An Exploratory Study of Bimodal Electro-Aural Stimulation Through the Ear Canals for Tinnitus.

OBJECTIVE: The aim of this study was to explore the potential for bimodal auditory and noninvasive electrical stimulation at the ears to alleviate tonal, somatic tinnitus that was investigated in a small preliminary trial (11 participants). DESIGN: Auditory stimulation took the form of short "notched noise" bursts customized to each participant's tinnitus percept. Simultaneous pulsed electrical stimulation, intended to facilitate neuroplasticity, was delivered via hydrogel electrodes placed in opposite ears. RESULTS: After a 6-week intervention period, average Tinnitus Functional Index (TFI) and Tinnitus Primary Function Questionnaire (TPFQ) scores were consistent with clinically meaningful improvements in the study population. Magnitudes and effect sizes of improvements in TFI and TPFQ are comparable to those reported in other recent bimodal therapy studies using different auditory and electrical stimulation parameters. CONCLUSIONS: Our results should be considered preliminary given the small sample size, lack of crossover data, and small subject pool. When considered alongside other recent bimodal therapy results, we do believe that there are therapeutic benefits of bimodal stimulation for tinnitus sufferers that have the potential to help some with tinnitus, with a variety of stimulation parameters and electrode placements. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25444546.

Reliability of the Minimum Masking Level as Outcome Variable in Tinnitus Clinical Research.

Purpose The minimum masking level (MML) is the minimum intensity of a stimulus required to just totally mask the tinnitus. Treatments aimed at reducing the tinnitus itself should attempt to measure the magnitude of the tinnitus. The objective of this study was to evaluate the reliability of the MML. Method Sample consisted of 59 tinnitus patients who reported stable tinnitus. We obtained MML measures on two visits, separated by about 2-3 weeks. We used two noise types: speech-shaped noise and high-frequency emphasis noise. We also investigated the relationship between the MML and tinnitus loudness estimates and the Tinnitus Handicap Questionnaire (THQ). Results There were differences across the different noise types. The within-session standard deviation averaged across subjects varied between 1.3 and 1.8 dB. Across the two sessions, the Pearson correlation coefficients, range was r = .84. There was a weak relationship between the dB SL MML and loudness, and between the MML and the THQ. A moderate correlation (r = .44) was found between the THQ and loudness estimates. Conclusions We conclude that the dB SL MML can be a reliable estimate of tinnitus magnitude, with expected standard deviations in trained subjects of about 1.5 dB. It appears that the dB SL MML and loudness estimates are not closely related.

Tinnitus Sound Therapy Trial Shows Effectiveness for Those with Tinnitus.

BACKGROUND: It is well accepted among clinicians that maskers and hearing aids combined with counseling are generally helpful to tinnitus patients, but there are few controlled studies exploring the efficacy of maskers alone to decrease the prominence of tinnitus. PURPOSE: We investigated the benefit of maskers for patients with chronic, bothersome tinnitus. RESEARCH DESIGN: Crossover single-participant design, where each participant served as their own control. STUDY SAMPLE: 18 adults with subjective, nonpulsatile, sensorineural tinnitus. INTERVENTION: Participants participated in two six-week trials: one with sound therapy and one without. No counseling was provided in either group. Masking devices were fit with sounds intended to reduce the tinnitus prominence. DATA COLLECTION AND ANALYSIS: Participants rated tinnitus loudness, tinnitus annoyance, and acceptability of the background sounds using a numeric 0-100 interval scale and completed the Tinnitus Primary Functions Questionnaire (TPFQ). RESULTS: Three participants dropped out. On the total score of the TPFQ, 5 of 15 remaining participants (33%) showed a benefit. Using a derived score based on functions showing a handicap before the study, maskers benefit was observed in the areas of sleep (five of nine), hearing (three of eight), thoughts and emotions (three of four), and concentration (four of eight). The TPFQ and annoyance data complemented each other well. CONCLUSIONS: This study demonstrates the benefit of partial masking, encouraging patients to seek help from audiologists interested in providing support for tinnitus patients.

An Exploratory Step Toward Measuring the "Meaning of Life" in Patients with Tinnitus and in Cochlear Implant Users.

BACKGROUND: Many questionnaires attempt to quantify the "quality of life." However, we believe understanding the quality of life is complex, and many widely used questionnaires do not capture the broad range of factors that we believe are important. Many do not include questions about communicating. PURPOSE: We developed a preliminary questionnaire designed to measure "The Meaning of Life" from a broader perspective. RESEARCH DESIGN: We reviewed other scales and sought input from individuals with disabilities and developed an initial 23-item questionnaire. STUDY SAMPLE: As a first step, we sampled 116 adults with tinnitus and 196 with cochlear implants (CIs). Individuals who were participating in our CI or tinnitus research programs participated. DATA COLLECTION AND ANALYSIS: To compare differences between the two participant groups, independent sample f-tests were completed for specific items on the questionnaire and for the total score. We compared age and gender differences across all participants using f-tests. Statistical significance was defined as p < 0.05. An exploratory factor analysis was conducted to examine the relationship among the questionnaire items using oblique rotation to produce correlated factors. Extracted factors with an eigenvalue >1.0 were retained according to the Kaiser-Guttman rule. RESULTS: Four factors were prominent in this initial sample, which we labeled (1) friendship and positive outlook, (2) physical health, (3) hearing and mental health, and (4) satisfaction with life. Participants with tinnitus reported more trouble sleeping than participants with CI, whereas both groups had lower scores on hearing. Older patients reported more difficulty with remembering things but were more satisfied with their financial situation. Female participants reportedly had more hobbies and were more satisfied with their sex lives than male participants. CONCLUSIONS: This exploratory study intended to take a broader look at quality of life scales. Further work is needed with a larger sample including younger and older participants with and without disabilities.

Tinnitus: How Partners Can Help?

Purpose Tinnitus can be distressing for sufferers, but for those who do not have tinnitus, it is difficult to understand what it is like. We attempted to gain an understanding of the knowledge and misconceptions of sufferers and their partners about tinnitus. Method Two different websites were created with surveys, 1 for tinnitus sufferers and the other for their partners. A mass e-mail was sent to employees and students at The University of Iowa inviting people with tinnitus and their significant others to fill out the online surveys. Those with tinnitus were asked to rate how their tinnitus affected their thoughts and emotions, sleep, concentration, and hearing. They were also invited to fill out the Iowa Tinnitus Primary Function Questionnaire (12-item version; Tyler et al., 2014 ). Partners completed a similar survey that asked how tinnitus affected the sufferer in these domains. Open-ended questions were also included to obtain more specific feedback from the participants regarding their experiences and how tinnitus affects their lifestyle and relationships. Results Two hundred twenty-two replies were obtained from 197 tinnitus sufferers and 25 partners of those with tinnitus. Partners and sufferers were not completely in agreement regarding their knowledge about tinnitus or familiar with the impact that this symptom may have on the sufferers. Sufferers showed more confidence in their hearing ability, regardless of tinnitus, than their partners. Furthermore, sufferers and partners do not generally talk about tinnitus to each other. Conclusion We conclude that both sufferers and partners would benefit from receiving counseling to address many misunderstandings regarding tinnitus and its consequences in their everyday life activities.

A Series of Case Studies of Tinnitus Suppression With Mixed Background Stimuli in a Cochlear Implant.

PURPOSE: Background sounds provided by a wearable sound playback device were mixed with the acoustical input picked up by a cochlear implant speech processor in an attempt to suppress tinnitus. METHOD: First, patients were allowed to listen to several sounds and to select up to 4 sounds that they thought might be effective. These stimuli were programmed to loop continuously in the wearable playback device. Second, subjects were instructed to use 1 background sound each day on the wearable device, and they sequenced the selected background sounds during a 28-day trial. Patients were instructed to go to a website at the end of each day and rate the loudness and annoyance of the tinnitus as well as the acceptability of the background sound. Patients completed the Tinnitus Primary Function Questionnaire (Tyler, Stocking, Secor, & Slattery, 2014) at the beginning of the trial. RESULTS: Results indicated that background sounds were very effective at suppressing tinnitus. There was considerable variability in sounds preferred by the subjects. CONCLUSION: The study shows that a background sound mixed with the microphone input can be effective for suppressing tinnitus during daily use of the sound processor in selected cochlear implant users.

Clinical trials for tinnitus: study populations, designs, measurement variables, and data analysis.

We review a few issues related to clinical trials for treating patients with tinnitus, including the study population, design, choice of measurement variables, and some new approaches to data analysis. We emphasize the importance of being aware of different subgroups of tinnitus patients, and that patients who have had tinnitus for less than 6 months could be more amenable to treatment than patients who have had their tinnitus for a longer period. We distinguish the tinnitus itself, from the reactions to the tinnitus. When the treatment is intended to reduce the tinnitus, we recommend measuring the magnitude of the tinnitus. We provide arguments and data to support the use of the Tinnitus Handicap Questionnaire as a measure of the reaction to the tinnitus. We suggest that the current quality of life measures are not valid for measuring lifestyle effects of alleviating tinnitus. Because tinnitus likely has different subgroups, and because tinnitus affects people differently, we believe data analysis should emphasize individuals, not groups. A clinically meaningful effect should represent a valid and reliable statistical change for an individual.