Tinnitus Activities Treatment with Total and Partial Masking.

BACKGROUND: There are many counseling and sound therapy approaches to treat tinnitus. Counseling approaches range from providing information using directive or collaborative approaches. Sound therapies include strategies that use background sounds to totally or partially mask tinnitus to reduce the prominence of or decrease the loudness or annoyance of the tinnitus. PURPOSE: We evaluated the effectiveness of tinnitus activities treatment (TAT) in two groups, those without hearing aids (HA) and those who were provided with HA. In both groups, comparisons were made among those receiving (1) counseling only, (2) counseling and partial masking, and (3) counseling and total masking. RESEARCH DESIGN: Participants were provided with HA or not, based on their choice, and then randomly assigned to one of the three groups. The Tinnitus Handicap Questionnaire (THQ) was used as the primary measure. RESULTS: For those without HA, significant benefits were obtained for 8 out of 22 participants in the counseling group, 8 of 13 in the total masking group, and 8 of 24 in the partial mask group. The average decrease in the THQ was 15% for the counseling group, 25% for the total mask, and 14% for the partial masking group. For those with HA; significant benefits were obtained for 5 of 16 in the counseling group, 3 of 14 in the total mask group, and 6 of 13 in the partial mask group. The average decrease in the THQ score was 12% for counseling, 13% for total masking, and 16% for partial masking. No significant differences among groups were observed. CONCLUSION: Individual differences were large. Many benefited from their treatment, but some did not. We believe this was likely influenced by their expectations.

Increased Incidence of Tinnitus Following a Hyperthyroidism Diagnosis: A Population-Based Longitudinal Study.

Background: An association between thyroid disease and tinnitus has been described previously but further longitudinal, population-based studies are limited. Objective: To investigate the incidence of tinnitus in patients with hyperthyroidism in a national sample, and to identify risk level and associated factors for tinnitus in hyperthyroidism patients. Design: Retrospective cohort study. Patient data were collected from the Longitudinal Health Insurance Database (LHID 2000), which includes national claims data of patient expenditures for admissions or ambulatory care from 1996 to 2011. Setting: Taiwan hospitals and clinics providing healthcare nationwide. Participants: Patients aged 20 years and older with newly diagnosed hyperthyroidism (ICD-9-CM code 242) between 2000-2010 were selected as the study cohort. Hyperthyroidism patient cohort were identified from the LHID2000. Those with tinnitus history (ICD-9-CM code 388.3) before the index date (first hyperthyroidism diagnosis), younger than 20 years, and with incomplete demographic data were excluded. The non-hyperthyroidism cohort included patients with no history of hyperthyroidism and no documented tinnitus. Main Outcomes and Measures: Incidence of tinnitus was the primary outcome. Baseline demographic factors and comorbidities possibly associated with tinnitus, including age, sex, and comorbidities of hearing loss, vertigo, insomnia and anxiety, were retrieved from the LHID 2000. Patients were followed until end of 2011. Results: During the study period, 780 (4.9%) hyperthyroidism patients and 2007 (3.2%) non-hyperthyroidism controls developed tinnitus. Incidence rate of tinnitus in the hyperthyroidism cohort was significantly higher in hyperthyroidism cohort (7.86 vs. 5.05 per 1000 person-years) than that in non-hyperthyroidism cohort. A higher proportion of patients with hyperthyroidism had comorbid insomnia (45.1% vs. 30.9%) and anxiety (14.0% vs. 5.73%) than those without hyperthyroidism. After adjusting for age, gender and comorbidities (vertigo, insomnia, anxiety, hearing loss), hyperthyroidism patients had 1.38-fold higher risk of tinnitus (95% CI = 1.27-1.50) than those without hyperthyroidism. Conclusions: This large population-based study suggests patients with diagnosed hyperthyroidism was more prone to develop tinnitus. Our findings suggest evaluation for comorbid vertigo, insomnia, anxiety and/or hearing loss may identify patients who are at high risk of developing tinnitus in patients with hyperthyroidism.

Use of a Smartphone App for Cochlear Implant Patients With Tinnitus.

Purpose Smartphone apps for tinnitus relief are now emerging; however, research supporting their use and effectiveness is lacking. Research has shown that Tinnitus Therapy sounds intended for individuals with acoustic hearing provide relief to some patients using cochlear implants (CIs) with tinnitus. Here, we evaluated the use and acceptability of a smartphone app to help CI patients with tinnitus. Method Participants completed a laboratory trial (n = 19) and an at-home trial (n = 14) using the ReSound Tinnitus Relief app to evaluate its acceptability and effectiveness in reducing their tinnitus. During the laboratory trial, participants selected a sound that was most acceptable in managing their tinnitus (termed chosen sound). Word recognition scores in quiet were obtained before and after sound therapy. Participants were randomly assigned to one of two groups for the at-home trial, that is, AB or BA, using (A) the chosen sound for 2 weeks and (B) the study sound (i.e., broadband noise at hearing threshold) for another 2 weeks. Ratings were collected weekly to determine acceptability and effectiveness of the app in reducing tinnitus loudness and annoyance. Results Results indicated that some, but not all, participants found their chosen sound to be acceptable and/or effective in reducing their tinnitus. A majority of the participants rated the chosen sound or the study sound to be acceptable in reducing their tinnitus. Word recognition scores for most participants were not adversely affected using the chosen sound; however, a significant decrease was observed for three participants. All 14 participants had a positive experience with the app during the at-home trial on tests of sound therapy acceptability, effectiveness, and word recognition. Conclusions Sound therapy using a smartphone app can be effective for many tinnitus patients using CIs. Audiologists should recommend a sound and a level for tinnitus masking that do not interfere with speech perception.

Reliability of the Minimum Masking Level as Outcome Variable in Tinnitus Clinical Research.

Purpose The minimum masking level (MML) is the minimum intensity of a stimulus required to just totally mask the tinnitus. Treatments aimed at reducing the tinnitus itself should attempt to measure the magnitude of the tinnitus. The objective of this study was to evaluate the reliability of the MML. Method Sample consisted of 59 tinnitus patients who reported stable tinnitus. We obtained MML measures on two visits, separated by about 2-3 weeks. We used two noise types: speech-shaped noise and high-frequency emphasis noise. We also investigated the relationship between the MML and tinnitus loudness estimates and the Tinnitus Handicap Questionnaire (THQ). Results There were differences across the different noise types. The within-session standard deviation averaged across subjects varied between 1.3 and 1.8 dB. Across the two sessions, the Pearson correlation coefficients, range was r = .84. There was a weak relationship between the dB SL MML and loudness, and between the MML and the THQ. A moderate correlation (r = .44) was found between the THQ and loudness estimates. Conclusions We conclude that the dB SL MML can be a reliable estimate of tinnitus magnitude, with expected standard deviations in trained subjects of about 1.5 dB. It appears that the dB SL MML and loudness estimates are not closely related.

Programming a Cochlear Implant for Tinnitus Suppression.

BACKGROUND: Electrical stimulation of the cochlea to treat tinnitus has been explored for decades. However, few studies have investigated the most salient programming parameters for tinnitus suppression in cochlear implant (CI) patients. PURPOSE: The purpose of this study was to review the available CI programming parameters for tinnitus suppression and to consider possible clinical research designs for selecting the optimal programming parameters for CI patients. RESULTS: Across research studies, the optimal parameters vary significantly and are often based on data fromonly a fewparticipants. Electrical stimulation using lowand high rates, different electrode numbers, and low T-levels were helpful in suppressing tinnitus, although more research is needed from a greater number of CI patients. Possible designs for evaluating these parameters in a clinical setting are presented. CONCLUSIONS: Programming a CI to reduce the prominence of tinnitus is complex, and audiologists should consider adjusting CI parameters systematically for CI patients with bothersome tinnitus.

Complaints of People with Hyperacusis.

BACKGROUND: Hyperacusis is a prevalent auditory disorder that causes significant distress and negatively affects quality of life for many patients. Patients with hyperacusis often have different complaints about the sounds and situations that they experience. Audiologists may have few patients with hyperacusis, and a limited understanding of the sounds and situations that are reported to be challenging by their patients. PURPOSE: To investigate the common complaints reported by hyperacusis patients. RESEARCH DESIGN: A qualitative study was conducted with 11 hyperacusis patients who participated in a group session. RESULTS: All 11 hyperacusis patients experienced negative reactions to specific sounds. In addition, many patients reported physical symptoms such as headaches, balance problems, dysosmia (strong smell problems), and light sensitivity. Sounds that induced discomfort were wide ranging and included low-frequency sounds, high-frequency sounds, wide-band noise, and sudden, high-intensity sounds. Most patients (9/11, 81.8%) reported negative reactions to music in loud rock concerts. Patients reported that stress/tension (90.9%) worsened their hyperacusis, while removing themselves from noise (90.9%) relieved their hyperacusis. CONCLUSION: Loudness is only one of the many factors related to the discomfort of patients with hyperacusis. Across patients, we observed that there were different complaints about the sounds and situations that produced difficulty due to hyperacusis. Physical symptoms following sound exposure were also reported by the patients, suggesting that hyperacusis is a complex disorder and requires intervention that often involves multiple members of the medical team.

Tinnitus Sound Therapy Trial Shows Effectiveness for Those with Tinnitus.

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.

An Exploratory Step Toward Measuring the "Meaning of Life" in Patients with Tinnitus and in Cochlear Implant Users.

BACKGROUND: Many questionnaires attempt to quantify the "quality of life." However, we believe understanding the quality of life is complex, and many widely used questionnaires do not capture the broad range of factors that we believe are important. Many do not include questions about communicating. PURPOSE: We developed a preliminary questionnaire designed to measure "The Meaning of Life" from a broader perspective. RESEARCH DESIGN: We reviewed other scales and sought input from individuals with disabilities and developed an initial 23-item questionnaire. STUDY SAMPLE: As a first step, we sampled 116 adults with tinnitus and 196 with cochlear implants (CIs). Individuals who were participating in our CI or tinnitus research programs participated. DATA COLLECTION AND ANALYSIS: To compare differences between the two participant groups, independent sample f-tests were completed for specific items on the questionnaire and for the total score. We compared age and gender differences across all participants using f-tests. Statistical significance was defined as p < 0.05. An exploratory factor analysis was conducted to examine the relationship among the questionnaire items using oblique rotation to produce correlated factors. Extracted factors with an eigenvalue >1.0 were retained according to the Kaiser-Guttman rule. RESULTS: Four factors were prominent in this initial sample, which we labeled (1) friendship and positive outlook, (2) physical health, (3) hearing and mental health, and (4) satisfaction with life. Participants with tinnitus reported more trouble sleeping than participants with CI, whereas both groups had lower scores on hearing. Older patients reported more difficulty with remembering things but were more satisfied with their financial situation. Female participants reportedly had more hobbies and were more satisfied with their sex lives than male participants. CONCLUSIONS: This exploratory study intended to take a broader look at quality of life scales. Further work is needed with a larger sample including younger and older participants with and without disabilities.

Establishing a Group Educational Session for Hyperacusis Patients.

Purpose Audiologists should be treating hyperacusis patients. However, it can be difficult to know where to begin because treatment protocols and evidence-based treatment studies are lacking. A good place to start in any tinnitus and hyperacusis clinic is to incorporate a group educational session. Method Here, we outline our approach to establishing a hyperacusis group educational session that includes specific aspects of getting to know each patient to best meet their needs, understanding the problems associated with hyperacusis, explaining the auditory system and the relationship of hyperacusis to hearing loss and tinnitus, describing the influence of hyperacusis on daily life, and introducing treatment options. Subjective responses from 11 adults with hyperacusis, who participated in a recent clinical group education session, were discussed to illustrate examples from actual patients. Conclusions Due to the devastating nature of hyperacusis, patients need to be reassured that they are not alone and that they can rely on audiologists to provide support and guidance. A group approach can facilitate the therapeutic process by connecting patients with others who are also affected by hyperacusis, and by educating patients and significant others on hyperacusis and its treatment options. Supplemental Material https://doi.org/10.23641/asha.8121197.

Tinnitus: How Partners Can Help?

Purpose Tinnitus can be distressing for sufferers, but for those who do not have tinnitus, it is difficult to understand what it is like. We attempted to gain an understanding of the knowledge and misconceptions of sufferers and their partners about tinnitus. Method Two different websites were created with surveys, 1 for tinnitus sufferers and the other for their partners. A mass e-mail was sent to employees and students at The University of Iowa inviting people with tinnitus and their significant others to fill out the online surveys. Those with tinnitus were asked to rate how their tinnitus affected their thoughts and emotions, sleep, concentration, and hearing. They were also invited to fill out the Iowa Tinnitus Primary Function Questionnaire (12-item version; Tyler et al., 2014 ). Partners completed a similar survey that asked how tinnitus affected the sufferer in these domains. Open-ended questions were also included to obtain more specific feedback from the participants regarding their experiences and how tinnitus affects their lifestyle and relationships. Results Two hundred twenty-two replies were obtained from 197 tinnitus sufferers and 25 partners of those with tinnitus. Partners and sufferers were not completely in agreement regarding their knowledge about tinnitus or familiar with the impact that this symptom may have on the sufferers. Sufferers showed more confidence in their hearing ability, regardless of tinnitus, than their partners. Furthermore, sufferers and partners do not generally talk about tinnitus to each other. Conclusion We conclude that both sufferers and partners would benefit from receiving counseling to address many misunderstandings regarding tinnitus and its consequences in their everyday life activities.

Tinnitus Suppression in Cochlear Implant Patients Using a Sound Therapy App.

PURPOSE: The use of acoustic stimuli to reduce the prominence of tinnitus has been used for decades. Counseling and tinnitus sound therapy options are not currently widespread for cochlear implant (CI) users. The goal of this study was to determine whether tinnitus therapy sounds created for individuals with acoustic hearing may also benefit CI users. METHOD: Sixteen sounds from the ReSound Relief app (Version 3.0) were selected for the study. Sixteen participants were asked to rate the overall acceptability of each sound and to write the description of the sound they perceived. Sounds were streamed from an Apple™ iPod (6th generation) to the CI using a Cochlear™ Wireless Mini Microphone 2+. Thirteen participants then completed a 5-min trial where they rated their pretrial and posttrial tinnitus and the acceptability of a subset of preferred sounds. Ten out of these 13 participants completed a 2-week home trial with a preferred sound after which they answered an online tinnitus questionnaire and rated the effectiveness of the sound therapy. RESULTS: Individual differences were large. Results from the 5-min trial showed that sounds perceived as rain, music, and waves were rated the most acceptable. For all of the participants, the posttrial tinnitus loudness rating was lower than the pretrial rating, with some participants experiencing greater difference in their tinnitus loudness than others. At the end of the 2-week home trial, 3 of 10 participants rated the effectiveness of sound therapy 70% or higher. CONCLUSION: The results suggest that the use of tinnitus therapy sounds delivered through a CI can be acceptable and provides relief for some tinnitus sufferers.