Sound therapy for tinnitus management: practicable options.
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October 30, ; Accepted date: December 01, ; Published date: This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Educational counseling, sound stimulation and stress reduction have been shown to be effective in reducing tinnitus distress.
Hearing aids that include a sound generator capable of producing relaxing fractal tones and amplification seem to be an ideal solution for managing tinnitus patients.
This study aimed to investigate the effectiveness of counseling, amplification and fractal tones applied sequentially. The tinnitus management had three phases: Each phase lasted two months on average. The intervention period was six months.
Most subjects initially reported tinnitus to have a moderate to severe negative impact on their quality of life. Subjects were instructed to use the hearing aids several hours per day and listen to the fractal tones for a minimum of two hours per day. THI questionnaires were applied at baseline, after each phase of the protocol i. Additional questionnaires sound therapy for tinnitus management practicable options trading hearing aid and sound stimulation experiences were also collected.
The vast majority of subjects were very satisfied with the hearing aids and evaluated the sound stimulation as being either satisfactory or very satisfactory. The average use of the hearing aids was 9 hours a day. Overall the findings show that a combined approach with counseling and hearing aids that include a sound generator capable of producing fractal tones is a successful tool in tinnitus management. Tinnitus represents one of the most common and distressing otologic problems.
It is most clearly sound therapy for tinnitus management practicable options trading with noise exposure and aging and can present with comorbid sleep disturbancehearing difficulty, social withdrawal, and negative emotional reactions such as anxiety and depression [ 12 ].
The role of psychosomatics and stress reactions in the development of tinnitus is corroborated by the neurophysiological model proposed by Jastreboff and Hazell [ 3 ]. There are no cures available for chronic tinnitus [ 6 ]. Consequently, the majority of treatment options are directed primarily toward reducing or managing the accompanying symptoms associated with tinnitus [ 7 ].
Traditional approaches to tinnitus management typically combine education and counseling, stress reduction, relaxation and use of therapeutic sounds [ 8 ] to reduce the tinnitus distress and improve the Health Related Quality of Life HRQoL. Directive counseling has been considered effective in tinnitus management [ 9 ]. Clinically significant changes in tinnitus measures after directive sound therapy for tinnitus management practicable options trading have been reported over no intervention or undirected self-help [ 10 - 12 ].
Sound enrichment is offered in many tinnitus management programs, whether the intention is to make tinnitus less noticeable, provide immediate relief, promote control, promote habituation, provide a distraction of attention, or promote plastic change in the central auditory system [ 6 ].
However it is speculated that the favorable results obtained with sound therapy treatment may be mediated from the counseling and not necessarily from the acoustic stimulation itself [ 13 ].
Hearing aids are a current mainstay of the audiological management of tinnitus [ 14 - 17 ] because hearing loss is the main risk factor for tinnitus [ 18 ]. It is uncertain, how much of the benefit results from a change in reactions to tinnitus and how much to an improvement in hearing function [ 19 ]. Other forms of sound therapy have been applied to tinnitus management such as sound generators [ 2021 ] and Neuromonics Tinnitus Treatment - NTT [ 22 - 24 ].
Recently combination devices that consist of hearing sound therapy for tinnitus management practicable options trading with either noise generators or some kind of music [ 25 ] have been used in tinnitus management.
Music is believed to be helpful in reducing stress because of the wide range of neural structures that are activated during music appreciation.
This includes the cerebellum, frontal lobe, limbic systemand auditory cortex [ 26 ]. The use of music has been shown in numerous studies to reduce the stress of patients in clinical settings [ 27 - 29 ].
Hearing aids with fractal tones have also been used in tinnitus management [ 193031 ]. The fractal tones are semi-randomly generated tones that sound like wind chimes. Predictable without being monotonous, they sound familiar, but are not associated directly with music that the listener can remember [ 32 ]. Fractal tones are pleasant and have been proposed to promote relaxation, which might in turn have some benefits for persons with tinnitus. The fractal tones are available as a hearing aid program Wide Zen program in most Widex hearing aids.
The hearing aids have the option to include programs that provide amplification alone, Zen with the microphone amplification turned on or off [ 30 ]. There are six Zen styles available - five different fractal tones that differ in pitch and tempo, and Zen noise. Aqua style is the most preferred Zen tone pattern [ 33 ] and is also the default recommendation.
A number of studies have supported the use of fractal tones in hearing aids in tinnitus management. Sweetow and Sabes [ 26 ] monitored changes in the Tinnitus Inventory Handicap THI questionnaire and TRQ over a six month period following the fitting of fractal tones in the hearing aids to 14 subjects. Herzfeld and Kuk [ 33 ] also reported that the fractal tones were effective sound therapy tool in tinnitus management. Recently, Herzfeld et al. Fractal hearing aids associated with directive counseling seem to be an effective tool for tinnitus management.
A range of studies have been conducted on the effectiveness of counseling, amplification and fractal tones but no clinical study has investigated the isolated effect of each of the three components in a sequential tinnitus management program.
This study investigated the effectiveness of directive counseling, amplification and sound stimulation with fractal-based musical chimes on tinnitus severity, applied sequentially across subjects with significant tinnitus distress and hearing loss over a period of six months and 12 months. Additionally, this study aimed to investigate the effects of the fractal tones in inducing relaxation and reducing tinnitus distress. CHK is a public center that provides free hearing aids, combination devices or sound generators associated with counseling to patients with significant tinnitus distress.
Five subjects were sound therapy for tinnitus management practicable options trading from the study. Two subjects were excluded because their THI at baseline were lost. Three subjects were removed due to severe psychological problems. All subjects had undergone a recent ENT evaluation to rule out medical treatment for their tinnitus.
All participants had cognitive and manual dexterity abilities sufficient to undergo treatment. The subjects were informed about the study purpose and the phases of treatment and they signed a consent form. The mean hearing thresholds are shown in the Figure 1. Average sound therapy for tinnitus management practicable options trading thresholds for the 35 subjects included in the study. The subjects were then referred to CHK for tinnitus management.
The assessment appointment was carried out by an audiologist specialized in tinnitus management and included the collection of Tinnitus Handicap Inventory THICHK Tinnitus questionnaire and review of the evaluation and recommendations for the treatment.
The directive counseling was given by an audiologist with experience in tinnitus counseling. The staff at CHK used a structured client form and the counseling session varied from An extra counseling session was arranged for only three patients. Approximately one third of the subjects received a bed-side masker due to sleep problems. At the end of the counseling sessions, patients were told to return in 8 weeks for the hearing aid fitting.
Hearing aid fitting session: The second THI was collected two months post-counseling just prior to the hearing aid fitting. All subjects were fitted bilaterally with Widex Clear passion models with instant ear tips. Ninety percent of the sound therapy for tinnitus management practicable options trading were open fittings.
This is a 15 channel enhanced dynamic range compression hearing aid with a compression threshold as low as 0 sound therapy for tinnitus management practicable options trading HL. Among the features are noise reduction, active feedback cancellation and data logging. Additionally, the subjects used a remote control to adjust volume and to change hearing aid programs. The hearing aid fitting was done by an audiologist experienced with Widex hearing aids and Zen programs.
Fine-tuning of the hearing aid was done when necessary. The third THI was collected two months post-amplification together with the hearing aid questionnaire. Subjects were given two Zen programs during the Zen fitting visit: The subjects were instructed to listen to Zen programs a minimum of two hours per day and they could choose between Aqua with Microphone on or off, whatever Zen program would be most adequate for them.
Master amplification only was recommended for listening situations where hearing and communication were essential. A fine-tuning appointment was done if it was necessary.
The fourth THI form was collected two months post-fractal tones together with Zen questionnaire. The usage of the hearing aid was assessed through the data logs.
Subjects were told that they would be contacted 12 months after the treatment finished. It was chosen because of its well-established and robust psychometric properties, including test-retest reliability, construct validity, and internal consistency .
THI was collected at baseline, two months post-counseling, two months post-hearing aid sound therapy for tinnitus management practicable options trading, two months post-Zen program end of treatment and 12 months post-treatment, where THI forms were sent to the participants. Additionally, a hearing aid and a Zen questionnaire were administered to investigate the overall satisfaction with the hearing aids and the relaxation effects of Zen.
The use time for the Master main program and fractal tones programs was assessed in the final session. Post hoc analysis with Wilcoxon related-samples signed rank test was applied to compare the effects of different treatment phases counseling, amplification and sound therapy with fractal tones. Descriptive statistics were compiled on Excel The mean THI scores are shown in Figure 2.
No statistically significant improvement was seen post-hearing aid fitting. Mean values sound therapy for tinnitus management practicable options trading THI at baseline, post-counseling, postamplification and post-Zen are shown. Individual THI scores between six months and baseline are displayed in the scatter plot shown in Figure 3A. Additionally, individual outcomes between baseline and post-counseling; post-counseling and post-amplification and post-amplification and post-Zen fitting are also displayed in Figure 3B, C and D respectively.
The solid diagonal line reflects identical pre and post scores i. Any points falling below this diagonal suggests a reduction in tinnitus handicap. Any point above this line indicates a worsening of tinnitus handicap. The dashed line represents the 20 point criterion that indicates a clinically significant reduction in THI scores and an improvement of quality of life [ 35 ].
Inspection of individual data revealed that fifty one percent 18 subjects had a clinically significant reduction on THI scores after six months. The scatter plots in Figures 3B, C and D allowed one to estimate the efficacy of each treatment component in a two sound therapy for tinnitus management practicable options trading period.