耳鸣声学治疗被定义为声音的任何使用,其中意图是以临床上有益的方式改变耳鸣感知和/或对耳鸣的反应。可能导致有益效果的声音参数,然而,目前只有有限的数据支持它们的有效性。残余抑制是通常在适当的听觉刺激后观察到的耳鸣的暂时抑制或消除。我们的初步研究调查了单独定制的治疗性声刺激的效果,以最大程度地抑制耳鸣的残留并延长其持续时间,以确定是否可以持续抑制耳鸣信号(即,耳鸣响度降低)和对耳鸣的心理和情绪反应减少。这项初步研究有两个目标:(1)通过日常使用助听器来评估残留抑制技术治疗的可行性;(2)通过用耳鸣功能指数(TFI)测量耳鸣的反应性变化和耳鸣响度的感知变化来确定其效果。共有20名成年人(14名男性,6名女性;平均年龄:58岁,SD=12.88)慢性耳鸣患者参加了一项四次访视研究,该研究包括:(1)基线访视和干预期的开始,(2)干预后1个月的访问,(3)2个月的干预后访问和开始一个清洗期,和(4)3个月的访问,以评估冲洗期和干预措施的任何持续效果。干预措施包括安装双侧助听器并创建个性化的残留抑制刺激,该刺激通过蓝牙从智能手机应用程序流式传输到助听器。在2个月的干预期内,参与者被指示佩戴助听器并在所有醒着的时间内传输残留的抑制刺激。在清洗期间,参与者被指示使用助听器进行放大,但剩余的抑制刺激已停止。在所有访问中,参与者完成了TFI,针对研究的自我报告措施,以记录耳鸣的感知,由耳鸣响度和音调匹配组成的心理声学测试电池,和由最小掩蔽和最小残留抑制水平组成的残留抑制测试电池。审判结束时,参与者接受了关于残留抑制治疗技术的研究经验和可接受性的访谈.在所有四次访问中对两个主要结果(TFI总分和耳鸣响度)进行重复测量方差分析(ANOVA)。结果显示访视对TFI总分有显著的主要影响(p<0.0001)。具体来说,结果表明,从基线到干预后1个月,TFI总分显着降低,在干预后的2个月和冲洗期保持稳定。ANOVA结果没有显示耳鸣响度作为访问函数的显著变化(p=0.480)。大多数参与者在退出面试时报告了研究干预的积极经验。这项初步研究表明,残余抑制作为耳鸣的良好疗法,特别是通过日常使用助听器,对于患有慢性耳鸣的个体来说是可行和可接受的。此外,参与者对耳鸣的反应有所改善,这表现为在治疗期间TFI评分平均持续降低.实现残余抑制还可以为患者提供控制耳鸣的感觉,这可能在减少与耳鸣相关的心理和情绪困扰方面具有协同作用。残留抑制治疗导致的长期耳鸣响度没有显着降低;但是,目前的试点研究可能没有足够的权力来检测这种变化。耳鸣抑制和改善对耳鸣的心理社会/情绪反应的组合可能导致短期和长期的更好的生活质量。需要进行更大规模的研究来确定使用残留抑制作为临床治疗选择的有效性,并确定对耳鸣的感知和反应的任何影响。
Tinnitus acoustic therapy is defined as any use of sound where the intent is to alter the tinnitus perception and/or the reactions to tinnitus in a clinically beneficial way. The parameters of sound that may cause beneficial effects, however, are currently only theorized with limited data supporting their effectiveness. Residual inhibition is the temporary suppression or elimination of tinnitus that is usually observed following appropriate auditory stimulation. Our pilot
study investigated the effects of a therapeutic acoustic stimulus that was individually customized to maximize residual inhibition of tinnitus and extend its duration to determine if there could be a sustained suppression of the tinnitus signal (i.e., reduced tinnitus loudness) and a reduction in the psychological and emotional reactions to tinnitus. This pilot
study had two objectives: (1) to evaluate the feasibility of residual inhibition technique therapy through daily use of hearing aids and (2) to determine its effects by measuring reactionary changes in tinnitus with the Tinnitus Functional Index (TFI) and perceptual changes in tinnitus loudness. A total of 20 adults (14 males, 6 females; mean age: 58 years, SD = 12.88) with chronic tinnitus were enrolled in a four-visit study that consisted of the following: (1) baseline visit and initiation of the intervention period, (2) a 1-month postintervention visit, (3) 2-month postintervention visit and initiation of a wash-out period, and (4) a 3-month visit to assess the wash-out period and any lasting effects of the intervention. The intervention consisted of fitting bilateral hearing aids and creating an individualized residual inhibition stimulus that was streamed via Bluetooth from a smartphone application to the hearing aids. The participants were instructed to wear the hearing aids and stream the residual inhibition stimulus all waking hours for the 2-month intervention period. During the wash-out period, the participants were instructed to use the hearing aids for amplification, but the residual inhibition stimulus was discontinued. At all visits, the participants completed the TFI, study-specific self-report measures to document perceptions of tinnitus, a psychoacoustic test battery consisting of tinnitus loudness and pitch matching, and a residual inhibition test battery consisting of minimum masking and minimum residual inhibition levels. At the end of the
trial, participants were interviewed about the
study experience and acceptability of the residual inhibition treatment technique. Repeated measures analyses of variance (ANOVA) were conducted on the two main outcomes (TFI total score and tinnitus loudness) across all four visits. The results showed a significant main effect of visit on the TFI total score ( p < 0.0001). Specifically, the results indicated a significant reduction in TFI total scores from baseline to the 1-month post-intervention period, which remained stable across the 2-month post-intervention period and the wash-out period. The ANOVA results did not show a significant change in tinnitus loudness as a function of visit ( p = 0.480). The majority of the participants reported a positive experience with the
study intervention at their exit interview. This pilot
study demonstrated that residual inhibition as a sound therapy for tinnitus, specifically through the daily use of hearing aids, was feasible and acceptable to individuals suffering from chronic tinnitus. In addition, participants showed improvement in reactions to tinnitus as demonstrated by sustained reduction in TFI scores on average over the course of the treatment period. Achieving residual inhibition may also provide patients a feeling of control over their tinnitus, and this may have a synergistic effect in reducing the psychological and emotional distress associated with tinnitus. There was no significant reduction in long-term tinnitus loudness resulting from the residual inhibition treatment; however, the current pilot study may not have had sufficient power to detect such a change. The combination of tinnitus suppression and improved psychosocial/emotional reactions to tinnitus may result in a better quality of life in both the short and long term. A larger-scale study is needed to determine the validity of using residual inhibition as a clinical therapy option and to ascertain any effects on both perception and reactions to tinnitus.