Effectiveness of sound therapy in patients with tinnitus resistant to previous treatments: importance of adjustments

Personalized Sound Therapy Combined with Low and High-Frequency Electromagnetic Stimulation for Chronic Tinnitus

This study investigates a novel multimodal treatment for chronic tinnitus, a condition that significantly affects quality of life, by combining personalized sound therapy with both low- and high-frequency electromagnetic wave stimulation. Conducted at Tor Vergata University Hospital in Rome, the research involved 55 patients and employed a portable medical device for therapy delivery. Treatment effectiveness was measured through the Tinnitus Functional Index (TFI), Tinnitus Handicap Inventory (THI), Visual Analogue Scale (VAS), Hyperacusis Questionnaire (HQ), and Short Form-36 Health Survey (SF-36), encompassing initial sound therapy and subsequent multimodal treatment phases. Remarkably, 73% of participants experienced notable improvements in TFI scores, with 39% reporting a significant enhancement of 13 points or more. This improvement was mirrored in secondary outcomes like THI, VAS, and HQ scores, along with certain SF-36 domains, indicating enhanced life quality and reduced tinnitus distress. The study underscored high compliance and no adverse effects, suggesting the combined therapy's promising potential in chronic tinnitus management. The findings advocate for further research to discern the distinct contributions of each treatment modality, positing that this innovative approach could ameliorate tinnitus symptoms and improve patient well-being, confirming its safety and efficacy.

The Impact of Daily Hours of Sound Therapy on Tinnitus Relief for People With Chronic Tinnitus: A Randomized Controlled Study

PURPOSE

Tinnitus is defined as the perception of sounds in the absence of extrinsic sound stimuli. Sound therapy is an option for tinnitus rehabilitation, which aims to mitigate the functional and emotional effects of tinnitus. Several studies have reported that a longer duration of sound therapy may result in a greater tinnitus relief effect. However, the relationship between the daily hours of sound therapy and the tinnitus relief effect remains unclear. Thus, we aimed to evaluate the tinnitus relief effect according to the time spent in daily performing sound therapy.

METHOD

Fifty-eight chronic tinnitus participants were randomly assigned to three groups according to their daily hours of sound therapy (1-hr, 3-hr, and 5-hr groups), and mixing point-based sound therapy, which adjusts the volume of the external stimulus to blend with the participant's tinnitus sound, was administered for 3 months. The effectiveness of sound therapy was determined based on changes in the tinnitus loudness level, visual analog scale for loudness score, and the Korean version of the Tinnitus Primary Function Questionnaire (K-TPFQ) score between the baseline and 3-month time points.

RESULTS

Longer daily sound therapy hours were associated to a greater effect of sound therapy in the tinnitus loudness level and the total K-TPFQ scores, including the emotion and hearing subcategories. Particularly, the 3-hr and 5-hr groups showed a greater tinnitus relief than the 1-hr group.

CONCLUSION

An increase in the daily sound therapy hours may increase the possibility of improving tinnitus relief effects.

A randomized single-blind controlled trial of a prototype digital polytherapeutic for tinnitus

Objective

This randomized single-blind controlled trial tested the hypothesis that a prototype digital therapeutic developed to provide goal-based counseling with personalized passive and active game-based sound therapy would provide superior tinnitus outcomes, and similar usability, to a popular passive sound therapy app over a 12 week trial period.

Methods

The digital therapeutic consisted of an app for iPhone or Android smartphone, Bluetooth bone conduction headphones, neck pillow speaker, and a cloud-based clinician dashboard to enable messaging and app personalization. The control app was a popular self-help passive sound therapy app called White Noise Lite (WN). The primary outcome measure was clinically meaningful change in Tinnitus Functional Index (TFI) between baseline and 12 weeks of therapy. Secondary tinnitus measures were the TFI total score and subscales across sessions, rating scales and the Client Oriented Scale of Improvement in Tinnitus (COSIT). Usability of the US and WN interventions were assessed using the System Usability Scale (SUS) and the mHealth App Usability Questionnaire (MAUQ). Ninety-eight participants who were smartphone app users and had chronic moderate-severe tinnitus (>6 months, TFI score > 40) were enrolled and were randomly allocated to one of the intervention groups. Thirty-one participants in the USL group and 30 in the WN group completed 12 weeks of trial.

Results

Mean changes in TFI for the USL group at 6 (16.36, SD 17.96) and 12 weeks (17.83 points, SD 19.87) were clinically meaningful (>13 points reduction), the mean change in WN scores were not clinically meaningful (6 weeks 10.77, SD 18.53; 12 weeks 10.12 points, SD 21.36). A statistically higher proportion of USL participants achieved meaningful TFI change at 6 weeks (55%) and 12 weeks (65%) than the WN group at 6 weeks (33%) and 12 weeks (43%). Mean TFI, rating and COSIT scores favored the US group but were not statistically different from WN. Usability measures were similar for both groups.

Conclusions

The USL group demonstrated a higher proportion of responders than the WN group. The usability of the USL therapeutic was similar to the established WN app. The digital polytherapeutic demonstrated significant benefit for tinnitus reduction supporting further development.

Chronic Tinnitus and the Positive Effects of Sound Treatment via a Smartphone App: Mixed-Design Study

Background

Tinnitus is a phantom auditory sensation in the absence of an external stimulus. It is accompanied by a broad range of negative emotional symptoms and a significantly lower quality of life. So far, there is no cure for tinnitus, although various treatment options have been tried. One of them is mobile technology employing dedicated apps based on sound therapy. The apps can be managed by the patient and tailored according to their needs.

Objective

The study aims to assess the effect of a mobile app that generates background sounds on the severity of tinnitus.

Methods

The study involved 68 adults who had chronic tinnitus. Participants were divided into a study group (44 patients) and a control group (24 patients). For 6 months those in the study group used a free mobile app that enriched the sound environment with a background sound. Participants were instructed to use the app for at least 30 minutes a day using their preferred sound. The participants in the control group did not use the app. Subjective changes in the day-to-day functioning of both groups were evaluated using the Tinnitus Handicap Inventory (THI) questionnaire, a visual analog scale, and a user survey.

Results

After 3 months of using the app, the THI global score significantly decreased (P<.001) in the study group, decreasing again at 6 months (P<.001). The largest improvements were observed in the emotional and catastrophic reactions subscales. A clinically important change in the THI was reported by 39% of the study group (17/44). Almost 90% of the study participants (39/44) chose environmental sounds to listen to, the most popular being rain and ocean waves. In the control group, tinnitus severity did not change over 3 or 6 months.

Conclusions

Although the participants still experienced limitations caused by tinnitus, the advantage of the app was that it led to lower negative emotions and thus reduced overall tinnitus severity. It is worth considering whether a mobile app might be incorporated into the management of tinnitus in a professional setting.

Effect of Auditory Discrimination Therapy on Attentional Processes of Tinnitus Patients

Tinnitus is an auditory condition that causes humans to hear a sound anytime, anywhere. Chronic and refractory tinnitus is caused by an over synchronization of neurons. Sound has been applied as an alternative treatment to resynchronize neuronal activity. To date, various acoustic therapies have been proposed to treat tinnitus. However, the effect is not yet well understood. Therefore, the objective of this study is to establish an objective methodology using electroencephalography (EEG) signals to measure changes in attentional processes in patients with tinnitus treated with auditory discrimination therapy (ADT). To this aim, first, event-related (de-) synchronization (ERD/ERS) responses were mapped to extract the levels of synchronization related to the auditory recognition event. Second, the deep representations of the scalograms were extracted using a previously trained Convolutional Neural Network (CNN) architecture (MobileNet v2). Third, the deep spectrum features corresponding to the study datasets were analyzed to investigate performance in terms of attention and memory changes. The results proved strong evidence of the feasibility of ADT to treat tinnitus, which is possibly due to attentional redirection.

Effects of different personalised sound therapies in tinnitus patients with hearing loss of various extents

BACKGROUND

Limited by difficulties in choosing the appropriate sound, sound therapies could only effectively restrain the development of tinnitus in some patients. Thus, individualised sound therapies are of urgent needs.

OBJECTIVE

The purpose of this study was to determine the therapeutic effect of different individualised sound therapies in tinnitus patients complicated with hearing loss of various extents.

RESEARCH DESIGN

Participants were assigned to two different personalised sound therapies as counterbalanced by age and gender in this observational study.

STUDY SAMPLE

Ninety-two tinnitus patients with hearing loss admitted to our hospital from January 2018 to January 2020 were enrolled and evenly grouped as the observation group and the control group in accordance with the random number table.

DATA COLLECTION AND ANALYSES

Tinnitus characteristics of both the groups were determined before treatment. Patients from the observation group received pure tone sound therapy composed of 7 octaves (0.125, 0.25, 0.5, 1, 2, 4 and 8 kHz) based on frequencies determined from their tinnitus characteristics. The control group received pure tone sound therapy composed of 9 one-third octaves based on their tinnitus characteristics.

RESULTS

The observation group had better therapeutic effects than that in the control group (91.30% vs 73.91%, P < .05). After 1 week, and 1- to 3-month treatment, patients in the observation group all presented with decreased tinnitus handicap, decreased tinnitus volume and improved sleep quality compared with the control group (P < .05).

CONCLUSION

This study found that both personalised sound therapies were effective in tinnitus treatment while 7-octave pure tone adjusted from tinnitus frequencies were more promising in decreasing tinnitus handicap and tinnitus volume.

Content validity of the tinnitus outcome questionnaire for sound management

Standardized instruments are often used to monitor one’s progress in tinnitus relief although they were developed to screen and diagnose tinnitus. The need for the development for a tinnitus outcome assessment tool is high in the field of audiology and otolaryngology. The purpose of this study was to develop a tinnitus outcome questionnaire for sound management (listening to sound stimuli for tinnitus relief) and assess its content validity. A total of 32 questions with six domains (Tinnitus characteristics, the impact of tinnitus, tinnitus and hearing issues, handedness, tinnitus management, and sound management outcome) were generated after closely investigating major tinnitus questionnaires used worldwide (i.e. Tinnitus Handicap Inventory and Tinnitus Handicap Questionnaire) as well as literature. Ten healthcare professionals evaluated the appropriateness of the questionnaire items on a five-point Likert scale, where 1 is strongly inappropriate and 5 is strongly appropriate. Content relevance was assessed by computing the content validity index with the cut-off value of 0.75. Each response was first weighted as follows: 1 = 0; 2 = 0.25; 3 = 0.5; 4 = 0.75; and 5 = 1.0. The weighted average was then calculated. Items with a content validity index less than 0.75 were discarded and some items were revised according to the experts’ feedback. As a result, 31 out of the 32 items had the content validity index higher than 0.75, indicating that the items are appropriate to obtain information about the six domains. Reflecting the experts’ feedback, some questions were revised to be more specific. The study provides a baseline structure regarding potential questions to be included in a tinnitus outcome questionnaire for sound management. Development and standardization of such questionnaire would be a pathway to validating tinnitus relief via sound therapy.

Effectiveness of tinnitus therapy using a mobile application

Background

The World Health Organization reports that the number of tinnitus sufferers is increasing year on year. Given the common use of mobile devices and the availability of applications designed to support patients in tinnitus therapy and reduce tinnitus severity, patients seeking help are likely to try this form of support. The aim of this study was to evaluate the effectiveness of a mobile application in tinnitus sound therapy, in this case ReSound Tinnitus Relief™.

Methods

The study involved 52 patients hospitalized for tinnitus. All participants used the free ReSound Tinnitus Relief application for 6 months. The application is based on sound therapy. Patients were advised to use the application for at least 30 min per day, the sounds should not completely mask the tinnitus, and they should be listened to via a loudspeaker. The effects of the therapy were evaluated by means of standardized questionnaires for tinnitus severity: the Tinnitus Handicap Inventory and the Tinnitus Functional Index.

Results

The study showed a reduction in tinnitus severity as measured by both questionnaires. The general severity decreased after the first 3 months and again in the following 3 months of using the application. In both questionnaires the biggest changes were observed in the subscales of emotions.

Conclusions

Results obtained here from standardized questionnaires indicate that the tested application may contribute to tinnitus reduction. However, it is advisable to conduct further research on the applicability of such technology in medical practice.

Clinical randomized trial study of hearing aids effectiveness in association with Ginkgo biloba extract (EGb 761) on tinnitus improvement

Introduction

Tinnitus is defined as the perception of sound without its actual presence in the environment. It has been the subject of a great number of studies, especially considering its consequences on patient's quality of life.

Objective

This study aimed to investigate the effect of hearing aids and/or Ginkgo biloba extract EGb 761 on tinnitus in patients with hearing loss.

Methods

This is a trial randomized-controlled treatment, parallel, double-blind, with three-arm. Thirty-three adults subjects were divided into three groups: group 1 — subjects undergoing drug therapy with Ginkgo biloba extract EGb 761; group 2 — individuals fitted with digital hearing aids; group 3 — individuals submitted to drug therapy with Ginkgo biloba extract EGb 761 and using hearing aids. The tinnitus handicap inventory and visual analogue scale were used to evaluate self-perception of tinnitus loudness and severity before treatment and 90 days after treatment.

Results

This study demonstrated a significant correlation between tinnitus handicap inventory and visual analogue scale, before and after treatment. We observed a significant improvement in self-perception of tinnitus loudness and severity after 90 days of treatment with Ginkgo biloba extract EGb 761 and/or hearing aids. No correlation was found between tinnitus onset time and self-perception of tinnitus loudness and severity. Hearing aids were more effective in patients with a shorter tinnitus onset time and Ginkgo biloba extract was effective regardless of tinnitus duration.

Conclusions

It was possible to prove the effectiveness of the hearing aids and/or Ginkgo biloba extract EGb 761 treatment, which shows success in the control of tinnitus contributing to the improvement of this symptom.

Sound Generator: Analysis of the Effectiveness of Noise in the Habituation of Tinnitus

Introduction  Tinnitus is a disorder that affects 10 to 15% of de world's population. Sound therapy performed through hearing aids (HAs) with integrated sound generator (SG) is one of the forms of tinnitus treatment. Objective  To analyze the effectiveness of four masking noises in relieving tinnitus in individuals with mild and moderate bilateral sensorineural hearing loss and their influence in speech perception. Methods  The participants were 35 individuals with tinnitus and mild and moderate bilateral sensorineural hearing loss, divided into four groups. All groups underwent HA and SG adaptation, being regulated in the combined mode (HA and SG). In group 1 (G1), the white noise stimulus was applied, in group 2 (G2), pink noise was applied, in group 3 (G3), speech noise, and in group 4 (G4), the high tone was applied. All patients were subjected to the following procedures: audiological diagnosis, acuphenometry, tinnitus handicap inventory (THI), visual analogue scale (VAS), and hearing in noise test (HINT). The procedures were performed prior to and after hearing intervention, and after 3 months of use of HA and SG. Results  All groups presented a statistically significant difference for the THI, VAS, and HINT pre and postintervention. In the case of the HINT, only pink noise presented a significant difference. However, in the comparation among groups there was no significant difference. Conclusion  The present study made it possible to conclude that the four noises were equally effective in relieving tinnitus, with no statistically significant differences between the analyzed groups.

Functional Impact of Tinnitus in Patients with Hearing Loss

Introduction  Tinnitus, which is considered the third worst symptom for humans, is a common complaint among people living with hearing loss and may negatively affect the quality of life of those who have it. Objective  To analyze the perception of the handicap in patients with tinnitus and hearing loss as well as the possible associations between the variables hearing loss, loudness, onset, frequency and annoyance by tinnitus, and the correlation between the visual analogue scale (VAS) and the Tinnitus Handicap Inventory (THI). Methods  A total of 30 patients with complaints of tinnitus and the presence of sensorineural hearing impairment were selected for this cross-sectional, observational, and descriptive study. The loudness of the tinnitus was measured by a VAS and classified as mild, moderate, or severe. The THI was classified as slight, mild, moderate, severe, and catastrophic. Data were submitted to statistical analysis using the Fisher exact test and Spearman correlation coefficient. Results  Eleven male (36.7%) and 19 female (63.3%) subjects with a mean age of 56.5 years old were evaluated. There was no significant association between loudness, annoyance, time and frequency of tinnitus, nor between hearing loss and tinnitus. There was a significant association between the variables hearing loss and loudness, and a weak correlation between VAS and THI. Conclusion  Tinnitus has a practical impact in the lives of patients with hearing loss in terms of catastrophic, functional, and emotional aspects, regardless of loudness, frequency, or time of onset. Hearing loss was a factor that had an impact on the loudness of tinnitus. There was no statistically significant correlation between VAS and THI.

Applicability of the real ear measurement for audiological intervention of tinnitus

INTRODUCTION

Tinnitus is present in a large part of chronic health complaints, and it is considered a public health problem injurious to the individual's quality of life. Considering the increase of the world population associated with an increase of life expectancy, tinnitus remains a cause for medical concern, since during aging the occurrence of auditory impairments due to the deterioration of the peripheral auditory structures and central impairs the quality of life.

OBJECTIVE

The aim of the present study was to analyze the applicability of real ear measurements for audiological intervention of tinnitus through specific evaluation, selection, verification and validation of the hearing aids combined with the sound generator.

METHODS

Forty individuals of both genders with hearing loss and tinnitus complaints were deemed eligible to compose the sample. They were enrolled according to clinical symptoms and submitted to the following procedures: anamnesis and previous complaint history, high frequency audiometry, immittanciometry and acuphenometry with the research of psychoacoustic thresholds of pitch, loudness and minimum masking threshold, sound generator, in addition to the application of the Tinnitus Handicap Inventory and Visual Analog Scale tools. The entire sample was adapted with Siemens hearing aids and a sound generator, participated in a counseling session with support of digital material and evaluated in two situations: Initial Assessment (before the hearing aids and sound generator adaptation) and Final Assessment (6 months, after adaptation). The statistical analyzes were descriptive and inferential, adopted a significance level of 5% and the T-Paired Test and the Spearman Correlation test were performed.

RESULTS

The results showed that there was a benefit with the use of hearing aids combined with a sound generator from the statistically significant values and strong correlations between the sound generator verification data regarding acuphenometry and the nuisance/severity questionnaires. Regarding the verification of the sound generator, it is important to highlight that the entire sample selected the effective acoustic stimulation based on the comfort levels, which was proved in the present study to be a sufficient intensity for positive prognosis, whereas the users' noises were found below the psychoacoustic thresholds of acuphenometry.

CONCLUSION

The present study concluded that the audiological intervention with any level of sound stimulus is enough to obtain a positive prognosis in the medium term. Data that specifies that the verification of sound generator was effective at the real ear measurements are important in the evaluation and intervention of the complaint. In addition, it points out that the greater the tinnitus perception, the greater its severity, and the greater the nuisance, the higher the psychoacoustics thresholds of frequency and the minimum threshold of masking.

Comparative study of sensation and repercussion of tinnitus on the quality of life and craniocervical posture in teachers

ABSTRACT Purpose: to verify whether there is a correlation between tinnitus sensation and repercussion on the quality of life and craniocervical posture in teachers, participating in the Pró-Mestre project. Methods: a cross-sectional study with a sample of 90 teachers, mean age of 47.70 years, who responded to the Craniocervical Dysfunction Index (CDI), to verify the craniocervical posture, the analog visual scale (AVS), and the Portuguese adaptation of the Tinnitus Handicap Inventory (THI), to investigate tinnitus and its impact on the quality of life. Appropriate statistical tests were applied, by adopting a significance level lower than 0.05. Results: out of the 90 teachers, 18 (20%) had tinnitus. There was a statistically significant difference between the sensation of tinnitus, according to the AVS and the craniocervical posture (CDI) in teachers (p <0.001). There was also an association between tinnitus complaint and right-rotation range of motion, with age and right lateral tilt being independent factors, regarding teachers' tinnitus sensation. In the correlation of the THI (total and domains), there was an association with cervical mobility, only in the left inclination. Conclusion: since a statistically significant difference was found between the subjective sensation of tinnitus and the craniocervical posture with a correlation between tinnitus sensation and repercussion on the quality of life and craniocervical posture in teachers, these aspects should be considered in the assessment of teachers presented with tinnitus, as well as further studies with a population of teachers, healthy adults, in order to increase the knowledge on the subject.

Management of adult patients with tinnitus: Preparedness, perspectives and practices of audiologists

Background

Audiologists, globally, are generally challenged when assessing and creating intervention plans to help patients suffering from tinnitus. Tinnitus is very common among individuals and may significantly affect one’s quality of life, especially if not addressed by health care professionals. In South Africa, there seems to be limited published studies regarding the current practices of tinnitus management by audiologists. This is mainly because of limited training and a lack of guidelines and strategies for the management of tinnitus. In particular, some participants reported being unfamiliar on how to approach the identification of tinnitus and difficulty is also encountered when counselling tinnitus patients.

Aim

The aim of this study was to describe the preparedness, perspectives and practices of audiologists who manage adult patients with tinnitus.

Method

Two hundred and forty-three registered Health Professions Council of South Africa (HPCSA) participants were involved in the study by responding to an electronic questionnaire survey. Data were collected online from Survey Monkey and were exported to Statistical Packages for the Social Sciences (SPSS) (Version 23) for statistical analysis. Data were analysed using descriptive and inferential statistics. Closed-ended questions were analysed within a quantitative framework and thematic analysis for open-ended questions that were descriptively quantified.

Results

The results of the study are presented according to the objectives. Approximately 44% of participants (44.3%) disagreed that the undergraduate university training had sufficiently prepared them to manage adult patients with tinnitus. Very few (12.3%) had the opportunity to attend specialist training on how to assess patients with tinnitus. Similarly, only 11.6% received any specialist training with regard to tinnitus intervention. With regard to its overall management, 49.4% felt adequately informed in the assessment of patients with tinnitus, while a further 39.2% rated their experience as being limited with regard to tinnitus intervention. There is no statistical significance relationship between participants’ years of experience and tinnitus intervention (p = 0.075). Most participants did not follow any standard guidelines for its management. Some participants (26.8%) reported that further education and training are required in the overall management of patients with tinnitus, while a further 17.7% required training in all areas of tinnitus.

Conclusion

The feedback relating to the study suggests that overall management of tinnitus seems to be a challenge among South African audiologists, irrespective of their years of experience. Audiologists in the study perceived that tinnitus services are limited mainly because of a lack of or limited knowledge, training and guidelines, these being affected by contextual restraints.

Individual Reliability of the Standard Clinical Method vs Patient-Centered Tinnitus Likeness Rating for Assessment of Tinnitus Pitch and Loudness Matching

Importance

Current individualized sound therapies for tinnitus rely on tinnitus pitch assessment, which is commonly derived from the standard clinical 2-alternative forced-choice (2-AFC) approach driven by the examiner. However, this method is limited by lack of individual test-retest reliability and focuses on a single rather than multiple tinnitus frequencies.

Objective

To assess individual test-retest reliability of the 2-AFC, with a single final frequency (and corresponding loudness), and the tinnitus likeness rating (TLR), with the participant exposed to the entire audible frequency spectrum, from which 3 dominant frequencies and corresponding loudness were extracted.

Design, Setting, and Participants

In this case series, participants with tinnitus underwent testing twice with both methods at a 1-month interval by experienced clinicians from January 6 through March 17, 2017. Each clinician tested each patient only once at visit 1 or 2 in a university audiology training setting with standardized equipment and was blind to previous assessment. Participants with bilateral or unilateral chronic tinnitus for longer than 6 months, in good health, without total deafness in either ear, and without cerumen in the ear canal were recruited through advertisements (community and clinics) and word of mouth (volunteer sample). The audiologists were likewise participants in the planned comparison between TLR and 2-AFC in the test-retest measures.

Main Outcomes and Measures

Test-retest concordance with 95% CIs for each method, calculated as the proportion of participants with the same final frequency between the 2 visits (2-AFC) or with at least 1 concordant dominant frequency (TLR) as well as loudness differences of no greater than 10 dB.

Results

The study sample included 31 participants (55% men; mean [SD] age, 50.7 [13.7] years). For TLR, 26 of 31 participants had at least 1 concordant dominant frequency between the 2 visits (proportion, 0.84; 95% CI, 0.66-0.95), whereas for 2-AFC, 7 of 31 participants had a concordant final tinnitus pitch in either ear (proportion, 0.23; 95% CI, 0.10-0.41). Loudness reliability followed the same pattern, with more concordant loudness levels in the TLR (proportion, 0.73; 95% CI, 0.52-0.88) than in the 2-AFC (proportion, 0.40; 95% CI, 0.05-0.85). Mean time taken to complete the tests was less than 15 minutes, and general appreciation by participants with tinnitus and audiologists were overall similar for both.

Conclusions and Relevance

Superior test-retest concordance can be demonstrated at the individual level using the several dominant frequencies extracted from the patient-centered TLR.

Depression in Patients with Tinnitus: A Systematic Review

OBJECTIVE

Tinnitus is a condition that causes distress and impairment across cognitive, functional, and psychiatric spectra. In the psychiatric realm, tinnitus has long been associated with depression. To better characterize the co-occurrence of depression and tinnitus, we performed a systematic review of the prevalence of depression among patients with tinnitus.

DATA SOURCES

We comprehensively examined original studies reporting the prevalence of depression in adult populations with tinnitus, as indexed in the PubMed and Web of Science databases and published from January 2006 to August 2016.

REVIEW METHODS

All identified articles were reviewed independently by 2 researchers, with a third reviewer for adjudication. Included studies were evaluated for threats to validity across 3 domains-representativeness, response rate, and ascertainment of outcome-on a 4-point modified Newcastle-Ottawa Quality Assessment Scale.

RESULTS

Twenty-eight studies were included, representing 15 countries and 9979 patients with tinnitus. Among the included studies, the median prevalence of depression was 33%, with an interquartile range of 19% to 49% and an overall range of 6% to 84%. Studies were high quality overall, with a mean score of 3.3 (SD = 0.76), and 89% utilized a validated tool to ascertain depression.

CONCLUSIONS

We conducted one of the largest contemporary comprehensive reviews, which suggests a 33% prevalence of depression among patients with tinnitus. Our review reaffirms that a substantial proportion of patients with tinnitus have depression, and we recommend that all who treat tinnitus should screen and treat their patients for depression, if present.

Recording of tinnitus psychoacoustic measurements: an integrative literature review

ABSTRACT Purpose: to review both the national and international literature as well as to describe the methods used to collect psychoacoustic measurements in tinnitus patients. Methods: the current integrative review was conducted on articles in specialized national and international journals, in both the Portuguese and English languages, available in the PubMed/Medline, BVS - LILACS and SCIELO databases. The following keywords and descriptors were used: hearing, tinnitus, psychoacoustic measurements, acuphenometry, and assessment, in both the Portuguese and English languages. The retrieved articles were read and selected for the review according to the eligibility criteria, which included the use of psychoacoustic measurements in tinnitus patients and the presence of a detailed methodological description of the protocol employed, in individuals with normal hearing and those with hearing loss. Results: a total of 12 articles, in which psychoacoustic measures were used for the characterization and the measurement of tinnitus in individuals with normal hearing and in those with hearing loss, were reviewed. The main findings were associated with the sample characterization and the way in which the psychoacoustic measures were performed. Conclusion:given the grouping of several protocols for tinnitus evaluation, which were determined following an integrative literature review, a great heterogeneity in the methods used to perform psychoacoustic measurements for tinnitus assessment for both clinical and scientific purposes was noted.

Psychoacoustic classification of persistent tinnitus

Introduction

Tinnitus is a difficult to treat symptom, with different responses in patients. It is classified in different ways, according to its origin and associated diseases.

Objective

to propose a single and measurable classification of persistent tinnitus, through its perception as sounds of nature or of daily life and its comparison with pure tone or noise, of high or low pitch, presented to the patient by audiometer sound.

Methods

A total of 110 adult patients, of both genders, treated at the Tinnitus Outpatient Clinic, were enrolled according to the inclusion and exclusion criteria. Otorhinolaryngologic and Audiological, Pitch Matching and Loudness, Visual Analog Scale, Tinnitus Handicap Inventory and Minimum Masking Level assessments were performed.

Results

In these 110 patients, 181 tinnitus complaints were identified accordingly to type and ear, with 93 (51%) Pure Tone, and 88 (49%) Noise type; 19 at low and 162 at high frequency; with a mean in the Pure Tone of 5.47 in the Visual Analog Scale and 12.31 decibel in the Loudness and a mean in the Noise of 6.66 and 10.51 decibel. For Tinnitus Handicap Inventory and Minimum Masking Level, the 110 patients were separated into three groups with tinnitus, Pure Tone, Noise and multiple. Tinnitus Handicap Inventory higher in the group with multiple tinnitus, of 61.38. Masking noises such as White Noise and Narrow Band were used for the Minimum Masking Level at the frequencies of 500 and 6000 Hz. There was a similarity between the Pure Tone and Multiple groups. In the Noise group, different responses were found when Narrow Band was used at low frequency.

Conclusion

Classifying persistent tinnitus as pure tone or noise, present in high or low frequency and establishing its different characteristics allow us to know its peculiarities and the effects of this symptom in patients’ lives.

A State-of-the-Art Review: Personalization of Tinnitus Sound Therapy

Background: There are several established, and an increasing number of putative, therapies using sound to treat tinnitus. There appear to be few guidelines for sound therapy selection and application. Aim: To review current approaches to personalizing sound therapy for tinnitus. Methods: A "state-of-the-art" review (Grant and Booth, 2009) was undertaken to answer the question: how do current sound-based therapies for tinnitus adjust for tinnitus heterogeneity? Scopus, Google Scholar, Embase and PubMed were searched for the 10-year period 2006-2016. The search strategy used the following key words: "tinnitus" AND "sound" AND "therapy" AND "guidelines" OR "personalized" OR "customized" OR "individual" OR "questionnaire" OR "selection." The results of the review were cataloged and organized into themes. Results: In total 165 articles were reviewed in full, 83 contained sufficient details to contribute to answering the study question. The key themes identified were hearing compensation, pitched-match therapy, maskability, reaction to sound and psychosocial factors. Although many therapies mentioned customization, few could be classified as being personalized. Several psychoacoustic and questionnaire-based methods for assisting treatment selection were identified. Conclusions: Assessment methods are available to assist clinicians to personalize sound-therapy and empower patients to be active in therapy decision-making. Most current therapies are modified using only one characteristic of the individual and/or their tinnitus.

A Mixed-Methods Trial of Broad Band Noise and Nature Sounds for Tinnitus Therapy: Group and Individual Responses Modeled under the Adaptation Level Theory of Tinnitus

Objectives: A randomized cross-over trial in 18 participants tested the hypothesis that nature sounds, with unpredictable temporal characteristics and high valence would yield greater improvement in tinnitus than constant, emotionally neutral broadband noise. Study Design: The primary outcome measure was the Tinnitus Functional Index (TFI). Secondary measures were: loudness and annoyance ratings, loudness level matches, minimum masking levels, positive and negative emotionality, attention reaction and discrimination time, anxiety, depression and stress. Each sound was administered using MP3 players with earbuds for 8 continuous weeks, with a 3 week wash-out period before crossing over to the other treatment sound. Measurements were undertaken for each arm at sound fitting, 4 and 8 weeks after administration. Qualitative interviews were conducted at each of these appointments. Results: From a baseline TFI score of 41.3, sound therapy resulted in TFI scores at 8 weeks of 35.6; broadband noise resulted in significantly greater reduction (8.2 points) after 8 weeks of sound therapy use than nature sounds (3.2 points). The positive effect of sound on tinnitus was supported by secondary outcome measures of tinnitus, emotion, attention, and psychological state, but not interviews. Tinnitus loudness level match was higher for BBN at 8 weeks; while there was little change in loudness level matches for nature sounds. There was no change in minimum masking levels following sound therapy administration. Self-reported preference for one sound over another did not correlate with changes in tinnitus. Conclusions: Modeled under an adaptation level theory framework of tinnitus perception, the results indicate that the introduction of broadband noise shifts internal adaptation level weighting away from the tinnitus signal, reducing tinnitus magnitude. Nature sounds may modify the affective components of tinnitus via a secondary, residual pathway, but this appears to be less important for sound effectiveness. The different rates of adaptation to broadband noise and nature sound by the auditory system may explain the different tinnitus loudness level matches. In addition to group effects there also appears to be a great deal of individual variation. A sound therapy framework based on adaptation level theory is proposed that accounts for individual variation in preference and response to sound. Clinical Trial Registration: www.anzctr.org.au, identifier #12616000742471.