation (12 dB SL) and an increased number of sessions over time. Additionally, auditory brainstem response differences between tinnitus patients and controls further suggest that auditory path- way transmission may influence abnormal habituation. Such a condition could hyperactivate the medial temporal and prefrontal lobes, resulting in problematic tinnitus characterized by annoyance, and could trigger autonomic reactions. Ultra-highfrequency acoustic stimulation and tinnitus control: A positron emission tomography study. Functional inactivation of the amygdale before but not after auditory fear conditioning prevents memory formation. Local improvement in auditory frequency discrimination is associated with hearing-loss slope in subjects with cochlear damage. Loudness perception and frequency discrimination in subjects with steeply sloping hearing loss: Possible correlates of neural plasticity. Test-retest reliability of pure-tone thresholds from 0.5 to 16 kHz using Sennheiser HDA 200 and Etymotic Research ER-2 earphones. High-frequency (8 to 16 kHz) reference thresholds and intrasubject threshold variability relative to ototoxicity criteria using a Sennheiser HDA 200 earphone. Environmental enrichment improves response strength, threshold, selectivity, and latency of auditory cortex neurons.
Abnormal auditory mismatch response in tinnitus sufferers with high frequency hearing loss is associated with subjective distress level.
What happens is the tiny hair nerves that are contained in the basilar membrane die as a result to over-exposure to loud noises.
It might not even be something noticeable at the time; rather, it will be a slow deterioration.
Carrying around a pair of the smaller ones are a good idea, especially if you think you might be exposed to noise. While there is no cure as such for hearing loss, there are a range of treatments and aids to improve the quality of hearing.
There is only a limited amount of times the ears can be exposed to loud noises before they start to deteriorate.
A range of ear protection, from the large rubber earmuffs to smaller earplugs, are a great investment and should always be close to hand ? This is hypothesized to be due to noise induced hearing factors from an increase of noise in daily activities, including everything from normal environmental noise to the increased use of ear buds for music listening. The second way, known as nonlinear frequency compression, uses a compression ratio on the high frequency sound to lower it. Audiometric thresholds were determined in dBHL across octave frequencies 9, 10, 12,5, 14, 16, 18 and 20 kHz for both groups. Cada frequencia caracteristica ira promover um padrao de deslocamento descrito como onda viajante, com capacidade de estimular melhor determinada regiao da coclea.As celulas sensoriais localizadas na regiao estimulada sao capazes de promover a transducao deste estimulo em sinal eletrico, que sera propagado pelas fibras do nervo auditivo que partem da regiao coclear. These tinnitus products can be divided into five different categories: natural medicine, cognitive, prescription drug, non-surgical medical devices, and surgical procedures. Vitamin or mineral deficiencies that are causing ringing in the ears can sometimes be helped by magnesium, zinc, potassium, and vitamins A, B, and C supplements.
Neurofeedback teaches a person to alter brainwave states to better cope with the ongoing head noise.
People who have high-frequency hearing loss as well as tinnitus may need to wear a hearing aid in order for a tinnitus masker to work. Surgery carries more risk; although some procedures have a success rate of about 50%, many also come with a 100% chance of deafness following surgery. No tinnitus product is 100% successful, but a physician can suggest tinnitus products that have worked for other patients in the practice.
This is not a hallucination but rather a result of damaged hearing and most commonly noise-induced hearing loss. Usually these sounds are masked by the sounds of the environment and do not lead to a pathological condition.
In modern medical literature the classification based on the concepts of objective and subjective noise is used.
Any situation in which increased blood pressure, as well as food and beverages, may provoke the development of pulsatile tinnitus.
Reduction of the inner lumen of the carotid arteries and jugular veins washes causes turbulence circulation, in which there is noise in the ears. For example, arterio-venous shunts (and other disease), sometimes appear pulsating noise in a head. We assessed tinnitus relief by questionnaires directed at weighing patient response to overall effectiveness, tinnitus loudness, tinnitus severity, and tinnitus annoyance. The effect of this expansion on connections to the limbic system and other cortical areas is not known, nor have the tuning characteristics of these "recruited" neurons been measured. Preliminary clinical reports were encouraging [2] and a calibration procedure, anchored to international standards, was followed [18]. The pitch match to the tinnitus for 14 of the 15 subjects was high-pitched, matching to either a pure-tone or a narrowband noise or a combination of both, with frequencies between 3 and 16 kHz; 1 subject had a low-pitched tonal tinnitus at 450 Hz.
Group 2 received stimulation twice weekly for 3 weeks, stopped the stimulation for 2 weeks, then received stimulation twice weekly for 3 weeks, for a total of 12 sessions. Further improvement may be present but is obscured by the duration parameters of the three groups. The mean data are perhaps as revealing; when patient and ear data are collapsed, a high-frequency reduction in masking is observed (Fig.
Although we saw an increase in some thresholds in some patients, twice as many thresholds improved as those that decreased.
Nonetheless, the frequency range of masking is important in obtaining neurological reprogramming and inhibition [16,18]. Those patients with the best thresholds beyond 10 kHz exhibited the best behavioral and physiological activity [15].
The question of the minimal number of trials needed to note tinnitus relief, given that choices were limited to 10, 12, and 14 sessions, can be answered only by stating that 10 session of therapy (and probably fewer) are not as effective as 12 and 14 sessions, on the basis of questionnaire results after therapy. Patients with problematic tinnitus appear not to exhibit normal habituation, and this can influence their perception of tinnitus loudness. Although we readily recognize that the neural substrate of problematic tinnitus encompasses much more than the auditory pathway, the role of the auditory pathway in masking, RI, neurological reprogramming, and habituation is significant [37].
In GE Reich, JA Vernon (eds), Proceedings of the Fifth International Tinnitus Seminar 1995. Poster presented at the Twenty-First Annual Meeting of the Association for Research in Otolaryngology, 1999. Presented at the Thirty-First Congress of the Neurootological and Equilibriometric Society, Bad Kissingen, Germany, March 25-27,2004. These hair nerves are what transmit sound to the brain to be interpreted into aural messages ? This means that instead of taking in a whole day?s worth of exposure to loud noises, we see them as isolated incidents.
We know better than that: we cover up our skin, we use sunblock, and we get our skin checked for moles and melanomas. A medical practitioner will be able to determine exactly what hearing loss you suffer from, as well as in what frequencies, and will be able to recommended treatment. The testimonials you see on this web site are some of our better results and are not typical. Quanto mais alta a frequencia que atinge o sistema, mais restrita a estimulacao a regiao basal da coclea.
Chininum sulphuricum, calcarea carbonica, or salicylicum acidumare are often included in homeopathic remedies for tinnitus and can be purchased off the shelf.
In hypnosis, a person's subconscious mind is given a suggestion to respond in a particular way to the sound of the tinnitus; when hearing the ringing, the individual will feel empowered rather than fearful and out of control. Approximately 70% of people who have used a tinnitus product called the Inhibitor say that it is effective. A deaf person with tinnitus may be helped by a cochlear implant and electric nerve stimulation. For some this can be a minor irritation, but in more extreme cases it can be highly distressing and cause depression, mood swings, headaches and difficulty concentrating and sleeping.


Additionally, we performed audiological measures (including pure-tone and speech audiometry, minimal masking levels, pitch and loudness matching, and residual inhibition). That is, tinnitus masking may be a complicated product of peripheral and central processes, and sounds outside of traditional psychoacoustic ranges can be effective with tinnitus [2], including ultrasound masking delivered through bone conduction [11]. If neural space expansion of the tinnitus frequency (or frequencies) is associated with synchronized activity, ignoring an attentiongenerating tinnitus percept that could readily arise may be impossible. The UltraQuiet system has a maximum output of 53 dB hearing level (HL) when it is massloaded to the artificial mastoid with 5.4 Newtons of force applied. Group 3 received stimulation twice weekly for 4 weeks, stopped the stimulation for 1 week, then received stimulation twice weekly for 3 weeks, for a total of 14 sessions. The threshold for stimulation was established, and the stimulation was presented 6 dB above threshold or 6-dB sensation level (SL).
That is, for the latter sessions, the number of patients being tested dropped, owing to the session limitations for each of the three treatment groups.
No consistent pattern was noted between Feldmann masking curve type and tinnitus pitch match (Fig. If highfrequency stimulation is essential for auditory cortical reprogramming, the sensitivity to such stimulation should be an essential variable. What should be noted is that the stimulating intensity was only 6 dB SL, and this may not have been sufficient energy to elicit RI in the other patients, a metric to be systematically studied in the future. If the auditory cortex has reprogrammed, stimulation with very high frequencies might stabilize and reverse the process and perhaps restore the normal frequency map.
According to these serial measures, therapy of fewer than 12 sessions would not be as satisfactory as therapy lasting 12 and 14 sessions.
A plastic auditory pathway treated with a stimulus specifically designed for highpitched tinnitus may, with time, provide long-term relief. Only a very low percentage of patients will ask for a hearing test when they visit their GP. Any music lover should consider the volume levels they enjoy their music at, as many people turn music up far too high (especially with ear-buds). Hearing aids, sound therapy and possibly surgery are all methods that are used to help amplify and possibly correct to a degree a person?s hearing. They stuck to the dose as directed and maintained a healthy lifestyle and balanced diet alongside it.
Disposto ao longo de seu eixo longitudinal, o Orgao de Corti abriga celulas ciliadas internas e externas. A large percentage of people report that they are more able to cope with the tinnitus after these types of treatments even if the loudness of the ringing remained the same. This device emits a painless, one-minute ultrasonic sound wave when the unit is held just behind the ear. All patients showed some long-term gains, and most exhibited relief in at least one measurement parameter, providing support for the use of high-frequency vibration in the treatment of tinnitus. Growing evidence suggests that high-frequency masking is desirable in cases of high-frequency tinnitus [2,11].
Increased degrees of neural synchronydyssynchrony could activate and continue to stimulate the amygdala, an organ known to be critical in evoking emotional and autonomic nervous responses [17].
Although the stimulus is presented on only one side of the head, it is heard binaurally through bone conduction [23]. The frequency area that exhibited the greatest effect is the octave from 3 to 6 kHz, below the lowest resonance in our transducer (6 kHz). Annoyance and tinnitus intensity seemed to persist in most throughout the sessions, suggesting that the tinnitus, while reduced in severity, was still present. In the normal auditory system, an increase in loudness is related to an increase in neural activity.
The changes in MMLs and auditory thresholds suggest an adaptive central nervous system, responsive to high-frequency sound therapy.
If there is a ringing noise in the ears in an otherwise silent room, this is tinnitus1 and suggests that the ears have been over-exposed to noise. If it?s someone who works with heavy machinery, or in areas of high traffic, or even as a bartender, a day?s worth of sound exposure could be happening at levels that damage the ears. Two problems exist: One is developing an efficient, commercially viable, and calibratable transducer and the other is determining a reliable clinical-use protocol.
For many patients, substituting one sound for another is not considered a significant enough improvement; additional relief is desired.
Stated another way, the frequencies that required less energy to mask tinnitus were those just below the lowest effective stimulating frequencies in the UltraQuiet system. The UltraQuiet masking mechanism appears to be different when using conventional audiological masking at 250-8,000 Hz than when using ultra-high frequencies. High-frequency stimulation with the UltraQuiet passband of 10-20 kHz has the added quality of disrupting the tinnitus frequency synchrony and reducing the overrepresentation, which might be verified with cortical potentials. Patients who do not exhibit normal habituation and who rate their tinnitus as loud may have more active dyssynchronous neurons involved in tinnitus perception than do patients who assess their tinnitus loudness as low. Long-term tinnitus relief cannot be solely defined by one metric as complete masking or RI on the order of hours. In a preliminary report [2], we found a high-frequency tinnitus device, UltraQuiet, to be efficacious. The masking stimulation, if properly chosen, may have the capacity of changing how the brain processes tinnitus, which could provide long-lasting benefit.
These frequencies were on the edge of the patients' audiometric hearing loss, a region often associated with increased discrimination possibly due to neural plasticity [24,25]. With ultra-high frequency, the stimulus is apparently combined with neurological reprogramming and plasticity involving the auditory cortex. Such a situation would be predicted in the tinnitus frequency map expansion in the auditory cortex and would influence both the medial temporal lobe system and other cortical area identified as active in tinnitus [37]. Relief is a complex function of many factors arising both within and outside the auditory system, and successful treatment takes time.
The MML improvement was related to the measured tinnitus pitch in that both were high-frequency (with one pitch match exception). RI increased with masker intensity, but the relationship of RI to tinnitus frequency, masker center frequency, and bandwidth was complex and varied among individuals. Brain imaging and high-frequency audiometries seem to be important indices in quantifying tinnitus relief. Uma das principais aplicacoes clinicas da audiometria em altas frequencias e a monitorizacao da audicao em pacientes com presenca ou suspeita de alteracoes audiologicas, tais como:ototoxicose, sequela de otite media, insuficiencia renal, presbiacusia, disturbios de processamento auditivo, investigacao da audicao de familiares de portadores de deficiencia auditiva de origem genetica e monitorizacao de individuos com exposicao frequente ao ruido (3,4). Often, behavioral measures are contradictory, rendering efficacy determination problematic. Outra aplicacao da pesquisa de limiares em altas frequencias esta na influencia das respostas da regiao basal coclear sobre a geracao das emissoes otoacusticas produto de distorcao, em regioes mais apicais da coclea.
A audicao em altas frequencias influencia as emissoes otoacusticas por produto de distorcao, mesmo as captadas por estimulacao de frequencias mais baixas, devido ao fato de as emissoes serem sensiveis as mudancas subitas nas celulas ciliadas externas (CCE).A audiometria tonal convencional nao e tao sensivel a estas pequenas varia- coes das CCE, desta forma, alteracoes em emissoes otoacusticas na presenca de audiometria convencional normal poderiam estar relacionadas a alteracoes em altas frequencias (2). O estudo de HALL e HAYNES (2001) evidencia a importancia da realizacao da avaliacao da audicao em altas frequencias acima de 10.000 Hz na presenca de audiometria convencional e emissoes otoacusticas normais em pacientes com zumbido.
O zumbido e uma sensacao sonora produzida na ausencia de fonte externa geradora de som, na qual a lesao das celulas ciliadas externas pode provocar aumento nos disparos das mesmas, estimulando as fibras nervosas de modo semelhante ao som real.Pode ainda reduzir a inibicao realizada pelo Sistema Nervoso Central (SNC), permitindo maior atividade neuronal espontanea no sistema auditivo (6,7).
O zumbido pode ser explicado por meio de uma teoria neurofisiologica associada a um modelo psicoacustico, baseado em uma lesao periferica na coclea ou no nervo auditivo (8).Alguns autores referem que o zumbido pode decorrer da presenca de celulas ciliadas externas danificadas e celulas ciliadas internas normais (5).
O zumbido gerado por lesao neurossensorial manifesta- se em situacoes em que ocorre disfuncao na coclea, principalmente nas estruturas neuroepiteliais do Orgao de Corti em todo sistema nervoso auditivo. Foram selecionados 28 individuos (56 orelhas) do genero feminino com idade entre 20 a 60 anos, constituindo o Grupo Estudo. O Grupo Controle foi formado por amostra pareada por idade, incluindo um total de 43 individuos (86 orelhas).Para assegurar a homogeneidade na distribuicao das idades em ambos os grupos, foi realizada analise estatistica (ANOVA) verificando que nao existe diferenca media estatisticamente significante entre os grupos (Tabela 1). Objective tinnitus is interesting in that a clinician can actually perceive the sound emanating from the subjects ears. This can be the result of muscle spasms in the ears which are most likely to cause clicks of crackling noises around the middle of the ear. A analise estatistica foi realizada para comparacao dos limiares auditivos do Grupo Estudo e do Grupo Controle a fim de estabelecer se estes valores foram estatisticamente iguais ou diferentes.Alem disso, foi realizada a comparacao entre os limiares em altas frequencias dos individuos do Grupo Estudo de acordo com a localizacao de zumbido bilateral, unilateral a direita e unilateral a esquerda. Some people will also experience 'pulsatile tinnitus' which is usually objective and is normally in time with the pulse caused by blood flow.
Para tanto, foi utilizada a comparacao por meio da Analise de Variancia (ANOVA) e da Correlacao de Pearson. In some cases this can be a sign of life threatening conditions such as carotid artery aneurysm or carotid artery dissection, so it is very important to have any pulsatile tinnitus checked out as soon as possible. As diferencas significantes foram assinaladas com asterisco (*) nas tabelas dos resultados.RESULTADOSInicialmente foi realizada a analise comparativa entre os limiares em altas frequencias das orelhas direita e esquerda, separadamente, no Grupo Estudo e no Grupo Controle. Nao foi observada diferenca estatisticamente significante entre orelhas direita e esquerda, em ambos os grupos, permitindo uma analise conjunta dos limiares como apresentado a seguir.
In some cases tinnitus is part and parcel of a normal hearing impairment associated with age related decline. Para verificar o efeito da idade nos resultados obtidos foi realizada analise por faixa etaria em ambos os grupos, para todas as frequencias envolvidas no estudo. A Tabela 3 apresenta os resultados por faixa etaria para o Grupo Controle e a Tabela 4 os resultados para o Grupo Estudo.
Por meio dos resultados das Tabelas 3 e 4 foi possivel verificar que existe diferenca entre as tres faixas etarias quando comparadas simultaneamente.Na compara cao das faixas duas a duas, foi observada diferenca estatisticamente significante (pConsiderando como “BOA” uma correlacao acima de 60%, foi verificado que as altas frequencias mantem uma boa correlacao com o efeito idade (Tabela 5). Na comparacao entre os limiares em altas frequencias dos individuos do Grupo Estudo segundo a localizacao de zumbido bilateral, unilateral a direita e unilateral a esquerda foi evidenciada uma distribuicao equilibrada (Tabela 6). Por meio da comparacao dois a dois foi possivel determinar a nao existencia de diferenca entre tais localiza coes (p>0,05). Sendo assim, os resultados obtidos no Grupo Estudo independem da condicao de zumbido.DISCUSSAOEste estudo privilegiou as respostas auditivas em altas frequencias em individuos do genero feminino. A literatura aponta diferencas entre limiares em altas freq uencias entre genero feminino e masculino, com tendencia a diminuicao do nivel de intensidade nas respostas do genero feminino (17).Estudos em pacientes com zumbido tem sido realizados em casuistica exclusiva envolvendo um dos generos (18,19). A ausencia de diferencas significantes dos limiares em altas frequencias entre as orelhas direita e esquerda confirma resultados anteriores de outros estudos envolvendo este metodo (17-20). Alguns estudos mostram que a idade interfere nas respostas a audiometria tonal em altas frequencias, havendo um aumento deste limiar em funcao do aumento da idade (10-13).
However while these mechanisms are relatively easy to understand, some of the other apparent causes for tinnitus ? such as dental disorders ? currently have no wholly accepted explanation. A ocorrencia de zumbido em pacientes sem perda auditiva poderia ser explicada pelo dano difuso de ate 30% das celulas ciliadas externas em toda a espiral da coclea, sem haver o comprometimento do limiar auditivo (6).Outros estudos mostraram a diminuicao da amplitude das emissoes otoacusticas em individuos com audicao normal e com queixa de zumbido quando comparados a individuos com os mesmos limiares e sem queixa de zumbido (2,16). Estes resultados sao sugestivos de reducao no nivel de atividade de celulas ciliadas da regiao basal coclear nos individuos com queixa de zumbido em relacao aos indivi- duos sem queixa, revelando a audiometria em altas freq uencias como uma ferramenta diagnostica de valor na investigacao precoce do comportamento auditivo em individuos com queixa de zumbido.REFERENCIAS BIBLIOGRAFICAS1.
Electrical stimulation of the auditory cortex through implanted electrodes for instance can help to prevent tinnitus at a neural level, meanwhile repair of the perilymph fistula through surgery has been found to be helpful. However the success of treatment will vary greatly depending on the precise nature of the tinnitus.
In cases where the tinnitus is the result of another underlying condition then treatment of that condition may help to alleviate the tinnitus symptoms.
High-frequency hearing influences lower- frequency distortion-product otoacoustic emissions. Audicao em altas frequencias: repercussoes no reconhecimento de fala no ruido e nas emissoes otoacusticas. Some sufferers choose also to use a 'tinnitus masker' which creates loud white noise in order to 'mask' the sound. Media dos limiares tonais na audiometria de alta frequencia em individuos normais de 4 a 60 anos. The influence of hearing and age on speech recognition scores in noise in audiological patients and in the general population.
Amplitude de emissoes otoacusticas produto de distorcao em individuos com queixa de zumbido. Estudo dos limiares de audibilidade nas altas frequencias em trabalhadores expostos a ruido e solvente.
Extended high frequency hearing and history of acute otitis media in 14 year old children in Finland. High frequency (10-18 kHz) hearing thresholds: reliability, and effects of age and occupational noise exposure.



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