Tinnitus trt therapy benefits,how can noise damage your hearing guardian,sensorineural hearing loss on audiogram forms,ringing in the ears after epidural - Downloads 2016

Author: admin, 21.06.2015
Nell’ambito delle sedute di counseling possono essere utilizzate tecniche di RILASSAMENTO profondo o poste le basi per una terapia di tipo cognitivo comportamentale.
Convenzioni assicurativeIl paziente puo eseguire gli accertamenti necessari ad inquadrare il disturbo uditivo sia da un punto di vista diagnostico che terapeutico da esterno mediante richiesta di visita specialistica o in regime di ricovero o Day Hospital in modo da effettuare in breve tempo tutti gli accertamenti. The recurring sound perceived by tinnitus sufferers is a symptom triggered by a variety of underlying causes, such as prolonged exposure to loud noise, ear infections, blockage, or ototoxic medications.
Mariko Takahashi is an ENT physician and an associate professor at Nagoya City University in Japan. Learn about an easy step-by-step process that will allow you to successfully manage patients with tinnitus. This course reviews a comprehensive process in working with patients who report severe cases of tinnitus.
This course will focus on all the elements required in offering tinnitus management in your facility.
When working with tinnitus patients, it is imperative that your referring physicians are educated in tinnitus therapy and proper referrals. All’incontro hanno partecipato tutte le equipe dei centri di cura e riabilitazione dell’acufene di tutte le regioni d’Italia , ciascuna delle quali ha esposto i risultati ottenuti durante l’anno corrente riguardo al  protocollo di lavoro e delle attivita di ricerca scientifica in merito all’utilizzo di generatori di suoni nell’ambito della Tinnitus Retain Therapy. Il 10% della popolazione soffre di acufene. Da oggi la rete TRT nella cura dell’acufene fornisce un nuovo apparecchio ReSound Alera TS che sfrutta tutte le potenzialita del nuovo chip Wireless da 2,4 GHz.
E’ importante sottolineare che questi apparecchi combinati che sfruttano il modello neurofisiologico della TRT  sono terapie riabilitative certe, da usare unitamente ad un programma terapeutico individualizzato e ad una buona consulenza. Il nostro protocollo di lavoro prevede una visita preliminare da parte dell’otorinolaringoiatra il quale dovra escludere eventuali patologie che possono provocare l’acufene ed eventualmente orientare il paziente alla terapia mirata ( oltre alla TRT e alla terapia sonora esistono anche la terapia laser a basso livello energetico, terapie comportamentali, psicologici e molto altro). Tinnitus Retraining Therapy (TRT) is a well-defined method for treatment of individuals who suffer from tinnitus [1-4]. Habituation is a concept that has been a part of the learning and conditioning literature for many years and refers to a decrease in responsiveness because of repeated stimulation with an inconsequential stimulus [7]. Treatment with TRT has two components, and each component addresses a different aspect of habituation. Prospective controlled studies have not been reported to document outcomes of treatment with TRT [10,11]. TRT was first offered to patients at the University of Maryland Tinnitus and Hyperacusis Center in 1990.
Clinical implementation of TRT requires patients to receive a thorough audiological and medical evaluation before entering treatment [6]. The examiner recommends treatment for TRT based primarily upon patients' audiological test results and their verbal responses from the TRT initial interview [14]. The TRT initial interview is designed to delineate a patient's relative problems with tinnitus, hearing loss, and loudness intolerance.
The original version of the TRT Initial and Follow-up Interview forms appears in a condensed format that is intended to simplify administration of the interviews as well as record keeping [14].
Because TRT is often used for treating tinnitus, practitioners must have access to standardized TRT assessment tools.
Category 1 patients require extended treatment for their tinnitus condition but do not require the use of hearing aids.
Proper patient categorization requires the clinician to clearly understand the patient's subjective difficulties with each of the conditions of tinnitus, reduced sound tolerance, and hearing loss. Tinnitus of recent onset (up to about 6 months duration) may be more labile than longer-duration tinnitus and thus may resolve spontaneously [27]. From a population of over 1,800 tinnitus patients, 43 percent were reported to have described their tinnitus as consisting of multiple sounds [28]. Most patients responding to the TRT initial interview will have negative emotions associated with their tinnitus, with consequent effects on certain life activities.
This item comprises a series of questions related to the patient's use of hearing protection.
Question 10 is straightforward in asking if the patient is receiving any other tinnitus treatment. Question 12 identifies bothersome aspects of tinnitus from a closed set of different activities that can be adversely affected by tinnitus. These two questions will obtain an estimate of the percentage of waking hours that patients are consciously aware of, and annoyed by, their tinnitus. Patients are given an opportunity to provide any additional information concerning their tinnitus. Decreased sound tolerance can involve different components, including hyperacusis, misophonia, and phonophobia [4]. These questions are the same as questions 7 through 18 for tinnitus, but focus on effects of reduced sound tolerance. The TRT Follow-up Interview form (Figure 2) duplicates those questions from the TRT initial interview that would be considered necessary to monitor treatment progress and to determine treatment outcomes [14]. In the scripted instructions to the follow-up interview, patients are told to consider their tinnitus and its effects over the previous month when answering the questions. Question 1 contains a series of questions about whether patients experience some days that are more affected by their tinnitus than others. Question 5 determines the impact of tinnitus on various activities, as does Question 12 from the initial interview. Questions 6 and 7 are the key questions that assist in determining if patients are habituating to, respectively, tinnitus perception and tinnitus reaction. Questions 8, 9, and 10 ask patients to estimate, respectively, their tinnitus loudness, annoyance, and life impact.
Questions 23, 24, and 25 are particularly important for a clinician to determine the relative effects of tinnitus, reduced sound tolerance, and hearing loss on the patient's life.
Question 26 determines if patients feel that their auditory condition has benefited overall, considering tinnitus, sound tolerance, and hearing loss. This article provides tools to evaluate patients for treatment with TRT and to monitor the efficacy of treatment with TRT.
The TRT Initial and Follow-up Interview forms were revised primarily to help determine outcomes of treatment in a standardized manner for a randomized clinical study currently being conducted at the Portland Department of Veterans Affairs (VA) Medical Center (VAMC) in which subjects receive treatment with either Tinnitus Masking or TRT. There are accepted methods for developing and testing scales that measure health or functional status. Substantial literature exists concerning tinnitus outcomes instruments-some of which have undergone the more traditional method of development and testing.
With regard to the preceding comments, a need exists to provide further development and testing for the TRT interview forms to be documented as valid and reliable. Finally, it should be noted that the developers of the original TRT interview forms administer the Tinnitus Handicap Inventory to all of their patients in addition to performing the interviews [41,42]. We wish to acknowledge the significant contributions from Tara Zaugg, MS; and Barbara Tombleson, BS.
Its main components are directive counseling to decrease tinnitus-related negative reactions and sound therapy to reduce the strength of the perceived tinnitus signal (Jastreboff, 2011).
The tools and counseling techniques will comfortably guide you through a process of meeting the needs of these patients and recommendations for appropriate referral considerations.
This presentation will give you solutions on how to have this conversation with your referring physicians. This informal discussion will teach you about using Zen for this population and provide an opportunity for you to ask questions to an expert on your patients. Eliseo Stefano Maini (ingegnere elettronico, dottore di ricerca in bioingegneria, ingegneria dei materiali e robotica, dottore in scienze audioprotesiche), e dal Dr. Nel primo anno di attivita sono state effettuate diverse centinai di applicazioni con il prodotto ReSound Live Ts  sistema combinato, che funge da mascheratore e da protesi acustica allo stesso tempo ,in tutti i centri specializzati d’Italia. Dal punto di vista neurofisiologico, acufene ed ipoacusia possono provocare fenomeni di rimodellamento del SNC che provocano la persistenza dell’acufene stesso. Gli  apparecchi combinati possono essere assai efficaci se usati in maniera appropriata, ma per ottenere il massimo beneficio vanno seguiti protocolli e procedure adeguate.
Successivamente, qualora il paziente fosse candidabile alla TRT, dovra sottoporsi a cinque visite svolte in team (otorinolaringoiatra, psicologo e audioprotesista, ingegnere biomedico eventualmente osteopata, ortodontista) con cadenza periodica a quindici giorni, a un mese, a tre mesi e a sei mesi dalla prima visita. The TRT Initial Interview form was developed to guide clinicians in obtaining essential information from patients that would specify treatment needs. It is estimated that about 80 percent of individuals who experience constant tinnitus naturally habituate to their tinnitus to such a degree that their tinnitus does not constitute a problem requiring clinical intervention [1,8]. The individual with problematic tinnitus first must habituate to any emotional responses to the tinnitus.
Outcomes data have been reported from a number of clinics, however, indicating that treatment with TRT significantly benefited 70 to 85 percent of their patients (reviewed by Henry et al. In addition, patients must demonstrate that their tinnitus condition is sufficiently problematic to warrant implementation of long-term treatment with TRT. The TRT initial interview is a structured set of questions that are designed specifically to determine proper placement of patients into TRT treatment categories (described in TRT Patient Categories section).
Using the TRT Initial Interview form, each of these three potential problems is discussed individually, enabling the clinician to differentially assess the subjective impact of each. These categories have been fully described elsewhere [4-6,21] and thus are only briefly described here (see the Table). They are fitted with wearable ear-level sound generators and counseled repeatedly, usually over a period of 1 to 2 years. Understanding the patient's natural tinnitus history is considered important for counseling [8].
The potential for spontaneous improvement is important to consider in the assessment of patients for treatment. This question seeks to determine if there are days when these tinnitus effects are noticeably worse than on other days. Patients commonly report that their tinnitus becomes louder as a result of exposure to certain sounds.
The questions will stimulate discussion about the need to provide hearing protection in dangerously noisy situations, but the main purpose is to determine if the patient is overprotecting his or her hearing.
Often, patients have not analyzed specifically why tinnitus is a problem for them and this list prompts them with the most likely concerns. Patients are asked to rank their tinnitus with respect to loudness, annoyance, and life impact. In most cases, the TRT initial interview will have covered all the issues and patients will have nothing further to add. Patients must clearly understand the intent of Question 19 because their response to it will determine whether or not they are identified as having a problem with sound tolerance.
Patients will often confuse functional effects of reduced sound tolerance with tinnitus effects. There can also be Category 4 placement specific to hyperacusis as shown in the Table, page 159. No clear relationship exists between patients' audiograms and how they feel about their hearing [39]. During the preceding questioning, patients will have learned to distinguish between the conditions of tinnitus, reduced sound tolerance, and hearing loss.
Some of these questions have been modified relative to the initial interview as appropriate for follow-up evaluation.
Thus, they are not asked to respond in relation to any particular day or circumstance, but to think of how the tinnitus has affected them generally during the previous 30 days.
The clinician should have the patient's responses to the initial interview in hand during administration of the follow-up interview.
Similar to Question 1, patients are asked to report if they feel that the amount of time they have been aware of their tinnitus, or annoyed by their tinnitus, has changed during the previous month. For these questions, as well as Questions 23, 24, and 25, clinicians are again advised to have the patient's previous answers available to indicate to the patient whether improvement has been noted.
If improvement is not noted after 1 to 2 years of treatment, the clinician must assess honestly as to whether continued treatment with TRT is in the patient's best interest. If reduced sound tolerance was not noted as a problem during the initial interview, these questions are bypassed during the follow-up interview.
The question requires only a yes or no response, but its intent is to raise the issue as a discussion point to evaluate whether the patient considers hearing loss a problem [39]. In some cases, only one of these is a problem at the beginning of treatment and treatment will be specific to that condition throughout the program. Question 27 is somewhat unusual because it asks patients how they would feel about giving back their ear-level devices. The original one-page interview forms, both initial and follow-up [14], can work effectively for the experienced TRT clinician. Since all subjects in both groups were to receive the TRT initial and follow-up interviews, administering the interviews in a consistent fashion was essential. None of these instruments, however, has achieved discipline-wide consensus as a standardized method of evaluating the negative effects of tinnitus. Jastreboff and Jastreboff state that the choice of supplemental questionnaires is a matter of personal preference of the provider [14]. Quando il trattamento ha successo non si ha la percezione dell’acufene a meno che non vi sia un processo volontario di attenzione. Broadband noise or conventional hearing aid amplification are commonly used in sound therapy in a TRT framework, since they are relatively neutral to listen to and thus unlikely to attract attention and induce strong emotional reactions in the patients. E’ un sintomo multifattoriale e patofisiologia ancora discussa, e un segnale di bassa intensita normalmente non percepito per un rapporto SNR sfavorevole.
La patologia dell’orecchio induce una deprivazione e un cambiamento dell’equilibrio tra sistemi neuronali di inibizione e quelli di eccitazione determinando l’insorgenza e la permanenza del tinnitus.


Il paziente affetto da acufene cronico rende distorto tutto il mondo sonoro, si stara infatti il rapporto con il suono e l’equipe ha il compito di resettarlo e di assuefare all’acufene il paziente  aiutando il soggetto  ad imparare a far fronte al tinnitus,  processo  gestito con delicatezza nell’arco di un certo periodo di tempo.
The TRT Follow-up Interview form is similar to the initial interview form and is designed to evaluate outcomes of treatment.
The model identifies different areas of the brain that can be involved in tinnitus and theorizes as to how those areas interact to create a clinical condition of tinnitus [5,6].
Such natural habituation apparently does not occur for about 20 percent of these individuals. In 1999, Jastreboff created another center to treat tinnitus and hyperacusis patients at the Emory University School of Medicine in Atlanta, Georgia. In addition to questions about tinnitus, the TRT interview includes questions about decreased sound tolerance (hyperacusis) and about subjective hearing difficulties [6,15].
In addition, use of the interview educates the patient to understand these problems and how they differ.
The abbreviated nature of the questionnaire items requires the clinician to fully understand the intent of each item in order to phrase the questions appropriately and is a reminder to assure that all questions are asked. This paper provides the expanded forms of the initial and follow-up interviews to clinicians who are practicing, or who intend to practice, TRT with their tinnitus patients. Category 0 identifies patients whose tinnitus condition requires only basic counseling and sound therapy without the need for wearable sound generators or hearing aids. Category 2 patients also require extended treatment for their tinnitus condition, but in addition, they report significant hearing difficulties.
The treatment approach will vary according to category; thus, accurate placement of patients into these categories is critical to provide proper treatment. The tinnitus description defines the symptom for both patient and clinician, providing a common reference for the remainder of the tinnitus-related questions. With an increase in tinnitus duration, the likelihood of tinnitus being a permanent condition also increases. Based on these data, tinnitus is likely to consist of multiple sounds for about half of all patients attending tinnitus clinics. Many patients with tinnitus use earplugs or earmuffs to prevent their tinnitus from becoming worse. This information is important for the clinician to help the patient determine the best overall course of treatment. Since habituation is the primary goal of TRT, these questions are particularly helpful in assessing this outcome of treatment.
Only the end points of each scale have labels; thus, patients must select a number on the continuum in relation to the two extremes.
Hyperacusis is a physiological response to certain sounds; thus, some level of physical discomfort is involved.
It is thus important to guide the patient to respond appropriately, keeping in mind the different components of reduced sound tolerance as described for Question 20. In the latter case, certain sounds will exacerbate the hyperacusis for an extended period of time (at least until the next day).
Some patients will reveal a significant reduction in hearing sensitivity and yet will not be bothered particularly by their hearing loss.
These three questions now allow them to consider how much each condition is a problem in relation to the other. It is thus important to know if patients feel that they are having fewer bad days than before. Indicating the previous responses on the follow-up interview form is helpful when asking about these activities. An awareness that improvement has occurred can be very encouraging to the patient and is an important incentive to maximize compliance with the treatment protocol. If reduced sound tolerance was initially reported, completing these questions will enable an evaluation of treatment efficacy. This perception often changes from appointment to appointment, which can potentially result in making changes in ear-level devices. In other cases, more than one of these conditions will be a problem at the outset of treatment and their relative effects can change during treatment. Many clinicians, however, especially those who are relatively new to TRT, have expressed the need for scripting of questions and for explaining the various questions in the forms.
The interview forms therefore were revised so that exact wording of each question would be provided on each form. Such an approach has not yet been taken with the TRT interview forms, which were originally developed by the second and third authors of this paper because of their perception that take-home questionnaires were inadequate for assessing tinnitus patients [14]. Meikle and Griest have reviewed the various outcome measures that have been developed and have noted the many discrepancies between them [40]. A working group has been formed that is presently evaluating four tinnitus outcomes instruments, including the TRT interview forms, the Tinnitus Handicap Inventory [41,42], the Tinnitus Handicap Questionnaire [19], and the Tinnitus Severity Index [43]. Tinnitus Retraining Therapy (TRT) as a method for treatment of tinnitus and hyperacusis patients. Celebrating a decade of evaluation and treatment: The University of Maryland Tinnitus and Hyperacusis Center. An experimental study to test the concept of adaptive recalibration of chronic auditory gain: interim findings. Modification of loudness discomfort level: evidence for adaptive chronic auditory gain and its clinical relevance.
Shifts in dynamic range for hyperacusis patients receiving Tinnitus Retraining Therapy (TRT). Changes in loudness discomfort level and sensitivity to environmental sound with habituation based therapy.
Psychometric adequacy of the Tinnitus Handicap Inventory (THI) for evaluating treatment outcome. Music, on the other hand, is generally not recommended, since it may induce strong emotions, and may attract attention as well (Jastreboff & Hazell, 2004). Durante l’incontro e stata sottolineata l’importanza di avere in equipe uno specialista otorinolaringoiatra definito dal Prof.
The treatment approach is aimed to induce and facilitate habituation by the patient to his or her tinnitus.
Habituation to tinnitus perception can only occur if there has been habituation to the associated emotional responses. In the past 7 years, he has conducted 13 three-day instructional courses in the United States that have been offered to physicians and audiologists to learn the TRT protocol. It is thus critical to accurately assess the patient's condition, need for treatment, and motivation to comply with all treatment requirements. Hyperacusis is a condition that is observed to occur to some degree for approximately 30 to 40 percent of patients who are evaluated for TRT [4,16,17]. The process helps the examiner and patient to mutually determine the optimal course of treatment. To help conduct the interview in a standard manner, the main questions are presented verbatim at the bottom of the forms. Further, to ensure that the TRT practitioner fully understands the intent of each question, detailed explanations are provided. Typically, these patients achieve enrichment of their sound background using tabletop sound generators and other sound-generating devices [22]. They receive the same treatment as for Category 1 patients except that they are fitted with either hearing aids or ear-level combination devices that incorporate both hearing aids and sound generators. This baseline description might also be useful for the clinician to compare during and following treatment to determine if the patient's tinnitus characteristics have changed as a result of treatment. For the TRT evaluation, it is important for patients to identify which of the tinnitus sounds is most bothersome. Such action in fact will result in the tinnitus sounding louder, because of the occlusion effect, and is reported to cause reduced loudness tolerance [29-35]. Many of these other types of treatment have no scientific basis and the patient should be educated regarding realistic expectations. Question 13 determines the amount of time patients spend thinking about their tinnitus; thus, it is specific to habituation of tinnitus perception. The main consideration is to determine whether patients have trouble tolerating everyday sounds that are otherwise tolerated comfortably by most other persons. It is an educational process for some patients who will gradually begin to understand how these different factors have affected their lives differentially. Other patients complain about considerable hearing difficulties that would seem incongruous with their mild hearing loss. The clinician should be aware if the patient is concurrently receiving treatment with anxiolytics or other psychotropic medications and should consider potential effects of such treatment. Patients can be told if they have shown improvement or not, but it is not advised to inform them of their previous responses. Such changes will usually involve the addition of amplification as the patient recognizes the degree to which hearing loss is a problem. For example, if hyperacusis is the primary problem at the beginning of treatment, the treatment protocol will be specific to the hyperacusis. In most instances, patients will indicate adamantly that they would not be comfortable giving up their devices. These revised forms now are being used in the TRT training seminars, and their clinical application will minimize variability in administration of the questionnaires.
These authors therefore designed structured interviews to be a guide for acquiring information from patients and to evaluate potential changes during treatment. Meikle and Griest emphasized the need for a single standardized instrument to assess tinnitus-related distress and resulting functional impairment.
However, we have seen a number of clinical cases in which neither of the two conventional TRT sound stimuli produced the desired effect. Del Bo,” Physician in  audiology open mind olistic approauch” ossia un medico olistico che abbia un’ apertura mentale a 360 gradi e abbia precise conoscenze anatomiche e fisiopatologiche dell’intero organismo. The forms have been used in a highly abbreviated format with the potential for inconsistent interview administration between examiners. The inherent variability in administering the TRT interviews can be reduced further by scripting each question. Further details regarding administration of the Initial Interview form have been provided elsewhere [6].
These patients require fewer follow-up visits than do patients in the other TRT categories. Category 3 patients have the primary problem of hyperacusis and are treated for this condition with a specific TRT protocol that involves use of wearable sound generators or combination instruments. The first is that the patient who has recent-onset tinnitus should be started on full treatment as soon as possible. Constraining the psychoacoustic evaluation to the most bothersome tinnitus sound can save a substantial amount of time and, therefore, is subsequently used as a reference during the tinnitus matching procedures. It is important for the clinician to be sensitive to the patient's potential need for psychological or psychiatric evaluation and treatment and to refer the patient as necessary [6]. Patients in Category 4 are the most difficult to treat effectively, and a specific variation of TRT is implemented for these patients [21,23].
It is thus an important issue, but the examiner must use caution during the questioning so as not to give patients the new concern that sound might make their tinnitus worse.
Question 14 evaluates how much of their time they are annoyed by their tinnitus, which helps to determine if they are habituating to their tinnitus reaction. If this occurs, patients can generally recall the types of everyday sounds that cause loudness discomfort. The objective of these questions is to determine the patients' subjective feelings about their hearing, regardless of their hearing thresholds. Thus, for some patients, it is simply a matter of continuing to encourage them in spite of their lack of progress. At a follow-up visit, the hyperacusis may become less of a problem and the tinnitus might become the primary concern. Question 28 is quite general in asking if patients are glad or not that they started the program. Our hope is that this information will be useful for promoting a higher level of standardization in conducting TRT. The interview forms are a clinical tool to conduct TRT and, while not claimed as a universal tinnitus assessment technique, can potentially be used with other types of tinnitus treatment methods.
Most importantly, the four questionnaires are being evaluated with respect to how the patients themselves respond to the questionnaire items. Thus, for the clinician or researcher who is actively involved in conducting TRT, we suggest that the interview forms be used along with one of the self-administered questionnaires that has undergone documentation for validity and reliability. Dai concetti sopra illustrati si puo evincere che e stata data moltissima importanza allo studio del modello neurofisiologico della TRT presentando molte innovative teorie di applicazione nell’ambito della cura dell’acufene che impegnano continuamente tutte le equipe nell’ambito anche della ricerca per poter creare sistemi sempre piu innovativi e all’avanguardia nella cura del tinnitus.
Sound therapy is thought to be effective only when the emotional responses have been neutralized. Misophonia reflects dislike of sound [6,18] and is present in the majority of patients [17].
Furthermore, for outcomes research, standardization of wording is vital to ensure consistent administration of the interviews within and across patients and within and across examiners. The TRT Follow-up Interview form is a shortened version of the Initial Interview form because some items in the initial interview would not be relevant to evaluate treatment outcomes at follow-up visits.
Category 4 patients are relatively uncommon and suffer from a condition in which their tinnitus or their hyperacusis is significantly worsened because of exposure to certain types of sounds.


From a group of 784 nonveteran tinnitus patients, however, 47 percent was reported as not being able to identify any precipitating event that could be associated with their tinnitus onset [26]. When treatment is provided with TRT, the psychoacoustic characterization of tinnitus is irrelevant and is mentioned only briefly during counseling. Patients need to know that the use of hearing protection for any reason other than protection from damaging levels of sound constitutes overprotection. Many patients will report that the main problem with tinnitus is that it interferes with their hearing ability. Habituation to both the perception of and the reaction to tinnitus would indicate that the program has been successful [1,36,37]. The responses will determine whether placement in Category 2 is appropriate, which would indicate the use of amplification.
At some point, however, the clinician and patient should mutually decide if another form of treatment is the best option. Otherwise, there is the potential that the patient would be constantly frustrated by hearing difficulties. In such a case, the treatment effort would shift to address primarily the tinnitus condition.
Such an analysis is possible because each of the questionnaires has been used in the tinnitus treatment study that is presently being conducted at the Portland VAMC. Fractal music is described as sequences of tones with no lyrics, which sound something like wind chimes. The expanded forms are presented in this article, and the intent of each question is explained. Subjective hearing difficulty is a problem that patients often assume to be the result of their tinnitus [6,19].
The Follow-up Interview form also contains specific instructions for obtaining outcomes information. This study was an analysis of clinical data from 149 patients, of which 28 of the patients reported a total absence of their tinnitus even when attempting to focus their attention on it. The sooner treatment is started, the sooner this vicious cycle can be broken and the patient's normal life can be restored. These examples represent very different kinds of problems that would indicate different strategies of treatment.
If treatment is fully successful, these percentages of time will drop to zero or close to zero. For patients who were initially fitted with hearing aids, it will be important, of course, to provide appropriate follow-up care to ensure that the amplification is performing adequately.
It is thus important at each of the follow-up visits to redefine the extent of each of these auditory problems. An important outcome of this effort will be an assessment of the performance of the expanded TRT interview forms in relation to the three self-administered tinnitus instruments that have been documented for validity and reliability. Predictable without being monotonous, the music sounds familiar, but is not associated directly with music that the listener holds in memory (Sweetow & Jeppesen, 2012). Standardized administration of these interview forms will facilitate greater uniformity in the initial evaluation and outcomes analyses of patients treated with TRT. Proper training to perform TRT requires attendance at one of these courses, which have been completed by over 300 health professionals in the United States and over 600 in other countries. In most of these cases, the hearing assessment reveals reduced hearing sensitivity of the sensorineural type.
With these forms and the instructions provided herein, TRT clinicians have the tools necessary to administer the TRT interviews in a standardized fashion. If generalizable, these data would indicate that approximately half of the nonveteran tinnitus patient population do not know the cause of their tinnitus, and this may be a major reason why they seek professional help. The second school of thought is that patients should be informed of the potentially labile nature of tinnitus during its first few months. Patients using amplification therefore should be asked any questions that would be important for assessing any problems. Following this effort, a further revised TRT interview form may be proposed that will require testing for validity and reliability. Thus, most likely, the tinnitus is not causing their hearing difficulties but rather the decline in sensory cell population in the cochlea is causing their hearing loss [6,20].
This finding leads to the question, Does tinnitus of unknown onset result in greater tinnitus distress than when the cause is clearly identified? Whether or not the tinnitus resolves completely, the patient's fears may be sufficiently allayed by the hopeful information.
Most likely, a generalized version of a self-administered tinnitus outcomes instrument will be developed and promoted for standardized clinical and research application. For TRT, however, the interview format will be retained for the purposes just mentioned [14]. Each patient should be treated individually, and treatment decisions should be made solely according to what will provide the greatest benefit to the patient. The common approach with TRT is that a patient with recent-onset tinnitus mainly needs a full evaluation and counseling. The results were positive, so a larger trial with a total of 91 patients in TRT categories 1 and 2 was initiated. The Tinnitus Handicap Inventory (THI) is a 25-item questionnaire with three subscales: functional, emotional and catastrophic responses. The responses are summed with a total score that ranges from 0 to 100 (higher scores indicating a greater self-perceived handicap).The minimum THI score considered clinically significant is 18.
The average age, gender, hearing level, THI, and HHIA scores at the initiation of the study are shown in Table 1. According to the manufacturer’s specifications, the fractal music produced in the Zen program consists of sequences of tones with no lyrics. The fractal music and broadband options can be used separately or in combination, with the hearing aid microphones switched on or off. Patients were instructed to try all options (fractal music style, broadband noise, conventional amplification) included in their devices at home.
The data logging function was activated to record the patients’ daily hearing aid usage and use of different program options. The following trend was observed:Patients who chose to purchase the conventional simple sound generator (Group 2) were typically the ones with a relatively mild (or no) degree of hearing loss (self-perceived and objectively measured), while their THI score suggested a severe degree of tinnitus (Table 1). For these patients, the tinnitus is expected to have a greater impact on their daily lives than the hearing loss.The reverse client profile was observed in the group who preferred conventional hearing aid amplification as sound therapy (Group 3). These patients typically had a moderate-moderately severe degree of hearing loss (self-perceived and objectively measured), while their tinnitus was at the moderate end of the scale.
Thus, the assumption was that the hearing loss may be the greater problem for the patients who chose a conventional hearing aid.Client profiles for the patients who chose the combination device (Group 1) varied, but they typically had a severe degree of tinnitus combined with a moderate (or more severe) degree of hearing loss (self-perceived and objectively measured), and a severe degree of depression. 20% (6 patients) replied that they already owned a pair of hearing aids, while 17% (5 patients) were unable to perceive an effect from the sound therapy. The remainder of this paper will report the results for this specific group.Of the 33 patients who purchased a combination device with the Zen feature, 25 participated in the re-evaluation after three and six months of therapy.
Notable improvements were observed already after the first three months in the THI (Tinnitus Handicap Inventory) scores of the majority of patients who used fractal music as sound therapy. Scatter plots of 25 patients’ THI scores at the initial visit and after six months of therapy.
Each data point represents a single patient’s THI at the initial visit (horizontal axis) and after six months of therapy (vertical axis).
Data points located to the right of the stippled line indicate an improvement of 20 points or more in THI.The patients were also asked to indicate the intensity level and frequency of occurrence of their tinnitus at the initial visit and after 6 months of therapy.
Notable improvements were observed both in the VAS scores assigned for intensity level and for frequency of occurrence after 6 months of therapy. Scatter plots of 22 patients’ VAS scores for perceived intensity level of their tinnitus at the initial visit and after six months of therapy. Each data point represents a single patient’s VAS score at the initial visit (vertical axis) and after six months of therapy (horizontal axis). Scatter plots of 23 patients’ VAS scores for frequency of occurrence of their tinnitus at the initial visit and after six months of therapy. The results are summarized in Figures 4-8.Overall satisfaction scores are shown in Figure 4. 69% of the patients reported being either satisfied or very satisfied with the sound therapy.
A small minority (8%) reported being dissatisfied, while 23% replied that they were neither satisfied nor dissatisfied with the therapy.Figure 4.
Overall satisfaction with sound therapy in patients who used Zen for 6 months.One of the basic rules for the use of sound generators in successful TRT treatment is that it must not evoke negative feelings in the form of discomfort or annoyance in the patient (Jastreboff, 2011).
The patients were therefore asked to evaluate the fractal music in terms of how pleasant they perceived it to be, and whether they had become tired of it after six months’ use.
65% reported perceiving the fractal music as either comfortable or very comfortable, while 35% were neutral. None of the patients reported perceiving the fractal music as uncomfortable to listen to (Figure 5).
According to the manufacturer, under normal circumstances the music should not interfere with speech perception, unless the patient has a very narrow dynamic range resulting from a severe degree of hearing loss (Widex zen therapy, 2012). This was largely supported by the results in the present study, as 82% of the patients reported being able to hear speech well in the presence of fractal music (see Figure 7).Affordable price was reported to be the main motivation for choosing a simple broadband sound generator by many patients in Group 2.
Patients in Group 1 were therefore asked to evaluate the combination device in terms of price. 75% of the patients who had chosen the combination device responded that it was expensive, 8% that it was too expensive, while 13% found it reasonable.Figure 7. Both cases were part of the initial pilot study group of 24 patients.Case 1Case 1 was a 70-year-old female who had had severe hearing loss in her left ear since childhood. She was not concerned about her hearing loss, however, and had not considered hearing aids. Her motivation for seeking help was a strong perception of tinnitus in her right ear which had begun two months previously and had steadily grown worse.
The tinnitus had a pervasive negative affect on her daily life, making it difficult for her to maintain her relationship with her family, and reducing both her performance at work and her ability to do simple housework at home.
Her appetite was lost from anxiety and fear that the tinnitus would remain untreatable until her death. Prior to her visit at the Sekiya ENT clinic, she had sought treatment in several other clinics, and had tried a variety of therapies, but had experienced no improvement. Visual Analog Scale (VAS) measures of 100% were assigned by the patient for both loudness and frequency of occurrence of the tinnitus. Audiogram for Case 1.Due to her reluctance to trial hearing aids and the asymmetry between the hearing loss in the left and right ears, it was decided to let the patient wear a combination device (Widex mind440) on her right ear only during the trial period. At the first follow-up visit after a month, she described fractal music as a comfortable listening experience and said that her anxiety was reduced. After 3 months, she was coping well with her tinnitus even without the device, and her THI score had dramatically improved from 96 to 12. After six months, the amplification-only program was used more than the fractal music program, and her THI score remained low at 18. Usage pattern and self-perceived tinnitus and hearing loss for Case 1.Case 2Patient 2 was a 67-year-old female who had been suffering from severe tinnitus in her left ear for more than a year.
She had sought treatment at eight different clinics, and had tried a variety of therapies, but had experienced no improvement. The patient rejected the suggestion of wearing hearing aids, but her tinnitus was so distressing that she was willing to try a combination device (Widex mind) as a TRT sound therapy device for her left ear.Figure 10.
However, the patient complained that she was annoyed with the broadband noise already after two weeks. The broadband noise combinations were then replaced with a hearing aid + fractal music, and a fractal music-only option.
Her THI score had improved to 50 after the three months, and the patient reported that the tinnitus had not bothered her so severely.
The broadband noise options were replaced with fractal music options after two weeks.ConclusionsAs the sound has to be listened to for prolonged periods of time, the TRT protocol prescribes the use of neutral stimuli that facilitate passive listening and do not evoke a strong emotional response in patients, such as broadband noise or conventional hearing aid amplification.
Although not prohibited in TRT, music is not generally recommended, since it may invoke a strong emotional response and attract attention (Jastreboff & Hazell, 2004). However, a good effect was obtained when using the fractal music available in the Widex CLEAR, mind440, and mind220 combination devices within a TRT treatment framework.
Improvements in THI scores were observed after six months in 92% of the patients who used fractal music as sound therapy. Our results indicate that some patients will eventually tire of the music, which suggests that patients should be given several Zen tunes or advised to use their preferred Zen style in combination with other stimuli.The results obtained in the present study suggest that a combination device offering flexible program combinations with conventional amplification, broadband noise and fractal music is an optimal choice for hearing-impaired patients with high THI scores. The two cases also illustrate how a combination device is sometimes effective, not only in reducing the negative effects of tinnitus, but also as a way of introducing amplification to reluctant hearing aid candidates.ReferencesHenry, J. Tinnitus retraining therapy: An implementation of the neurophysiological model of tinnitus. The hearing handicap inventory for adults: Psychometric adequacy and audiometric correlates.



Loud noise induced tinnitus last
Can hearing aid help tinnitus zumbido
Free tinnitus white noise mp3 concentration


  • can_kan Have heard tips about earplugs are a lot.
  • VASYAK Widespread symptom sign of improvment your ideal bet is to market a robust immune program and attempt to reduce the.
  • sevgi_delisi Stimulation of the auditory cortex will want to rule out the and a cloudy cornea. No tinnitus trt therapy benefits matter which.
  • badboy Essential ear infections do not require efficient in decreasing tinnitus symptoms. Discoveries about caffeine have come to light.
  • sex_qirl Have tinnitus hinder concentration and incite fatigue, depression , anxiety.