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CHFS Certificate in health and fitness studies, Simon Fraser U, three years 1985

BGS in psychology, anthropology, kinesiology, and communications disorders. MSU 1987

MSc in Audiology, Speech and Language Pathology, and Education of the Deaf, MSU. 1990

Aud (C) over twenty years dispensing hearing aids etc. hospital, clinic, foreign, and diagnostic clinical experience, musicians, industrial, executive, Royals, with all age groups, USA, Kuwait, KSA, Canada.

 

Any questions related to hearing, hearing loss, ear aches, speaking and hearing in small children, child language development, ear tubes, candling, diagnostic audiology, handicapped, veterans, WCB cases, seniors, born deaf, acquired hearing loss, special needs, pilots or musicians; consultations are available.

 

This includes getting the right treatment and assessment, directions for public benefits or claims, public funding sources, special needs programs, assessing the right costs and types of hearing aids to purchase, advice on warranties etc.

 

I can usually save most persons purchasing hearing aids up to thousands or at least hundred dollars, and years of added life by giving you  advice which most hearing aid providers do not tell you about, alone.  Ask and see if i told you the truth!

 

Mothers or Father worried about; your child is not speaking, is mispronouncing, is not learning well, does not communicate well, has frequent ear aches, is having trouble at school, and/ or at home, etc. Worry less, ask me more.

 

Playing the TV so loud others complain? Can't hear the lecture anymore? Asking others to repeat themselves?  Friends and in-laws are complaining because you are not listening well? Ringing in your ears? Diabetic? There's likely a good reason... ask me.

 

You ask, I reply. If the reply  or replies prove valuable to you, then you can make a small donation, $19. for audiology inquiry, $ 35. for audiology inquiry re; for hearing instruments and aids, advices, how to get the right aid(s) and save money also;  donations to the site by Paypal, or cheque, payable c/o Thomas Garden, #209-1035 Wilkes Ave., Winnipeg, Manitoba, Canada R3P1T1.

You may donate, or not, at any time. Sound good ? Yes, its good for me too, so comments may be added below for consultations, let us see what we can do together.  I can also be reached at ( Canada 1-)  204-255-2096

 

I am sure I can help you, and in many cases save you a lot of money and grief. An expert on your side when purchasing hearing aids can save you big bucks, as a pair can easily run 3000.$ or more these days.

 

Hare Krsna.  - Srila Prabhupada's brahmana-initiated in 1976 

Tom Garden, MSc. Aud (C)  nationally CASLPA registered and certified since 1990, retired.

 

 

 

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    Northwest Indiana Hearing Loss Meeting with CaptionCall and Engage
    Wednesday, October 31, 2012 9:30

    On Saturday November 10, from 1-3pm come and talk with representatives from CaptionCall and Engage for the Northwest Indiana Hearing Loss Meeting. The meeting will be held at the Dyer Schereville Library at 1001 W. Lincoln Hwy Schereville, Indiana.

    Engage offers a new mobile app that alerts people of Deaf news, events, and emergencies in a 30-second ASL video.

    CaptionCall offers an innovative new telephone service for people who have difficulties hearing/understanding people on the phone. CaptionCall provides voice recognition technology and features what the callers say in written transcript form. The transcript is then projected on a large, easily read screen.

    The CaptionCall phone offers consumers self-assurance and ease with this new piece of revolutionary technology. With free FCC-funded service coupled with friendly customer service, CaptionCall helps consumers communicate on the phone easier than ever!

    To learn more call 877-447-2227 or visit www.CaptionCall.com. After ordering, you will receive the CaptionCall phone at no cost, including free installation. Use the Promo Code: HS3026 when ordering.

    vXgtq1BbI1Q

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    redOrbit Staff & Wire Reports - Your Universe Online

    If you want to study space and explore quantum worlds and computers in greater detail, you need an amplifier, something that will boost the weakest of signals. Now, researchers at Caltech and NASA's Jet Propulsion Laboratory have developed a new type of amplifier for boosting electrical signals, according to a joint statement issued by both institutions.

    "This amplifier will redefine what it is possible to measure," says Jonas Zmuidzinas, Caltech's Merle Kingsley Professor of Physics, the chief technologist at JPL, and a member of the research team.

    "Amplifiers play a basic role in a wide range of scientific measurements and in electronics in general," says Peter Day, a visiting associate in physics at Caltech and a principal scientist at JPL. "For many tasks, current amplifiers are good enough. But for the most demanding applications, the shortcomings of the available technologies limit us."

    Conventional transistor amplifiers, similar to the ones that power your car stereo speakers, work with a large span of frequencies. They can also boost signals ranging from the faint to the strong, and this so-called dynamic range enables your speakers to play both the quiet and loud parts of a song. But when an extremely sensitive amplifier is needed  to boost the faint, high-frequency radio waves from distant galaxies, transistor amplifiers tend to introduce too much noise, resulting in a signal that is more powerful but less clear.

    One type of highly sensitive amplifier is a parametric amplifier, which boosts a weak input signal by using a strong signal called the pump signal. As both signals travel through the instrument, the pump signal injects energy into the weak signal, therefore amplifying it.

    About 50 years ago, Amnon Yariv, Caltech's Martin and Eileen Summerfield Professor of Applied Physics and Electrical Engineering, showed that this type of amplifier produces as little noise as possible: the only noise it must produce is the unavoidable noise caused by the jiggling of atoms and waves according to the laws of quantum mechanics. The problem with many parametric amplifiers and sensitive devices like it, however, is that they can only amplify a narrow frequency range and often have a poor dynamic range.

    But the Caltech and JPL researchers say their new amplifier, which is a type of parametric amplifier, combines only the best features of other amplifiers. It operates over a frequency range more than ten times wider than other comparably sensitive amplifiers, can amplify strong signals without distortion, and introduces nearly the lowest amount of unavoidable noise. The researchers say that design improvements should be able to reduce that noise to the absolute minimum. Versions of the amplifier can be designed to work at frequencies ranging from a few gigahertz to a terahertz (1,000 GHz). For comparison, a gigahertz is about 10 times greater than commercial FM radio signals in the U.S., which range from about 88 to 108 megahertz (1 GHz is 1,000 MHz).

    "Our new amplifier has it all," Zmuidzinas said in a recent statement. "You get to have your cake and eat it too."

    One of the key features of the new parametric amplifier is that it incorporates superconductors—materials that allow an electric current to flow with zero resistance when lowered to certain temperatures. For their amplifier, the researchers are using titanium nitride (TiN) and niobium titanium nitride (NbTiN), which have just the right properties to allow the pump signal to amplify the weak signal.

    The new amplifier has a host of potential applications, however, the reason the researchers built the device was to help them study the universe. The team built the instrument to boost microwave signals, but the new design can be used to build amplifiers that help astronomers observe in a wide range of wavelengths, from radio waves to X rays.

    One example is that the instrument can directly amplify radio signals from faint sources like distant galaxies, black holes, or other exotic cosmic objects. Boosting signals in millimeter to submillimeter wavelengths (between radio and infrared) will allow astronomers to study the cosmic microwave background— the afterglow of the Big Bang — and to peer behind the dusty clouds of galaxies to study the births of stars, or probe primeval galaxies. The team has already begun working to produce such devices for Caltech's Owens Valley Radio Observatory (OVRO) near Bishop, California, about 250 miles north of Los Angeles.

    These amplifiers, Zmuidzinas says, could be incorporated into telescope arrays like the Combined Array for Research in Millimeter-wave Astronomy at OVRO, of which Caltech is a consortium member, and the Atacama Large Millimeter/submillimeter Array (ALMA) in Chile.

    Instead of directly amplifying an astronomical signal, the instrument can be used to boost the electronic signal from a light detector in an optical, ultraviolet, or even X-ray telescope, making it easier for astronomers to tease out faint objects.

    Because the instrument is so sensitive and introduces minimal noise, it can also be used to explore the quantum world.

    Keith Schwab, a professor of applied physics at Caltech, is planning to use the amplifier to measure the behavior of tiny mechanical devices that operate at the boundary between classical physics and the strange world of quantum mechanics. The amplifier could also be used in the development quantum computers—which are still beyond our technological reach but should be able to solve some of science's hardest problems much more quickly than any regular computer.

    "It's hard to predict what all of the applications are going to end up being, but a nearly perfect amplifier is a pretty handy thing to have in your bag of tricks," Zmuidzinas says. And by creating their new device, the researchers have shown that it is indeed possible to build an essentially perfect amplifier. "Our instrument still has a few rough edges that need polishing before we would call it perfect, but we think our results so far show that we can get there."

    The team recently described the new instrument in the journal Nature Physics. In addition to Zmuidzinas and Day, the other authors of the paper are Byeong Ho Eom, an associate research engineer at Caltech, and Henry LeDuc, a senior research scientist at JPL. This research was supported by NASA, the Keck Institute for Space Studies, and the JPL Research and Technology Development program.

    redOrbit.com
    offers Science, Space, Technology, Health news, videos, images and reference information. For the latest science news, space news, technology news, health news visit redOrbit.com frequently. Learn something new every day."

  • Hi,
    I would like to test an 8 year old for auditory processing disorder.  He
    has had a hearing test which indicated he had no hearing problems.  But
    what I notice is that he cannot hear in noisy environments and often
    confuses words that rhyme, and often uses the opposite words of what he
    means in sentences.  So I would like to test for a processing problem.
    Please let me know if this is possible at your clinic at his age.  Thank
    you,
    Monica


    Tdasa; Which city are you in?


    Monica; Airdrie


    Tdasa; I'm in Winnipeg. I can suggest you go to see professionals locally who specialize  in Speech and Language Pathology, as well as early education and Central Auditory Processing Disorders. You might find such services among government programs associated with the hospitals and schools. They will not charge, and will have all the necessary connections for follow up.

     

    Do not accept any referrals for ritalin or other pschoactive drugs for the child. Beware, once your child is within  the schools and health cares system, such channeling into unwanted situations can arise. Early exposure to vaccines and mercury contained therein have been causing an epidemic of subtle disorders in children. Also, allergies can be involved.

     

    That said, it does indeed sound like there is a processing disorder, best to find out exactly to the degree asap. One thing, they can test for CAPD disorder   well   after age 7 or so, by audiology, and Speech Language Pathologists also have other types of  tests.  Both an audiologist and a Speech Language Pathologist should be consulted, ideally. SLPs have areas of specialty, so shop for one that works with children and such.

     

    symptoms of CAPD; social misbehaviors /"behavioral problems" frequent

    emotional stress

    family history sometimes

    cant carry musical tunes well

    dsylexic behaviors

    falling behind at school

    sometimes cannot hear well, especially in noise or other distractions

     

    Hare Krishna, God Bless. The Alberta College of Speech Pathologists and Audiologists, can direct you further.

     

    PS How did you get my name, dear? Do we know each other?

    Tuesday, March 6, 2012 9:56:23 AM
    Thank you for your long reply, I got your name from the speech Canada
    database, I must have thought you were in the Airdrie area:
    http://www.speechandhearing.ca/en/find-a-professional
    I have a referal form and all I need is a speech evaluation now.
    I was suggested a ritalen solution as well but, as they say, over my dead
    body :)
    Thanks so much for your time,
    Monica


  •  

    Draft Analytic Framework

    Figure 1. Preliminary analytic framework for treatments of tinnitus

    Figure 1: This figure depicts the key questions within the context of the PICOTS described in this document. In general, the figure illustrates how the instruments used to evaluate tinnitus (KQ1) may lead to different treatment/intervention choices. The comparative effectiveness of treatment interventions (KQ2) may result in long-term outcomes such as changes in sleep disturbances, reduction in discomfort, anxiety, or depression or increased quality of life. The comparative effectiveness of treatment interventions as influenced by prognostic factors (e.g. length of time to treatment after onset; degree of hearing loss; head injury; anxiety; mental health disorders; duration of tinnitus); individual patient characteristics (e.g. age, gender, race, personality, lifestyle, acoustic environment, medical or mental health comorbidities, hyperacusis) and symptom characteristics (e.g. origin of tinnitus, ototoxicity, duration of tinnitus, etiology of tinnitus, severity of tinnitus) (KQ3) may result in long-term outcomes such as changes in sleep disturbances, reduction in discomfort, anxiety, or depression or increased quality of life. Also, adverse effects such as worsening of tinnitus may occur at any point after the treatment is received. Prognostic factors (KQ4) for diagnoses and treatment outcomes will be identified.

    Abbreviations: KQ = key question

    Background

    Tinnitus is the perception of sound in the absence of an external stimulus, described as “ringing of the ears.” Tinnitus is a distressing condition that can disturb one’s day-to-day life through its annoyance, leading to disruption of sleep, anxiety and depression. An estimated 16 percent of the American population (50 million people) experience tinnitus to some extent, with up to 16 million seeking medical help and 2 million being unable to lead a normal life.1

    A variety of conditions and experiences can lead to tinnitus, but its exact physiology is still unknown. As a symptom, it may be associated with a number of conditions—ranging from impacted wax to acoustic tumors—that warrant medical attention. Tinnitus can also be a side-effect of many potentially ototoxic drugs, ranging from aspirin taken to alleviate arthritic pain to life-saving drugs used to treat cancer.2 The severity of tinnitus experienced by patients may vary, depending on their comorbidities. For example, individuals who are deaf may be confused by tinnitus because visual information does not help them understand that their tinnitus is not an external sound. The prevalence of tinnitus increases with age and noise exposure.3 According to the American Tinnitus Association (ATA), noise exposure is the largest attributed cause of tinnitus, making tinnitus the primary disability resulting from active duty in the Armed Forces.4 It is also a common problem of people exposed to hazardous levels of industrial and/or recreational noise.

    In both clinical and academic contexts, there is no real consensus in the classification of tinnitus subcategories. A patient is often described as presenting symptoms of either objective or subjective tinnitus. Due to the rarity of objective tinnitus, some investigators have argued that all tinnitus is subjective and should instead be classified by origin, either as somatic or neurophysiologic.5

    Somatic tinnitus is classified as tinnitus with an underlying medical condition that creates internal acoustic mechanical sounds; in this case, the tinnitus has a vascular, muscular, respiratory, or temporomandibular joint (TMJ) origin.6 The sounds associated with somatic tinnitus (somatosounds) are most commonly pulsatile and can be heard by an observer either directly or through the use of a stethoscope or microphone. Somatic tinnitus can be treated by identifying the source or the underlying condition and appropriately treating it.6 Although sserious pathology is rarely a cause of tinnitus, pulsatile somatic tinnitus, tinnitus in only one ear (unilateral tinnitus), and tinnitus associated with vertigo require a specialist referral.7

    Neurophysiologic tinnitus, in which the perceived sound originates from the auditory nervous system, is the default diagnosis, since most patients experience this subjective form of tinnitus.6 This form of tinnitus is nonpulsatile and most often affects both ears (bilateral tinnitus). It can be heard only by the patient and cannot be directly observed by a physician, thus making it difficult to evaluate these patients. These “phantom sounds” are attributed to a disruption in the neurological auditory pathway.8 Audiological protocols can be used to match the loudness and pitch of the tinnitus perceived by a patient to external sounds with known acoustical parameters.8

    Measures such as the Visual Analog Scale (VAS), the Tinnitus Severity Index (TSI), the Tinnitus Handicap Inventory (THI), and the Tinnitus Reaction Questionnaire (TRQ) can be used to evaluate the presence and severity of the tinnitus.9 Psychological grading scales can aid in the discrimination between clinically significant and insignificant tinnitus.10 If the patient suffers from the constant perception and/or annoyance of tinnitus, the condition is identified as chronic tinnitus. The Visual Analog Scale (most often used to assess chronic pain) enables a patient to assign a score of 0 to 10 to his or her tinnitus. The score is assessed in relation to volume and disturbance of the tinnitus.11 The Tinnitus Severity Index provides an index score ranging between 0 and 48 to indicate lesser to greater severity. This score is used to quantify the everyday impact of tinnitus on a patient’s life in five categories: intrusiveness, distress, hearing loss, sleep disturbance, and need for medication.12,13 The Tinnitus Handicap Inventory assesses three main items14:

    • Functional reactions to tinnitus (e.g., inability to concentrate and antisocial trends)
    • Emotional reactions to tinnitus (e.g., anger, frustration, irritability, and depression)
    • Catastrophic reactions to tinnitus (e.g., despair, feelings of hopelessness, fear of a "severe disease," loss of control, and inability to cooperate)

    The Tinnitus Reaction Questionnaire is a scale designed to assess the psychological aspects of tinnitus, in particular the nature and extent of distress caused by the condition.15 The 26-item scale covers various symptoms of personal and social handicaps due to tinnitus (anger, despair, helplessness, intrusiveness, and activity avoidance).

    Given the diagnostic challenges presented by the multiple etiologies of tinnitus and the highly subjective presentation of its symptoms, reviewing the comparative effectiveness of the clinical instruments used to identify patients for further evaluation or treatment will form the initial part of our review. The remainder of the review will focus on patients with neurophysiologic (bilateral, nonpulsatile) tinnitus. Patients with this type of tinnitus form the majority of those seeking help because it interferes with some aspect of their lives. Patients diagnosed with unilateral and/or pulsatile tinnitus need to be evaluated for other medical conditions.

    Tinnitus Treatments

    With neurophysiologic tinnitus, physicians can initially treat the symptoms by prescribing drugs and/or suggesting ways to cope with the discomfort associated with tinnitus. Various clinical evaluation instruments, as identified above, can be used to characterize a subjective diagnosis and measure the severity of tinnitus. The treatment of tinnitus, however, is complicated by its possible interaction with the treatment given for the underlying condition, which may entail the use of ototoxic drugs and/or by comorbidities that modulate the experience of tinnitus. The complex relationships between tinnitus and a range of physical and mental health conditions have complicated the development and the evaluation of intervention strategies.

    Treatment methods can be targeted to either “habituate the reaction” by improving the ability of the patient to deal with tinnitus or to “habituate the perception” with the aim of decreasing or eliminating the phantom noises.16 The range of interventions can include the sound treatments and associated technologies, medical/surgical treatments, and psychological treatments outlined below.

    Sound treatment and associated technologies

    Some therapists consider hearing aids to be a treatment for tinnitus. The rationale for this approach is that making valid external stimuli audible will divert attention or mask the tinnitus that is often associated with hearing loss.17 Other technologies (called “maskers”) are sometimes used by patients who do not have sufficient hearing loss to warrant a hearing aid. Maskers provide an external sound to distract the patient from his or her tinnitus. Masking devices are available both as portable or wearable instruments and as stationary environmental maskers. Masking devices have received Class II approval from the U.S. Food and Drug Administration (FDA). However, because they are considered to be “experimental, investigational, or unproven” therapies,17 they are generally not covered under health insurance plans.18 Electrical stimulation is used to stimulate the auditory system and has been shown to provide tinnitus relief, yet the underlying mechanisms of this effect are not yet understood.12 Transcranial magnetic stimulation (TMS) delivers an electrical field to the cerebral cortices modulating the excitability in the area of the cerebral cortex believed to be associated with tinnitus.19 Cochlear implants reduce tinnitus by masking newly perceived sounds or through electrical stimulation of the auditory nerve but are only used on a specific subset of patients.12

    Medical/surgical treatments

    Pharmacological treatment

    Various pharmacological treatments, including antidepressants, anxiolytics, vasodilators and vasoactive substances, and intravenous lidocaine have been prescribed for tinnitus (see Table 1 for examples).20-24 These treatments have generally been indirect solutions because they are focused on an underlying cause or tinnitus-associated symptoms such as depression, stress, or sleep disturbance.25 However, newer medications, such as pramipexole, that attempt to modulate the central hearing pathways are now also being used.26

    Table 1: Some Pharmacological Treatments for Tinnitus
    Drug Class Agents (Examples)
    Botox = botulinum toxin type A
    Antidepressants
    • Tricyclic: amitriptyline, nortriptyline, and trimipramine
    • Selective serotonin-reuptake inhibitors: fluoxetine and paroxetine
    • Other: trazodone
    Anxiolytics Alprazolam
    Vasodilators/Vasoactive Substances Prostaglandin E1, naftidrofuryl, and carbogen (5% CO2 and 95% O2)
    Other Lidocaine, gabapentin, Botox®, and pramipexole

    Temporomandibular joint treatment

    Tinnitus, vertigo, and otalgia are recognized complaints that often accompany temporomandibular joint (TMJ) disease.27 TMJ disease consists of a collection of medical and dental conditions that affect the temporomandibular joint, masticulatory muscles, and/or the adjoining structures and cause pain and tenderness, most frequently felt in the jaw and the temple but also in the ear and surrounding area.28 Treatment of TMJ disease can range from the use of dental orthotics and self-care instructions to surgery in instances where injury to the jaw is the underlying cause.29

    Complementary and alternative medicine therapies

    Complementary and alternative medicine therapies—including G. biloba extracts, acupuncture, and hyperbaric oxygen—are also being used by patients with tinnitus. Extracts from G. biloba leaves are a traditional Chinese medicinal treatment used to increase blood flow, inhibit the platelet-activating factor, alter neuron metabolism, and prevent free radicals from damaging cell membranes. These improvements, as well as relief from tinnitus, are attributed to the chemical compounds flavonoid and terpenoid, which are found within the G. biloba plant.30 The use of acupuncture as a tinnitus treatment originated in East Asian countries and has since expanded to North America. This therapy is suggested to reduce discomfort associated with tinnitus when needles are applied to the hand and face on the affected side.31 Hyperbaric oxygen therapy is suggested to aid in tinnitus relief by improving the oxygen supply to the inner ear.32 This therapy, which is used to treat a variety of medical conditions, requires that the patient sit inside a pressured chamber containing an atmosphere of 100 percent oxygen, which increases the oxygen supply to body tissues.

    Individuals seeking general information about tinnitus relief on the Internet will find a dizzying array of other alternative approaches proposed to relieve tinnitus. These include, but are not limited to, diet modifications, such as limiting the intake of high-sodium foods, caffeine, chocolate, and other stimulants and avoiding refined sugars, artificial sweeteners, saturated and unsaturated fats, and monosodium glutamate.33-36

    Psychological treatments

    Cognitive behavioral therapy

    In addition to its association with many physical health problems, tinnitus is also associated with many clinical and subclinical psychological health problems, both as a cause and a consequence of tinnitus. For example, individuals with tinnitus may experience difficulties with attention and anxiety, but those who are most distressed by tinnitus may be psychologically vulnerable.37 Interventions such as cognitive behavioral therapy may effectively increase quality of life by increasing the patient’s ability to deal with chronic tinnitus by restructuring thought patterns and habituating those patterns when reacting to tinnitus.38 Cognitive behavior therapy is suggested as one of the first recommendations a general practitioner should make according to the good practice guidelines developed by the Department of Health in the United Kingdom.39

    Tinnitus retraining therapy, biofeedback, education, and relaxation therapies

    Since its proposal in 1990, tinnitus retraining therapy has been used to reprogram how a patient interprets the “tinnitus” sounds by combining cognitive behavioral therapy with partial masking.40 Biofeedback, education, and relaxation therapies aim to teach the patient to control or habituate to the perceived ringing and the subsequent distress. Biofeedback treatments are based on the presumption that the stress caused by tinnitus exaggerates a patient’s discomfort.41 Biofeedback therapy for tinnitus involves listening to an audio signal produced by an electromyograph (EMG) of the frontalis muscle. The EMG uses surface electrodes in the detection of muscle action potentials from underlying skeletal muscles that initiate muscle contractions.42 Listening to the audio signal is thought to reduce the perceived ringing and muscle tension. Educating patients about their tinnitus has been proposed to improve the management of tinnitus-related symptoms and their associated discomfort.42 Relaxation therapies also offer strategies to focus the patient’s attention away from the sound, aiming to psychologically improve their symptoms.41 Although these therapies may not eliminate the tinnitus, they aim to improve the subject’s quality of life through habituation to decrease their consciousness of the noise.

    Justification for Review

    In a rehabilitative context, the discomfort of tinnitus is often more common than hearing loss in triggering people to seek hearing health care, yet typical audiological interventions focus on the remediation of hearing loss rather than on treatments for tinnitus.43 Recent research findings from cognitive and auditory neuroscience studies have advanced our knowledge of the biological underpinnings of some forms of tinnitus, while findings from clinical psychological studies have underscored the interactions among the auditory, cognitive, affective, and mental health issues that must be considered in designing and evaluating interventions to meet the needs of clinical subpopulations of patients. How some people "live with it" so much better than others remains unclear. The comparative effectiveness review we propose offers an opportunity to explore prognostic factors and strategies for the optimal management of tinnitus.

    The range of tinnitus treatments has prompted the need for a comparative effectiveness review. Despite many available and promising treatments, there are no universally accepted therapies for managing tinnitus. In 2008, the Tinnitus Research Institute created, and still continues to modify, a flowchart outlining for the diagnosis and management of tinnitus; however, this clinical protocol has yet to be adopted by any government or agency.44 Organizations such as the ATA provide information on a variety of treatment options, but do not endorse or recommend any specific treatment. As mentioned previously, the Department of Health in the United Kingdom has developed a good practice guidelines to assist in tinnitus management.45 Comparable guidelines are currently not standardized in the United States, although individual efforts and strategies appear in the research literature.6,46

    As there is no “cure” for tinnitus, the absence of firm guidelines and management strategies demonstrates the need for further evaluation of current treatment options. Our proposed review aims to clarify the effectiveness of the various tinnitus treatments currently in use and their measurable outcomes.

    PICOTS Framework

    Population(s)
    • Key Question (KQ) 1: Adult patientsa who visit primary care practitioners with symptoms of tinnitus (ringing in the ears)
    • KQs 2–4: Adults with a subjective diagnosis of neurophysiologic (bilateral, nonpulsatile) tinnitusb
      Notes:

      a For all KQs, “adults” will include individuals 18 years of age and older.
      b For KQs 2–4: Adults diagnosed with unilateral and/or pulsatile tinnitus need to be evaluated for other serious medical conditions and will be excluded from the proposed review.
    Interventions
    • KQ 1: Direct observation or observation of sound with stethoscope; magnetic resonance imaging or computerized tomography; referral to an otolaryngologist or audiologist; scales/questionnaires to assess severity (Visual Analog Scale; Tinnitus Severity Index; Tinnitus Handicap Inventory; Tinnitus Reaction Questionnaire)
    • KQs 2–4: Any treatment/therapy used to reduce/help cope with tinnitus including:
      • Medical/Surgical
        • Pharmacological treatments (for generic drug names and FDA approval see Appendix A):
          • Tricyclic antidepressants (e.g., amitriptyline, nortriptyline, and trimipramine
          • Selective serotonin-reuptake inhibitors: fluoxetine and paroxetine
          • Other: trazodone; anxiolytics (e.g., alprazolam); vasodilators and vasoactive substances (e.g., prostaglandin E1, naftidrofuryl, carbogen (5% CO2 and 95% O2); intravenous lidocaine; gabapentin; Botox (botulinum toxin type A); and pramipexole
        • Laser treatments
        • TMJ treatment: dental orthotics and self-care; surgery
        • Complementary and alternative medicine therapies: G. biloba extracts; acupuncture; hyperbaric oxygen therapy; diet and lifestyle modifications (caffeine avoidance, exercise); and progressive tinnitus management52
      • Technologicala
        • Hearing aids
        • Cochlear implants
        • Maskers (both wearable and stationary)
        • Electrical stimulation
        • Transcranial magnetic stimulation
          a Information on the FDA approval status of devices is included in Appendix A.
      • Psychological
        • Cognitive behavioral therapy
        • Tinnitus retraining therapy
        • Biofeedback
        • Education
        • Relaxation therapies
      • Combination therapies
        Any combination of tinnitus interventions (e.g., pharmacological treatment with cognitive behavioral therapy)
    Comparators
    • KQ 1: Different clinical evaluation methods/tools used to characterize a subjective diagnosis and measure severity of tinnitus
    • KQ 2: Placebo; other intervention/treatment
    • KQ 3: Different:
      • Prognostic factors (e.g., length of time to treatment after onset; degree of hearing loss; head injury; anxiety; mental health disorders; duration of tinnitus)
      • Patient characteristics (e.g., age; gender; race; personality; lifestyle; acoustic environment including work-related and other environmental noise exposure; medical or mental health comorbidities, including anxiety, hearing loss, and hyperacusis; recreational activities; socioeconomic factors; involvement in litigation)
      • Symptom characteristics (e.g., origin of tinnitus; severity of tinnitus; ototoxicity; tinnitus duration; presumed etiology of tinnitus; subcategory of tinnitus)
    • KQ 4: Length of time to treatment after onset; degree of hearing loss; head injury; anxiety; mental health disorders; duration of tinnitus
    Outcomes
    • KQ 1
      • Final outcomes:
        1. Treatment recommendation
    • KQ 2
      • Final outcomes:
        1. Sleep disturbance
        2. Discomfort
        3. Anxiety
        4. Depression
        5. Quality of Life
      • Adverse effects
        1. Worsening of tinnitus
        2. Sedation
        3. Surgical complications
    • KQ 3
      • Final outcomes:
        1. Time until improvement noted
        2. Sleep disturbance
        3. Discomfort
        4. Anxiety
        5. Depression
        6. Quality of Life
      • Adverse effects
        1. Worsening of tinnitus
        2. Sedation
        3. Surgical complications
    • KQ4
      • Final outcome
        1. Quality of Life
    Timing
    • Duration of followup (no time restrictions)
    Setting
    • Primary care; specialty care

     

     


     

     

    • References

      1. American Tinnitus Association ATA Web site. Top 10 Most Frequently Asked Questions. Available at: www.ata.org/for-patients/faqs. Accessed: October 2011
      2. Savage J, Cook S, Wadell A. Tinnitus. Clin Evid (Online) 2007 Aug 1;2007. pii: 0506. PMID: 19454115.
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      8. Holgers K-M. Mechanisms and classification of tinnitus: a discussion paper. Audiol Med 2003;1(4):238-41.
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      Appendix A: Medical and Technological Interventions

      Type of Drug Drug Name
      (where applicable)
      Comments

      Amitriptyline

      Elavil, Tryptizol, Laroxyl, Sarotex, Lentizol

      Elavil FDA Approval
      Amitriptyline  Hydrochloride FDA Approval

      Notriptyline

      Sensoval, Aventyl, Pamelor, Norpress, Allegron, Noritren and Nortrilen

      Aventyl FDA Approval
      Pamelor FDA Approval

      Trimipramine

      Surmontil, Rhotrimine, Stangyl

      Surmontil FDA Approval

      Fluoxetine

      Prozac, Sarafem, Fontex

      Prozak FDA Approval
      Sarafem FDA Approval

      Paroxetine

      Aropax, Paxil, Seroxat, Sereupin

      Paxil FDA Approval
      Paroxetine FDA Approval

       

      Alprazolam

      FDA Approval

      Trazodone

      Desyrel, Oleptro, Beneficat, Deprax, Desirel, Molipaxin, Thombran, Trazorel, Trialodine, Trittico, and Mesyrel

      Desyrel FDA Approval
      Oleptro FDA Approval
      Trialodine FDA Approval
      Trazodone FDA Approval

      Pramipexole

      Mirapex, Mirapexin, Sifrol

      Mirapex FDA Approval
      Pramipexole FDA Approval

      Prostaglandin E1

      Alprostadil

      Alprostadil FDA Approval

      Nicotinic acid

       

       

      Intravenous lidocaine

       

      Lidocaine FDA Approval

      Naftidrofuryl

      Nafronyl or as the oxalate salt naftidrofuryl oxalate or nafronyl oxalate

       

      Gabapentin

      Fanatrex, Gabarone, Gralise, Neurontin, Nupentin

      Gabapentin FDA Approval

       

      Type of Device Comments
        Company Device 510(k) Number
      Cochlear Implants

      KARL STORZ ENDOSCOPY-AMERICA, INC.

      KARL STORZ MICRO-INSTRUMENT FOR COCHLEAR IMPLANTATION

      K946332

      COCHLEAR AMERICAS

      BIA300 SERIES IMPLANT AND ABUTMENT, BI300 IMPLANT, BA300 ABUTMENT
      Many others with PMA Approval

      K100360

      COCHLEAR CORPORATION

      Nucleus 24 Cochlear Implant System

      PMA Approved:
      P970051

      Nucleus 22 Channel Cochlear Implant System

      PMA Approved:
      P840024/S071 

      Nucleus 22 Channel Cochlear Implant System for Adults and Children

      PMA Approved:
      P840024/S072

      Nucleus 22 Channel Cochlear Implant System

      PMA Approved:
      P890027/S040

      Nucleus 22 Channel Cochlear Implant System for Adults and Children

      PMA Approved:
      P890027/S041

      MEDEL

      MED-EL COMBI 40+ Cochlear Implant System with C40+, C40+S, and C40+GB Implants, CIS-PRO+ and TEMPO+ speech processors

      PMA Approval: P000025

      ADVANCED BIONICS CORPORATION

      Many with PMA Approval.

       

      NEUROLEC

       

      No Approval Found

      Masking Devices

      ASSOCIATED HEARING INSTRUMENTS

      MICRO MASKER

      K924991

      AUDIOTRONE

      T-570 TINNITUS MASKER

      K800701

      TA-641 TINNITUS INSTRUMENT

      K800702

      BELTONE ELECTRONICS CORP.

      MINUET MASKER; JUBILEE MASKER

      K800784

      FOUNDATION FOR FLUENCY, INC

      EDINBURGH MASKER

      K800445

      GN RESOUND A/S

      TINNITUS SOUND GENERATOR MODULE

      K110932

      TINNITUS SOUND GENERATOR MODULE

      K073636

      HAL-HEN CO., INC

      NUVOX BEDSIDE TINNITUS MASKER

      K802750

      HEARING INNOVATIONS, INC.

      HISONIC-TRD TINNITUS RELIEF DEVICE

      K013253

      MAGNATONE HEARING AID CORP. DBA PERSONA MEDICA

      EVOK 900 SERIES HEARING AID/TINNITUS MASKER OPTION

      K093715

      MARPAC, INC.

      MODEL#1550 MARSONA(R) TINNITUS MASKER

      K940567

      BEDSIDE TINNITUS MASKER #1500

      K802234

      MICROBIO-MEDICS, INC.

      321Q MINIMUM ENERGY TINNITUS SUPPRESSOR

      K922572

      NEUROMONICS PTY LTD

      NEUROMONICS TINNITUS TREATMENT

      K043274

      PETROFF AUDIO TECHNOLOGIES

      DIGITAL TINNITUS MASKING SYSTEM

      K974501

      SIEMENS HEARING INSTRUMENTS, INC.

      CUSTOM TCI (TINNITUS CONTROL INSTRUMENT)

      K011364

      TCI (TINNITUS CONTROL INSTRUMENT

      K003559

      TCI COMBI (TINNITUS CONTROL INSTRUMENT COMBINATION)

      K003558

      CUSTOM TCI-COMBI (TINNITUS CONTROL INSTRUMENT COMBINATION

      K011366

      STARKEY LABORATORIES, INC.

      STARKEY TM-3, TM-5 HIGH FREQUENCY TINNITUS MASKER

      K964216

      STARKEY TM AIR CONDUCTION TINNITUS MASKER

      K963838

      STARKEY MA-3 AIR CONDUCTION COMBINATION HEARING AID/TINNITUS MASKER

      K963995

      MODEL TM2-BEHIND-THE-EAR TINNITUS

      K792214

      MODEL TM5 BEHIND EAR TINNITUS MASKER

      K791790

      MODEL MA3 BEHIND-THE-EAR MASKER/HEARING

      K791071

      TINNITUS MASKER

      K781798

      TINNITUS RESEARCH AUDIOMETER

      K802560

      CRESCENT TINNITUS RETAINING SOUND GENERATOR

      K030180

      TELEX COMMUNICATIONS, INC.

      TELEX TINNITUS-COMPANION

      K984243

      TINNITUS CONTROL, INC.

      TINNITUS PHASE-OUT

      K061111

      TINNITUS RX

      K031624

      TINNITUS TREATMENT CENTERS, INC

      PILLOW MASKER, C2007M, C2008M,CE2000, WONDER EAR, MINI WONDER EAR, PT-2SM, PT-3SM, PT-3LFM, PT-3HFM

      K982432

      VICAN INSTRUMENT CO.

      TINNITUS MASKERS MODEL S584

      K790190

      VICON INSTRUMENT CO.

      TINNITUS MASKERS, MODELS S564&S574

      K771769

      TINNITUS AID, MODEL S244

      K770938

      TINNITUS DEVICES

      K790064

      Hearing Aids

      A variety of companies produce this device.

      Many available, not specific to tinnitus

      Many FDA Approvals Exist

      Acupuncture

      A variety of companies produce this device.

      Many available, not specific to tinnitus

      Many FDA Approvals Exist

      Transcranial Magnetic Stimulation

      NEUROSTAR TMS THERAPY SYSTEM, MODEL 1.1

      NEURONETICS

      K083538

      NEUROSTAR TMS SYSTEM

      K061053

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