By Beck, Douglas L. AuD,
Hearing Journal: June 2011 - Volume 64
Some 50 million people in the United States have tinnitus. Ten to twenty percent of tinnitus patients manifest a “clinically significant condition,” and the average tinnitus patient waits more than six years between tinnitus onset and seeking relief. The majority of tinnitus patients have sensorineural hearing loss.
The vast majority of all tinnitus patients have subjective tinnitus. Subjective tinnitus typically accompanies sensorineural hearing loss, secondary to presbycusis, noise-induced hearing loss, and acoustic trauma, etc. Subjective tinnitus is generally defined as the perception of sound in the absence of an external sound source.
There are many options for management of subjective tinnitus. The condition is generally managed by hearing aid amplification, cognitive behavioral therapy, electrical stimulation, tinnitus maskers, combined tinnitus masker and hearing aids.
Hearing aid amplification is useful for managing tinnitus in two ways. First, hearing aids amplify ambient background noise which may simply cover up or mask the patient's perception of tinnitus. Second, while wearing hearing aids, the patient improves their communication ability, likely leading to a reduction of stress. Hearing aid amplification has served as the audiologic mainstay of tinnitus treatment for more than half a century. They note that even for marginal hearing aid candidates, high frequency amplification may be “accepted and beneficial.” Over 90% of tinnitus patients may benefit from hearing aid amplification.
Tinnitus patients receive two major benefits from hearing aids: the patient becomes less aware of their tinnitus and the patient improves their communication ability. They report tinnitus is often a result of neural plasticity, evoked via deprivation of auditory input (i.e., hearing loss), and as hearing aid amplification activates the auditory nervous system, the perception of tinnitus is reduced. For the best results, binaural amplification with open fittings and the widest possible bandwidth are recommended and interestingly, they suggest noise reduction should be disabled, so as to allow background and inconsequential noise to enter the auditory system. Open-canal fittings were also useful for tinnitus patients with mild hearing loss.
Tinnitus may impact a person's emotional well-being and may negatively impact socialization, relaxation, and job performance, and may contribute to psychological problems such as depression, stress, anxiety and anger.
Hearing aids can be enormously effective in assisting tinnitus patients based on the five factors listed here:
* Hearing aid amplification serves to increase neural activity. Presuming tinnitus is exacerbated by silence, the brain may seek neural stimulation which is otherwise attenuated secondary to hearing loss.
* Tinnitus may be related to a lack of neural inhibition and hearing aid amplification may help the brain's inhibitory function correct itself.
* Because tinnitus is not subject to in-depth analysis (as is speech), the brain may not be able to determine its meaning. In this regard, hearing aid amplification may supply a truer auditory signal to attend to, thus helping the brain recognize true sound versus pseudo-sound.
* Hearing aids amplify background noise such that they may provide partial masking while reducing the difference between amplified sound and tinnitus.
* As hearing aids reduce listening fatigue and stress, the ability to cope with tinnitus is improved.
Hearing Journal:
June 2011 - Volume 64