Perspectives of the ASHA Special Interest Groups, 2017
There is a growing area of research investigating the relationship between hearing impairment and... more There is a growing area of research investigating the relationship between hearing impairment and deprivation; However, this has not been investigated in New Zealand. This study used the Health Belief Model as a framework to investigate if men of high relative deprivation had barriers to seeking hearing services. Twelve participants were recruited and semi-structured interviews were conducted using the Hearing Beliefs Questionnaire. Overall, participants thought they were susceptible to hearing impairment and the impact of hearing impairment could be severe. All participants identified barriers to help-seeking for hearing services and amplification. Most participants believed that amplification would be beneficial, but only under certain conditions.
TINNITUS: the conscious awareness of sound, perceived in the ear/ears or head, lacking an externa... more TINNITUS: the conscious awareness of sound, perceived in the ear/ears or head, lacking an external, driving sound source or mechanical activation of the cochlea
BACKGROUND: Tinnitus is the conscious awareness of sound, perceived in the ears or head, without ... more BACKGROUND: Tinnitus is the conscious awareness of sound, perceived in the ears or head, without an external sound source (Lockwood et al., 1998; McFadden, 1982). Imaging studies have identified regional activation associated with tinnitus perception similar to areas implicated in attention, memory and emotion
Background: This study was conducted to investigate the short-term behavioral and neurophysiologi... more Background: This study was conducted to investigate the short-term behavioral and neurophysiological effects of MDMA (3,4-methylenedioxymethamphetamine) on tinnitus perception. Methods: A doubleblind randomized controlled cross-over design. Part 1. Behavioural measures of tinnitus following 30 mg MDMA or placebo administration (N=5 participants) and Part 2. Behavioral measures of tinnitus and correlations between pairs of apriori regions of interest (ROI) using resting-state functional magnetic resonance imaging (rs-fMRI) before and after 70 mg of MDMA or placebo (N=8 participants). Results: The results to MDMA were similar to placebo. For the 70 mg dose there was a significant reduction after 4 hours in annoyance and ignore ratings. RsMRI showed decreased connectivity compared to placebo administration between the left hippocampal, right hippocampal, left amygdala and right amygdala regions, and between the right posterior parahippocampal cortex and the left amygdala after two hours of 70 mg MDMA administration. Increased connectivity compared to placebo administration was found post MDMA between the right post-central gyrus and right posterior and superior temporal gyrus, and between the thalamus and frontoparietal network. Conclusions: Following 70 mg of MDMA two tinnitus rating scales significantly improved. There was, however, a placebo effect. Compared to placebo the rsMRI following the MDMA showed reductions in connectivity between the amygdala, hippocampus and parahippocampal gyrus. There is sufficient proof of concept to support future investigation of MDMA as a treatment for tinnitus.
Tinnitus, head and ear noise, is due to maladaptive plastic changes in auditory and associated ne... more Tinnitus, head and ear noise, is due to maladaptive plastic changes in auditory and associated neural networks. Tinnitus has been traditionally managed through the use of sound to passively mask or facilitate habituation to tinnitus, a process that may take 6-12 months. A game-based perceptual training method, requiring localization and selective attention to sounds, was developed and customized to the individual's tinnitus perception. Eight participants tested the games usability at home. Each participant successfully completed 30minutes of training, for 20 days, along with daily psychoacoustic assessment of tinnitus pitch and loudness. The training period and intensity of training appears sufficient to reduce tinnitus handicap. The training approach used may be a viable alternative to frequency discrimination based training for treating tinnitus (Hoare et al., 2014) and a useful tool in exploring learning mechanisms in the auditory system. Integration of tinnitus assessment wi...
We hypothesize that abnormal attention and auditory scene analysis contribute to the severity of ... more We hypothesize that abnormal attention and auditory scene analysis contribute to the severity of tinnitus and that the incongruence between tinnitus and normal auditory perception is responsible for its resistance to traditional sound-based habituation therapies. New methods of treatment using auditory and visual attention training are proposed as a means to augment counseling and sound therapies for tinnitus management. Attention training has been demonstrated to improve an individuals' ability to attend to relevant sounds while ignoring distracters. The main aim of the current study was to determine the effectiveness of structured Auditory Object Identification and Localization (AOIL) tasks to train persons to ignore their tinnitus. The study looked at the effects of a 15-day (30 min/day) take-home auditory training program on individuals with severe tinnitus. Pitch-matched tinnitus loudness levels (TLLs), tinnitus minimum masking levels (MMLs) and measures of attention were compared before and after the auditory training. The results of this study suggest that short-duration auditory training which actively engages attention, object identification and which requires a response from participants, reduces tinnitus. There was a greater effect on pitch-matched tinnitus MMLs than on actual TLLs. The reason(s) for this are unclear, although a correlation found between changes in MMLs and improvements in the ability to shift attention may be one underlying reason. Although this study followed a small number of participants over a limited time-span, it is believed that the training and accompanying model are a promising approach to investigate and treat some forms of tinnitus.
This pilot study aimed to investigate whether revising a hearing aid user guide (HAUG) is associa... more This pilot study aimed to investigate whether revising a hearing aid user guide (HAUG) is associated with improved hearing aid self-efficacy and utility performance. In Part 1, an HAUG was evaluated using the Suitability Assessment of Material (SAM) and readability formulas (Flesch Reading Ease [Flesch, 1943], Flesch-Kincaid Readability Formula [Kincaid, Fishburne, Rogers, & Chissom, 1957], and Simple Measure of Gobbledygook [McLaughlin, 1969]). The HAUG was revised using results from the SAM and best practice guidelines. The revision included generating a video. In Part 2, 30 adults with hearing impairment were randomly assigned to use either the original guide (N = 15) or the revised guide and video (N = 15) to perform a utility task. Participants' self-efficacy was measured using the Basic and Advanced Handling subscales of the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids questionnaire. SAM and readability were compared between the original and revised guides (Doak, Doak, & Root, 1996). SAM and readability were improved following the revision. Participants in the revised guide group performed significantly better on the utility task and on the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids subscales than participants in the original guide group. These results are encouraging as they indicate that there is scope to influence self-efficacy and utility performance through the use of appropriate HAUGs.
Aim: To assess the readability of online hearing-related information in Traditional Chinese. Meth... more Aim: To assess the readability of online hearing-related information in Traditional Chinese. Methods: Adult Mandarin speakers (N = 39) identified keywords in Traditional Chinese that were entered into google.com.tw (Google Taiwan) and google.com.hk (Google Hong Kong). Jing [1995. 中文國文教材的適讀性研究: 適讀年級的推估. 教育研究資訊, 3(3), 113-127] and CRIE 1.0 readability formulas were used to assess readability. Results: A total of 31 websites were assessed. The CRIE 1.0 and Jing formulas revealed different results. Using the Chinese Readability Index Explorer (CRIE) 1.0 formula, 25% of the websites had a reading grade level greater than 6. Using the Jing formula, 81% of the websites had a reading grade level greater than 6. When websites were analyzed according to organization type, there was no significant difference in reading grade level between the different type of organizations (commercial, non-profit, government). Conclusions: Readability of online hearing-related information in Traditional Chinese is higher than recommended levels when using the Jing formula, but not with the CRIE formula. An area of future research is to determine which formula is best suited for online health information.
Perspectives of the ASHA Special Interest Groups, Mar 31, 2016
A lack of evidence base presently exists, to validate the efficacy of mobile technology applicati... more A lack of evidence base presently exists, to validate the efficacy of mobile technology applications (apps) for tinnitus—highlighting a need for research. We reviewed tinnitus apps available via two popular smartphone operating systems: the Apple iOS and Google Android platforms. A March (2016) search using platforms available in the Austral-Asia region yielded over 260 tinnitus-related apps. Search parameters required apps to employ an English language format and feature the keyword “tinnitus” in the app name or description. Those apps retained for consideration (257) enabled 4 primary themes to emerge, featuring apps offering: (1) sound therapy approaches, (2) information, tips or assessment, (3) health promotion or alternative approaches, and (4) miscellaneous, non-therapeutic apps. Themes enabled further organization of related app characteristics into sub-groups. Numerous apps (44.3%) presented sound menus, ordered into a virtual library of presumably beneficial listening options. To place tinnitus apps in the context of current therapeutic considerations, an overview of the clinical presentation of tinnitus, and approaches aimed at mediating the perception of tinnitus and affective responses, precedes the review. We suggest future research addresses: the relative benefit(s) of one app over another, efficacy of tinnitus apps as a therapeutic option, long-term outcomes, and generalizability across populations.
Conclusions: Dizziness and/or imbalance in chronic TBI was associated with impaired postural stab... more Conclusions: Dizziness and/or imbalance in chronic TBI was associated with impaired postural stability for tasks requiring high levels of use of vestibular and Frontiers in Neurology frontiersin.org Taylor et al.. /fneur.. visual input for balance. Vestibular hypofunction identified through vHIT, VEMP and caloric testing was recorded but was less common, except when the injury involved a fractured skull-base. There was no specific pattern of end-organ or nerve involvement which characterized this group of patients.
Abnormal executive top-down control of attention may result in, or be a consequence of, tinnitus.... more Abnormal executive top-down control of attention may result in, or be a consequence of, tinnitus. On the basis of a study indicating the feasibility of a game designed to treat tinnitus, a Phase II controlled trial of an auditory attention training game was undertaken. Measures of tinnitus, as well as behavioral and electrophysiological measures of attention, were compared before and after 20 consecutive days of 30-minute training sessions using a game developed with LabVIEW™ software (National Instruments Corp., Austin, TX). Fifteen participants played an experimental attention training game ("Terrain"), and 16 participants played a control game ("Tetris") on their home computers. Clinically significant reductions in the primary measure, the Tinnitus Functional Index (TFI), were obtained for "Terrain." The secondary measures of Tinnitus Handicap Inventory and rating scales (ability to ignore and tinnitus annoyance) were significantly improved. The redu...
This pilot study aimed to investigate whether revising a hearing aid user guide (HAUG) is associa... more This pilot study aimed to investigate whether revising a hearing aid user guide (HAUG) is associated with improved hearing aid self-efficacy and utility performance. In Part 1, an HAUG was evaluated using the Suitability Assessment of Material (SAM) and readability formulas (Flesch Reading Ease [Flesch, 1943], Flesch-Kincaid Readability Formula [Kincaid, Fishburne, Rogers, & Chissom, 1957], and Simple Measure of Gobbledygook [McLaughlin, 1969]). The HAUG was revised using results from the SAM and best practice guidelines. The revision included generating a video. In Part 2, 30 adults with hearing impairment were randomly assigned to use either the original guide (N = 15) or the revised guide and video (N = 15) to perform a utility task. Participants' self-efficacy was measured using the Basic and Advanced Handling subscales of the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids questionnaire. SAM and readability were compared between the original and revised ...
Background. This proof-of-concept study investigated a method of multisensory perceptual training... more Background. This proof-of-concept study investigated a method of multisensory perceptual training for tinnitus, and whether a short, low-dose administration of fluoxetine enhanced training effects and changed neural connectivity. Methods. A double-blind, randomized placebo controlled design with 20 participants (17 male, 3 female, mean age = 57.1 years) involved 30 min daily computer-based, multisensory training (matching visual, auditory and tactile stimuli to perception of tinnitus) for 20 days, and random allocation to take 20 mg fluoxetine or placebo daily. Behavioral measures of tinnitus and correlations between pairs of a priori regions of interest (ROIs), obtained using resting-state functional magnetic resonance imaging (rs-fMRI), were performed before and after the training. Results. Significant changes in ratings of tinnitus loudness, annoyance, and problem were observed with training. No statistically significant changes in Tinnitus Functional Index, Tinnitus Handicap Inv...
A lack of evidence base presently exists, to validate the efficacy of mobile technology applicati... more A lack of evidence base presently exists, to validate the efficacy of mobile technology applications (apps) for tinnitus—highlighting a need for research. We reviewed tinnitus apps available via two popular smartphone operating systems: the Apple iOS and Google Android platforms. A March (2016) search using platforms available in the Austral-Asia region yielded over 260 tinnitus-related apps. Search parameters required apps to employ an English language format and feature the keyword " tinnitus " in the app name or description. Those apps retained for consideration (257) enabled 4 primary themes to emerge, featuring apps offering: (1) sound therapy approaches, (2) information, tips or assessment, (3) health promotion or alternative approaches, and (4) miscellaneous, non-therapeutic apps. Themes enabled further organization of related app characteristics into subgroups. Numerous apps (44.3%) presented sound menus, ordered into a virtual library of presumably beneficial listening options. To place tinnitus apps in the context of current therapeutic considerations, an overview of the clinical presentation of tinnitus, and approaches aimed at mediating the perception of tinnitus and affective responses, precedes the review. We suggest future research addresses: the relative benefit(s) of one app over another, efficacy of tinnitus apps as a therapeutic option, long-term outcomes, and generalizability across populations.
Objective: Abnormal executive top-down control of attention may result in, or be a consequence of... more Objective: Abnormal executive top-down control of attention may result in, or be a consequence of, tinnitus. On the basis of a study indicating the feasibility of a game designed to treat tinnitus, a Phase II controlled trial of an auditory attention training game was undertaken. Materials and Methods: Measures of tinnitus, as well as behavioral and electrophysiological measures of attention, were compared before and after 20 consecutive days of 30-minute training sessions using a game developed with LabVIEWÔ software (National Instruments Corp., Austin, TX). Fifteen participants played an experimental attention training game (''Terrain''), and 16 participants played a control game (''Tetris'') on their home computers. Results: Clinically significant reductions in the primary measure, the Tinnitus Functional Index (TFI), were obtained for ''Terrain.'' The secondary measures of Tinnitus Handicap Inventory and rating scales (ability to ignore and tinnitus annoyance) were significantly improved. The reductions in the TFI were correlated with improvements in a mixed auditory–visual task (Comprehensive Attention Battery Ò ; Neuropsych-Works, Inc., Greensboro, NC) and reduction in N1 auditory-evoked potential latency to stimuli remote from tinnitus pitch. Conclusions: The results suggest that the attention training game may have reduced focus on the tinnitus, potentially through improved selective attention. ''Terrain'' was superior to ''Tetris'' in the population tested and therefore shows promise as a management option for tinnitus. Further testing in a larger, more general, population would be enabled through improving the game's accessibility.
Abstract: We hypothesize that abnormal attention and auditory scene analysis contribute to the se... more Abstract: We hypothesize that abnormal attention and auditory scene analysis contribute to the severity of tinnitus and that the incongruence between tinnitus and normal auditory perception is responsible for its resistance to traditional sound-based habituation therapies. New methods of treatment using auditory and visual attention training are proposed as a means to augment counseling and sound therapies for tinnitus management. Attention training has been demonstrated to improve an individuals’ ability to attend to relevant sounds while ignoring distracters. The main aim of the current study was to determine the effectiveness of structured Auditory Object Identification and Localization (AOIL) tasks to train persons to ignore their tinnitus. The study looked at the effects of a 15-day (30 min/day) take-home auditory training program on individuals with severe tinnitus. Pitch-matched tinnitus loudness levels (TLLs), tinnitus minimum masking levels (MMLs) and measures of attention were compared before and after the auditory training. The results of this study suggest that short-duration auditory training which actively engages attention, object identification and which requires a response from participants, reduces tinnitus. There was a greater effect on pitch-matched tinnitus MMLs than on actual TLLs. The reason(s) for this are unclear, although a correlation found between changes in MMLs and improvements in the ability to shift attention may be one underlying reason. Although this study followed a small number of participants over a limited time-span, it is believed that the training and accompanying model are a promising approach to investigate and treat some forms of tinnitus.
Perspectives of the ASHA Special Interest Groups, 2017
There is a growing area of research investigating the relationship between hearing impairment and... more There is a growing area of research investigating the relationship between hearing impairment and deprivation; However, this has not been investigated in New Zealand. This study used the Health Belief Model as a framework to investigate if men of high relative deprivation had barriers to seeking hearing services. Twelve participants were recruited and semi-structured interviews were conducted using the Hearing Beliefs Questionnaire. Overall, participants thought they were susceptible to hearing impairment and the impact of hearing impairment could be severe. All participants identified barriers to help-seeking for hearing services and amplification. Most participants believed that amplification would be beneficial, but only under certain conditions.
TINNITUS: the conscious awareness of sound, perceived in the ear/ears or head, lacking an externa... more TINNITUS: the conscious awareness of sound, perceived in the ear/ears or head, lacking an external, driving sound source or mechanical activation of the cochlea
BACKGROUND: Tinnitus is the conscious awareness of sound, perceived in the ears or head, without ... more BACKGROUND: Tinnitus is the conscious awareness of sound, perceived in the ears or head, without an external sound source (Lockwood et al., 1998; McFadden, 1982). Imaging studies have identified regional activation associated with tinnitus perception similar to areas implicated in attention, memory and emotion
Background: This study was conducted to investigate the short-term behavioral and neurophysiologi... more Background: This study was conducted to investigate the short-term behavioral and neurophysiological effects of MDMA (3,4-methylenedioxymethamphetamine) on tinnitus perception. Methods: A doubleblind randomized controlled cross-over design. Part 1. Behavioural measures of tinnitus following 30 mg MDMA or placebo administration (N=5 participants) and Part 2. Behavioral measures of tinnitus and correlations between pairs of apriori regions of interest (ROI) using resting-state functional magnetic resonance imaging (rs-fMRI) before and after 70 mg of MDMA or placebo (N=8 participants). Results: The results to MDMA were similar to placebo. For the 70 mg dose there was a significant reduction after 4 hours in annoyance and ignore ratings. RsMRI showed decreased connectivity compared to placebo administration between the left hippocampal, right hippocampal, left amygdala and right amygdala regions, and between the right posterior parahippocampal cortex and the left amygdala after two hours of 70 mg MDMA administration. Increased connectivity compared to placebo administration was found post MDMA between the right post-central gyrus and right posterior and superior temporal gyrus, and between the thalamus and frontoparietal network. Conclusions: Following 70 mg of MDMA two tinnitus rating scales significantly improved. There was, however, a placebo effect. Compared to placebo the rsMRI following the MDMA showed reductions in connectivity between the amygdala, hippocampus and parahippocampal gyrus. There is sufficient proof of concept to support future investigation of MDMA as a treatment for tinnitus.
Tinnitus, head and ear noise, is due to maladaptive plastic changes in auditory and associated ne... more Tinnitus, head and ear noise, is due to maladaptive plastic changes in auditory and associated neural networks. Tinnitus has been traditionally managed through the use of sound to passively mask or facilitate habituation to tinnitus, a process that may take 6-12 months. A game-based perceptual training method, requiring localization and selective attention to sounds, was developed and customized to the individual's tinnitus perception. Eight participants tested the games usability at home. Each participant successfully completed 30minutes of training, for 20 days, along with daily psychoacoustic assessment of tinnitus pitch and loudness. The training period and intensity of training appears sufficient to reduce tinnitus handicap. The training approach used may be a viable alternative to frequency discrimination based training for treating tinnitus (Hoare et al., 2014) and a useful tool in exploring learning mechanisms in the auditory system. Integration of tinnitus assessment wi...
We hypothesize that abnormal attention and auditory scene analysis contribute to the severity of ... more We hypothesize that abnormal attention and auditory scene analysis contribute to the severity of tinnitus and that the incongruence between tinnitus and normal auditory perception is responsible for its resistance to traditional sound-based habituation therapies. New methods of treatment using auditory and visual attention training are proposed as a means to augment counseling and sound therapies for tinnitus management. Attention training has been demonstrated to improve an individuals' ability to attend to relevant sounds while ignoring distracters. The main aim of the current study was to determine the effectiveness of structured Auditory Object Identification and Localization (AOIL) tasks to train persons to ignore their tinnitus. The study looked at the effects of a 15-day (30 min/day) take-home auditory training program on individuals with severe tinnitus. Pitch-matched tinnitus loudness levels (TLLs), tinnitus minimum masking levels (MMLs) and measures of attention were compared before and after the auditory training. The results of this study suggest that short-duration auditory training which actively engages attention, object identification and which requires a response from participants, reduces tinnitus. There was a greater effect on pitch-matched tinnitus MMLs than on actual TLLs. The reason(s) for this are unclear, although a correlation found between changes in MMLs and improvements in the ability to shift attention may be one underlying reason. Although this study followed a small number of participants over a limited time-span, it is believed that the training and accompanying model are a promising approach to investigate and treat some forms of tinnitus.
This pilot study aimed to investigate whether revising a hearing aid user guide (HAUG) is associa... more This pilot study aimed to investigate whether revising a hearing aid user guide (HAUG) is associated with improved hearing aid self-efficacy and utility performance. In Part 1, an HAUG was evaluated using the Suitability Assessment of Material (SAM) and readability formulas (Flesch Reading Ease [Flesch, 1943], Flesch-Kincaid Readability Formula [Kincaid, Fishburne, Rogers, & Chissom, 1957], and Simple Measure of Gobbledygook [McLaughlin, 1969]). The HAUG was revised using results from the SAM and best practice guidelines. The revision included generating a video. In Part 2, 30 adults with hearing impairment were randomly assigned to use either the original guide (N = 15) or the revised guide and video (N = 15) to perform a utility task. Participants' self-efficacy was measured using the Basic and Advanced Handling subscales of the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids questionnaire. SAM and readability were compared between the original and revised guides (Doak, Doak, & Root, 1996). SAM and readability were improved following the revision. Participants in the revised guide group performed significantly better on the utility task and on the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids subscales than participants in the original guide group. These results are encouraging as they indicate that there is scope to influence self-efficacy and utility performance through the use of appropriate HAUGs.
Aim: To assess the readability of online hearing-related information in Traditional Chinese. Meth... more Aim: To assess the readability of online hearing-related information in Traditional Chinese. Methods: Adult Mandarin speakers (N = 39) identified keywords in Traditional Chinese that were entered into google.com.tw (Google Taiwan) and google.com.hk (Google Hong Kong). Jing [1995. 中文國文教材的適讀性研究: 適讀年級的推估. 教育研究資訊, 3(3), 113-127] and CRIE 1.0 readability formulas were used to assess readability. Results: A total of 31 websites were assessed. The CRIE 1.0 and Jing formulas revealed different results. Using the Chinese Readability Index Explorer (CRIE) 1.0 formula, 25% of the websites had a reading grade level greater than 6. Using the Jing formula, 81% of the websites had a reading grade level greater than 6. When websites were analyzed according to organization type, there was no significant difference in reading grade level between the different type of organizations (commercial, non-profit, government). Conclusions: Readability of online hearing-related information in Traditional Chinese is higher than recommended levels when using the Jing formula, but not with the CRIE formula. An area of future research is to determine which formula is best suited for online health information.
Perspectives of the ASHA Special Interest Groups, Mar 31, 2016
A lack of evidence base presently exists, to validate the efficacy of mobile technology applicati... more A lack of evidence base presently exists, to validate the efficacy of mobile technology applications (apps) for tinnitus—highlighting a need for research. We reviewed tinnitus apps available via two popular smartphone operating systems: the Apple iOS and Google Android platforms. A March (2016) search using platforms available in the Austral-Asia region yielded over 260 tinnitus-related apps. Search parameters required apps to employ an English language format and feature the keyword “tinnitus” in the app name or description. Those apps retained for consideration (257) enabled 4 primary themes to emerge, featuring apps offering: (1) sound therapy approaches, (2) information, tips or assessment, (3) health promotion or alternative approaches, and (4) miscellaneous, non-therapeutic apps. Themes enabled further organization of related app characteristics into sub-groups. Numerous apps (44.3%) presented sound menus, ordered into a virtual library of presumably beneficial listening options. To place tinnitus apps in the context of current therapeutic considerations, an overview of the clinical presentation of tinnitus, and approaches aimed at mediating the perception of tinnitus and affective responses, precedes the review. We suggest future research addresses: the relative benefit(s) of one app over another, efficacy of tinnitus apps as a therapeutic option, long-term outcomes, and generalizability across populations.
Conclusions: Dizziness and/or imbalance in chronic TBI was associated with impaired postural stab... more Conclusions: Dizziness and/or imbalance in chronic TBI was associated with impaired postural stability for tasks requiring high levels of use of vestibular and Frontiers in Neurology frontiersin.org Taylor et al.. /fneur.. visual input for balance. Vestibular hypofunction identified through vHIT, VEMP and caloric testing was recorded but was less common, except when the injury involved a fractured skull-base. There was no specific pattern of end-organ or nerve involvement which characterized this group of patients.
Abnormal executive top-down control of attention may result in, or be a consequence of, tinnitus.... more Abnormal executive top-down control of attention may result in, or be a consequence of, tinnitus. On the basis of a study indicating the feasibility of a game designed to treat tinnitus, a Phase II controlled trial of an auditory attention training game was undertaken. Measures of tinnitus, as well as behavioral and electrophysiological measures of attention, were compared before and after 20 consecutive days of 30-minute training sessions using a game developed with LabVIEW™ software (National Instruments Corp., Austin, TX). Fifteen participants played an experimental attention training game ("Terrain"), and 16 participants played a control game ("Tetris") on their home computers. Clinically significant reductions in the primary measure, the Tinnitus Functional Index (TFI), were obtained for "Terrain." The secondary measures of Tinnitus Handicap Inventory and rating scales (ability to ignore and tinnitus annoyance) were significantly improved. The redu...
This pilot study aimed to investigate whether revising a hearing aid user guide (HAUG) is associa... more This pilot study aimed to investigate whether revising a hearing aid user guide (HAUG) is associated with improved hearing aid self-efficacy and utility performance. In Part 1, an HAUG was evaluated using the Suitability Assessment of Material (SAM) and readability formulas (Flesch Reading Ease [Flesch, 1943], Flesch-Kincaid Readability Formula [Kincaid, Fishburne, Rogers, & Chissom, 1957], and Simple Measure of Gobbledygook [McLaughlin, 1969]). The HAUG was revised using results from the SAM and best practice guidelines. The revision included generating a video. In Part 2, 30 adults with hearing impairment were randomly assigned to use either the original guide (N = 15) or the revised guide and video (N = 15) to perform a utility task. Participants' self-efficacy was measured using the Basic and Advanced Handling subscales of the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids questionnaire. SAM and readability were compared between the original and revised ...
Background. This proof-of-concept study investigated a method of multisensory perceptual training... more Background. This proof-of-concept study investigated a method of multisensory perceptual training for tinnitus, and whether a short, low-dose administration of fluoxetine enhanced training effects and changed neural connectivity. Methods. A double-blind, randomized placebo controlled design with 20 participants (17 male, 3 female, mean age = 57.1 years) involved 30 min daily computer-based, multisensory training (matching visual, auditory and tactile stimuli to perception of tinnitus) for 20 days, and random allocation to take 20 mg fluoxetine or placebo daily. Behavioral measures of tinnitus and correlations between pairs of a priori regions of interest (ROIs), obtained using resting-state functional magnetic resonance imaging (rs-fMRI), were performed before and after the training. Results. Significant changes in ratings of tinnitus loudness, annoyance, and problem were observed with training. No statistically significant changes in Tinnitus Functional Index, Tinnitus Handicap Inv...
A lack of evidence base presently exists, to validate the efficacy of mobile technology applicati... more A lack of evidence base presently exists, to validate the efficacy of mobile technology applications (apps) for tinnitus—highlighting a need for research. We reviewed tinnitus apps available via two popular smartphone operating systems: the Apple iOS and Google Android platforms. A March (2016) search using platforms available in the Austral-Asia region yielded over 260 tinnitus-related apps. Search parameters required apps to employ an English language format and feature the keyword " tinnitus " in the app name or description. Those apps retained for consideration (257) enabled 4 primary themes to emerge, featuring apps offering: (1) sound therapy approaches, (2) information, tips or assessment, (3) health promotion or alternative approaches, and (4) miscellaneous, non-therapeutic apps. Themes enabled further organization of related app characteristics into subgroups. Numerous apps (44.3%) presented sound menus, ordered into a virtual library of presumably beneficial listening options. To place tinnitus apps in the context of current therapeutic considerations, an overview of the clinical presentation of tinnitus, and approaches aimed at mediating the perception of tinnitus and affective responses, precedes the review. We suggest future research addresses: the relative benefit(s) of one app over another, efficacy of tinnitus apps as a therapeutic option, long-term outcomes, and generalizability across populations.
Objective: Abnormal executive top-down control of attention may result in, or be a consequence of... more Objective: Abnormal executive top-down control of attention may result in, or be a consequence of, tinnitus. On the basis of a study indicating the feasibility of a game designed to treat tinnitus, a Phase II controlled trial of an auditory attention training game was undertaken. Materials and Methods: Measures of tinnitus, as well as behavioral and electrophysiological measures of attention, were compared before and after 20 consecutive days of 30-minute training sessions using a game developed with LabVIEWÔ software (National Instruments Corp., Austin, TX). Fifteen participants played an experimental attention training game (''Terrain''), and 16 participants played a control game (''Tetris'') on their home computers. Results: Clinically significant reductions in the primary measure, the Tinnitus Functional Index (TFI), were obtained for ''Terrain.'' The secondary measures of Tinnitus Handicap Inventory and rating scales (ability to ignore and tinnitus annoyance) were significantly improved. The reductions in the TFI were correlated with improvements in a mixed auditory–visual task (Comprehensive Attention Battery Ò ; Neuropsych-Works, Inc., Greensboro, NC) and reduction in N1 auditory-evoked potential latency to stimuli remote from tinnitus pitch. Conclusions: The results suggest that the attention training game may have reduced focus on the tinnitus, potentially through improved selective attention. ''Terrain'' was superior to ''Tetris'' in the population tested and therefore shows promise as a management option for tinnitus. Further testing in a larger, more general, population would be enabled through improving the game's accessibility.
Abstract: We hypothesize that abnormal attention and auditory scene analysis contribute to the se... more Abstract: We hypothesize that abnormal attention and auditory scene analysis contribute to the severity of tinnitus and that the incongruence between tinnitus and normal auditory perception is responsible for its resistance to traditional sound-based habituation therapies. New methods of treatment using auditory and visual attention training are proposed as a means to augment counseling and sound therapies for tinnitus management. Attention training has been demonstrated to improve an individuals’ ability to attend to relevant sounds while ignoring distracters. The main aim of the current study was to determine the effectiveness of structured Auditory Object Identification and Localization (AOIL) tasks to train persons to ignore their tinnitus. The study looked at the effects of a 15-day (30 min/day) take-home auditory training program on individuals with severe tinnitus. Pitch-matched tinnitus loudness levels (TLLs), tinnitus minimum masking levels (MMLs) and measures of attention were compared before and after the auditory training. The results of this study suggest that short-duration auditory training which actively engages attention, object identification and which requires a response from participants, reduces tinnitus. There was a greater effect on pitch-matched tinnitus MMLs than on actual TLLs. The reason(s) for this are unclear, although a correlation found between changes in MMLs and improvements in the ability to shift attention may be one underlying reason. Although this study followed a small number of participants over a limited time-span, it is believed that the training and accompanying model are a promising approach to investigate and treat some forms of tinnitus.
Tinnitus (the phantom perception of sound) often accompanies hearing loss. Two common methods for... more Tinnitus (the phantom perception of sound) often accompanies hearing loss. Two common methods for managing tinnitus are masking (Vernon and Meikle, 2000) and auditory habituation therapy (Jastreboff, 2000). Hearing aids are often used to amplify ambient sounds in these therapies. Digital hearing aids have recently become available that allow a great deal of flexibility in fitting hearing losses and potentially, managing tinnitus. This study is the first to compare the relative merits of two prescriptive procedures (DSL [i/o] and NAL-NL1) for tinnitus management. The study was undertaken to help determine whether one hearing aid setting is appropriate for both hearing loss and tinnitus management, or whether separate amplification strategies are required for each purpose. Changes in perception of tinnitus were determined in 15 subjects using visual analogue rating scales in conjunction with various hearing aid settings. The preferred setting for tinnitus management was also compared to those providing optimal speech discrimination using tests of audibility and speech quality. No statistically significant differences were seen in tinnitus and noise mixing point; the analogue rating scale scores for the prescriptive procedure used. However, DSL [i/o] with a low compression knee-point was found to result in the greatest reduction in tinnitus awareness in 80% (n = 12) of subjects. Although the preferred DSL [i/o] setting interfered most with tinnitus audibility, analogue rating scale scores for noise annoyance indicated DSL [i/o] caused statistically significant greater annoyance to environmental sound than NAL-NL1. No statistically significant differences were noted for analogue rating scale scores for speech quality and intelligibility, prescriptive procedure used or knee-point. This suggests that either NAL-NL1 or DSL [i/o] prescriptions are suitable for maintaining speech quality and intelligibility. However, using the Speech in Noise (SIN) test, it was determined that the NAL-NL1 prescriptive procedure resulted in higher word recognition scores than the prescriptive procedure that interfered most with tinnitus, indicating that a prescription optimised to reduce tinnitus awareness resulted in poorer ability to hear speech in noise. It is suggested that tinnitus therapy using amplification may best be achieved through the use of a multi-programmable aid. One program should be optimised for communication and a separate one should be optimised for tinnitus reduction. A prescriptive procedure, tailored for management of tinnitus through amplification of ambient noise, should be investigated further. Modern digital signal processing instruments allow for a range of combinations of hearing aid settings, the ramifications of such processing for tinnitus management, should be explored.
BACKGROUND: Tinnitus is the conscious awareness of sound, perceived in the ears or head, without ... more BACKGROUND: Tinnitus is the conscious awareness of sound, perceived in the ears or head, without an external sound source (Lockwood et al., 1998; McFadden, 1982). Imaging studies have identified regional activation associated with tinnitus perception similar to areas implicated in attention, memory and emotion (Golm, Schmidt-Samoa, Dechent, & Kröner-Herwig, 2012; Mirz et al., 1999; Mühlau et al., 2006; Vanneste et al., 2010). The importance of attention and memory in tinnitus has not been well-researched but studies suggest attention may play a role in tinnitus’ salience sustaining its presence, promoting annoyance or tinnitus-related disability (Alpini, Cesarani, & Hahn, 2007; Cuny, Noreña, El Massioui, & Chéry-Croze, 2004; Hallam, McKenna, & Shurlock, 2004; Jacobson et al., 1996). Studies described in this thesis (3 pilot studies [A, B and C] and 1 main study) describe the development of an attention-based training method to manage tinnitus. AIMS: Pilot A: determine any potential procedural learning-related effects occurring from repeated administration of an attention battery (CAB®). Pilot B: determine if an available attention training approach (APT-II) was adaptable to a client-centred approach consistent with a pervasive healthcare model. Pilot C: test the feasibility and efficacy of a take-home computerised attention training programme “Terrain” for tinnitus treatment. Main study: determine if the “Terrain” a computer-based auditory attention training game, would reduce tinnitus perception and if any changes were related to attention mechanisms. METHODS: Different participants were recruited into each study: Pilot A (7 tinnitus participants, 16 control participants); Pilot B (9 tinnitus participants); Pilot C (8 tinnitus participants) and 1 main study (15 in an experimental group, 16 in a control group). Each study used a combination of questionnaires (e.g. Tinnitus Functional Index, Tinnitus Handicap Inventory and numeric scales) and psychoacoustic assessments (e.g. MMLs and tinnitus pitch-match). The main study also incorporated auditory event-related potentials. RESULTS: Pilot A: repeated administration of the (CAB®) resulted a significant increase in correct responses (p=0.011) for tinnitus participants and controls (p=0.009). Pilot B: APT-II was an effective approach for tinnitus management with a significant decrease in THI (p=0.050) but it was concluded that APT-II had practical limitations for use in a pervasive healthcare model. Pilot C: “Terrain” was effective in reducing tinnitus with a significant reduction in THI (p=0.015). Main study: significant reductions in TFI (15 points) and THI (9 points) were associated with significant improvements in attention (p<0.001) for “Terrain” compared to a iii control group (Tetris) TFI (6 points); THI (1 point). The “Terrain” training also resulted in significant reduction in numeric scales (ability to ignore tinnitus (p<0.001); annoyance (p<0.001)). Changes observed in (CAB®) (p<0.001) and ERPs (p<0.001) suggest that the reduction in tinnitus was related to changes in selective attention. CONCLUSIONS: A game-based attention training method shows promise as an attention management option, and such a method suits implementation in a pervasive healthcare model (Arnrich, Mayora, Bardram, & Tröster, 2010), enabling widespread access to tinnitus treatment when and where required by the patient.
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Papers by KJ Wise
tinnitus and that the incongruence between tinnitus and normal auditory perception is responsible for its
resistance to traditional sound-based habituation therapies. New methods of treatment using auditory and
visual attention training are proposed as a means to augment counseling and sound therapies for tinnitus
management. Attention training has been demonstrated to improve an individuals’ ability to attend to
relevant sounds while ignoring distracters. The main aim of the current study was to determine the effectiveness
of structured Auditory Object Identification and Localization (AOIL) tasks to train persons to
ignore their tinnitus. The study looked at the effects of a 15-day (30 min/day) take-home auditory training
program on individuals with severe tinnitus. Pitch-matched tinnitus loudness levels (TLLs), tinnitus minimum
masking levels (MMLs) and measures of attention were compared before and after the auditory
training. The results of this study suggest that short-duration auditory training which actively engages
attention, object identification and which requires a response from participants, reduces tinnitus. There was
a greater effect on pitch-matched tinnitus MMLs than on actual TLLs. The reason(s) for this are unclear,
although a correlation found between changes in MMLs and improvements in the ability to shift attention
may be one underlying reason. Although this study followed a small number of participants over a limited
time-span, it is believed that the training and accompanying model are a promising approach to investigate
and treat some forms of tinnitus.
tinnitus and that the incongruence between tinnitus and normal auditory perception is responsible for its
resistance to traditional sound-based habituation therapies. New methods of treatment using auditory and
visual attention training are proposed as a means to augment counseling and sound therapies for tinnitus
management. Attention training has been demonstrated to improve an individuals’ ability to attend to
relevant sounds while ignoring distracters. The main aim of the current study was to determine the effectiveness
of structured Auditory Object Identification and Localization (AOIL) tasks to train persons to
ignore their tinnitus. The study looked at the effects of a 15-day (30 min/day) take-home auditory training
program on individuals with severe tinnitus. Pitch-matched tinnitus loudness levels (TLLs), tinnitus minimum
masking levels (MMLs) and measures of attention were compared before and after the auditory
training. The results of this study suggest that short-duration auditory training which actively engages
attention, object identification and which requires a response from participants, reduces tinnitus. There was
a greater effect on pitch-matched tinnitus MMLs than on actual TLLs. The reason(s) for this are unclear,
although a correlation found between changes in MMLs and improvements in the ability to shift attention
may be one underlying reason. Although this study followed a small number of participants over a limited
time-span, it is believed that the training and accompanying model are a promising approach to investigate
and treat some forms of tinnitus.
It is suggested that tinnitus therapy using amplification may best be achieved through the use of a multi-programmable aid. One program should be optimised for communication and a separate one should be optimised for tinnitus reduction. A prescriptive procedure, tailored for management of tinnitus through amplification of ambient noise, should be investigated further. Modern digital signal processing instruments allow for a range of combinations of hearing aid settings, the ramifications of such processing for tinnitus management, should be explored.
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control group (Tetris) TFI (6 points); THI (1 point). The “Terrain” training also resulted in significant reduction in numeric scales (ability to ignore tinnitus (p<0.001); annoyance (p<0.001)). Changes observed in (CAB®) (p<0.001) and ERPs (p<0.001) suggest that the reduction in tinnitus was related to changes in selective attention. CONCLUSIONS: A game-based attention training method shows promise as an attention management option, and such a method suits implementation in a pervasive healthcare model (Arnrich, Mayora, Bardram, & Tröster, 2010), enabling widespread access to tinnitus treatment when and where required by the patient.