The impact of head-worn devices in an auditory-aided visual search task.

Head-worn devices (HWDs) interfere with the natural transmission of sound from the source to the ears of the listener, worsening their localization abilities. The localization errors introduced by HWDs have been mostly studied in static scenarios, but these errors are reduced if head movements are allowed. We studied the effect of 12 HWDs on an auditory-cued visual search task, where head movements were not restricted. In this task, a visual target had to be identified in a three-dimensional space with the help of an acoustic stimulus emitted from the same location as the visual target. The results showed an increase in the search time caused by the HWDs. Acoustic measurements of a dummy head wearing the studied HWDs showed evidence of impaired localization cues, which were used to estimate the perceived localization errors using computational auditory models of static localization. These models were able to explain the search-time differences in the perceptual task, showing the influence of quadrant errors in the auditory-aided visual search task. These results indicate that HWDs have an impact on sound-source localization even when head movements are possible, which may compromise the safety and the quality of experience of the wearer.

Investigating sound-field reproduction methods as perceived by bilateral hearing aid users and normal-hearing listeners.

A perceptual study was conducted to investigate the perceived accuracy of two sound-field reproduction approaches when experienced by hearing-impaired (HI) and normal-hearing (NH) listeners. The methods under test were traditional signal-independent Ambisonics reproduction and a parametric signal-dependent alternative, which were both rendered at different Ambisonic orders. The experiment was repeated in two different rooms: (1) an anechoic chamber, where the audio was delivered over an array of 44 loudspeakers; (2) an acoustically-treated listening room with a comparable setup, which may be more easily constructed within clinical settings. Ten bilateral hearing aid users, with mild to moderate symmetric hearing loss, wearing their devices, and 15 NH listeners were asked to rate the methods based upon their perceived similarity to simulated reference conditions. In the majority of cases, the results indicate that the parametric reproduction method was rated as being more similar to the reference conditions than the signal-independent alternative. This trend is evident for both groups, although the variation in responses was notably wider for the HI group. Furthermore, generally similar trends were observed between the two listening environments for the parametric method. The signal-independent approach was instead rated as being more similar to the reference in the listening room.

Test-retest evaluation of a notched-noise test using consumer-grade mobile audio equipment.

OBJECTIVE: The aim of this study was to investigate whether consumer-grade mobile audio equipment can be reliably used as a platform for the notched-noise test, including when the test is conducted outside the laboratory. DESIGN: Two studies were conducted: Study 1 was a notched-noise masking experiment with three different setups: in a psychoacoustic test booth with a standard laboratory PC; in a psychoacoustic test booth with a mobile device; and in a quiet office room with a mobile device. Study 2 employed the same task as Study 1, but compared circumaural headphones to insert earphones. STUDY SAMPLE: Nine and ten young, normal-hearing participants completed studies 1 and 2, respectively. RESULTS: The test-retest accuracy of the notched-noise test on the mobile implementation did not differ from that for the laboratory setup. A possible effect of the earphone design was identified in Study 1, which was corroborated by Study 2, where test-retest variability was smallest when comparing results from experiments conducted using identical acoustic transducers. CONCLUSIONS: Results and test-retest repeatability comparable to standard laboratory settings for the notched-noise test can be obtained with mobile equipment outside the laboratory.

Effect of sound therapy on whole scalp oscillatory brain activity and distress in chronic tinnitus patients.

Introduction: Sound therapy is a common tinnitus treatment, where the tinnitus percept is either fully or partially masked by an external sound. Some tinnitus patients experience a decrease in tinnitus related distress after the use of sound therapy. Differences in the neural response to sound therapy may form a basis for classifying tinnitus patients. Methods: In this study, the long-term (2 months) effects of sound therapy on the oscillatory brain activity and tinnitus related distress were investigated in chronic tinnitus patients. Baseline oscillatory activity in the group of tinnitus participants was also compared to a matched control group. Results: No differences were found in the oscillatory activity when comparing the tinnitus group to the control group. Differences were found for the frequency range between 27.5 and 41.5 Hz corresponding to high beta and gamma power when comparing the tinnitus group before and after the use of sound therapy. Furthermore, a reduction of the tinnitus-related distress was found after the long-term use of sound therapy. However, there was no correlation between the changes in the oscillatory activity and the reductions of the tinnitus-related distress. Discussion: Overall, the lack of correlation between the changes in tinnitus-related distress and changes in power activity hampers the interpretability of the findings and undermines the utility of using oscillatory activity as a biomarker for the effect of sound therapy treatment.

The Short and Long-Term Effect of Sound Therapy on Visual Attention in Chronic Tinnitus Patients.

Sound therapy is one of the most common tinnitus treatments that can be used either to mask or to shift attention away from the tinnitus percept. However, the actual benefit of sound therapy and the mechanisms leading to the benefits remain limited. The objective of this study was to investigate the short-term (15 min) and long-term (2 months) effects of sound therapy on visual attention in chronic tinnitus patients. Visual attention was evaluated with the behavioral Attention Network Task, while the tinnitus-related distress was evaluated with the Tinnitus Handicap Inventory (THI) to quantify the effect of sound therapy. The study included 20 participants with chronic and bothersome tinnitus (>6 months, THI > 18) and 20 matched control participants. All participants took part in a first session consisting of a baseline condition, a short-term sound therapy condition and a silent control condition. The tinnitus participants also took part in a second session that evaluated the long-term effect of the therapy. A reduction in the tinnitus-related distress was found after the long-term use of sound therapy. Furthermore, a reduction in the differential index of the executive control (EC) attention network, indicating improved attention, was found after long-term use of sound therapy in the sound condition but not in the silent control condition. In contrast to earlier research, no differences were found between the tinnitus group and the control group for the baseline measurement of the EC attention network. Overall, the results suggest that there is no link between the visual attention networks and the sound therapy's effect on tinnitus-related distress.

Broadband Amplification as Tinnitus Treatment.

This study investigated the effect of broadband amplification (125 Hz to 10 kHz) as tinnitus treatment for participants with high-frequency hearing loss and compared these effects with an active placebo condition using band-limited amplification (125 Hz to 3-4 kHz). A double-blinded crossover study. Twenty-three participants with high-frequency (≥3 kHz) hearing loss and chronic tinnitus were included in the study, and 17 completed the full treatment protocol. Two different hearing aid treatments were provided for 3 months each: Broadband amplification provided gain in the frequency range from 125 Hz to 10 kHz and band-limited amplification only provided gain in the low-frequency range (≤3-4 kHz). The effect of the two treatments on tinnitus distress was evaluated with the Tinnitus Handicap Inventory (THI) and the Tinnitus Functional Index (TFI) questionnaires. The effect of the treatment on tinnitus loudness was evaluated with a visual analog scale (VAS) for loudness and a psychoacoustic loudness measure. Furthermore, the tinnitus annoyance was evaluated with a VAS for annoyance. The tinnitus pitch was evaluated based on the tinnitus likeness spectrum. A statistically significant difference was found between the two treatment groups (broadband vs. band-limited amplification) for the treatment-related change in THI and TFI with respect to the baseline. Furthermore, a statistically significant difference was found between the two treatment conditions for the annoyance measure. Regarding the loudness measure, no statistically significant differences were found between the treatments, although there was a trend towards a lower VAS-based loudness measure resulting from the broadband amplification. No changes were observed in the tinnitus pitch between the different conditions. Overall, the results from the present study suggest that tinnitus patients with high-frequency hearing loss can experience a decrease in tinnitus-related distress and annoyance from high-frequency amplification.

Enhancing binaural rendering of head-worn microphone arrays through the use of adaptive spatial covariance matching.

In this article, the application of spatial covariance matching is investigated for the task of producing spatially enhanced binaural signals using head-worn microphone arrays. A two-step processing paradigm is followed, whereby an initial estimate of the binaural signals is first produced using one of three suggested binaural rendering approaches. The proposed spatial covariance matching enhancement is then applied to these estimated binaural signals with the intention of producing refined binaural signals that more closely exhibit the correct spatial cues as dictated by the employed sound-field model and associated spatial parameters. It is demonstrated, through objective and subjective evaluations, that the proposed enhancements in the majority of cases produce binaural signals that more closely resemble the spatial characteristics of simulated reference signals when the enhancement is applied to and compared against the three suggested starting binaural rendering approaches. Furthermore, it is shown that the enhancement produces spatially similar output binaural signals when using these three different approaches, thus indicating that the enhancement is general in nature and could, therefore, be employed to enhance the outputs of other similar binaural rendering algorithms.

Low inter-rater consistency in semantic profiles of tinnitus-like sounds rated by tinnitus patients.

Characterizations of the tinnitus sound percept are always based on a subjective description by the person affected. Since the experimenter cannot have access to the tinnitus percept, it is not possible to verify whether individuals use the adjectives describing the sound in the expected way, i.e., whether a label given to the tinnitus percept corresponds to the label that the experimenter or another individual would give to the same sound percept. However, if it is assumed that tinnitus patients can reliably describe their own tinnitus, then they should also be able to reliably describe tinnitus-like sounds, presented acoustically. In this study, 26 tinnitus patients used a tablet computer to rate 18 pre-defined adjectives on their level of descriptiveness for their own tinnitus percept as well as 17 tinnitus-like sounds presented via headphones. The main interest of the current study was to calculate intraclass correlation (ICC) and Krippendorff's alpha coefficients for the rating profiles of the acoustically-presented sounds, in order to quantify how well the individuals agreed on the ratings of known sounds, i.e., whether the adjectives would receive similar ratings from all participants for a specific tinnitus-like sound. The results show that the level of agreement was low for all adjectives and sounds, meaning that the different individuals did not use the adjectives in a consistent manner. The conclusion is that subjective tinnitus descriptions should be interpreted with great caution, and that the inherent variability involved in the characterization of sounds by naïve listeners can contribute to the observed heterogeneity in tinnitus symptoms and treatment outcomes.

tACS-mediated modulation of the auditory steady-state response as seen with MEG.

BACKGROUND: Previous studies have shown that transcranial electrical stimulation can be successfully applied during simultaneous MEG measurements. In particular, using beamforming they have established that changes of stimulus induced as well as evoked activity can be inspected during transcranial alternating current stimulation (tACS). OBJECTIVE/HYPOTHESIS: We studied tACS-mediated changes of the auditory steady-state response (ASSR), hypothesizing that-due to the putatively inhibitory role of alpha oscillations-these evoked responses would be diminished. METHODS: We compared ASSRs in conditions with and without 12-Hz and 6.5-Hz sinusoidal 1.5 mA tACS, applied bilaterally over temporal areas. Source-level activity was estimated using a linearly constrained minimum variance beamformer and compared across tACS conditions using paired t-tests following a condition-internal normalization procedure. CONCLUSIONS: By separating the electrical and auditory stimulation to non-overlapping parts of the frequency spectrum, we were able to compare auditory-evoked steady-state activity across tACS conditions. We observed a significant decrease in normalized ASSR power in the 12-Hz tACS condition, illustrating that tACS could induce immediate changes in auditory evoked activity. This study sets a methodology to further interrogate the causal roles of oscillatory dynamics in auditory cortices, as well as suggests perspectives for employing tACS in clinical contexts.

Hearing disorder from music; a neglected dysfunction.

CONCLUSION: Music-induced acute acoustic trauma is not inevitably linked to hearing dysfunction as validated by conventional pure tone audiometry. Tinnitus is often in combination with hyperacusis. Our results point at 'silent hearing loss' as the underlying pathology, having afferent nerve terminal damage rather than hair cell loss as the structural correlate. OBJECTIVES: Exposure to loud music is one of the most common causes of acute acoustic trauma, which adolescents and teenagers experience by voluntary exposure to loud music of sound levels up to 110 dB(A). METHODS: The clinical and psychophysical data of 104 consecutive patients with music-induced hearing disorder (MIHD) were analyzed to construct individual hearing and tinnitus profiles. In all cases, tinnitus was the presenting symptom. RESULTS: Hearing abilities were normal in about two-thirds of the tinnitus patients. Tinnitus was experienced most often as a high-frequency tone (83%). The Tinnitus Handicap Inventory (THI) scores ranged from 0 to 94 with an average score of 43.1. Visual analog scales (VAS) were used to assess tinnitus loudness (average 42.4) and annoyance (average 54.2), and tinnitus awareness was estimated (average 60.3). All VAS values correlated strongly with the THI. Hyperacusis was present in 65% and 71% of the patients reported sleeping disorders.

Attenuation of Positive Valence in Ratings of Affective Sounds by Tinnitus Patients.

Affective processing appears to be altered in tinnitus, and the condition is to a large extent characterized by the emotional reaction to the phantom sound. Psychophysiological models of tinnitus and supporting brain imaging studies have suggested a role for the limbic system in the emergence and maintenance of tinnitus. It is not clear whether the tinnitus-related changes in these systems are specific for tinnitus only, or whether they affect emotional processing more generally. In this study, we aimed to quantify possible deviations in affective processing in tinnitus patients by behavioral and physiological measures. Tinnitus patients rated the valence and arousal of sounds from the International Affective Digitized Sounds database. Sounds were chosen based on the normative valence ratings, that is, negative, neutral, or positive. The individual autonomic response was measured simultaneously with pupillometry. We found that the subjective ratings of the sounds by tinnitus patients differed significantly from the normative ratings. The difference was most pronounced for positive sounds, where sounds were rated lower on both valence and arousal scales. Negative and neutral sounds were rated differently only for arousal. Pupil measurements paralleled the behavioral results, showing a dampened response to positive sounds. Taken together, our findings suggest that affective processing is altered in tinnitus patients. The results are in line with earlier studies in depressed patients, which have provided evidence in favor of the so-called positive attenuation hypothesis of depression. Thus, the current results highlight the close link between tinnitus and depression.

Non-invasive vagus nerve stimulation reduces sympathetic preponderance in patients with tinnitus.

CONCLUSION: Transcutaneous vagal nerve stimulation (tVNS) might offer a targeted, patient-friendly, and low-cost therapeutic tool for tinnitus patients with sympathovagal imbalance. OBJECTIVES: Conventionally, VNS has been performed to treat severe epilepsy and depression with an electrode implanted to the cervical trunk of vagus nerve. This study investigated the acute effects of tVNS on autonomic nervous system (ANS) imbalance, which often occurs in patients with tinnitus-triggered stress. METHODS: This study retrospectively analysed records of 97 patients who had undergone ANS function testing by heart rate variability (HRV) measurement immediately before and after a 15-60 min tVNS stimulation. RESULTS: The pre-treatment HRV recording showed sympathetic preponderance/reduced parasympathetic activity in about three quarters (73%) of patients. Active tVNS significantly increased variability of R-R intervals in 75% of patients and HRV age was decreased in 70% of patients. Either the variability of R-R intervals was increased or the HRV age decreased in 90% of the patients. These results indicate that tVNS can induce a shift in ANS function from sympathetic preponderance towards parasympathetic predominance. tVNS caused no major morbidity, and heart rate monitoring during the tVNS treatment showed no cardiac or circulatory effects (e.g. bradycardia) in any of the patients.

Auditory localization by subjects with unilateral tinnitus.

Tinnitus is associated with changes in neural activity. How such alterations impact the localization ability of subjects with tinnitus remains largely unexplored. In this study, subjects with self-reported unilateral tinnitus were compared to subjects with matching hearing loss at high frequencies and to normal-hearing subjects in horizontal and vertical plane localization tasks. Subjects were asked to localize a pink noise source either alone or over background noise. Results showed some degree of difference between subjects with tinnitus and subjects with normal hearing in horizontal plane localization, which was exacerbated by background noise. However, this difference could be explained by different hearing sensitivities between groups. In vertical plane localization there was no difference between groups in the binaural listening condition, but in monaural listening the tinnitus group localized significantly worse with the tinnitus ear. This effect remained when accounting for differences in hearing sensitivity. It is concluded that tinnitus may degrade auditory localization ability, but this effect is for the most part due to the associated levels of hearing loss. More detailed studies are needed to fully disentangle the effects of hearing loss and tinnitus.

Self-Administered Domiciliary tDCS Treatment for Tinnitus: A Double-Blind Sham-Controlled Study.

Transcranial direct current stimulation (tDCS) has shown potential for providing tinnitus relief, although positive effects have usually been observed only during a short time period after treatment. In recent studies the focus has turned from one-session experiments towards multi-session treatment studies investigating long-term outcomes with double-blinded and sham-controlled study designs. Traditionally, tDCS has been administered in a clinical setting by a healthcare professional but in studies involving multiple treatment sessions, often a trade-off has to be made between sample size and the amount of labor needed to run the trial. Also, as the number of required visits to the clinic increases, the dropout rate is likely to rise proportionally.The aim of the current study was to find out if tDCS treatment for tinnitus could be patient-administered in a domiciliary setting and whether the results would be comparable to those from in-hospital treatment studies. Forty-three patients with chronic (> 6 months) tinnitus were involved in the study, and data on 35 out of these patients were included in final analysis. Patients received 20 minutes of left temporal area anodal (LTA) or bifrontal tDCS stimulation (2 mA) or sham stimulation (0.3 mA) for ten consecutive days. An overall reduction in the main outcome measure, Tinnitus Handicap Inventory (THI), was found (mean change -5.0 points, p < 0.05), but there was no significant difference between active and sham treatment outcomes. Patients found the tDCS treatment easy to administer and they all tolerated it well. In conclusion, self-administered domiciliary tDCS treatment for tinnitus was found safe and feasible and gave outcome results similar to recent randomized controlled long-term treatment trials. The results suggest better overall treatment response-as measured by THI-with domiciliary treatment than with in-hospital treatment, but this advantage is not related to the tDCS variant. The study protocol demonstrated in the current study is not restricted to tinnitus only.

Transcutaneous vagus nerve stimulation modulates tinnitus-related beta- and gamma-band activity.

OBJECTIVES: The ability of a treatment method to interfere with tinnitus-related neural activity patterns, such as cortical gamma rhythms, has been suggested to indicate its potential in relieving tinnitus. Therapeutic modulation of gamma-band oscillations with vagus nerve stimulation has been recently reported in epileptic patients. The aim of this study was to investigate the effects of transcutaneous vagus nerve stimulation (tVNS) on neural oscillatory patterns. DESIGN: We calculated the power spectral density and synchrony of magnetoencephalography recordings during auditory stimulation in seven tinnitus patients and eight normal-hearing control subjects. Comparisons between subject groups were performed to reveal electrophysiological markers of tinnitus. tVNS-specific effects within each group were studied by comparing recording blocks with and without tVNS. We also investigated the correlation of each measure with individual ratings of tinnitus distress, as measured by the tinnitus handicap inventory questionnaire. RESULTS: Tinnitus patients differed from controls in the baseline condition (no tVNS applied), measured by both cortical oscillatory power and synchronization, particularly at beta and gamma frequencies. Importantly, we found tVNS-induced changes in synchrony, correlating strongly with tinnitus handicap inventory scores, at whole-head beta-band (r = -0.857, p = 0.007), whole-head gamma-band (r = -0.952, p = 0.0003), and frontal gamma-band (r = -0.952, p = 0.0003). CONCLUSIONS: We conclude that tVNS was successful in modulating tinnitus-related beta- and gamma-band activity and thus could have potential as a treatment method for tinnitus.

Transcutaneous vagus nerve stimulation in tinnitus: a pilot study.

CONCLUSIONS: This pilot study shows that transcutaneous vagus nerve stimulation (tVNS), if combined with sound therapy (ST), reduces the severity of tinnitus and tinnitus-associated distress. Our magnetoencephalography (MEG) results show that auditory cortical activation can be modulated by the application of tVNS. Thus, tVNS might offer a new avenue to treat tinnitus and tinnitus-associated distress. OBJECTIVES: Recent studies suggest that tinnitus can be improved by tailored ST or by VNS plus ST. Our aims were to study whether tVNS has therapeutic effects on patients with tinnitus and, additionally, if tVNS has effects on acoustically evoked neuronal activity of the auditory cortex. METHODS: The clinical efficacy was studied by a short-term tVNS plus ST trial in 10 patients with tinnitus using disease-specific and general well-being questionnaires. tVNS was delivered to the left tragus. The acute effects of tVNS were evaluated in eight patients in the MEG study in which the N1m response was analyzed in terms of source level amplitude and latency in the presence or absence of tVNS. RESULTS: The treatment with tVNS plus ST produced improved mood and decreased tinnitus handicap scores, indicating reduced tinnitus severity. The application of tVNS decreased the amplitude of auditory N1m responses in both hemispheres.