Subjective tinnitus is a highly prevalent sound sensation produced in most cases by persistent ne... more Subjective tinnitus is a highly prevalent sound sensation produced in most cases by persistent neural activity in the auditory pathway of the patient. Audiologists should be confident that they can employ elements of sound therapy and related counseling to support patients in coping. However, patients with bothersome tinnitus may be challenged by mental health complications, and they struggle to find adequate care when tinnitus and psychological distress co-occur. Audiologists in many cases lack the confidence to provide in-depth counseling while mental health providers lack basic understanding of tinnitus, its mechanisms, and the elements of audiologic management that could support patients in coping. At the very least, audiologists should be able to explain the mechanisms involved in and contributing to negative tinnitus effects, conduct valid measures of these effects, and offer reasonable options for managing the consequences linked by the patient to bothersome tinnitus and soun...
Purpose An Internet-based tinnitus intervention for use in the United States could improve the pr... more Purpose An Internet-based tinnitus intervention for use in the United States could improve the provision of tinnitus-related services. Although clinical trials of such interventions were completed in Europe, the United Kingdom, and Australia, their suitability for adults with tinnitus in the United States is yet to be established. The aim of this study was to improve the cultural and linguistic suitability, and lower the readability level, of an existing program for tinnitus to ensure its suitability for U.S. English- and Spanish-speaking populations. Method Guidelines for adaptation were followed and involved four phases: (a) cultural adaptations, as interventions targeted at specific cultures have been shown to improve outcomes; (b) creating Spanish materials to improve access of the materials to the large Spanish-speaking population in the United States; (c) professional review of the materials for acceptability as an intervention tool for a U.S. population; and (d) literacy-leve...
... Fostering a Community of Scholars in a Graduate Program. ... This modification provided the o... more ... Fostering a Community of Scholars in a Graduate Program. ... This modification provided the opportunity to include all faculty members (academic and clinical) in the department, as well asdoctoral-level professionals who received full-time (non-tenure-track) appointments from a ...
Tinnitus has the potential to influence a wide range of routine and important activities in a per... more Tinnitus has the potential to influence a wide range of routine and important activities in a person's life. It can impair sleep, communication, concentration, and in severe cases can be affected by depression, anxiety, and other mental health issues. Perhaps more important, tinnitus may influence the patient's psychological state; its bidirectional effects, although well established, often challenge patients and providers across a variety of clinical settings. Management of tinnitus requires audiologists to be adept at communicating and supporting coping strategies that may include, but should not be limited to, patient-centered counseling and delivery of sound therapy or hearing aids. In the short term, patient care may benefit from interprofessional collaborations and effective referral networks. In the long term, the inclusion of tinnitus clinic rotations, classes, and interprofessional opportunities for students in Audiology programs should provide AuD students the expe...
Individuals with tinnitus and co-occurring psychological conditions typically rate their tinnitus... more Individuals with tinnitus and co-occurring psychological conditions typically rate their tinnitus as more disturbing than individuals without such comorbidities. Little is known about how tinnitus self-efficacy, or the confidence that individuals have in their abilities to successfully manage the effects of tinnitus, is influenced by mental or psychological health (PH) status. The purpose of this study was to examine the influence of psychological state on tinnitus perceptions and tinnitus self-efficacy in individuals with chronic tinnitus. Observational study. Three groups (N = 199) were examined and included: (1) those with tinnitus without a concurrent psychological condition (tinnitus-only; n = 103), (2) those with tinnitus and concurrent PH condition other than post-traumatic stress disorder (PTSD; tinnitus + PH; n = 34), and (3) those with tinnitus and PTSD (tinnitus + PTSD; n = 62). The Self-Efficacy for Tinnitus Management Questionnaire (SETMQ) was administered. Responses on the SETMQ were compared among the groups, as well as to other indicators of tinnitus perception such as (1) the percentage of time tinnitus was audible (tinnitus awareness), (2) the percentage of time tinnitus was distressing/bothersome, (3) tinnitus loudness, (4) tinnitus handicap inventory scores, (5) subjective ratings of degree of hearing loss, and (6) subjective ratings of sound tolerance problems. The tinnitus + PTSD group reported significantly poorer tinnitus self-efficacy levels on average than the tinnitus-only group on all SETMQ subscales and poorer self-efficacy levels than the tinnitus + PH group for most subscales (except for routine management and devices). Tinnitus self-efficacy levels were similar between the tinnitus + PH and tinnitus-only groups except for the emotional response subscale in which the tinnitus-only patients reported higher self-efficacy on average than both the other groups. Group differences were not seen for tinnitus loudness ratings nor for the amount of time individuals were aware of their tinnitus. Group differences were observed for the percentage of time tinnitus was distressing/bothersome, self-reported degree of hearing loss, sound tolerance problems ratings, and responses on the tinnitus handicap inventory (THI). In general, the group differences revealed patient ratings for the tinnitus-only group were least severe, followed by the tinnitus + PH group, and the tinnitus + PTSD group rated tinnitus effects as most severe. With all patient responses, the tinnitus + PTSD group was found to be significantly more affected by tinnitus than the tinnitus-only group; in some cases, the responses were similar between the tinnitus + PTSD and tinnitus + PH group and in other cases, responses were similar between the tinnitus + PH group and the tinnitus-only group. Tinnitus self-efficacy, along with other self-assessed tinnitus characteristics, varied across groups distinguished by PH diagnoses. In general, individuals with tinnitus and concurrent PTSD reported significantly poorer tinnitus self-efficacy and more handicapping tinnitus effects when compared to individuals with other psychological conditions or those with tinnitus alone. The group differences highlighted the need to consider tinnitus self-efficacy in intervention strategies, particularly for patients with tinnitus and concurrent PTSD as the results reiterated the unique ability of PTSD to interact in powerful and disturbing ways with the tinnitus experience and with patients' coping ability.
T he sensory mislabelling of environ-mental events is one of the more pronounced disruptions asso... more T he sensory mislabelling of environ-mental events is one of the more pronounced disruptions associ-ated with posttraumatic stress disorder (PTSD) [1]. Mislabelling, in this context, results from an erroneous or exaggerated neural representation of a sound, sight, tactile sensation, or smell producing a perception that does not correspond accu-rately to the magnitude of the related stim-ulus. The exaggerated perception may trigger in the patient with PTSD a state of hyperarousal that produces profound negative reactions and ultimately contributes to avoidance behaviours. The resulting sensations of pain and anguish experienced by the affected individual may upset their most valued relationships, drive family members apart, and produce in the sufferer a sense of despair or self-loathing. In order to facilitate a patient's ability to manage hyperacusic responses, and to understand the physiologic mechanisms of sensory mislabelling, it is essential for clini-cians to address the co...
Sound pressure levels (SPLs) were measured in the external auditory canals (EACs) of 16 subjects ... more Sound pressure levels (SPLs) were measured in the external auditory canals (EACs) of 16 subjects with normal hearing and normal middle ear immittance. SPLs were the result of bone-conduction (BC) stimulation at 500, 1000, 2000, and 4000 Hz, with the oscillator placed either on the forehead or on the mastoid process. At 1000, 2000, and 4000 Hz, significantly higher SPLs were measured when the head was stimulated from the mastoid than from the forehead. When SPLs were compared between right and left EACs, forehead placement of the oscillator produced no interaural differences, while mastoid placement resulted in significantly greater EAC SPLs ipsilateral to the oscillator at 2000 and 4000 Hz. We conclude that forehead placement of a BC vibrator may help to lessen the (unwanted) contribution of the EAC to measurements of hearing sensitivity by BC.
Tinnitus continues to challenge patients from all walks of life and clinicians from a variety of ... more Tinnitus continues to challenge patients from all walks of life and clinicians from a variety of disciplines. The lack of an evidence base to support a specific treatment confounds efforts to provide consistent benefit to patients and in many instances creates in the patient the impression that nothing can be done to improve their situation. Part of the problem is that although patients rarely experience complete elimination of a tinnitus signal, they often experience relief when receiving effective counseling, specific coping strategies, and sound therapy. Although in most clinical activities the tinnitus remains (i.e., it is not cured), its influence may wane as the patient learns to manage their environment, activities, and ultimately their response to tinnitus. At the same time, several medical interventions target reduction of the tinnitus sound, an approach more consistent with what patients expect as a cure. Therefore, the majority of clinical activity directed at care for patients with tinnitus typically targets either elimination of the tinnitus sound (tinnitus treatment) or modification of the patient's response to the sound (tinnitus management). This review distinguishes and offers examples of both treatment and management programs employed clinically for patients with tinnitus.
The Journal of the Acoustical Society of America, 1994
Spectral moments vs discrete cosine transformation coefficients: Evaluation of acoustic measures ... more Spectral moments vs discrete cosine transformation coefficients: Evaluation of acoustic measures distinguishing two merging German fricatives
The Journal of the Acoustical Society of America, 1993
... of Washington, Seattle, WA 98195) and James W. Pitton (Univ. of Washington, Seattle, WA 98195... more ... of Washington, Seattle, WA 98195) and James W. Pitton (Univ. of Washington, Seattle, WA 98195) Previously it has been shown [eg, Keefe et al., J. Acoust. Soc. Am. Suppl. 1 88, S 17 (1990)] that in ears with multiple spontaneous otoa-coustic emissions (SOAEs) there are often ...
Subjective tinnitus is a highly prevalent sound sensation produced in most cases by persistent ne... more Subjective tinnitus is a highly prevalent sound sensation produced in most cases by persistent neural activity in the auditory pathway of the patient. Audiologists should be confident that they can employ elements of sound therapy and related counseling to support patients in coping. However, patients with bothersome tinnitus may be challenged by mental health complications, and they struggle to find adequate care when tinnitus and psychological distress co-occur. Audiologists in many cases lack the confidence to provide in-depth counseling while mental health providers lack basic understanding of tinnitus, its mechanisms, and the elements of audiologic management that could support patients in coping. At the very least, audiologists should be able to explain the mechanisms involved in and contributing to negative tinnitus effects, conduct valid measures of these effects, and offer reasonable options for managing the consequences linked by the patient to bothersome tinnitus and soun...
Purpose An Internet-based tinnitus intervention for use in the United States could improve the pr... more Purpose An Internet-based tinnitus intervention for use in the United States could improve the provision of tinnitus-related services. Although clinical trials of such interventions were completed in Europe, the United Kingdom, and Australia, their suitability for adults with tinnitus in the United States is yet to be established. The aim of this study was to improve the cultural and linguistic suitability, and lower the readability level, of an existing program for tinnitus to ensure its suitability for U.S. English- and Spanish-speaking populations. Method Guidelines for adaptation were followed and involved four phases: (a) cultural adaptations, as interventions targeted at specific cultures have been shown to improve outcomes; (b) creating Spanish materials to improve access of the materials to the large Spanish-speaking population in the United States; (c) professional review of the materials for acceptability as an intervention tool for a U.S. population; and (d) literacy-leve...
... Fostering a Community of Scholars in a Graduate Program. ... This modification provided the o... more ... Fostering a Community of Scholars in a Graduate Program. ... This modification provided the opportunity to include all faculty members (academic and clinical) in the department, as well asdoctoral-level professionals who received full-time (non-tenure-track) appointments from a ...
Tinnitus has the potential to influence a wide range of routine and important activities in a per... more Tinnitus has the potential to influence a wide range of routine and important activities in a person's life. It can impair sleep, communication, concentration, and in severe cases can be affected by depression, anxiety, and other mental health issues. Perhaps more important, tinnitus may influence the patient's psychological state; its bidirectional effects, although well established, often challenge patients and providers across a variety of clinical settings. Management of tinnitus requires audiologists to be adept at communicating and supporting coping strategies that may include, but should not be limited to, patient-centered counseling and delivery of sound therapy or hearing aids. In the short term, patient care may benefit from interprofessional collaborations and effective referral networks. In the long term, the inclusion of tinnitus clinic rotations, classes, and interprofessional opportunities for students in Audiology programs should provide AuD students the expe...
Individuals with tinnitus and co-occurring psychological conditions typically rate their tinnitus... more Individuals with tinnitus and co-occurring psychological conditions typically rate their tinnitus as more disturbing than individuals without such comorbidities. Little is known about how tinnitus self-efficacy, or the confidence that individuals have in their abilities to successfully manage the effects of tinnitus, is influenced by mental or psychological health (PH) status. The purpose of this study was to examine the influence of psychological state on tinnitus perceptions and tinnitus self-efficacy in individuals with chronic tinnitus. Observational study. Three groups (N = 199) were examined and included: (1) those with tinnitus without a concurrent psychological condition (tinnitus-only; n = 103), (2) those with tinnitus and concurrent PH condition other than post-traumatic stress disorder (PTSD; tinnitus + PH; n = 34), and (3) those with tinnitus and PTSD (tinnitus + PTSD; n = 62). The Self-Efficacy for Tinnitus Management Questionnaire (SETMQ) was administered. Responses on the SETMQ were compared among the groups, as well as to other indicators of tinnitus perception such as (1) the percentage of time tinnitus was audible (tinnitus awareness), (2) the percentage of time tinnitus was distressing/bothersome, (3) tinnitus loudness, (4) tinnitus handicap inventory scores, (5) subjective ratings of degree of hearing loss, and (6) subjective ratings of sound tolerance problems. The tinnitus + PTSD group reported significantly poorer tinnitus self-efficacy levels on average than the tinnitus-only group on all SETMQ subscales and poorer self-efficacy levels than the tinnitus + PH group for most subscales (except for routine management and devices). Tinnitus self-efficacy levels were similar between the tinnitus + PH and tinnitus-only groups except for the emotional response subscale in which the tinnitus-only patients reported higher self-efficacy on average than both the other groups. Group differences were not seen for tinnitus loudness ratings nor for the amount of time individuals were aware of their tinnitus. Group differences were observed for the percentage of time tinnitus was distressing/bothersome, self-reported degree of hearing loss, sound tolerance problems ratings, and responses on the tinnitus handicap inventory (THI). In general, the group differences revealed patient ratings for the tinnitus-only group were least severe, followed by the tinnitus + PH group, and the tinnitus + PTSD group rated tinnitus effects as most severe. With all patient responses, the tinnitus + PTSD group was found to be significantly more affected by tinnitus than the tinnitus-only group; in some cases, the responses were similar between the tinnitus + PTSD and tinnitus + PH group and in other cases, responses were similar between the tinnitus + PH group and the tinnitus-only group. Tinnitus self-efficacy, along with other self-assessed tinnitus characteristics, varied across groups distinguished by PH diagnoses. In general, individuals with tinnitus and concurrent PTSD reported significantly poorer tinnitus self-efficacy and more handicapping tinnitus effects when compared to individuals with other psychological conditions or those with tinnitus alone. The group differences highlighted the need to consider tinnitus self-efficacy in intervention strategies, particularly for patients with tinnitus and concurrent PTSD as the results reiterated the unique ability of PTSD to interact in powerful and disturbing ways with the tinnitus experience and with patients' coping ability.
T he sensory mislabelling of environ-mental events is one of the more pronounced disruptions asso... more T he sensory mislabelling of environ-mental events is one of the more pronounced disruptions associ-ated with posttraumatic stress disorder (PTSD) [1]. Mislabelling, in this context, results from an erroneous or exaggerated neural representation of a sound, sight, tactile sensation, or smell producing a perception that does not correspond accu-rately to the magnitude of the related stim-ulus. The exaggerated perception may trigger in the patient with PTSD a state of hyperarousal that produces profound negative reactions and ultimately contributes to avoidance behaviours. The resulting sensations of pain and anguish experienced by the affected individual may upset their most valued relationships, drive family members apart, and produce in the sufferer a sense of despair or self-loathing. In order to facilitate a patient's ability to manage hyperacusic responses, and to understand the physiologic mechanisms of sensory mislabelling, it is essential for clini-cians to address the co...
Sound pressure levels (SPLs) were measured in the external auditory canals (EACs) of 16 subjects ... more Sound pressure levels (SPLs) were measured in the external auditory canals (EACs) of 16 subjects with normal hearing and normal middle ear immittance. SPLs were the result of bone-conduction (BC) stimulation at 500, 1000, 2000, and 4000 Hz, with the oscillator placed either on the forehead or on the mastoid process. At 1000, 2000, and 4000 Hz, significantly higher SPLs were measured when the head was stimulated from the mastoid than from the forehead. When SPLs were compared between right and left EACs, forehead placement of the oscillator produced no interaural differences, while mastoid placement resulted in significantly greater EAC SPLs ipsilateral to the oscillator at 2000 and 4000 Hz. We conclude that forehead placement of a BC vibrator may help to lessen the (unwanted) contribution of the EAC to measurements of hearing sensitivity by BC.
Tinnitus continues to challenge patients from all walks of life and clinicians from a variety of ... more Tinnitus continues to challenge patients from all walks of life and clinicians from a variety of disciplines. The lack of an evidence base to support a specific treatment confounds efforts to provide consistent benefit to patients and in many instances creates in the patient the impression that nothing can be done to improve their situation. Part of the problem is that although patients rarely experience complete elimination of a tinnitus signal, they often experience relief when receiving effective counseling, specific coping strategies, and sound therapy. Although in most clinical activities the tinnitus remains (i.e., it is not cured), its influence may wane as the patient learns to manage their environment, activities, and ultimately their response to tinnitus. At the same time, several medical interventions target reduction of the tinnitus sound, an approach more consistent with what patients expect as a cure. Therefore, the majority of clinical activity directed at care for patients with tinnitus typically targets either elimination of the tinnitus sound (tinnitus treatment) or modification of the patient's response to the sound (tinnitus management). This review distinguishes and offers examples of both treatment and management programs employed clinically for patients with tinnitus.
The Journal of the Acoustical Society of America, 1994
Spectral moments vs discrete cosine transformation coefficients: Evaluation of acoustic measures ... more Spectral moments vs discrete cosine transformation coefficients: Evaluation of acoustic measures distinguishing two merging German fricatives
The Journal of the Acoustical Society of America, 1993
... of Washington, Seattle, WA 98195) and James W. Pitton (Univ. of Washington, Seattle, WA 98195... more ... of Washington, Seattle, WA 98195) and James W. Pitton (Univ. of Washington, Seattle, WA 98195) Previously it has been shown [eg, Keefe et al., J. Acoust. Soc. Am. Suppl. 1 88, S 17 (1990)] that in ears with multiple spontaneous otoa-coustic emissions (SOAEs) there are often ...
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