Strategies for the Selection of Music in the Short-Term Management of Mild Tinnitus

A scoping review of tinnitus research undertaken by New Zealand researchers: Aotearoa-an international hotspot for tinnitus innovation and collaboration

Tinnitus is a very common oto-neurological disorder of the perception of sound when no sound is present. To improve understanding of the scope, strengths and weaknesses of New Zealand tinnitus research, a critical scoping review was undertaken. The aim was to help develop priorities for future research. A review of the literature was undertaken using a 6-stage scoping review framework of Scopus and Pub Med were searched in May 2023 with the combination of following key word [Tinnitus] and country of affiliation [New Zealand]. The search of PubMed resulted in 198 articles and that of Scopus 337 articles. After initial consideration of title relevance to the study (165 from PubMed and 196 from Scopus) removal of duplicates and after reading the articles and adding from references, 208 studies were chosen for charting of data. Nine themes were identified and described: A. Epidemiology; B. Models; C. Studies in animals; D. Mechanisms; E. Assessment and prognosis; F. Pharmacotherapy; G. Neuromodulation; H. Sensory therapies; I. Clinical practice. An urgent priority for future tinnitus research in NZ must be to address the absence of cultural and ethnic diversity in participants and consideration of traditional knowledge.

Investigation on chronic tinnitus efficacy of combination of non-repetitive preferred music and educational counseling: a preliminary study

PURPOSE

To improve the efficacy of music therapy on tinnitus relief, specific music that was not repetitively played and satisfies individualized preference was developed. The aim of this study was to investigate effects of combination of the specific music and educational counseling on tinnitus relief in short term.

METHODS

Sixty patients suffering from chronic tinnitus were included. The non-randomized controlled study was designed with two intervention groups: educational counseling (EC, which included a 1-h individualized instruction) and preferred music therapy [PMT, which included EC plus 15, 30-min preferred music sessions (PMS)]. Three assessments-the Chinese-Mandarin version of Tinnitus Handicap Inventory (THI-CM), Tinnitus Evaluation Questionnaire (TEQ), and Visual Analogue Scale (VAS) were administered before and 1, 2, 3 weeks after initiation of treatment to evaluate the efficacy.

RESULTS

Twenty-six patients in PMT group attained a clinically meaningful improvement in THI compared to 15 in the EC group, though both groups achieved a statistically relevant reduction in the 3 assessments.

CONCLUSION

The PMT had a positive impact on chronic tinnitus and related distress in a short term. It outperformed the separate EC, which is an appropriate treatment option in clinic. Therefore, it presents a possible complement to the therapeutic spectrum in chronic tinnitus.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR1900022624. Registered on 19 April 2019.

Sense and Sensibility: A Review of the Behavioral Neuroscience of Tinnitus Sound Therapy and a New Typology

Tinnitus Sound Therapy is not a single strategy. It consists of many different sound types, targeting many different mechanisms. Therapies that use sound to cover, reduce attention to, or facilitate habituation of tinnitus are among the most common tinnitus treatment paradigms. Recent history has seen a proliferation of sound therapies, but they have each been criticized for having limited empirical support. In this review, Sound Therapy's modern history will be described, and a typology will be introduced and discussed in light of current behavioral neuroscience research. It will be argued that contributing factors to the limited evidence for the efficacy of Sound Therapy are its diversity, plural modes of action, and absence of a clear typology. Despite gaps in understanding the efficacy of sound's effects on tinnitus, there is compelling evidence for its multiple, but related, neurophysiological mechanisms. Evidence suggests that sound may reduce tinnitus through its presence, context, reaction, and potentially adaptation. This review provides insights into the neurocognitive basis of these tinnitus Sound Therapy modes. It concludes that a unifying classification is needed to secure and advance arguments in favor of Sound Therapy.

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.