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19.01.2015

Customized sound therapy for tinnitus, sleepiness synonym - For Begninners

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Tinnitus, a condition that causes people to hear sounds such as ringing in the ears even when all is quiet, afflicts at least 10 percent of American adults. Welcome to the Scientific American Blog Network, a forum for a diverse and independent set of voices to share news and opinions and discuss issues related to science.
There is considerable evidence that many forms of tinnitus are caused by central changes that may occur after peripheral lesions. Auditory stimulation is one of the most employed therapeutic methods for tinnitus, and one of the most beneficial.
Sound generators that emulate environmental sounds are small devices that allow a person to select the favorite kind of sound at the most comfortable volume. Custom sound generators, for normal hearing persons, are similar to hearing aids, very light, and to be worn behind the ear.
Hearing aids designed for people with tinnitus and hearing loss provide amplification that facilitates auditory stimulation to ameliorate tinnitus.
Implantable hearing aids are now used by many people, which made it possible to assess their efficacy in tinnitus treatment. Other devices can be used for tinnitus management for immediate relief before a more complete sound therapy can be initiated. Sound stimulation has its beneficial effect on most forms of tinnitus by activating neural plasticity, which requires time to develop.
The specific guidelines on hearing aid device adaptation are crucial for an effective auditory stimulation of tinnitus-affected patients.
The most frequent causes of tinnitus seem to be cochlear damage, as almost all individuals with tinnitus have hearing loss. Auditory stimulation is one of the most employed therapeutic methods and one of the most beneficial for patients suffering from tinnitus [32].
Sound environment generators are contained in a small case, in which batteries and speakers are also housed.
Custom sound generators look like regular hearing aids; they are light and designed to be worn behind the ear. Unlike the sound generated by environmental sound machines, the sound generated by custom sound generators can only be heard by the person wearing the device. The most suitable hearing aids for sound therapy are the open-ear hearing aids [38, 39], which have a mini speaker placed at the entrance of the ear canal. Traditional acoustic prostheses and Combi hearing aids are not generally recommended for patients with conductive hearing loss caused by external and middle- ear malformations or in patients with chronic middle-ear infection. Besides sound generators and acoustic prostheses, other devices that are not specifically designed for treatment of tinnitus can be used for tinnitus management. Clinical studies [29, 34, 35] have shown that not only do hearing aids improve hearing ability, but they can also reduce or suppress tinnitus.
For instance, in a study carried out in 1999 [44], 50% of hearing aid wearers experienced relief from tinnitus, with a median improvement of 10% after only 6 weeks from the first application. Individuals with hearing loss that is limited to mild damage of hair cells not affecting the subjective hearing sensitivity benefit from custom sound generators or sound environment generators [46].
Favoring the ability to listen to tinnitus according to Jastreboff’s neurophysiologic hypothesis. Improving communication and reducing the discomfort often reported by patients as sounds and voices covered by tinnitus. Stimulating the auditory nervous system in a normal way and not only with tinnitus (phantom sounds).
The role of the therapist should not be limited to the technical aspects of hearing aids and their application, but should aim at developing an empathic and confident relationship with the individual patient. In order to achieve an optimal auditory stimulation, specific guidelines on hearing aid device adaptation should be followed, for custom sound generators, Combi devices, or prostheses [29, 34]. The introduction of the so-called open-ear hearing aids helped overcome some of these problems, allowing application of hearing aids to individuals with mild hearing loss, such as many individuals with tinnitus have.
Optimal results in management of tinnitus are not only obtained with the application of technologically advanced hearing aid devices but, most of all, with their adjustment to the individual person’s needs and through patient counselling.
Anyone with tinnitus can benefit from the ReSound ReliefTM app as part of a tinnitus management program. If you have a hearing loss, you can stream the tinnitus relief audio to your wireless hearing aids. The time it takes for sound stimulation to reduce an individual’s tinnitus varies and may require a 6- to 8-month time frame.
Especially regarding treatment with sound, it is important to know if tinnitus is caused by pathology of the ear or the auditory nervous system. Such nonspecific effects could account for the increase in SA in the cochlear nerve after the administration of high doses of salicylate (see above). Importantly, cochlear damages – induced after noise trauma, for instance – cause a dramatic decrease of SA in the cochlear nerve [18, 19].
This decrease in central inhibition is supposed to account for the changes in the evoked and SA after cochlear damage. These central changes could ultimately result in the emergence of an aberrant neural activity that could induce tinnitus.
Such therapy has no noticeable side effects and may be administered through simple devices [33]. These devices generate a wide band sound that can be adjusted by the audiologist to meet the final user’s needs by means of high-pass or low-pass filters and may even be modulated in width. Once they have been worn and the volume regulated, the person may “forget” they are wearing them for the rest of the day.


Unfortunately, hearing aids currently available are not able to amplify sounds with a frequency above 6–7 kHz, a range of hearing that is often impaired in individuals with tinnitus; for this reason, ordinary hearing aids may be less efficient in compensating for lost auditory stimulation. Such individuals may benefit from the bone-anchored hearing aids, which transmit sound vibrations to the inner ear through a titanium rod implanted into the bone. These results were confirmed by subsequent studies, which extended the investigation to individuals who had tinnitus and mild hearing loss [34, 45]. Only a comprehensive evaluation may allow the therapist to have an accurate picture, in order to tailor the most appropriate and effective therapeutic plan. For example, sound environment generators are mostly indicated during night rest in patients affected by mild tinnitus. The parameters are crucial for auditory stimulation achieving maximal benefits on tinnitus. In fact, even partial occlusion of the auditory canal may cause unease of use and may even increase tinnitus perception.
Open-ear hearing aids also provide a stimulation mainly in the frequency region of the tinnitus pitch. In fact, many tinnitus patients are sensitive to amplification, which sometimes requires less gain and maximum output than in patients who do not have tinnitus.
Patients are generally able to fully understand the volume regulation procedure and to safely carry it out, but often more than one round of counselling is necessary and analog scales should be used to track the intensity of both tinnitus and therapeutic sound. Each single patient must be listened to, counselled, and informed throughout therapy planning and during follow-up.
Tonndorf J (1987) The analogy between tinnitus and pain: a suggestion for a physiological basis of chronic tinnitus. Norena AJ and JJ Eggermont (2003) Changes in spontaneous neural activity immediately after an acoustic trauma: implications for neural correlates of tinnitus. Norena A, C Micheyl, S Chery-Croze et al (2002) Psychoacoustic characterization of the tinnitus spectrum: implications for the underlying mechanisms of tinnitus.
Puel JL, J Ruel, M Guitton et al (2002) The inner hair cell synaptic complex: physiology, pharmacology and new therapeutic strategies.
Moffat G, K Adjout, S Gallego et al (2009) Effects of hearing aid fitting on the perceptual characteristics of tinnitus. Norena AJ and JJ Eggermont (2006) Enriched acoustic environment after noise trauma abolishes neural signs of tinnitus.
Han BI, HW Lee, TY Kim et al (2009) Tinnitus: characteristics, causes, mechanisms, and treatments. Jastreboff PJ and JWP Hazell (2004) Tinnitus retraining therapy: implementing the neurophysicological model.
Del Bo L, U Ambrosetti, M Bettinelli et al (2006) Using open-ear hearing aids in tinnitus therapy. Lantz J, OD Jensen, A Haastrup et al (2007) Real-ear measurement verification for open, non-occluding hearing instruments.
Van de Heyning P, K Vermeire, M Diebl et al (2008) Incapacitating unilateral tinnitus in single-sided deafness treated by cochlear implantation. Holgers KM and BE Hakansson (2002) Sound stimulation via bone conduction for tinnitus relief: a pilot study.
Surr RK, JA Kolb, MT Cord et al (1999) Tinnitus Handicap Inventory (THI) as a hearing aid outcome measure. Henry JA, TL Zaugg and MA Schechter (2005) Clinical guide for audiologic tinnitus management II: treatment. Molini E, M Faralli, C Calenti et al (2009) Personal experience with tinnitus retraining therapy. Baracca GN, S Forti, A Crocetti et al (2007) Results of TRT after eighteen months: Our experience.
Sheldrake JB, JWP Hazell and RL Graham, (1999) Results of tinnitus retraining therapy, in Proceedings of the sixth International Tinnitus Seminar, Cambridge UK September 5th-9th 1999, J Hazell, Editor. Ito M, K Soma and R Ando (2009) Association between tinnitus retraining therapy and a tinnitus control instrument.
Balance the sounds between your right and left ears, or turn on the timer so you can fall asleep to soothing sounds. One of the latest is a sound-therapy device designed to produce unique tones that distract the wearer's brain from more irritating sounds.
There is now considerable evidence that most forms of tinnitus are caused by changes in the central nervous system after peripheral lesions [3, 4]. Sounds used may resemble environment sounds, which enrich the atmosphere in the room they are used. Different buttons may be pushed to select different sounds such as sea waves, creeks, waterfalls, rain, the woodlands, and white noise. Like the custom sound generators, their ease is such that wearers often do not even feel them.
Besides hearing aids, the new generation Combi (combination hearing aids) now available, combine common prostheses with the ability to generate an enrichment sound, similar to what custom sound generators provide. The increase in use of implantable hearing aids during recent years has made it possible to assess their efficacy for treatment of tinnitus. Conversely, these devices may be useful for immediate relief before a more complete sound therapy is started.
Hearing device application and control for adaptation may require a series of scheduled visits every 3–4 months, although in some cases a stricter follow-up schedule may be necessary. However, patients with disturbing tinnitus and without subjective hearing impairments benefit from custom sound generators, which should be worn at least 8 h during the daytime, in combination with an environment generator during night rest.


It may also affect the natural acoustic properties of the external ear, with further negative side effects causing a loss of the natural acoustic resonance, which is important for naturalness of hearing.
The open-ear hearing aids, thus, provide important advantages, such as sound enrichment, that reduce tinnitus by activating the neural plasticity. Moreover, the frequency band of hearing aids should be adjusted to mostly amplifying the frequency range that is most important for hearing. Patients with moderate to severe hearing loss often benefit from amplifications that are 50–70% lower than traditional prescription formulas.
During TRT therapy, the correct balance between sound stimulation and amplification can be determined with in situ instruments after some weeks of use [52].
This enables therapists to fully understand their patient’s problems and to solve them to the greatest extent through a proper selection of prosthetic devices and finding the optimal settings. For treatment of tinnitus, it is important to distinguish between these two models, as they imply different therapeutic strategies.
This strongly argues against a peripheral origin of tinnitus encountered in human subjects (related to peripheral damages). In case sound enrichment should be required all day long (and tinnitus is not associated to hearing loss), “custom” ear level sound generators may be suitable.
For most users, these sounds are relaxing, as they are monotonous and repetitive without interruption.
Custom sound generators are both useful for total masking therapy [36] and for partial masking therapy, according to tinnitus retraining therapy (TRT) [37] (Picture 2). The Combi devices represent the most innovative and efficient therapeutic tools for tinnitus and hearing loss, because they can combine auditory stimulation in impaired hearing areas with either partial or total tinnitus masking [40, 41]. Implantable middle-ear prostheses provide better sound therapy for some patients with tinnitus than traditional hearing aids [42], probably because they provide amplification in a wider frequency range and because of the “naturalness of the amplification”.
Recorded nature sounds played through home stereo systems are used for this purpose as well. Occlusion of the ear canal also causes over-emphasis of low frequencies with rumbling sensations resulting together with diminished perception of sound in the most important frequency range of hearing. Sound generators should be adjusted to the frequency of the tinnitus in order to activate the auditory nerve close to tinnitus frequency. The large variability of the requirements for tinnitus patients regarding amplification has prevented adaptation of an uniform formula that is suitable for all tinnitus patients. In fact, the peripheral model suggests that the aberrant neural activity is responsible for tinnitus perception. Once a given sound has been selected and the volume has been regulated, the user can use the environmental sound as background noise.
Audiometric test results do not usually reflect variations in tinnitus and thus, are not valid measures of relief [48]; tests, therefore, do not need to be periodically repeated.
It is also important not to underestimate the hearing of one’s own voice which often causes difficulties in the understanding of speech, as well as being unpleasant for the individual and may cause a sensation of “closure” that can worsen tinnitus.
Individuals with tinnitus often benefit from having the option of noise reduction switched off or turned down.
The tones are customized for each patient based on that person's specific level of tinnitus, although the reprieve is temporary, experienced only when the Serenade is in use.Reports of tinnitus are rising because of widespread use of personal entertainment and communication devices, particularly in children, according to researchers at the University of California at Irvine's Hearing Research Center, where Serenade was first developed. Finally, changes in the pattern of spontaneous discharge (increase in firing rate and synchrony), consistent with the psychoacoustic properties of tinnitus [4], have been observed after acoustic trauma [3, 27]. For individuals with hearing loss, open-ear hearing aids are suitable [34, 35], as well as tinnitus control combination instruments (Combi), which combine a prosthesis and a sound generator. For this reason, such sound generators are particularly useful during night rest (Picture 1).
Cochlear implants can provide input to the auditory nervous system that can reduce tinnitus in many individuals, both in those with severe hearing loss and in individuals with good hearing on one ear who have severe tinnitus referred to that side [43].
Cerebral plasticity requires some time to develop, and the needed duration of therapy may, therefore, vary from patient to patient [49]. In the selection of hearing aids, all elements that can cause a patient’s discomfort and increase the perception of tinnitus must be taken into account, including cosmetic aspects. In a paper published online in April by the Journal of the Association for Research in Otolaryngology, the researchers, who describe tinnitus as a "brain disorder," said their device was most effective when the volume was set at a level just softer than the sounds produced by tinnitus (pdf). A recent study [6] has shown that salicylate-induced tinnitus may be caused by activation of NMDA receptors expressed in the synapses of cochlear hair cells and dendrites of spiral ganglion neurons. Optimal relief from tinnitus may require a 6- to 8-month therapy using hearing aids and sound generators [50, 51]. Hearing aids and sound generators should ideally be forgotten after they have been applied. Tinnitus is also the most common disability among Afghanistan and Iraq war veterans, according to the U.S. If tinnitus was normally caused by increased activation of NMDA receptors, a possible therapeutic approach that could suppress such “peripheral tinnitus” would be inactivating NMDA receptors [6, 7]. Moreover, we could induce a dramatic decrease of hypersensitivity in human subjects reporting hyperacusis, after these subjects were stimulated a few hours a day for several weeks with a customized stimulus (the long-term spectrum of the stimulus corresponded to the hearing loss of each subject [28]).



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