Investigation of the Effectiveness of Sound Enrichment in the Treatment of Tinnitus Due to Hearing Loss

[Vadimus]

The results are very impressive. The program used in the study to create the therapy (Praat program) seems to be free and available for download.

Methods

A total of 96 patients with chronic tinnitus were included in the study. Fifty‐two patients in the study group and 44 patients in the placebo group considered residual inhibition (RI) outcomes and tinnitus pitches. Both groups received sound enrichment treatment with different spectrum contents. The tinnitus handicap inventory (THI), visual analog scale (VAS), minimum masking level (MML), and tinnitus loudness level (TLL) results were compared before and at 1, 3, and 6 months after treatment.

Results

There was a statistically significant difference between the groups in THI, VAS, MML, and TLL scores from the first month to all months after treatment (p < .01). For the study group, there was a statistically significant decrease in THI, VAS, MML, and TLL scores in the first month (p < .01). This decrease continued at a statistically significant level in the third month of posttreatment for THI (p < .05) and at all months for VAS‐1 (tinnitus severity) (p < .05) and VAS‐2 (tinnitus discomfort) (p < .05).

Conclusion

In clinical practice, after excluding other factors related to the tinnitus etiology, sound enrichment treatment can be effective in tinnitus cases where RI is positive and the tinnitus pitch is matched with a hearing loss between 45 and 55 dB HL in a relatively short period of 1 month.

Table 2 shows the VAS scores of the patients during the treatment and the statistical evaluation between the groups. There was a statistically significant difference between the groups for time‐dependent change of VAS scores (tinnitus severity, p < .001, tinnitus discomfort, p < .001, attention deficit, p < .001, and sleep difficulty, p < .001). VAS scores in the study group decreased statistically significantly during the treatment process (tinnitus severity, p < .001, tinnitus discomfort, p < .001, attention deficit, p < .001, and sleep difficulty, p < .001), whereas no statistically significant difference was observed in the placebo group (tinnitus severity, p = .74, tinnitus discomfort, p = .65, attention deficit, p = .57, and sleep difficulty, p = .63) during the treatment process.

Table 3 shows the THI scores of the patients during the treatment and the statistical evaluation between the groups. There was a statistically significant difference between the groups for the time‐dependent change of THI scores (p < .001). THI scores in the study group decreased statistically significantly during the treatment process (p < .001), whereas no statistically significant difference was observed in the placebo group (p = .59).

Investigation of the effectiveness of sound enrichment in the treatment of tinnitus due to hearing loss

 

[Tim Moore]

This is really interesting! It suggests that sound enrichment can be effective for people who have tinnitus specifically induced by hearing loss (like me). So, my next question is: how do I try it? How does someone go about obtaining the custom sounds needed for listening?

 

[Nick47]

This is really interesting! It suggests that sound enrichment can be effective for people who have tinnitus specifically induced by hearing loss (like me). So, my next question is: how do I try it? How does someone go about obtaining the custom sounds needed for listening?

Patients with positive RI, tinnitus pitch in the range of 45–55 dB HL hearing loss, and meeting both criteria were included in the study.

So those who experience residual inhibition and have hearing loss in the 45–55 dB range.

 

[Tim Moore]

So those who experience residual inhibition and have hearing loss in the 45–55 dB range.

From what I understand, I have a single notch of hearing loss at 45 dB in my left ear, specifically at 6000 Hz, with no loss in other areas. I suspect this is the source of my tinnitus, so I'm curious if this could help me!

 

[JRC1]

Can someone sort of "dumb this down" for me? Aren't these results really impressive?

 

[Vadimus]

I e-mailed the author of the study. I asked if I could send my audiogram and use it to prepare audio therapy based on his study. Or would I need to be there in person? I wrote that I am ready to pay for such a service, if it is possible. I also specified that my hearing loss is related to otosclerosis, i.e. I have a dysfunction in the middle ear. The author of the study lives in Turkey. I received a reply from him today.

Researcher's response:

Hello,

First of all, thank you for your kind thoughts. Since tinnitus is a symptom, it can be caused by many pathologies. When the underlying pathology is only hearing loss, the treatment we are working on can give very promising results. However, if tinnitus is accompanied by an etiology other than hearing loss, the results of the treatment may vary. For this reason, it would be better to examine first. I know it is not easy to come from another country, but it would not be right to make a treatment remotely.

 

[Tim Moore]

I e-mailed the author of the study. I asked if I could send my audiogram and use it to prepare audio therapy based on his study. Or would I need to be there in person? I wrote that I am ready to pay for such a service, if it is possible. I also specified that my hearing loss is related to otosclerosis, i.e. I have a dysfunction in the middle ear. The author of the study lives in Turkey. I received a reply from him today.

Researcher's response:

Hello,

First of all, thank you for your kind thoughts. Since tinnitus is a symptom, it can be caused by many pathologies. When the underlying pathology is only hearing loss, the treatment we are working on can give very promising results. However, if tinnitus is accompanied by an etiology other than hearing loss, the results of the treatment may vary. For this reason, it would be better to examine first. I know it is not easy to come from another country, but it would not be right to make a treatment remotely.

Thank you for following up on this! I also emailed who I believe is the author, though I haven't received a response yet. I think the person's name is Eser Sendesen? Would you mind sharing who you emailed? Thank you!

 

[Vadimus]

Thank you for following up on this! I also emailed who I believe is the author, though I haven't received a response yet. I think the person's name is Eser Sendesen? Would you mind sharing who you emailed? Thank you!

Yes, I wrote to him in both English and Turkish. He replied to me in Turkish, but it took about a week for him to respond.

ResearchGate: Eser Sendesen

He is a young scientist specializing in tinnitus who has published several scientific papers on the subject, referenced by other researchers, and conducted a case study with very encouraging results. Perhaps he would be a good candidate for a Tinnitus Quest grant?

Can someone sort of "dumb this down" for me? Aren't these results really impressive?

I think the results are extremely impressive, even if they only worked for a narrow group of patients. As far as I know, such significant tinnitus volume reduction has never been confirmed in a double-blind, placebo-controlled trial before. Additionally, the treatment is simple, affordable, and non-invasive, which makes it even more remarkable.

 

[JRC1]

Thank you for your response. I'm still wondering why this study isn't getting more attention. I don't quite understand the concept of residual inhibition, although I can look up the term to read the definition. You mentioned a "narrow group of patients"—does this mean the treatment wouldn't work for most people? Since most cases of tinnitus are due to hearing loss, would this treatment be effective for the majority?

I also have another question: the patients in the study initially used the treatment for hours each day. Do you think using the Susan Shore Device for hours daily might yield similar dramatic results?

 

[Furetto]

Does this mean that the treatment only works for those who experience residual inhibition, or does it also work for those who don't?

 

[Dizzyhead888]

I read the paper.

This chart summarizes it:

The criteria are as follows:

• Absence of pathology or tumors (presumably, this refers to patients whose tinnitus is due to hearing loss).
• Hearing loss of 45-55 dB.
• Residual Inhibition (RI): This means that your tinnitus temporarily stops after playing narrow-band noise for one minute that matches your tinnitus perception or frequency. Presumably, your tinnitus frequency corresponds to the frequency at which you have hearing loss, though it's unclear if this is always the case or if tinnitus perception can differ from the hearing loss frequency. A narrow-band noise refers to a limited range of frequencies around your tinnitus frequency.

It has been shown that if you meet these criteria, sound enrichment around the frequency of your hearing loss can reduce tinnitus.

As for whether people with no hearing loss, hidden hearing loss, or milder hearing loss benefit, we don't yet know.

The promising aspect of this paper is the placebo comparison: they used a placebo that involved playing a frequency far from the hearing loss frequencies. The placebo group showed no improvement, while the treatment group experienced significant improvements.

 

[UKBloke]

Perhaps he would be a good candidate for a Tinnitus Quest grant?

Disclaimer: I haven't read the paper as I'm maxed out reading tinnitus research for now!
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At the very least, I think where any tinnitus treatment study is concerned , particularly where the researcher is a young scientist, we should consider trying to pair the study team with the Bionics Institute.

If the Bionics Institute is currently looking to build its own fNIRS device to "collect data from more sites," then the addition of an objective tinnitus measurement in these studies would be hugely significant.

 

[MichaelBull]

I'm quite intrigued by this research. As someone who experiences temporary residual inhibition when using a specific neuromodulation tinnitus video I found online, I'm interested in possibly trying this approach. I don't have hearing loss based on my last hearing test (though it only tested up to 8 kHz, so I might have hearing loss in higher ranges). I'm not entirely sure how relevant this is for my situation.

I remember seeing a post a while back about someone who claimed a friend cured their tinnitus by playing the frequency of their tinnitus almost constantly for a couple of weeks. Perhaps there's some logic in reinforcing residual habituation to the point where the brain stops sending the tinnitus signal altogether.

However, I'm hesitant because I've come across rare posts from people saying their tinnitus worsened after excessive neuromodulation.

I'll think it over. I mostly work from home, so I could easily play these sounds throughout my workday during the initial month, as specified in the paper (for about 6 hours).

 

[RunningMan]

• Residual Inhibition (RI): This means that your tinnitus temporarily stops after playing narrow-band noise for one minute that matches your tinnitus perception or frequency. Presumably, your tinnitus frequency corresponds to the frequency at which you have hearing loss, though it's unclear if this is always the case or if tinnitus perception can differ from the hearing loss frequency. A narrow-band noise refers to a limited range of frequencies around your tinnitus frequency.

Residual inhibition could occur due to other sounds, including a single tone sound. I can can experience it most easily using single tone pulses. Also, residual inhibition could mean the tinnitus only temporarily "reduces in intensity" rather than temporarily stopping completely.

 

[withintention]

Reading the paper, it seemed like creating a specific sound for each person is somewhat of an audio engineering challenge. It requires various filters and audio mixing techniques. I'd be very interested in trying this at home, but I'm not sure my relatively basic audio engineering skills are up to the task.

 

[PeterPan]

I noticed a few things about the participants. They are all relatively young, ranging in age from 18 to 43, and their tinnitus frequency is tightly clustered around 6.2 kHz. The average duration of tinnitus was two years, with none lasting longer than four years. A few candidates had reverse residual inhibition (RI) and were excluded from the study.

The results, however, are quite remarkable. The placebo-controlled design is also excellent, as the placebo group received exactly the same treatment, but at a frequency outside their tinnitus range. Could this be a treatment that actually works?

 

[Vadimus]

Reading the paper, it seemed like creating a specific sound for each person is somewhat of an audio engineering challenge. It requires various filters and audio mixing techniques. I'd be very interested in trying this at home, but I'm not sure my relatively basic audio engineering skills are up to the task.

I've considered asking a sound engineer I know about creating sound therapy based on the study. However, from what I understand, the published text of the study doesn't provide enough data on how the sound was processed to develop the therapy

 

[PeterPan]

The same author wrote this paper. The results show that the therapy does NOT work for those without residual inhibition. Interestingly, the results for the residual inhibition group were not as good/convincing as those in the paper under discussion. Perhaps he was more selective in the most recent paper in some way?

 

[Joeseph Stope]

The same author wrote this paper. The results show that the therapy does NOT work for those without residual inhibition. Interestingly, the results for the residual inhibition group were not as good/convincing as those in the paper under discussion. Perhaps he was more selective in the most recent paper in some way?

Perhaps this is an indicator of the current direction tinnitus therapy is headed. It involves finding an ENT who can accurately diagnose the type of tinnitus you have and recommend the most suitable therapy. If they can't completely cure it, that's unfortunate, but it would still be the next line of defense, or maybe I should say, the next line of support.

It might be easier on your wallet if the process were split into two steps: one ENT or audiologist conducts the examination and diagnosis, and then you can shop around for a health practitioner that fits your budget. Tinnitus support groups, like this one, could play an important and active role in guiding people through this process.

Am I overthinking this?

 

[slc]

From what I understand, I have a single notch of hearing loss at 45 dB in my left ear, specifically at 6000 Hz, with no loss in other areas. I suspect this is the source of my tinnitus, so I'm curious if this could help me!

Ok, I'm no expert, but I would start by determining if a broader range of sound, such as white noise, might work. Perhaps the author includes information on this in the study, or maybe the study's author could provide insight into whether white, blue, or violet noise would be helpful.

If that's the case, it could be beneficial to have your ENT read the study and direct an audiologist to set your programmable hearing aids or maskers to the relevant sound band, either white noise, which includes all audible frequencies, or another band like blue or violet noise, as they both emphasize higher frequencies. Essentially, find a range that includes 6000 Hz.

Personally, I find that wearing my hearing aids or maskers with pink noise throughout the night can sometimes reduce the intensity of tinnitus the following day. Perhaps that's a less precise version of the method used in the study.

It might also be worth asking your ENT and audiologist if they could program your hearing aids or maskers to target the exact frequency you need.

 

[withintention]

The study follows a specific protocol for generating sound using white noise, which is then processed through two band-pass filters: one for the tinnitus frequency and another for the hearing loss frequencies. You would need someone with audio engineering skills to create this type of sound. I doubt my audiologist could help with that. It would be great if someone here with an audio engineering background could provide a how-to guide.

 

[Cmspgran]

I'm not an audio engineer, but I used to dabble in Logic and made my own notched noise using Audacity. In terms of actual steps, it doesn't sound too difficult; someone into audio could probably do it easily. Maybe we could reach out to Dale Snale to create a guide video? Some of his videos almost cover this already, producing something like flat pink noise with a peak at, say, 13 kHz. I use them a lot.

 

[withintention]

I think it's white noise passed through two band-pass filters: one at the tinnitus frequency and one at the hearing loss frequency. Then, somehow, they are mixed back together to create one sound.

I'm not an audio engineer, but I dabble. So I guess we would need to find out from the study:

1. How did they generate the initial white noise?
2. What were the parameters of the band-pass filters?
3. What kind of mix was done to merge the two filtered white noise tracks into one?

Does that sound right? I think we'd need those details before trying to replicate this on our own.

 

[HighleyTall]

This is horseshit.

 

[PeterPan]

This is horseshit.

What I'd like to know is what percentage of chronic tinnitus sufferers meet the eligibility criteria for this treatment. Let's say it's 50%. If we take the results of this trial at face value, it's fair to say the author has solved the problem of chronic tinnitus for 50% of the population. So why isn't this making headline news? Why aren't other researchers clamoring to reproduce the results? Why aren't medical companies jockeying to be the supplier of this treatment?

Perhaps the answer is that people don't trust the results. There are many successful tinnitus trials, yet none seem to translate into treatments that truly satisfy patients.

 

[Vadimus]

The same author wrote this paper. The results show that the therapy does NOT work for those without residual inhibition. Interestingly, the results for the residual inhibition group were not as good/convincing as those in the paper under discussion. Perhaps he was more selective in the most recent paper in some way?

I'm not entirely sure how the active treatment group differs from the group in the first study. The results here are not as impressive but still promising—a nearly twofold reduction in volume after six months. Let's hope he finds something that works, at least for those with residual inhibition. I think it's worth following this scientist's work, as he seems to be taking the topic seriously and making quick progress.

What I'd like to know is what percentage of chronic tinnitus sufferers meet the eligibility criteria for this treatment. Let's say it's 50%. If we take the results of this trial at face value, it's fair to say the author has solved the problem of chronic tinnitus for 50% of the population. So why isn't this making headline news? Why aren't other researchers clamoring to reproduce the results? Why aren't medical companies jockeying to be the supplier of this treatment?

Perhaps the answer is that people don't trust the results. There are many successful tinnitus trials, yet none seem to translate into treatments that truly satisfy patients.

I don't think everyone is just sitting around, waiting for a study on a more or less successful treatment for tinnitus to come out, then immediately rushing to write about it in the popular media, reproduce the results, and develop a treatment based on it. Susan Shore's study was quite promising, but it didn't exactly make global headlines. Scientists are often unaware of parallel studies and are sometimes surprised when patients send them links. There are many studies that have shown at least some positive results, but most of them end up shelved for one reason or another, and no one is in a hurry to reproduce them. I believe the biggest reaction and activity comes from tinnitus sufferers in communities like Tinnitus Talk. So, you shouldn't expect a reaction like: "If it works, tomorrow the whole world will rush to test it and create a treatment for us.

 

[IYIiKe]

I wonder how much benefit there is in receiving any treatment. For example, it would be embarrassing to admit, after countless appointments and excused absences from work or life, that I had not gained any benefit from tinnitus treatment. That's how it feels with CBT for tinnitus.

 

[PeterPan]

Susan Shore's study was quite promising, but it didn't exactly make global headlines.

The Susan Shore device has generated a lot of press in the mainstream media, but the results for her device are nowhere near as convincing as the results from this study.