Tinnitus clinic new york 9000,tenis nike para skate feminino,bad taste with sinus infection - Step 2

02.03.2016
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People who suffer from hyperacusis may even have a reduced tolerance to normal environmental sounds. Hearing aids are very advanced instruments and it should be fitted and programmed correctly for optimal benefit.
We auditorily stimulated patients affected by subjective tinnitus with broadband noise containing a notch around their tinnitus frequency.
We recruited tinnitus sufferers from among patients attending the Oto-Rhino-Laryngology II Clinic of the University of Parma, Italy, in the period 2004-2006.
We determined hearing sensitivity using tonal stimuli presented in octave steps, from 125 Hz to 8,000 Hz, and 1-dB increments. The experimental pitch-matching test was performed shortly after the patient had performed the loudnessmatching test using pure tones as comparison stimuli.
Conversely, in our study, an essential prerequisite for the correct application of the experimental acoustic therapy (notched broadband noise; see later) was the reliability (and repeatability) of the measurement of the tinnitus pitch.
Our method was based on the classic pure tone-matching paradigm and consisted of two phases.
During both the upward and downward sweeps, we stopped tone presentation every time the subject reported a match between the tone and the pitch of the tinnitus. The second phase (termed sequential binary choice) resembled the traditional 2AFC procedure.
During this phase, a number of patients reported more than one tone as matching their tinnitus pitch. We should note that any procedure of tinnitus pitch assessment is subject to many errors owing to, for example, differences in the ability of subjects to compare and discriminate among tones, the uniqueness of the tinnitus sensation, or the presence of different types of tinnitus. The experimental design consisted of randomly assigning to each patient either the experimental sound therapy (WWN)* or one of the two control sound therapies (WN or Wa) following a double-blind procedure.
We examined variation of the tinnitus parameters (F t , dB t ) over time for each patient by repeating measurements, ideally after 1, 3, and 6 months from the start of the therapy, following the same procedures of the first visit.
In addition, when the subject's tinnitus pitch was reassessed during a control visit, usually the observed value of F t was not exactly the same as the one measured in the previous visit. Therefore, the following compromise criterion was adopted: A new, updated WWN acoustic sequence was constructed only when the re-measured value of F t fell outside the noise window previously determined. The temporal variation of tinnitus loudness in the three groups of patients was examined by computing the values of Δ dB t using the patient's values of dB t measured during subsequent control visits. Table 1 summarizes the characteristics of patients of each treatment group together with the clinical measurements of their tinnitus at their first visit.
The average time elapsed from the beginning of the acoustic therapy and the last tinnitus measurement was similar in the three groups of patients: 148 dd (+ 20), 145 dd (+ 25), and 127 dd (+ 16), respectively, for the WN, Wa, and WWN groups.
Figure 4 shows the variation of tinnitus loudness with time elapsed from the start of therapy for three patients taken as an example (one for each type of therapy) and for one subject initially receiving the Wa therapy and later re-treated with the WWN therapy (see further discussion later). The mean decibel attenuation between 3 and 6 months of therapy was less than 1 dB in patients of the Wa group and 4-5 dB in those in the WN and WWN groups. In the four patients re-treated with the WWN therapy, the value of dBt measured at the last control visit was compared to that measured at the control visit preceding the change of therapy. Our method for the treatment of subjective tinnitus differs substantially from previous methods (but see Goldstein et el.
Indeed, the most striking result of our study was the marked decrease of tinnitus loudness observed in patients after approximately 4-5 months of daily listening to the WWN sound stimulation but not seen in those listening to either the WN or the Wa sound stimulations for an equivalent amount of time. The presence of subjects without residual tinnitus in the WWN group but not in the two control groups further strengthens this conclusion. Apart from the beneficial effects on tinnitus loudness perception, another remarkable aspect of this study was the development of a novel tinnitus pitch-matching procedure using binary comparison of tones selected by the patient in a previous test on the basis of their resemblance to tinnitus. A potential methodological criticism that should be addressed in this study is the lack of control by experimenters over the patients' motivation or willingness to carefully follow the procedures established by the therapeutic listening program.
First, both the Wa and WN therapies were equally ineffective in reducing tinnitus loudness, despite the greater tolerability and pleasantness of the first therapy according to the patients' judgment.
The key element of the WST was the auditory stimulation of tinnitus sufferers with masking noise presumably not comprising the tinnitus frequencies, often suggested to be responsible for the exacerbation of the symptom. An alternative explanation for the decreased tinnitus loudness in patients treated with WST might involve a change in the neural reorganization in the tinnitus region induced by stimulation with noise around, but not inside, the tinnitus pitch region.
The Tinnitus Clinic is providing a new range of evidence-based tinnitus treatments for people living in and around Manchester.
Our specialist audiologists can provide assessment and treatment for tinnitus and hyperacusis, using pioneering therapies that are exclusive to The Tinnitus Clinic. For other audiological conditions that may be causing tinnitus or require further examination before tinnitus treatment can begin, our audiologists can provide a referral to a relevant specialist.
Mike gained a Masters degree in Scotland before training as a Registered Hearing Aid Dispenser, successfully completing the Hearing Aid Council practical and theoretical examinations in August 2007. Mike is a Registered Hearing Aid Dispenser with the Health and Care Professions Council (HCPC). Mr Loughran works as a full time ENT consutlant at Manchester Royal Infirmary, Royal Manchester Childrens Hospital and Salford Royal Hospital. Acoustic CR® Neuromodulation, Tinnitus Desensitisation Therapya„? and hearing loss treatments are being carried out The Tinnitus Clinic in Manchester. You can self-refer to see one of our audiologists, or be referred by your GP or another healthcare professional. The Tinnitus Clinic is the leading provider of the latest evidence-based tinnitus treatments in the UK. From my clinical experience and according to Chinese medicine theory, some cases of tinnitus can be associated with internal organ disorder and certain channels being blocked. In this article I would like to share my knowledge with you, and help you to find the cause of your tinnitus. Tinnitus is a ringing condition in the inner ear, the ringing frequency can be dissimilar, it can be of high or low pitch, heavy or fine pitch.
The ringing sound can be as fine as insect sounds, if you use your hands to cover the ears, the ringing sound will be diminished or disappear. Usually with this type of tinnitus we tonify the kidneys to help improve the circulation to the ear.
As the kidneys are located in the lower back, you should keep the lower back in a good condition to ensure that the area is warm and rich in circulation.
This type of tinnitus has a particular sound intensity and feature: it sounds like running water or loud machinery noise.
If you have this type of tinnitus, you should avoid spicy food and deep-fried foods, you should eat a reasonable amount of food that clears and balances the Liver and gallbladder.
Doing regular relaxing exercise such as walking, light jogging, swimming, yoga, tai chi, meditation and listening to soft music is good for your liver and gallbladder function. Ping Wang is the director and senior practitioner of Ping Ming Health with over 30 years of experience in traditional Chinese medicine teaching and practice.
The food therapy knowledge in our articles is sourced from many traditional Chinese medical texts.
Authors such as Michael Pollan have written excellent books about food and health, we hope to build upon this important discussion by sharing the traditional food wisdoms of Chinese medicine. Appointments available 7 days across our six Perth clinic locations and Melbourne CBD clinic (Mon-Sat). Acupuncture in Melbourne: Experience our caring, professional service now on the east coast.
Like us on FacebookThe Open Acupuncture ProjectHow do you decide if Chinese medicine is the right treatment for you?
Supporting families for over 20 yearsWe provide quality and comprehensive Chinese medicine care trusted by generations of families in Perth and Melbourne. You can see us for a wide range of health issues, from fertility and pregnancy care to women's, men's, children's, senior's and preventative health. There’s much more to Chinese medicine than acupunctureOur clinical experience combines acupuncture, herbal medicine, meridian massage, cupping and scrubbing with diet and lifestyle advice to achieve the best results.
Prevention is the best medicineDon't wait for minor health symptoms to become worse and more difficult to solve.
Working together for a healthier futureOur clinic is committed to health promotion, preventative education and clinical training of Australia's next generation of Chinese medicine practitioners. The information provided on our website is not intended to diagnose or treat any health problem or disease. Protecting your privacyOur clinic complies with Australian Privacy Principles according to Australian law (Privacy Act 1988). University at Buffalo, Main Street Campus, 144 Farber Hall UB's Main Street Campus is located at the corner of Main Street (Route 5) and Bailey Avenue (Route 62). For immediate assistance with tinnitus, contact Sue Roberts (716) 829-5507 or Chris Stocking (716)829-5540. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. The Windowed Sound Therapy: A New Empirical Approach for an Effective Personalized Treatment of Tinnitus.
We assessed the long-term effects on tinnitus perception in patients listening to notched noise stimuli (referred to as windowed sound therapy [WST]) by measuring the variation of subjects' tinnitus loudness over a period of 2-12 months. Epidemiological surveys indicate that the sensation caused by the tinnitus is present in 5-15% of the human population. All subjects of the study were patients reporting a ringing or hissing sound in one or both ears (Table 1) and willing to take part voluntarily in the experiment and to scrupulously follow the assigned therapy. With a few exceptions, we noted that all patients had, in one or both ears, a more or less pronounced hearing loss at frequencies above 3-4 kHz, an important predisposing factor for the occurrence of tinnitus [9]. We stopped the procedure when a patient reported that the pitch of the comparison stimulus was similar to the tinnitus pitch.
The difference between the two measurements was the estimated loudness of the patient's tinnitus (dB t [decibels SL]). Pure tones were generated with a function generator (Kenwood model FG-273; Kenwood Corporation, Taiwan) connected to a custom portable electronic switchboard (left, right, binaural), and the output signal was sent to a pair of Sennheiser HD 202 (Sennheiser Sales, Dublin, Ireland) closed-cup headphones. Pure tones are commonly used for measuring the pitch of both noise-like and tonal tinnitus [10].


In such cases, the frequency value of the matching tone was noted, and the tone sweep was resumed, starting from the frequency at which it had been interrupted. We asked subjects which of the previously identified tones were more similar to the pitch of their tinnitus.
This could happen for several reasons: presence of different kinds of tinnitus, such as a ringing associated to hissing tinnitus, presence of multiple tinnitus spectral peaks [13], or octave confusion. WWN was constructed from a 10-minute sequence of white noise generated by the white noise generation function of a suitable software for sound analysis (AVISOFT; Avisoft Bioacoustics, Berlin, Germany). For these reasons, the width of the erased band of WWN was set prudently to a value double the width of the critical band of the tinnitus frequency.
Spectral characterization of the three sound therapies with decibel values in relative units.
This was expected, as any procedure of pitch assessment is inherently imprecise for reasons already discussed. In this case, the patient was asked to return the old disk and listen to a new disk that contained the usual 8-minute sequence of equalized broadband noise recorded after a notch centered at the new tinnitus frequency or frequencies was created following the method explained earlier. Conversely, the presence of two control treatments allowed the effectiveness of the WWN therapy to be established regardless of the type of comparison stimuli used for the measurement of tinnitus loudness. The number of control visits (and re-measurements of dB t ) varied from one to seven per patient. When subsequent visits of the patient fell within the same temporal class, only the value of dBt measured during the last visit within the class was considered for analysis. If the difference among means was statistically significant, we used the multiple-comparisons procedure of the Kruskal- Wallis test to test the difference of mean value between pairs of treatments. Patients of the three groups did not differ significantly regarding gender ratio, mean age, mean hearing loss, and mean value of tinnitus parameters. In the WWN-treated patient, tinnitus intensity decreased by 12 dB after only 1 month of therapy and by 15 dB at the end of the observation period (after 7 months). Variation of tinnitus loudness over time in four patients (indicated with a different symbol) taken as an example.
The mean attenuation between 7 and 12 months was less than 1 dB in patients of both the WN and Wa groups and 3 dB in those of the WWN group. Results showed a remarkable reduction of tinnitus loudness in the three patients who were initially given the Wa therapy (one of them recovered from tinnitus; see Fig. Furthermore, about two-thirds of the differences were below 1 kHz, and approximately one-half of the differences were below 0.6 kHz. These acoustic stimulations are standard for each subject; they are not personalized in relation to the tinnitus frequency that characterizes the subjective tinnitus. Furthermore, patient's estimation of tinnitus loudness showed a clear negative relationship with the time of WST application; loudness decreased by approximately 1 dB per month of application of the therapy (see Fig.
This procedure yielded pitch estimates characterized by low between-session variability (mean absolute difference of 1.1 kHz between the tinnitus pitch measured at the initial visit and at the first control visit after 1-2 months). This could weaken the conclusions of our study if the patient's "at-home" listening behavior had been affected by the type of acoustic therapy they received.
Second, tinnitus loudness did not decrease significantly with months of application of the sound therapy by patients of the two control groups. This discrepancy, however, may be easily explained by considering the rough clinical procedure used in our study for finding pitch matches suitable for the loudnessmatching test. In our study, the pitchmatching test conducted during audiological evaluation was aimed solely at obtaining a matching tone only approximately resembling the tinnitus frequency, the tinnitus pitch being accurately measured in a separate experimental test (see under Methods).
Jastreboff and Jastreboff [21] stressed the importance of ensuring that the sound-enriched environment provided with the TRT should not contain sounds causing annoyance and exacerbation of the tinnitus sensation. The auditory stimulation of patients with waterfall noise recorded underwater (Wa therapy) did not contain significant energy in the frequency range above 3-4 kHz (where hearing loss usually occurs and most tinnitus sensations pitch) and, furthermore, appeared to be better tolerated as compared to the stimulation with white noise (WN sound therapy). For instance, it has been hypothesized the overrepresentation of the edge frequencies before the hearing loss region is responsible for the tinnitus sensation [1]. Since then Mike has gained a wealth of experience working within the NHS and private sectors, providing specialist audiology services to a diverse patient group in a range of clinical settings. Mr Loughran also has a private practice based at the Alexandra Hospital Cheadle and the Wilmslow Hospital.
We offer a highly personalised service and a commitment to audiological best practices to significantly reduce your tinnitus symptoms and hearing loss.
They have undergone many tests but still can’t find the reason why they have this condition.
Chinese medicine believes that tinnitus is not an auditory disease, rather, it is often related to certain channels and particular internal organ.
In Chinese medicine the kidneys and ears have a close internal relationship because “the Kidneys open up to the ears”.
Foods such as; black sesame seeds, goji berries, prawns, beef or beef soup, black kidney beans, soya beans (If you would like some more suggestions, please see our other articles on diet therapy). If you have lower back pain it is important to resolve this issue while you are undergoing treatment for tinnitus.
Because the meridians of the Liver and Gall bladder run around the ears, when the Liver and Gall bladder have a blockage and heat, it will move along the meridians reaching the ears, blocking the ear circulation, causing tinnitus.
Celery, carrot, oranges, green tea, mint tea, lemon and green leafy vegetables help to clear the blockage and heat within the Liver and Gallbladder, and adjusts ear circulation to help tinnitus.
By slowing down you lifestyle and reducing the pressures on you it can support the liver and gallbladder which can prevent tinnitus. Chinese medicine is a very effective natural treatment which could help you with your tinnitus. Ping is experienced with all general health issues, women’s health, fertility and pregnancy problems.
Chinese medicine has a long history of using suitable foods and diet as a treatment modality.
Stage 4 liver cirrhosis is a serious medical condition and we advise you to follow the advice of your doctor regarding your need for a liver transplant. Levine MD, FPCP (C), CSPQ, Emeritus Professor of Medicine at the University of Ottawa, was Head of the Division of Nephrology from 1980 to 1997. We tested the effectiveness of WST using non-notched broadband noise and noise of water as control sound therapies.
Tinnitus is thought to consist of an abnormal neural activity of the auditory pathways [1]. In addition, though Jastreboff and Jastreboff [7] claimed that all types of tinnitus and intolerance to sounds can be beneficially treated with TRT, intolerances toward the wearable acoustic prostheses delivering the masking auditory stimuli (noise generators) have been reported, presumably owing to the annoyance caused by stimulation of the patient with frequencies similar to that of the tinnitus [8]. All participants were provided with informed consent, previously approved by the Ethics Committee of the School of Medicine of the University of Parma, before starting the therapy. Some patients (~25%) experienced difficulty in performing reliable comparisons because of the markedly different perceptual quality of pure tones as compared to that of their tinnitus. Comparison tones (or NBN segments) were presented consecutively for a few seconds at the interstimulus interval of about 1 second. In a subject reporting the tinnitus only, or predominantly, in one ear, the comparison tone was presented contralaterally, whereas if the intensity of the subject's tinnitus sensation was similar in both ears, the tone to be matched was presented bilaterally.
In our case, the use of pure tones facilitated the comparison of tinnitus pitch among subjects receiving different acoustic therapies and the tracking of its variation across time (see later).
During each tone sweep, the subject was asked to manually adjust the amplitude knob of the switchboard so as to keep the tone loudness approximately similar to the loudness of the tinnitus. Usually subjects reported more than one tone as matching the pitch of their tinnitus during both the upward and downward sweeps. In the latter case, subjects were asked to choose which one between the two tones (one having double the frequency of the other) best matched their tinnitus pitch. The noise sequence was band-passed from 50 Hz to 15 kHz and equalized to compensate for the low-frequency bias of the frequency response of the earphones used for sound stimulation (see later). The acoustic stimulation of the WN sound therapy was white noise in the frequency range 0.05-15 kHz equalized as shown in the figure to compensate for the poor low-frequency response of the earphones (see Methods section for details). These procedures aimed at obtaining a balanced design with an approximately equal number of subjects treated with the experimental therapy and with the control therapies (WN or Wa) and, at the same time, avoiding any possible bias in the process of data collection owing to, for example, the differential treatment of patients by the experimenters because of the type of therapy assigned. These noncompliant patients were not counted in the analysis, thereby reducing the sample to 49 patients. For each visit, we noted the number of days (dd) elapsed from the date of the start of therapy (usually within 1 week from the first visit) and the date of the control visit. This was necessary to ensure that each patient contributed only one measurement value (if available) to the class mean value. Of the 49 patients who started acoustic therapy, 2 in the WWN group, 3 in the WN group, and 1 in the Wa group withdrew before the first control visit. However, in the WWN group, the decrease was large (about -12 dB, corresponding to approximately a 75% decrease), whereas in the two other groups, the decrease was negligible (around -2 dB, corresponding to approximately a 10% decrease). By contrast, in two patients receiving the control therapies, tinnitus intensity was initially increased by about 5 dB, showing only minor fluctuations during subsequent control visits. Decibel units on the y-axis are mean values (+1 SE) of ∆dBt computed for three subsequent temporal classes using dBt measurements in subsequent control visits of the same patient. 4 for an example) and no change of tinnitus loudness in the subject who was initially assigned to the WN therapy. Thus, our sound therapy (WST) was tailored to the frequency characteristics of patients' tinnitus.
Indeed, analysis of the percentage of those withdrawing from each treatment group indicates that the WN therapy is the least tolerated, whereas the WWN therapy is the best tolerated by patients.
Third, in a few patients reporting subjective beneficial effects by the Wa therapy, the measure of the tinnitus loudness did not vary appreciably over the study period. The purpose of TRT is the reduction of the alarm reaction associated with the tinnitus sensation by altering the connections between the limbic and autonomic nervous systems (responsible for the alarm reaction) and the auditory system [5].
Conversely, tinnitus pitch is often located inside the hearing loss region toward the audiogram's edge frequencies, a phenomenon having strong analogy with the one described for the occurrence of the Zwicker tone using notched noise [22]. A comparison of variability among measurements of subjective tinnitus and objective stimuli. Psychoacoustic characterization of the tinnitus spectrum: Implications for the underlying mechanisms of tinnitus.
Acoustic communication in two freshwater gobies: Ambient noise and short-range propagation in shallow streams.


Mike has a particular interest in Tinnitus and the management of patients living with this condition. He is a fellow of the Royal College of Surgeons of England and was awarded the gold medal for the final intercollegiate speciality exam in ENT, awarded to the highest ranked candidate. The Kidneys are responsible for promoting Qi and Blood to the ears, and maintaining normal physiological functioning.
At the same time you may have the following symptoms, such as; easily to become angry, very emotional, stressed, reddened face and hot bodied, restlessness and frequent dreaming, insomnia, constipation or sluggish bowel movement, abdomen feeling full or bloating,neck and shoulder stiff and painful, headache, itchy ears. She especially enjoys sharing her knowledge of Chinese medicine through our popular clinic articles, seminars and clinical training of students and practitioners. However, it is important to consult an experienced Chinese medicine practitioner if you are unsure about the most appropriate food for your body type and condition, because everyone is different.
Chinese medicine does understand that Liver and Gall Bladder disorders can be a cause of tinnitus. We found a significant long-term reduction of tinnitus loudness in subjects treated with notched noise but not in those treated with control stimulations.
However, the physiological mechanisms and persistence of the sensation of the tinnitus have still not been fully clarified. Indeed, anecdotal clinical evidence suggests that the exacerbation of the tinnitus sensation by exposure to sounds comprising the tinnitus frequency is a common complaint from patients suffering from tinnitus. Initially (first visit), each participant subject received an audiogram and tinnitus loudness and pitch-matching tests. In such cases, we instead used narrow-band noise (NBN) of one-third of an octave, having a pitch similar to the tinnitus frequency (according to patient judgment) of tones.
It must be stressed, however, that during the loudness-matching test, no effort was made to obtain the best match to tinnitus pitch, this being determined in a separate, experimental test (see later).
Of course, the perceptual quality of a tone stimulus seldom corresponds to subjects' tinnitus sensation. The frequency values identified by the subject in the two sweep tests were grouped and ordered from the lowest to the highest. It might happen that the patient was undecided about the two alternatives when these were of similar frequency.
Wa stimulation was an 8-minute sequence of stream noise recorded underwater with a hydrophone placed close to a stream cascade [16] (see Fig. Patients were also asked to regulate the listening volume to a level approximately matching the loudness of their tinnitus.
In such cases, the patient usually informed the experimenters about the change that occurred.
Six subjects felt annoyed by the therapy and refused to continue before the first control visit (see Results). If these subjects are included in the total count of patients treated, the number voluntarily withdrawing from the therapy in the WWN, WN, and Wa groups amounted to three, four, and seven, respectively, the highest percentage being in the WN group (about 30% of subjects) and the lowest being in the WWN group (about 15% of subjects; Fig.
Figure 5 reports the variation of the mean value of ΔdBt, with time elapsed from the start of the therapy, for the three groups of patients. Decibel units on the y-axis are values of ∆dBt computed using dBt measurements in subsequent control visits of the same subject (date on the x-axis).
We tested the effectiveness of the therapy using two types of control sound treatments: nonnotched noise (WN) or waterfall noise recorded underwater (Wa).
However, the WWN group had the lowest percentage of those who withdrew (around 15% of subjects compared to 28% in the WN group and 23% in the Wa group) among the three treatment groups, suggesting that WST was the sound therapy best tolerated by patients (presumably owing to the lack of annoyance caused by the stimulation of the patient with frequencies similar to that of the tinnitus). Thus, WST determined an objective and significant reduction of patient's tinnitus loudness and, hence, it appeared to be an effective sound therapy for the treatment of tinnitus. Therefore, to the extent that these differences might correspond to a different listening behavior by patients in relation to the sound therapy they received, the decrease of tinnitus severity observed among the group of patients receiving the WWN therapy could partly be explained by their (supposed) higher tolerance and stamina in motivation to listen to the therapy as compared to patients receiving the control therapies.
Likewise, other patients treated with the WWN and reporting no subjective improvement of their tinnitus sensation showed in fact a decrease of tinnitus loudness measured over time. Therefore, the observed effectiveness of the WST in reducing tinnitus loudness appears consistent with the neurophysiological model of tinnitus underlying TRT [5]. One possibility is that Wa stimulation had poor masking effects on tinnitus in most patients, implying that the alarm reactions induced by tinnitus persisted in Wa-treated subjects. Thus, a conceivable hypothesis is that a stimulation of the edge frequencies, but not the tinnitus region, by the noise frequencies just below the notched region has occurred during the listening of the WWN sound treatment.
The ringing condition comes and goes without notice, especially during the quietest time the ringing becomes more obvious, this can greatly impede one’s life-style, for example, affecting listening ability and sleep, resulting in restlessness whilst sitting up or lying down.
When your Kidneys are disordered such as kidney yin weakness the ears are unable to receive adequate Blood and Qi from the Kidneys, resulting in tinnitus. You can consult with an experienced Chinese medicine practitioner to see if acupuncture can offer symptomatic relief of your tinnitus.
These results point to the importance of the personalized sound treatment of tinnitus sufferers for the development of an effective tinnitus sound therapy. This observation has been the foundation of our approach to the treatment of tinnitus and the key element for the development of an effective personalized sound therapy. This may partly explain the high betweensession variability of pitch-matching measurements often reported in the literature [11-13]. Therefore, before testing the patients for the first time, they were instructed in how to use the apparatus and make the tinnitus pitch-tone comparisons. This occurred frequently, as many subjects identified matching tones of similar frequency during the upward and downward sweeps. We note that the distinction made here between single- and multi-pitched tinnitus was intended solely for the development of an appropriate tinnitus therapy; it may or may not have a relationship with the internal spectrum of the tinnitus.
Therefore, the noise energy between the two broken lines is missing in the WWN sound therapy.
In case of marked hearing loss in one ear, subjects were advised to regulate the listening volume using the ear of best hearing.
Conversely, the key feature of the WWN therapy is the construction of a noise window around the tinnitus pitch, implying that the window features should track any observed change (real or supposed) of the value of F t .
Thus, sound stimulation of patients of the two control groups was not personalized on the basis of frequency characteristics of patient's tinnitus. Possible sources of between-session variability of pitch matches are, for example, the multipitched nature of many tinnitus percepts [13], the change of tinnitus pitch with time after application of the sound therapy [10] (Lugli et al., unpublished data), or judgment errors by patients.
However, the observation that many of these subjects experienced tinnitus relief by listening to the water noise soundtrack (Lugli et al., unpublished data) does not support this interpretation.
In addition, activation of the mechanism underlying the Zwicker tone must have occurred in patients listening to the WWN treatment, although none of them reported such an aftereffect, presumably because of the pitch similarity between the Zwicker tone and the tinnitus percepts.
Levine, who has been a tinnitus sufferer for 24 years, will be speaking as a non-expert patient. In addition, no treatment can be considered efficacious in providing longterm relief from tinnitus in comparison to placebo [2]. In such cases, the operator continuously varied the knob of the tone generator within the narrow band delimited by the two frequency values to allow the subject to identify the tone best matching the tinnitus pitch. Hence, our results cannot be compared with those of studies trying to assess the form of the tinnitus spectrum [13]. As compared to the waterfall noise recorded in air, the waterfall noise recorded underwater is characterized by greater energy content at lower frequencies and larger amplitude and frequency modulation [16]. In the Wa sound therapy, most energy is concentrated in the lower part of the spectrum (bottom spectrum = mean spectrum of the 8-minute sequence of waterfall noise; see Methods).
Thus, ideally, patients subjected to the WWN therapy should receive a new windowed noise sequence almost each time at every control visit.
Thus, the overall number of subjects available for the comparative analysis of data was of 43 patients, of whom 20 were treated with WWN, 11 were treated with WN, and 12 were treated with Wa. We did not attempt the chi-squared analysis of the proportion of those who withdrew in the three groups owing to the low number of those who withdrew, expected in each group under the null hypothesis. Though the reliability of the method of pitch assessment proposed here awaits further testing before being asserted, our findings nonetheless point to the type of pitch-matching procedure adopted as a major factor responsible for the unreliability of pitch estimates documented in the tinnitus literature [18]. These facts do not support a supposed presence of marked differences in the at-home use of the therapy by patients of different treatment groups. One or both of these phenomena might have determined a reorganization of the neural activity of the edge frequencies resulting in the observed longterm reduction of the tinnitus percept in such patients. We also thank all personnel in the audiological laboratory of the University of Parma for their invaluable contribution to the collection of clinical data.
Hence, the width of the band-stop filter amounts to 1,377 Hz, being 5,462 Hz and 6,838 Hz, respectively, the lower and upper frequency extremes of the band, with the center frequency at 6,150 Hz.
This is admittedly tedious and perhaps of little therapeutic significance when the re-measured value of F t is similar to the last one determined in the previous session. To explore the efficacy of the WWN therapy further, three Wa subjects and one WN subject were chosen among the group of patients reporting no relief from the therapy and were asked to abandon the assigned therapy and to start with the WWN therapy. Finally, 7 of the 20 patients treated with WWN were given one (n = 5) or two (n = 2) updated WWN treatments during the study period (see Methods for details). Hence, the lack of direct control by the experimenters over the patient's at-home listening behavior was unlikely to be a factor potentially affecting the main conclusion of this study about the effectiveness of the WST therapy in the treatment of tinnitus. The procedure was repeated until the tone identified up to that point was compared with the highest tone (F n) of the sequence. Cursory examination of pitch match position in relation to the patient's audiogram showed that the matches were frequencies above that at the beginning of the region of hearing loss on the audiogram.
The control-toexperimental therapy shift occurred after 3-7 months from the beginning of the experiment. The goal is the reduction of subjects' tinnitus perception by providing competing auditory stimuli masking the tinnitus. This observation agrees with results by earlier and recent studies on the relationship between tinnitus pitch and hearing loss [9]. However, no firm experimental evidence supports the effectiveness of these methods in the long term: an objective reduction of the loudness of the tinnitus or the complete recovery from tinnitus.



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