Prescription of hearing-aid output for tinnitus relief

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.

2018

Background and Aim: Using hearing aids is one of the most important management methods for patients with hearing loss and tinnitus. Many studies have been conducted to assess the effect of hearing aids on tinnitus using different tools, but there is no consensus on their usefulness and effect in relieving tinnitus. The present study aimed to investigate the effect of hearing amplification on tinnitus using the tinnitus handicap inventory (THI) and tinnitus psychoacoustic measurements. Methods: A total of 10 patients (5 male and 5 female), aged 39 to 70 years old with mild to severe sensorineural hearing loss (amplifiable hearing loss) and chronic tinnitus entered the study. The Persian version of the THI was completed for the patients and tinnitus psychoa-coustic measurements, the visual analogue scale (VAS) loudness, and the annoyance VAS were performed. The patients used hearing aids for six weeks, and measurements were repeated after the intervention. Results: Comparing the total mean score of all of the study variables before and after the intervention showed significant reductions (p<0.05). Based on tinnitus pitch matching, no significant difference was observed in mean

Trends in Hearing, 2014

Hearing aids with an integrated sound generator have been used to enhance the treatment of tinnitus. The main aim of this study was to verify whether the combined use of amplification and sound generator is more effective than conventional amplification alone in reducing tinnitus annoyance by means of the use of a new hearing aid with an integrated sound generator. A total of 49 patients underwent a blind randomized clinical trial. Tinnitus annoyance was measured by Tinnitus Handicap Inventory and numerical scales, and psychoacoustic measures of tinnitus were also performed. The sound generator was set at the lowest intensity capable of providing relief from tinnitus. Results showed that 62.5% of the patients presented a reduction in tinnitus annoyance in the combined fitting group and in the group with amplification alone, 78% showed a reduction. This difference between the groups was not statistically significant.

International Journal of Audiology, 2012

Objective: To assess the benefi ts of hearing aids on tinnitus according to the tinnitus reaction questionnaire (TRQ;, to verify whether the degree of masking provided by the hearing aid infl uenced the TRQ score, to examine whether the matched tinnitus pitch predicted the effectiveness of hearing aids in masking tinnitus, and to determine whether prescription of high-frequency amplifi cation might be desirable in tinnitus management when tinnitus pitch is high. Design and study sample: A retrospective evaluation of the clinical outcomes of 70 tinnitus patients fi tted with hearing aids was undertaken. The primary outcome measure was the TRQ, with a secondary subjective measure of tinnitus masking. Results: Participants who achieved masking with their hearing aids had greater reduction in TRQ scores. Masking was more likely to be achieved when participants had good low-frequency hearing and tinnitus pitch fell into the frequency range of the hearing aids. Conclusions: The results support the use of hearing aids for tinnitus management, and suggest that masking may be a signifi cant contributor to hearing aid success, implying that high-frequency amplifi cation may be effective in high-pitch tinnitus.

The Egyptian Journal of Otolaryngology, 2018

Background Evidence of systematic relationships between the perceptual characteristics of tinnitus, like its pitch or loudness, and those of the absolute hearing threshold curves, like the presence and degree of hearing loss at certain frequencies, would probably help to understand how tinnitus is related to the configuration of hearing loss. Objective The objective of this study was to determine the effects of hearing aid fitting on the perceptual characteristics of tinnitus. Participants and methods The participants of the study were 50 adults (20-60 years old) with subjective tinnitus and different degrees of hearing loss. Otorhinolaryngological examination, tonal audiometry, and acoustic immittance testing were done. Participants answered Tinnitus Handicap Inventory (THI) Questionnaire at the time of the first fitting with their hearing aid and performed at 0, 3, 6, and 12 months postfitting. Results THI showed a significant decrease throughout the 12 months from 74.80±15.98 at baseline to 61.84±14.02 3 months later, then 38.35±10.98 by the sixth month and 12.90±4.26 by the end of 12 months. At the baseline, no slight or mild cases were detected, whereas moderate THI represented 16%, severe 28%, and catastrophic 56%. These rates changed 3 months later as catastrophic cases decreased almost to one-third of its rate at the baseline. By the sixth month, no catastrophic cases were detected and severe stages recorded trivial rates, whereas most of cases were categorized as mild or moderate. By the end of the study, the great majority of cases were slight (81.6%) and the remaining portion was mild, with no moderate, severe, or catastrophic cases recorded. Conclusion Analysis of the results has shown that the use of hearing aids are one of the number of therapeutic options offered to tinnitus patients and promote the improvement in the perceptual characteristics of tinnitus.

Hearing Research, 2010

Acoustic stimulation with hearing aids or noise devices is frequently used in tinnitus therapy. However, such behind-the-ear devices are limited in their high-frequency output with an upper cut-off frequency of approximately 5e6 kHz. Theoretical modeling suggests that acoustic stimulation treatments with these devices might be most effective when the tinnitus pitch is within the stimulated frequency range. To test this hypothesis, we conducted a pilot study with 15 subjects with chronic tinnitus. Eleven subjects received hearing aids and four subjects noise devices. Perceived tinnitus loudness was measured using a visual analog scale, and tinnitus-related distress was assessed using the Tinnitus Questionnaire. After six months of device usage, reductions of perceived tinnitus loudness were seen only in subjects with a tinnitus pitch of less than 6 kHz. When subjects were grouped by tinnitus pitch, the group of patients with a tinnitus pitch of less than 6 kHz (n ¼ 10 subjects) showed a significant reduction in perceived tinnitus loudness (from 73.4 AE 6.1 before to 56.4 AE 7.4 after treatment, p ¼ 0.012), whereas in subjects with a tinnitus pitch of 6 kHz or more (n ¼ 5 subjects) tinnitus loudness was slightly increased after six months of treatment (65.0 AE 4.7 before and 70.6 AE 5.9 after treatment), but the increase was not significant (p ¼ 0.063). Likewise, tinnitus-related distress was significantly decreased in the low-pitch group (from 31.6 AE 4.3 to 20.9 AE 4.8, p ¼ 0.0059), but not in the group with high-pitched tinnitus (30.2 AE 3.3 before and 30.0 AE 5.1 after treatment, p ¼ 1). Overall, reductions in tinnitus-related distress in our study were less pronounced than those reported for more comprehensive treatments. However, the differences we observed between the low-and the high-pitch group show that tinnitus pitch might influence the outcome of acoustic stimulation treatments when devices with a limited frequency range are used.

IOSR Journal of Dental and Medical Sciences, 2016

The present study aimed to examine the impact of first time users of amplification devices by participants having presbycusis on tinnitus. Pure tone Audiometry along with immittance audiometry and speech Audiometry was carried out. The Tinnitus handicap inventory (THI) questionnaire, developed by Newman et al. (1996), was administered in all participants for pre and post hearing aid fitting conditions. The statistical analysis used were descriptive of mean, standard deviation, paired t-test and Welch two-sample t-test using SPSS software. The tinnitus profile varied among the participants in terms of onset, severity, site and duration. Majority of the participants (78.3%) in the study reported unilateral tinnitus. All of them were fitted with body worn analog hearing aids of different models with fitting style depending upon their nature of hearing loss. Administration of THI yielded changes in scores between the pre-hearing aid fitting and post-hearing aid fitting condition. Paired t-test revealed that there is a significant reduction [t (43) = 12.3271, p < .05] in tinnitus impact following amplification in the presbycusis cases. Welch two-sample t-test results revealed that there is no significantly greater decrease [t(19.906)=1.155,p < .05] of tinnitus after fitting with pseudobinaural hearing aids instead of unilateral hearing aids thus suggesting that pseudo-binaural fitting of amplification device will not have any greater impact on severity of tinnitus in presbycusis cases.

Structured Abstract Objectives: A review was undertaken to evaluate the peer-reviewed literature on three areas of tinnitus management for the following Key Questions (KQs): (1) measures used to assess patients for management needs (KQ1); (2) effectiveness of treatments (KQ2); and (3) identification of prognostic factors (KQ3). Data sources: MEDLINE®, Embase®, CINAHL®, PsycINFO®, AMED©, and Cochrane CENTRAL were searched from January 1970 to June 2012. An extensive grey literature search, which included documents from regulatory and tinnitus-related organizations, was also undertaken. Review methods: Standardized systematic review methodology was employed. Eligibility criteria included English-language studies of adults with subjective idiopathic (nonpulsatile) tinnitus; excluded studies involved tinnitus as the result of middle ear pathologies or focused on methods to determine psychosomatic tinnitus. For KQ2, all pharmacological/food supplement, medical/surgical, sound/technologic...

Journal of The American Academy of Audiology, 2019

Background: It is well accepted among clinicians that maskers and hearing aids combined with counseling are generally helpful to tinnitus patients, but there are few controlled studies exploring the efficacy of maskers alone to decrease the prominence of tinnitus. Purpose: We investigated the benefit of maskers for patients with chronic, bothersome tinnitus. Research Design: Crossover single-participant design, where each participant served as their own control. Study Sample: 18 adults with subjective, nonpulsatile, sensorineural tinnitus. Intervention: Participants participated in two six-week trials: one with sound therapy and one without. No counseling was provided in either group. Masking devices were fit with sounds intended to reduce the tinnitus prominence. Data Collection and Analysis: Participants rated tinnitus loudness, tinnitus annoyance, and acceptability of the background sounds using a numeric 0-100 interval scale and completed the Tinnitus Primary Functions Questionnaire (TPFQ). Results: Three participants dropped out. On the total score of the TPFQ, 5 of 15 remaining participants (33%) showed a benefit. Using a derived score based on functions showing a handicap before the study, maskers benefit was observed in the areas of sleep (five of nine), hearing (three of eight), thoughts and emotions (three of four), and concentration (four of eight). The TPFQ and annoyance data complemented each other well. Conclusions: This study demonstrates the benefit of partial masking, encouraging patients to seek help from audiologists interested in providing support for tinnitus patients.

2014

Tinnitus is a chronic condition that affects about 15% of the population and up to one in three older adults. For some it is a mild annoyance, for others it can be extremely distressing and can significantly deteriorate quality of life. Perceptual characteristics are a poor indicator of clinical need. Clinicians and researchers alike rely on self-report or questionnaires to quantify the severity of an individual‘s tinnitus and to gauge the changes in tinnitus severity or tinnitus-related handicap over time or after clinical intervention. This book chapter evaluates the psychometric properties of five tinnitus questionnaires; Tinnitus Handicap Questionnaire, Tinnitus Reaction Questionnaire, Tinnitus Questionnaire, Tinnitus Handicap Inventory, and Tinnitus Functional No part of this digital document may be reproduced, stored in a retrieval system or transmitted commercially in any form or by any means. The publisher has taken reasonable care in the preparation of this digital document...