Sound therapy international tinnitus tratamiento,helix earrings types,tinnitus sound therapy download free xp - You Shoud Know

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Sound Therapy International - Tinnitus treatment, relieve stress and get emotional relief. Sound Therapy International – Tinnitus treatment, relieve stress and get emotional relief. Tinnitus results when your brain pathways become over-reactive after suffering damage to your hearing system. Amazing all-natural Tinnitus breakthrough permanently eliminates Tinnitus issues without drugs or surgery.
Recent studies have indicated that the pathophysiological basis for tinnitus may be abnormal activity in the auditory areas of the brain rather than aberrant activity in the periphery. Tinnitus is the sensation of hearing a sound when no external auditory stimulus is present [1]. A variety of tinnitus treatments have been tried, but hearing aids, maskers, drugs, and surgical interventions thus far have not been shown to be very effective [10, 11]. In general, antidepressants appear to work best for those who are depressed or anxious, who have more severe tinnitus, or who are treated for a longer time with an adequate dose of medication [13]. Recent studies have suggested that the pathophysiological basis for chronic tinnitus is neural activity in the brain rather than aberrant activity in the peripheral auditory system [17-22].
These theories suggest that overactive feedback loops in the brainstem-thalamus-auditory cortex may be the underlying mechanism of this problem. Furthermore, the perception of tinnitus has been observed to be enhanced when the person perceiving the subjective noise "attends" to it and associates it with unpleasant emotions [28]. This model for the etiology of tinnitus suggests that, though tinnitus may be triggered by events in the periphery, the mechanisms that cause tinnitus to be a persistent and annoying condition are in the brain [32,33].
Given this theoretical background, we have approached the problem of tinnitus treatment by using customized sound-more specifically, a replica of the subjective tinnitus experience-to reduce the overactive sound-processing circuits. After completion of pilot study 1, we implemented a more formalized and longer-duration protocol.
We selected subjects between the ages of 20 and 60 years if they exhibited "primary tinnitus" as defined by Dr. In study 2, prior to recording of the EEG and eventrelated potentials (ERP), subjects had bilateral audiograms using adult routine clinical procedures with appropriate level of contralateral masking as needed.
Study 2 subjects underwent an otoscopic examination, tympanogram, and ipsilateral acoustic reflex screening.
The perceptual experience of tinnitus was characterized in both studies using a successive approximation technique. Auditory stimulation in both studies consisted of sine waves generated by a function generator (Goldstar FG2002C; LG Precision, Seoul, South Korea). Audiograms were taken from 7 of the tinnitus subjects and 13 of the control subjects in study 1. Most subjects indicated changes in their tinnitus perceptions very soon after beginning CST, in one case even after trying out the habituation sound for only a few minutes in the laboratory.
In four of the five subjects who completed the 3 weeks of CST, hearing threshold at the frequency closest to the subject's tinnitus pitch improved by 10 dB or more (Fig.
The EEG recording procedure required the determination of hearing thresholds prior to each session.
In study 1, we assessed the short-term effects of habituation on the electrophysiology by recording the N100 component from tinnitus and control subjects before and after 1 hour of CST.
In study 2, comparison of the N100 responses (slope) before and after 3 weeks of CST showed a decrease in the intensity dependence in response to the 4-kHz tinnitus frequency tones (Fig.
Recent studies indicate that an altered afferent input to the auditory pathway may be the initiator of a complex sequence of events resulting in the generation of tinnitus at the central level of the auditory nervous system [17]. The hearing loss observed at the tinnitus frequencies raises the possibility that the stronger intensity dependence observed in the responses of tinnitus subjects to tinnitus frequency tones may have been caused by recruitment (abnormal loudness growth) rather than tinnitus. The observed changed intensity dependence of the auditory N100 response in tinnitus subjects in the present studies and in previously published findings [19,27,50- 52] indicate that tinnitus is accompanied by a reorganization of the tonotopic map in the auditory cortex. Our studies on the effectiveness of CST were conducted without a placebo treatment and were not blinded.
Possible conflict of interest: Authors are shareholders in Tinnitus Otosound Products, LLC, a company developing diagnostic and treatment methods for tinnitus. INTRODUCTION: Traditional masking efforts have presented broadband noises, most typically white noise. OBJECTIVES: To evaluate the efficacy of a web-based delivery of customized sound therapy in reducing tinnitus loudness and increasing the residual inhibition.
MATERIALS AND METHODS: Thirty-two subjects matched their tinnitus frequency using a web-based protocol. Tinnitus is the perception of sound by the brain in the absence of an external acoustic stimulus.
It is acknowledged that targeted (customized) acoustic energy at the LEF provides more effective masking than broad-based acoustic energy. To address these issues, we have developed Harmonic Sound Therapy as a method of tinnitus treatment. In the current study, we evaluated the efficacy of Harmonic web-based delivery of customized sound therapy in reducing tinnitus loudness and increasing the residual inhibition (a temporary suppression of tinnitus following exposure to therapy sound).
Thirty-two participants were enrolled in the study through the Otolaryngology clinic at our institution or through patients who found the study via the web. The study protocol only included one introductory session with each participant to ensure the eligibility criteria and process of written informed consent. In the second step, the participants were asked to rematch their tinnitus with a choice of the tinnitus frequency and one octave above and below the tinnitus frequency.
The last step was to download the customized Harmonic Sound Therapy file, generated by the website, onto the MP3 player. Tinnitus loudness and annoyance were measured by visual analog scales (VAS) before and after treatment.
Means, standard deviation (SD) and range of values were calculated for loudness and annoyance before and after treatment. The median duration of residual inhibition was 33 minutes, with an average of 75 minutes (SD ± 132; range, 0-720). In the current study, participants were only seen once to be introduced to the study, sign the consent form and to be provided with the research equipment (MP3 player and headphones). There is controversy about the exact region of damage that leads to the perception of a specific tinnitus frequency. Recent studies have demonstrated the advantage of customized sound therapies over traditional sound therapies (i.e. Web-based delivery of customized sound therapy for tinnitus is a practical and potential solution for the treatment of tinnitus.
Paper submitted to the RBCMS-SGP (Publishing Management System) on December 7, 2011; and accepted on August 16, 2012. Tinnitus, which affects 1 in 5 Australians, is an annoying and potentially devastating condition. While normally initiated by damage to the ear, persistent tinnitus is generated by the repeated firing of auditory neural pathways in the brain. Hyperactive brain cells - neurons in the auditory processing parts of the brain firing when they shouldn't be. Effectively managing stress and maintaining a positive outlook on life is an important part of alleviating tinnitus. Sound Therapy is like physiotherapy for the ear and brain - daily exercise that helps strengthen the ear muscles and brain pathways. The "Electronic Ear" used in the recording of Sound Therapy challenges the ear with constantly alternating sounds of high and low tone.
These alternating frequencies exercise the middle ear muscles, improving their tone and responsiveness. Auditory mapping refers to the patterns we learn to recognize through repeated firing of certain groups of neurons in our auditory cortex.
Sound only makes sense to the degree that the brain can perceive the sounds it receives, and this depends on our auditory mapping.
See your health professional to check whether your tinnitus is affected by large secretions of wax, TMJ syndrome, or acoustic neuroma. You will learn more about all the available options, helping you make an informed choice about how to manage your own tinnitus. ABC's Second Opinion program followed Eric Mutton's progress as he tried Sound Therapy for his tinnitus.
Metal worker Paul Bazelmans was interviewed by the Sydney Morning Herald newspaper in an article called "The sound of therapy". Reverend Sarsha Carpenter was introduced to Sound Therapy during her studies to help her tinnitus, which left her housebound. As she was studying at the time, she put her Sound Therapy on in the morning and would leave it on all day. I still have bouts of dizziness (slight imbalance) but I find this much easier to deal with than vertigo.
I can testify that the tinnitus volume has decreased, it is much lower and the tone has also changed. Generally speaking, I think that my state improved in regards of well being and tinnitus especially. 2 months ago I really enjoyed going to the club whether in the past I hated such loud places. I can play the piano using hearing aids or using headphones (ita€™s a good quality digital piano), and can enjoy it both ways. In 2008 After some research into tinnitis I found Sound Therapy, and bought the Basic Music Kit, consisting of 4 sound cassettes. I bought the SOUND THERAPY gadget back in July after the specialist told me that I have tinnitus.
My tinnitus is much less intense and my hyperacusis has lessoned measurably after only thirty hours of listening. I've been using sound therapy for 5 months now and it works my tinnitus is greatly improved.
I have been away overseas so only started on the Sound Therapy programme a little over a week ago. As for the tinnitus, I have become aware that when I wake up some mornings it is no longer there. Personally, I have experienced phenomenal mind, body and spiritual benefits from Sound Therapy.
Last night, after weeks, in the bed I realized that the tremendous ringing in my right ear had disappeared. It's been several months without any big, deafening sound or that which affects my wellbeing. The benefits overall (after 300 hours) were that my tinnitus did decrease in volume and my sleeping improved. I stumbled across Sound Therapy when I was 26 when I found the book Sound Therapy: Music to Recharge Your Brain in a bookstore.
After extensive damage due to a long career performing in a loud rock band, I thought I would never hear 'silence' again. I suffered from Tinnitus for several years until it reached the stage where it was difficult to go to sleep. My tinnitus, which my doctor said was incurable, was cured after several weeks of 3 hours a day listening. One morning, it was the 22nd of August, I suddenly noticed that the noises on the left ear had gone.
About four years ago I started getting ringing in the left ear, followed by light-headedness and dizziness.
About eight years ago, I read an article in a Women's magazine about the damaging effects of loud noise on our hearing. A few months later, the ringing in my ears, my regular dizzy spells, and my headaches, were largely gone. My last visit to the Otologist showed no further hearing loss since my previous audiogram, 2 years prior. My experience of hearing as a child was disastrous with numerous infections and abscesses in my ears throughout my childhood. Mono Sodium Glutamate (MSG): a common additive to make food tastier, especially in chinese food. The sound of tinnitus is generated by brain cells in your auditory pathways firing repetitively.
Unlike a hearing aid which simply magnifies the volume of sound, Sound Therapy impacts the natural ear with sound waves that stimulate and enhance the responsiveness of the ear itself.
Sound Therapy may help many dysfunctions of your ear that you’ve gotten used to over the years. The US Food and Drug Administration (FDA) has not approved any drugs for treatment of tinnitus, though some studies have focused on medications, including benzodiazepines [12] and antidepressants [13]. Though studies of newer medications are ongoing, the use of current drugs involves a substantial incidence of side effects that individuals wish to avoid or often find intolerable. Functional imaging techniques have demonstrated a relationship between the intensity of tinnitus and the degree of reorganization of the primary auditory cortex.
Indeed, research from our own laboratory [27] has shown that the brain activity of tinnitus sufferers in response to sounds similar to their tinnitus is different from the response to other sounds or from the brain response to sounds of people without tinnitus. In this scenario, the person experiencing tinnitus is annoyed by the sound, thereby activating the limbic system. Subjects participated in this first experiment at different times, varying between 1 and 24 months. The THQ consists of 27 statements relating to the impact of tinnitus on an individual's life. We obtained pure-tone air and bone conduction hearing sensitivity thresholds for the standard audiometric frequencies of 250 Hz to 8 kHz in a double-walled sound suite meeting current American National Standards Institute standards for threshold air conduction and bone conduction testing.
We obtained middle-ear measures using a currently calibrated, portable Grason-Stadler GS-17 acoustic immitance Middle Ear Analyzer (Grason Stadler Inc., Madison WI).
Spectrogram of a typical tinnitus habituation stimulus, showing two closely spaced narrow-band noises centered at 2,800 Hz and 3,225 Hz and a very-narrow-band noise centered at 7,417 Hz that is almost 40 dB stronger than the first two. Data were recorded from 15 electrode sites mounted on an elastic cap and located over a variety of scalp sites (F3, Fz, F4, C3, Cz, C4, P3, Pz, P4, T3, T4, T5, T6, O1, and O2 according to the modified International 10-20 System). The intensity and duration of each stimulus were set by a specially designed programmable logarithmic amplifier that is controlled in real time by a stimulus presentation and data collection program running in ADAPT.
During study 2, they were required to wear their MPEG player and listen to the customized habituation sound for 6-8 hours daily as they went about their normal activities.
One of the tinnitus subjects had mild hearing loss, and three had moderate hearing loss on the right ear, whereas five had mild hearing loss, and none had moderate hearing loss on the left ear at their tinnitus frequency. Generally, they thought that their tinnitus was much more bearable when the habituation sound was present and that the tinnitus was less bothersome at other times. Changes in four tinnitus subjects' hearing levels at the tinnitus frequency during habituation training.
This provided records of the tinnitus subjects' hearing thresholds at their tinnitus frequency.


For the tinnitus patients, the habituation sound was the one used in habituation training, and the stimuli used for recording the N100 component were 1,000-Hz tones and the tinnitus frequency tones.
N100 intensity dependence in response to A) tinnitus frequency (4000 Hz) and B) control frequency (1000 Hz). Responses to 4-Hz tinnitus frequency tones A) before versus after customized sound therapy and B) tinnitus versus control. The results of our two studies indicate that CST aimed at this central dysfunction can reduce chronic tinnitus quickly and safely. However, the reduced intensity dependence observed in responses to 2,000-Hz tones, one octave below the tinnitus frequency, is opposite to the effect of recruitment and thus not attributed to it. The main correlate of this reorganization in our studies was the enhanced contrast between responses to tinnitus frequency and tones approximately one octave lower than the perceived tinnitus pitch.
Targeted (customized) sound therapies have been introduced to overcome the limitations of traditional maskers. A customized Harmonic Sound Therapy file was produced by the web-based software and downloaded by the patient onto an MP3 player. Some reduction in loudness was seen in 81%, while 72% experienced a reduction of 25% or more. This perception of sound is most often caused by damage to the peripheral auditory system, specifically the cochlea.
Sound therapy induces suppression of the spontaneous firing in the auditory cortex's LPZ, and hence provide tinnitus relief. In other words, the more closely the masking sound corresponds with the LEF, the more effective is the tinnitus suppression6-11. Harmonic Sound Therapy is a customized masking strategy specifically designed to deliver non-noxious targeted acoustic energy to the LPZ, yet at the same time allow significant portions of the hearing spectrum to remain unmasked. The inclusion criteria were being aged 18 years or older, presence of tinnitus for 6 months or more and constant tinnitus. After signing the informed consent form, each participant was introduced to the website created for the study with minimal further instructions.
AirDrives Interactive Stereo earphones: the speaker sits outside of the ear and transmits sound via the tragal cartilage. This allowed the elimination of octave confusion, which can occur when selecting the tinnitus frequency12. Third step in web-based protocol of Harmonic Sound Therapy for tinnitus treatment: balance adjustment on a scroll bar to compensate for asymmetry in tinnitus and hearing loss. A sample spectral plot of a Harmonic Sound Therapy File with the center frequency around 12000 Hz and first (6000 Hz) and fifth (375 Hz) sub-harmonics. Then, participants were instructed to place both headphones around the ear in a way that the speaker sits in front of the ear canal and then listens to the therapy file for an hour at a level equal to tinnitus loudness (mixing-point). After downloading the Harmonic Sound Therapy file and before starting to listen, participants were asked to score the loudness and annoyance of their tinnitus on separate scale lines numbered from 0 to 10. Non-parametric tests were used to compare the reduction in each participant's loudness and annoyance, and to evaluate the difference in reductions and residual inhibitions between different levels of independent variables. Harmonic Sound Therapy is effective in temporarily reducing the intensity and loudness of tinnitus in a significant group of patients; 2. They were given minimal instructions on the web-based protocol before using it, though a research staff was present by their side as the procedures were completed.
Although some authors have suggested that tinnitus frequency corresponds to the region of maximal hearing loss12,13 or some opposed the LEF theory15, many studies have supported it2,3,11,16. Findings of the current study should be interpreted with caution due to the small sample size and lack of a control group. This study has shown that Harmonic Sound Therapy is effective in at least temporary reduction of tinnitus in a large number of subjects.
Division of Neurotology and Skull Base Surgery, Department of Otolaryngology and Head and Neck Surgery - University of California, Irvine - Irvine - AC - United States. MD; Division of Neurotology and Skull Base Surgery, Department of Otolaryngology and Head and Neck Surgery, and Department of Biomedical Engineering - University of California, Irvine - Irvine - United States. Para reproducir la musica que tendra que actualizar su navegador o actualizar el Plugin de Flash. He reported that since using Sound Therapy his tinnitus "has definitely improved enormously".
This led to nerve deafness and tinnitus which I was told was irreversible, and an ear operation. It’s a very stressful condition which causes sleeplessness, anxiety and stress as well as making it hard for you to hear.
In addition, sound stimulation is provided to the whole auditory pathways from the ear to the brain.
However, such reorganization can be reversed through training-induced changes in the response pattern of cortical neurons. However, tinnitus sensations can be constant, loud, and annoying to the point that the sufferer is emotionally affected by this sensation. Finally, psychotherapy for tinnitus does help some, but it is aimed at mitigating the psychological effects of the problem rather than the sound itself. This suggests that aberrant activity exists in the sound-processing circuits for sounds that the tinnitus sufferer hears. A feedback mechanism under control of the limbic system is assumed to give rise to an increased generation of tinnitus-related activity [29,30]. These studies support the idea that tinnitusrelated neuronal activity is confined to certain isofrequency regions of the auditory cortex. We describe two studies: an initial pilot study (study 1) and one with a more formalized protocol (study 2).
We first required tinnitus subjects to complete the Tinnitus Handicap Questionnaire (THQ) [44], and subsequently we audiometrically evaluated all subjects and recorded their EEGs. Susan Gold, MS, CCC-A, of the University of Maryland Medical Center, Tinnitus and Hyperacusis Clinic. It contains three subscales relating to mental health, hearing, and attitude toward tinnitus [44].
We used a Macio MA-41 portable audiometer (Maico Diagnostics, Eden Prairie MN) with a current calibration sticker for the pure-tone testing.
In response to the subjects' statements, sounds were synthesized using highprecision, general-purpose sound synthesis software. Auditory stimuli of five different intensities were presented through insert earphones (Eartone 3A transducers with Earl link foam eartips; Cabot Safety Co, Indianapolis IN). The intensity of the habituation sound was set by the individual so that the tinnitus perception was slightly louder than the habituation sound.
The hearing tests in study 2 (Table 1) showed mostly normal hearing in both tinnitus and control subjects at 1 kHz and 2 kHz. For CST to be effective, the stimulus has to be audible but must not be so loud as to mask the tinnitus itself. However, in one case, a 10-dB improvement in one ear was offset by a 10-dB decrement in the other ear. For control subjects, the stimuli used for recording the N100 component were 1,000-Hz and 4,000-Hz tones.
Note that tinnitus subjects showed slightly higher slopes to their tinnitus tones than to the controls' 1,000-Hz tone, both before and after habituation.
Furthermore, the intensity dependence of the control 2-kHz tones (approximately one octave below the tinnitus frequency) was also significantly decreased in tinnitus subjects. This tinnitus suppression may reflect aspects of "residual inhibition" (RI), though distinct mechanisms may be involved as well.
Rather, we attribute this effect on intensity dependence to lateral inhibition caused by the tinnitus-related activity in auditory cortex. After 3 weeks of CST, the intensity dependence of responses to tinnitus frequency tones was decreased, rendering the responses to tinnitus frequency tones more similar to responses from normal subjects to tones in the same frequency range. However, to conceive of a placebo condition that is truly blinded is difficult, because CST subjects have to undergo the sound-matching process to create their own habituation stimulus.
Transient reduction of tinnitus intensity is marked by concomitant reductions of delta band power.
Changes in spontaneous neural activity immediately after an acoustic trauma: Implications for neural correlates of tinnitus.
Tinnitus sensitization: Sensory and psychophysiological aspects of a new pathway of acquired centralization of chronic tinnitus.
Tinnitus dyssynchrony-synchrony theory: A translational concept for diagnosis and treatment. Dynamical properties of a plastic neural network model for tinnitus therapy and inhibition of oscillation using noise stimulus. Experimental-neuromodeling framework for understanding auditory object processing: Integrating data across multiple scales. ADAPT (Analog Data Acquisition and Processing Tools)-a software system for PC-compatible computers, designed to be used in neuro- and psychophysiological experiments, and for analysis and monitoring of various parameters of human spontaneous and event related brain potentials.
Residual inhibition functions in relation to tinnitus spectra and auditory threshold shift.
Traditional (non-customized) masking efforts have presented broadband noises, most typically white noise. Unfortunately, with this approximation, the therapeutic sound might also become more noxious.
This design makes it possible to have dramatically increased exposure to the therapeutic sound because the ambient acoustic space is left open.
The exclusion criteria were: active illicit drug use or alcohol dependence, active ear infections, treatable cause of tinnitus, history of psychosis, abnormalities of the ear canal, subjects on medications known to cause tinnitus (aspirin, ibuprofen, naproxen, etc) which could not be stopped, and currently under another sound or masking therapy for tinnitus.
The website contained general information on the tinnitus, aim and procedure of the study, and instructions on every step of the web-based protocol. The subjects were instructed to have the level of the sound therapy file such that the tinnitus can still barely be heard. After one hour of listening to the file, they were asked to score the loudness and annoyance again. There were no associations between reduction in loudness or annoyance and other independent factors (age, gender, ear side and tinnitus pitch).
Among those with a 25% or more reduction in tinnitus loudness, median residual inhibition was 60 minutes (mean 99 ± 148 SD).
However, after they followed the online protocol, their tinnitus loudness and annoyance scores were significantly reduced temporarily. Harmonic Sound Therapy files are centered on the patient's tinnitus frequency and not only stimulate the LEF but its neighboring octave frequencies as well and theoretically will decrease the hyperactivity in the LPZ.
In the current study, we sought to test the feasibility of providing customized sound therapy over the internet. However, the results highlight the feasibility of a potentially cost-effective, customized treatment of tinnitus over the web. This will illuminate the path towards future studies and applications of internet-delivered customized Harmonic Sound Therapy in larger populations and controlled trials. Auditory cortical plasticity: Does it provide evidence for cognitive processing in the auditory cortex?
Listening to tailor-made notched music reduces tinnitus loudness and tinnitus-related auditory cortex activity.
The windowed sound therapy: a new empirical approach for an effectiv personalized treatment of tinnitus. Psychoacoustic characterization of the tinnitus spectrum: implications for the underlying mechanisms of tinnitus.
Due to neural plasticity, this enables the brain to become a more efficient processor of sound.
We address this problem by using customized sounds that reproduce the subjective experience to reduce overactive auditory circuits. Chronic sound sensations of tinnitus affect approximately 17% of the general US population [1-3], or approximately 44 million people, and approximately 33% of the elderly [4]. In one study, tinnitus subjects with depression treated with nortriptyline had decreased depression levels, functional disability, and tinnitus loudness [15,16]. We have hypothesized that mechanisms of lateral inhibition in the auditory areas of the brain act to confine the activity, driving the tinnitus sound perception to regions representing specific frequencies in the central auditory cortex and increasing the contrast between tinnitus-related activity in these regions and spontaneous activity in adjacent regions. The increased perception can then lead to increased annoyance, completing a positive feedback cycle that will render tinnitus persistent and annoying. Moreover, it has been shown that the changes in the size of the tonotopic map in the auditory cortex can be induced by training [35]. The rationale behind the use of white noise is to generate a decreased signal-to-noise ratio between the tinnitus-related neuronal activity and random background activity in the auditory system. Customized sound therapy (CST) involves an initial session with a sound specialist, during which a "customized" sound is created for each individual and closely mimics the subjective tinnitus. Primary-tinnitus subjects are those presenting to the otology clinic with a main complaint of tinnitus, regardless of type and degree of hearing sensitivity. The audiometer has standard Telephonic THD-39 earphones with MX-41-AR ear cushions (Audiometrics, Oceanside CA) and a standard Radioear B-71 bone vibrator (Radioear Corp., New Eagle PA).
We obtained initial baseline auditory brainstem response and auditory middle latency responses for each subject using a currently calibrated and certified electrically safe Biologic Brain Atlas (Advanced Biologic Corp., Toronto, Quebec, Canada) evoked potential machine with ER-3 insert earphones.
The tinnitus sound is synthesized according to the description provided by the subjects using the program "pcmusic" [46]. Experience from study 1 indicated that subjects had difficulty in distinguishing the continuous habituation sound from their tinnitus.
At 4 kHz, four of eight tinnitus subjects had mild or moderate hearing loss in their right ear, and five of eight subjects had mild hearing loss in their left ear. Therefore, the intensity settings that tinnitus subjects used on their noise generator gave an estimate of the loudness of the tinnitus.
Some subjects reported changes in the sound quality of their tinnitus, so that their habituation sound was no longer a match for their tinnitus perception. Nonetheless, they were carried out under defined conditions so that changes in the measurements reflected changes in hearing threshold. Both tinnitus and the recruitment due to hearing loss may have influenced the intensity dependence of the N100 response to tinnitus frequency tones. RI is the temporary suppression of tinnitus that occurs after the offset of an appropriate masking stimulus [48,49].
The main difference between tinnitus sufferers and controls manifested itself in the response to tones one octave below the tinnitus frequency (2 kHz in our studies). Consequently, all study subjects will know whether they are being habituated to a sound mimicking their tinnitus or to a "placebo" sound. Median duration of residual inhibition was 32.5 minutes, with an average of 75 minutes ± 132 SD.
First, damage or insult to a region of the cochlea increases the spontaneous firing rate in its corresponding area of the brain. A disadvantage with broadband noise is that it masks the subject's hearing at all frequencies. There are a number of drawbacks with most of the introduced sound therapy treatments as they require multiple visits to care provider, special equipments or they are simply too expensive.


To unify the delivery method, each participant was provided with a unique username and password. In bilateral cases, they were instructed to adjust the balance on a scroll bar to hear the pitch-matched sound equally in both ears, to allow for asymmetry in tinnitus and hearing loss (Figure 2). Nineteen (59.4%) described their tinnitus as tonal or ringing and 13 (41%) as hissing or buzzing.
There was no association between residual inhibition and other independent factors (age, gender, ear side and tinnitus frequency and type).
We found 25%, 50% and 100% temporary reduction in tinnitus loudness after one hour of Harmonic Sound Therapy usage in 72%, 34% and 13% of patients respectively. About 72% of the participants experienced a 25% or more reduction in loudness and annoyance that on average lasted for a median of approximately 60 minutes. By doing so, concentrated delivery of therapeutic sound is achieved, while at the same time the noxious quality, which might result by stimulation of the tinnitus frequency alone, is avoided.
Although web-based treatments of tinnitus have been introduced using other approaches such as cognitive behavioral therapy18, this is the first study to evaluate customized sound therapy as a possible telemedicine application through automated web-delivery of sound files. The results of two preliminary studies indicate that customized sound therapy (CST*) aimed at this central dysfunction reduces tinnitus quickly and safely.
Of this group, estimates project that some 10- 12 million individuals will experience tinnitus problems sufficiently serious to seek professional help [5,6]. Shulman and Goldstein [24] interpreted these as changes in the congruence or dyssynchrony in cortical regions in the auditory and frontal cortices. This leads to increased tinnitus perception and to what most tinnitus sufferers hear-a tone or group of tones, as opposed to cacophonous noise containing all frequencies. In short, individuals experiencing tinnitus unintentionally condition themselves to aggravate tinnitus through negative reinforcement. Taken together, these findings suggest that the observed tinnitus-related changes in the organization of the auditory cortex are the result of the involuntary learning process described earlier. This background activity is achieved by introducing a quasirandom, stimulus-related signal in all of the parallel, tonotopic channels of the auditory system. This is followed by a period of several weeks to months during which the individual listens to the customized sound for several hours every day while going about normal daily activities. On a separate day, subjects' tinnitus sound experiences were characterized and recorded on an MP3 sound player.
Behavioral loudness discomfort levels (LDLs) were also recorded at each frequency in both ears using pulsed pure tones with a 200-msec duration and 50% duty cycle. Auditory brainstem response and auditory middle-latency response two-channel recordings followed clinical recording and analysis parameters outlined in Ferraro's Laboratory Exercises in Auditory Evoked Potentials [45].
In an iterative process, the resulting sound was played back to the subjects, who responded with suggested adjustments, such as altering the pitch, number of components, balance, or quality of the synthetic sound. Within each series, 80 stimuli of different intensities, for a total of 400 stimuli, were presented in random order and at intervals varying randomly between 1 and 3 seconds. Hence, to help individuals compare the loudness of their tinnitus to that of the habituation sound, we instructed them to use the pulsed version of their customized sound. Conversely, only 2 of 12 control subjects had mild or moderate hearing loss in their left ear, and only 1 of 12 control subjects had moderate hearing loss in the right ear. Though most subjects did not keep a detailed log of the volume settings on their MP3 players, clearly the volume setting required for the habituation sound to be just audible over the subject's internal tinnitus perception decreased over time, in one case so much that the subject exhausted the available intensity settings and the stimulus had to be resynthesized at a lower intensity. When a new habituation sound mimicking the changed tinnitus perception was synthesized, the subjects reported the CST to be as effective as before. The first threshold measured was set to 0 dB normalized hearing level (nHL), and all other measurements were plotted with reference to it. Because CST caused a lowering of the subjects' hearing thresholds at frequencies near their perceived tinnitus pitch, these results reflect an effect of CST, regardless of whether the observed change is caused by a decrease of tinnitus-related neuronal activity or decreased recruitment due to lowered hearing thresholds. Some participants in this study described immediate relief, effects on the THQ, and changes in hearing threshold within 3 weeks. The change in the EEG pattern induced by CST manifests in responses to the tinnitus frequency. However, to assess the efficacy of CST in a crossover trial with comparable therapies might be possible, as that study design would not require a placebo condition and blinding.
Thus, this sets limits on the duration a subject is able to have the hyperactivity in the LPZ suppressed, and ultimately, on the rate and degree of tinnitus rehabilitation6,7. Furthermore, they were given a 2 GB Sansa Clip MP3 player (San Disk, Milpitas, CA) and an AirDrives Interactive Stereo Earphone (Mad Catz Inc, San Diego, CA). The participants were given the option of using a scrolling slider, to select the closest sound to their tinnitus if the multiple choices did not closely approximate their tinnitus. The website would then implement participants' selections of frequency, loudness and inter-aural characteristics to construct a customized Harmonic Sound Therapy file (Figure 3). If the loudness was reduced then the participants were instructed to report the duration that the tinnitus suppression lasted, in minutes. We believe that customized web-based sound therapy for tinnitus could be an effective and promising alternative to current methods of tinnitus treatment.
Furthermore, because Harmonic Sound Therapy only targets the regions of the hearing spectrum that involve the tinnitus frequency and its sub-harmonics, the remaining portions of the hearing spectrum are spared and allowed to pass through to the ear.
Participants described immediate relief, showed changes on the Tinnitus Handicap Questionnaire, and reported changes in hearing threshold within 3 weeks. Approximately 20% suffer to a degree that their quality of life and productivity are impaired [7].
Similarly, magnetoencephalography (MEG) studies [25] have reported increased gamma-band activity in a resting condition in individuals with tinnitus. Shulman [31] demonstrated the changes in cortical and limbic regions in tinnitus subjects as compared to controls and hypothesized a final common pathway for tinnitus.
Because training-induced changes in the response pattern of cortical neurons can be reversed by habituation, we hypothesize that habituation will ameliorate tinnitus. TRT is available currently, but it is expensive, time-consuming, of long duration, and only incompletely effective. Furthermore, subjects' tinnitus had to be present all the time with constant sound quality. We instructed each subject to push the signal button when an increasing continuous pulsed pure tone reached a subjective loudness level that represented initial annoyance. The evoked potential recording protocols sequentially programmed into the Brain Atlas were the same for each subject. In response to these suggestions, we modified the sound description file and repeated the process until the subjects reported that the synthesized sound matched their subjective tinnitus experience well. The EEG was amplified by 10,000 and band-pass filtered between 0.01 and 100 Hz at 3 dB down.
This facilitated the determination of the requisite intensity, at which point they could switch over to the continuous sound for the habituation itself. After 1 hour of habituation, the hearing threshold at the tinnitus frequency was lowered by as much as 15 dB nHL. Observations from one subject indicate that most of the tinnitus relief is gained during the first 4-8 weeks of CST.
However, the contrast between responses to tinnitus frequency tones and tones one octave below the tinnitus frequency was not changed after 3 weeks of CST.
The second phenomenon that occurs is that the tones that border the damaged zone in the cochlea become associated with the hyperactivity occurring in the LPZ. Additionally, there have been reports on deterioration of the intelligibility of speech with broadband noises compared with the other sound therapy signals in tinnitus treatment7. The innovative design of these headphones, where the speaker sits outside of the ear and transmits sound via the tragal cartilage, prevented the participant from being acoustically isolated (Figure 1). The Harmonic Sound Therapy file is composed of a series of narrow-band noise peaks centered on the tinnitus frequency and the first and fifth sub-harmonics.
The Harmonic Sound Therapy could be used as a complement to routine tinnitus management or as a replacement for patients who are unable to have frequent visits to their care provider or live in remote locations.
This could be explained by the nature of the Harmonic Sound Therapy files that are composed of a series of narrow-band noise peaks centered on the tinnitus frequency and the first and fifth sub-harmonics. This innovative approach is further exploited by the use of Air Drives Interactive Stereo Earphones. We also saw changes in the intensity dependence of the auditory N100 in tinnitus patients, supporting the idea that tinnitus reflects a reorganization of tonotopic maps in the auditory cortex. This translates to between 2% and 3% of the population whose lives are adversely affected by tinnitus [8,9].
Studies in experimental animals and humans have suggested that tinnitus is associated with a synchronized hyperactivity in the auditory cortex and proposed that the underlying pathophysiological mechanism is thalamocortical dysrhythmia. More precise methods of habituation have been suggested by computational models of tinnitus [37-41]; for a review, see Husain, [42,43]. This external sound appears to calm the internal overactive circuits and is not associated with annoyance and anxiety.
Subjects were initially interviewed at the Otolaryngology Clinic to ensure that they met all exclusionary criteria.
The LDL was repeated at each standard test frequency to determine whether the initial level was stable or adjusted upward. We required subjects to document the time during which the sound player was used and the intensity settings. Over several weeks of habituation training, we observed hearing thresholds at the tinnitus frequency to decrease by as much as 25 dB nHL.
After this initial period, apparently wearing the sound device regularly is unnecessary, and the experience with this one subject indicates that using the habituation sound occasionally as needed may be sufficient. Therefore, whether longer CST treatments can completely reverse the cortical reorganization associated with tinnitus remains to be seen. The ringing tone that people hear when they perceive tinnitus actually corresponds to these border regions, called Lesion Edge Frequencies (LEF)2,3. The speakers in these headphones do not sit in the ear canal, and therefore, the environment sound could pass into the ear canal and reach the users' ear. The web-based protocol allows patients to change their sound therapy file with changes in their tinnitus frequency. Therefore, they provide partial coverage one quarter-octave below and above the tinnitus frequency and are more likely to resemble the participants' tinnitus spectra11.
These headphones transmit sound via the tragus, and thus do not occlude the external ear canal. The main correlate of this reorganization was the enhanced contrast between responses to the perceived tinnitus pitch and tones approximately one octave lower. Estimates anticipate that the number of serious tinnitus cases will increase significantly over the next few years. Hence, decreased auditory stimulation results in decreased firing rate and decreased lateral inhibition.
These models explain how a decreased auditory input resulting from a peripheral hearing deficit can give rise to a specific tinnitus pitch. One contained a pulsed version of the subjects' tinnitus sound (250-msec pulse duration, 50% duty cycle), and the other was a 180-sec-long continuous sound. For stimulus presentation and data acquisition and analysis, the ADAPT scientific software [47] was used.
During this session, the participants were asked to run the MP3 player and headphone once to ensure they know how they work. The result was a file that sounded similar to generic white noise, but the amount of required acoustic energy was dramatically reduced and centered on the frequencies where therapy is needed. In general, the patients had no difficulty performing the web-based procedures and downloading the sound file onto an MP3 player.
This allows the patient to listen to their therapeutic sound files during the course of their everyday activities.
After 3 weeks of CST, the intensity dependence to the tinnitus pitch decreased, making these responses more similar to those from normal subjects responding to tones in the same frequency.
When the tinnitus sound itself is used as a habituation stimulus, Langner's model predicts that the tinnitus should disappear. Directive counseling would tend to draw the individual's attention to the tinnitus, whereas habituation is designed to draw attention away from the tinnitus. We recorded responses to pure-tone sounds at and below the tinnitus frequency before and after the 1-hour habituation treatment. Two subjects dropped out after reporting strange sounds from their MP3 player that seemed to make their tinnitus worse. We then downloaded the digitized sound into a small portable digital sound playback device (MPEG-player).
The underlying rationale for CST is to draw subjects' attention away from their tinnitus, and reports indicate that though subjects readily perceive their tinnitus and the habituation sound if they choose to, CST helps them to ignore their tinnitus. Some of the older patients, who had not used an MP3 player in the past, required some assistance. This model also assumes that the limbic system is a necessary component for stabilizing the tinnitus perception.
In one case, the cause of the disturbing sounds was a defective MP3 player; in the other case, the disturbing sounds were caused by an artifact in the conversion of the digitized sound from the WAV to the MP3 file format.
The time needed for this successive approximation procedure varied, depending on the subjects' ability to describe their subjective experience of tinnitus and on their ability to characterize differences between the tinnitus they experience and the sounds being synthesized by the computer. Directive counseling in connection with CST might actually be counterproductive because it might remind subjects of the annoyance associated with untreated tinnitus and thereby draw their attention to their tinnitus rather than away from it. On the basis of these models, we propose to use a frequency-specific or "custom-made" sound similar to an individual's tinnitus for habituation purposes. Halfway through the training period, we scheduled a second session to characterize the tinnitus sound to ensure that the stimulus still matched the subjects' tinnitus perception.
In one case, data were excluded because the subject did not wear the MP3 player for the requisite time and was not present for the follow-up examination owing to scheduling conflicts.
Because it produces effects after only a few weeks of treatment without involving directive counseling or requiring frequent regular visits to health care professionals, CST is expected to provide quick and lasting relief from tinnitus at relatively low cost.
We conjecture that using a customized sound and mimicking the tinnitus as closely as possible should be highly efficient in reducing the perception of tinnitus. After 3 weeks, all subjects underwent a second EEG and audiological assessment and a final clinical evaluation.
Before beginning CST, we required subjects to confirm that the habituation sound matched their tinnitus during two or more sessions separated by at least a week. Further, though adding a replica of the annoying sound that tinnitus patients experience would appear to be even more annoying, the method of playing the replica at the same volume as the experienced sound minimizes any discomfort. Adjustments to the stimulus were needed for some subjects after CST had progressed a few weeks. It seemed clear that this was owing to changes in the characteristics of the tinnitus itself rather than a mismatch in the initial sounds.




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