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23.10.2014

Tinnitus residual inhibition test, www tinnitus uni muenster de - Try Out

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Key words: audiology, automated testing, hearing disorders, hearing thresholds, loudness perception, pitch perception, reliability of results, tinnitus.
Clinical measures of tinnitus loudness and pitch can provide data important for patient assessment and for counseling [1-5]. Without procedures that are uniform and documented for response reliability, measurements indicating changes in the tinnitus percept do not possess clinical value. We used the number of participants and the two testing trials to provide a sufficient number of observations to assess reliability of the different responses. Following pilot testing to ensure proper performance of the system, we recruited 40 individuals who reported constant tinnitus through a local newspaper advertisement and flyers posted at the Portland Department of Veterans Affairs (VA) Medical Center (VAMC), Oregon.
Testing algorithms for determining hearing threshold, loudness match, and pitch match were completely redesigned.
Because of the combining of two programmatically linked computers required for testing (previously, one was used for patient control and one for main control of the system), programming advances have made the automated system more portable. We conducted test procedures in a double-walled sound-attenuated suite constructed by Acoustic Systems (Model RE-245S).
Prior to testing, participants viewed the series of screens, describing general operation of the automated system (Figure 1). Threshold testing at any test frequency was always followed by loudness-matching at the same frequency. After providing five pitch matches, participants took a short break, then returned to the sound booth to repeat the test protocol. Table 1 shows the across-subjects mean hearing thresholds (in decibel SPL) for each of two tests conducted during each of two sessions. We performed a repeated measures analysis of variance (ANOVA) at each test frequency on the four hearing-threshold means (Table 1). Cumulative numbers and percentages of individual responses having between-sessions test minus retest threshold differences within various decibel intervals. An automated tinnitus evaluation system has been developed in this laboratory, consisting of a patient-controlled touch-screen computer monitor, main computer, and Programmable Auditory Laboratory 3000 (PAL 3000) (a custom-built signal conditioning module).
Traditional approaches to clinical tinnitus measurement require patients to perform the subjective task of balancing a tone generated by a clinical audiometer to either the loudness or the pitch of the perceived tinnitus.


A computer-automated clinical procedure for tinnitus evaluation would be capable of consistently evaluating all parameters of tinnitus that are relevant to rehabilitation.
Based on results of multiple studies conducted in our laboratory, we have established normal variability of responses for the different tests that are performed by the tinnitus test system. For this study, the slides were launched and controlled via remote control from the tinnitus test platform. The knob is used to control loudness of tones for testing hearing thresholds and loudness matches and testing frequency of tones for pitch-matching. The actual divisor number is test-dependent-one divisor was used for obtaining thresholds and loudness matches and another for pitch-matching.
Thus, two complete tests (hearing thresholds, loudness matches, and pitch matches) were performed during the first session. Each ANOVA included only participants who provided a threshold response for each of the four tests (numbers [n] at each frequency were just specified). The system obtains and records data from tinnitus patients, including hearing thresholds and the pitch and loudness of their tinnitus. The large number of individuals impacted by tinnitus underscores the need for standardized tinnitus assessment methods [9-10]. A system to conduct computer-automated clinical procedures for tinnitus evaluation has been under development in our laboratory since 1995 [11]. With these changes, we intended to (1) reduce testing time by enabling more rapid responses by patients and (2) provide a testing platform that would result in more reliable pitch matches. A custom-built dynamic link library was designed and developed to interface PowerPoint objects with the tinnitus test program and also to allow responses to be sent back to the program. System control parameters and overall testing configuration continue to be database-driven. Depending on the test, too many steps per revolution would make the stimulus change too rapidly, while too few steps could frustrate the patient because so much rotation distance would be needed to change the stimulus.
The second test session was identical to the first, resulting in a total of four complete tests for each participant. At 8,000 Hz, one participant did not respond during the final test, thus the n = 39 for 8,000 Hz.


Audiological testing for hearing loss has been standardized for decades, and tinnitus testing needs to achieve comparable standardization. All participants confirmed that their tinnitus was essentially unchanged from the first to the second appointment. The present system was designed to enable the patient to reduce test time by directly controlling the relevant stimulus parameters during testing.
At frequencies above 8,000 Hz, a diminishing number of participants provided responses for each of the four tests (which we expected because of hearing loss that is usually associated with tinnitus). We conducted Sheffe post hoc testing to determine which pairs of means differed significantly. Table 3 also shows cumulative percentages (in parentheses) from the group of 20 cochlear-impaired participants who were tested with the previous version of the system [17]. Using the system, we evaluated 40 individuals with tinnitus to assess within- and between-session reliability of responses.
The system continues to undergo refinements, and although testing with the system has proven reliable for tinnitus loudness-matching, pitch-matching has continued to show considerable test-retest variability.
The initial phase of development and testing of the new automated system is described herein. Patients, therefore, now have the ability to self-adjust stimulus parameters rather than being guided through the program at the computer's pace, which requires additional time and more test steps. In addition, overall testing time was too lengthy to be acceptable for clinical application. To determine if this difference between the two data sets was significant, we performed the nonparametric Kolmogorov-Smirnov test [19]. Incorporating the new features has reduced testing time to an average of less than 19 minutes and has resulted in comparable loudness-match reliability and improved pitch-match reliability compared with the previous results.



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