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At least 19 recordsLinked to original sources

PubMed2003

Hearing impairment and tinnitus pitch in patients with unilateral tinnitus: comparison of sudden hearing loss and chronic tinnitus.

OBJECTIVES: The objectives were to analyze the results of pitch-matching and loudness-balance testing in patients with unilateral tinnitus and to evaluate the relationship between audiological findings based on the tinnitus-affected and tinnitus-unaffected threshold differences and tinnitus pitch by using linear interpolation methods. In addition, the effects of the duration of the tinnitus on this relationship were investigated. Sudden sensorineural hearing loss with tinnitus was selected for the "acute tinnitus" group, and unilateral tinnitus with unknown disease and a duration of more than 3 months was selected for the "chronic tinnitus" group. STUDY DESIGN: Retrospective study of the clinical records of patients. METHODS: One hundred thirty-two patients with unilateral tinnitus (comprising 68 female [51.5%] and 64 male [48.5%] patients) were investigated as subjects. Their mean age was 50.4 years (SD = 15.8 y). All patients underwent otoneurological testing, including the pure-tone audiogram and pitch-matching and loudness-balance tests. RESULTS: The mean difference in the hearing threshold between the tinnitus-affected ear and the tinnitus-unaffected ear was largest near the tinnitus pitch in both the acute and the chronic tinnitus groups. However, the relationship between hearing impairments and tinnitus pitch was somewhat different in the two groups: It exhibited a single smooth peak in the acute tinnitus group but a bimodal peak in the chronic tinnitus group. CONCLUSION: The results suggest that tinnitus is related to hearing impairment in the same frequency region in patients with sudden sensorineural hearing loss with tinnitus or in patients with chronic tinnitus, whereas some instances of chronic tinnitus are caused by reorganization in cortical cells.

Acute Disease↗

PubMed2005

Transcranial magnetic stimulation for tinnitus: influence of tinnitus duration on stimulation parameter choice and maximal tinnitus suppression.

OBJECTIVE: Tinnitus is a distressing symptom for which few treatments exist. It leads to an important decrease in quality of life in 2 to 3% of the population. Tinnitus is considered a phantom sound, the result of cortical reorganization. Transcranial magnetic stimulation (TMS) is a noninvasive method to modulate cortical reorganization and has been shown to be able to influence tinnitus perception. STUDY DESIGN: Retrospective analysis. SETTING: Tertiary referral center. PATIENTS: The effect of TMS of the contralateral auditory cortex in 114 patients with unilateral tinnitus is investigated as one of the selection criteria used for surgical implantation of electrodes on the auditory cortex. INTERVENTION: TMS is performed at 90% of motor threshold at 1, 3, 5, 10, and 20 Hz, with each stimulation session consisting of 200 pulses. Results were classified as no effect (0-19% improvement), partial effect (20-79% improvement), and good effect (80-100 suppression). MAIN OUTCOME MEASURES: TMS had a good effect in 25% of the patients studied, partial effect in 28% patients, and no effect in 47%. RESULTS: TMS at 200 pulses is capable of tinnitus suppression for seconds only. The results were influenced by tinnitus duration: the longer the tinnitus exists, the lower the stimulation frequency that yields maximal tinnitus suppression (p < 0.001). The maximal amount of tinnitus suppression decreases in time (p < 0.01), resulting in a 2% decrease of potential tinnitus suppression per year. CONCLUSION: TMS of the auditory cortex is capable of modifying tinnitus perception for a very short time. The maximal amount of suppression and best stimulation frequency depends on the tinnitus duration.

Auditory Cortex↗

PubMed1995

[Tinnitus models for use in tinnitus counselling therapy of chronic tinnitus patients].

Tinnitus models are an integral part of tinnitus counselling. In cases with compensated tinnitus, counselling represents the only therapeutic measure necessary. In contrast, patients with uncompensated tinnitus require further therapy in the form of medication, tinnitus-maskers or psychotherapy. Sound processing along the peripheral and central auditory pathways is achieved by functional loops that direct mechanical, electrical or chemical information to various points in the pathway. Minor damage to a loop can cause destabilization of this finely balanced system and can induce tinnitus. Current peripheral tinnitus models are reviewed and discussed with respect to in vitro data from isolated outer hair cells of the guinea pig cochlea. Audiological findings of a patient with central tinnitus after brainstem surgery are discussed in view of central tinnitus models. Specific models for common hearing disorders, such as tinnitus with normal hearing, noise trauma, sudden hearing loss, toxic cochlear lesions, presbyacusis, acoustic neurinoma and Menière's disease are presented for the ENT-surgeon involved with tinnitus-counselling.

Adult↗

PubMed2001

Effects of tinnitus retraining therapy (TRT) for patients with tinnitus and subjective hearing loss versus tinnitus only.

The patients with tinnitus and/or hyperacusis undergoing an 18-24 month period of TRT are divided into five categories of treatment. Different types of counselling and sound therapy are used in each category. Selection of patients into a specific category depends on such factors as: hyperacusis, subjective hearing loss and long-lasting effect of noise on tinnitus. The 108 cases were evaluated After 1 year of treatment. The results of therapy of 40 patients with tinnitus and subjective hearing loss (category II) were compared with the results of therapy of patients with tinnitus only (categories 0 and I). A special questionnaire, answered before and during the treatment, was used to assess the results. Our data indicate significant improvement in about 70% of patients with tinnitus only and in about 90% of patients with tinnitus and subjective hearing loss after one year of therapy.

Female↗

PubMed1994

[The tinnitus questionnaire. A standard instrument for grading the degree of tinnitus. Results of a multicenter study with the tinnitus questionnaire].

The clinical examination of patients with severe and chronic tinnitus must include associated psychological disturbances. The present paper describes traditional diagnostic methods of ENT practice as well as the Tinnitus Questionnaire (TQ) which has been evaluated in a number of studies. This instrument differentiates between emotional and cognitive distress, auditory perceptual difficulties and self-experienced intrusiveness produced by the tinnitus. The results of a German multicenter study are presented which show that the TQ can be used to demonstrate differences of tinnitus distress under different clinical conditions (e.g., ENT clinic vs psychosomatic clinic and in- vs out-patient care). The TQ can be employed for comparative studies in different tinnitus-related institutions and for the evaluation of the relative effects of different treatment approaches.

Adaptation, Psychological↗

PubMed1987

Can tinnitus be masked by band erased filtered masker? Masking tinnitus with sounds not covering the tinnitus frequency.

In this study, the effectiveness of masking sound not covering the tinnitus frequency was tested against that of conventional masking sound in 117 subjects. Successful masking was observed in 72% of the former and 70% of the latter. There was no remarkable difference between the two maskers regarding the acceptability and intensity. The duration of residual inhibition, however, was smaller in the masker not covering the tinnitus frequency. The masking sound tested could be useful as an alternative when the conventional one is not accepted.

Adolescent↗

PubMed2006

Tinnitus sensitization: Sensory and psychophysiological aspects of a new pathway of acquired centralization of chronic tinnitus.

OBJECTIVE: Acquired centralized tinnitus (ACT) is the most frequent form of chronic tinnitus. The proposed ACT sensitization (ACTS) assumes a peripheral initiation of tinnitus whereby sensitizing signals from the auditory system establish new neuronal connections in the brain. Consequently, permanent neurophysiological malfunction within the information-processing modules results. Successful treatment has to target these malfunctioning information processing. We present in this study the neurophysiological and psychophysiological aspects of a recently suggested neurophysiological model, which may explain the symptoms caused by central cognitive tinnitus sensitization. Although conditioned reflexes, as a causal agent of chronic tinnitus, respond to extinction procedures, sensitization may initiate a vicious circle of overexcitation of the auditory system, resisting extinction and habituation. DATA SOURCES: We used the literature database as indicated under "References" covering English and German works. STUDY SELECTION: For the ACTS model we extracted neurophysiological hypotheses of the auditory stimulus processing and the neuronal connections of the central auditory system with other brain regions to explain the malfunctions of auditory information processing. The model does not assume information-processing changes specific for tinnitus but treats the processing of tinnitus signals comparable with the processing of other external stimuli. The model uses the extensive knowledge available on sensitization of perception and memory processes and highlights the similarities of tinnitus with central neuropathic pain. DATA EXTRACTION: Quality, validity, and comparability of the extracted data were evaluated by peer reviewing. DATA SYNTHESIS: Statistical techniques were not used. CONCLUSION: According to the tinnitus sensitization model, a tinnitus signal originates (as a type I-IV tinnitus) in the cochlea. In the brain, concerned with perception and cognition, the 1) conditioned associations, as postulated by the tinnitus model of Jastreboff, and the 2) unconditioned sensitized stimulus responses, as postulated in the present ACTS model, are actively connected with and attributed to the tinnitus signal. Attention to the tinnitus constitutes a typical undesired sensitized response. Some of the tinnitus-associated attributes may be called essential, unconditioned sensitization attributes. By a process called facilitation, the tinnitus' essential attributes are suggested to activate the tinnitus response. The result is an undesired increase in responsivity, such as an increase in attentional focus to the eliciting tinnitus stimulus. The mechanisms underlying sensitization are known as a specific nonassociative learning process producing a structural fixation of long-term facilitation at the synaptic level. This sensitization model may be important for the development of a sensitization-specific treatment if extinction procedures alone do not lead to satisfactory outcome. Inasmuch as this model considers sensitization as a nonassociative learning process based on cortical plasticity, it is reasonable to assume that this learning process can be altered by counteracting learning procedures. These counteracting learning procedures may consist of tinnitus-specific cognitive and behavioral procedures.

Adaptation, Psychological↗

PubMed2006

Outcomes of long-term outpatient tinnitus-coping therapy: psychometric changes and value of tinnitus-control instruments.

OBJECTIVES: Increasing tinnitus compliance and coping are desirable aims of successful treatment in chronic tinnitus. However, application of established procedures such as tinnitus retraining therapy (TRT) is often relatively short. In addition, the value of tinnitus control instruments (TCI) is questionable, especially for minor severity levels of tinnitus, and the comparability of treatment results is low. To evaluate long-term changes of tinnitus-related distress, defined psychometric data were collected in patients with compensated tinnitus (cT) or decompensated tinnitus (dT) during a standardized 2-yr outpatient tinnitus-coping therapy (TCT). DESIGN: In a prospective clinical investigation, the data of 70 tinnitus patients were recorded at the beginning and at 6-mo intervals, with a final investigation after 24 mo. The first group consisted of 40 patients with cT and dT who were randomly assigned to a treatment group and a waiting-list control group. After a period of 12 mo without treatment, the control group was treated similarly. The tinnitus questionnaire (TQ) of Goebel and Hiller, visual analog scales (VAS), and a severity questionnaire for tinnitus-associated complaints were used as psychodiagnostic instruments. Therapy components consisted of counseling, fitting patients with TCIs (TCI provision), auditory and relaxation training, and psychosomatic care if necessary. A second group of 30 patients with cT receiving TCT without TCI devices was investigated to evaluate the additive efficacy of TCI in cT. RESULTS: The initial TQ score did not differ between the treatment group and the waiting-list control group. After 12 mo, the control group did not show any significant changes, but the treatment group had improved significantly. During TCT, the combined data of both groups showed a statistically significant decrease of the TQ score in dT (59.1 to 34.8) and cT (32.8 to 24.0). These changes were especially reflected by the subscales of cognitive and emotional distress and also by the VAS and the severity questionnaire. dT patients benefitted without dependence on age or duration of pre-existing tinnitus; for cT patients, this was true mainly of the younger and older subjects and for tinnitus lasting for less than 1 yr. TCI provision improved the efficacy of TCT in patients with cT. CONCLUSIONS: The psychometric changes demonstrate a clear decrease of tinnitus-related distress in all severity levels of sufficiently treated chronic tinnitus. Long-term TCT induces improvement even up to the time of 24 mo. With TCIs established particularly in patients with dT, our results suggest that a supporting adjustment of TCI devices is helpful in cT to foster quicker rehabilitation. The outpatient interdisciplinary TCT, consisting of cognitive tinnitus desensitization, TCI provision, and psychosomatic support if required, represents a successful treatment strategy for both dT and cT patients.

Adaptation, Psychological↗

PubMed1993

Tinnitus characteristics in tinnitus complainers and noncomplainers.

The aim of this study was to describe the characteristics of tinnitus in 87 patients (mean age = 53.7 years); 43 patients seeking professional help (complainers) and 44 patients who do not seek help for their tinnitus (noncomplainers). 'Left-sided or mostly left-sided' tinnitus was reported by 42% of complainers and 30% of noncomplainers, whereas 'right-sided or mostly right-sided' tinnitus was equally prevalent in the two groups (26 v. 25%); the differences between groups were not significant. Tinnitus 'in the head' was reported by 14% of the complainers and 6% of the noncomplainers, a nonsignificant difference, whereas noncomplainers perceived tinnitus in 'both ears equally' significantly more frequently than complainers. Complainers had significantly more often 'combined' (tonal plus buzzing) tinnitus sounds (51 v. 30%) and 'non-fluctuating tinnitus' (49 v. 25%) than had noncomplainers, whereas 'tonal' tinnitus was significantly more frequent in noncomplainers than in complainers (43 v. 16%). Further, noncomplainers had worse hearing than complainers: pure-tone averages over vocal as well as high frequencies were significantly higher. Complainers scored significantly higher than noncomplainers on the psychological variables concentration difficulties, irritability and sleep disturbance. Patients with 'combined' tinnitus sounds scored significantly higher on irritability and sleep disturbance than subjects with 'tonal' tinnitus. Patients with 'non-fluctuating tinnitus' scored significantly higher on the three psychological variables than patients with 'fluctuating tinnitus'. A conclusion to be drawn is that 'combined' tinnitus sounds and 'non-fluctuating tinnitus' might be determinants of psychological problems.

Adaptation, Psychological↗

PubMed2003

Tinnitus outcome profile and tinnitus control.

This reports recommends the consideration of development of additional outcome measures to be used as a battery of subjective self-assessment questionnaires for patients with tinnitus. The goal is improved overall care for the tinnitus patient. Five existing outcome measurements have been incorporated into this profile, which is called the tinnitus outcome profile: the tinnitus intensity index, the tinnitus annoyance index, the tinnitus stress test, the tinnitus handicap inventory, and the measurement of depression scale. Frequently, there is an inconsistency between the self-report outcomes and the patient's subjective report to the doctor. This study reports outcomes based on the tinnitus outcome profile for 19 patients who were seen for evaluation and treatment of subjective idiopathic tinnitus of the severe disabling type and who completed a treatment protocol called receptor-targeted therapy directed to the GABAA receptor. The drugs used were gabapentin and clonazepam. Using the 0.05 significance level, the tinnitus intensity index, tinnitus annoyance index, and tinnitus stress test scores all declined significantly over time. In contrast, there was no significant change in either the tinnitus handicap inventory or the measurement of depression scale. The percent of tinnitus control reported to the doctor by the patient did not appear to be correlated with the degree of change measured on the tinnitus outcome profile.

Adult↗

PubMed1990

Characterization of tinnitus by tinnitus patients.

A questionnaire was administered to 528 tinnitus patients to obtain data on their reactions to tinnitus. Results include a discussion of: (a) population characteristics, (b) perceptual characteristics, (c) the impact of tinnitus on daily life, and (d) etiology. Significant gender differences are also discussed. Tinnitus was not an occasional phenomenon, but was present for more than 26 days per month in 74% of the patients. Other important findings about tinnitus include: (a) Hearing levels at 1000 and 4000 Hz were less than or equal to 25 dB HL for 18% of the tinnitus patients, which suggests that some patients had normal hearing or mild hearing losses; (b) the prevalence of tinnitus in patients with noise-induced hearing loss (NIHL) was 30% for males and only 3% for females; (c) about 25% of the patients reported tinnitus severity had increased since tinnitus onset; (d) the effects of tinnitus were more severe in patients who reported tinnitus as their primary complaint and in patients diagnosed as having Ménière's syndrome tinnitus; and (e) some patients reported that noise exacerbated their tinnitus, whereas others reported that a quiet background exacerbated their tinnitus.

Adolescent↗

PubMed1997

Managing tinnitus: a comparison of different approaches to tinnitus management training.

A series of studies examining the interaction between the characteristics of individual tinnitus sufferers and the effectiveness of the methods used to assist them has been conducted. The first of these studies provided a baseline description of 96 people with tinnitus, according to a range of audiological and psychological variables. In the present paper four differing tinnitus management programmes are described and the related changes in tinnitus perception reported three months after tinnitus management training. For the majority of subjects, the tinnitus was less annoying and less distressing three months after attending tinnitus management training. However, the majority of subjects reported no change in tinnitus loudness, or tinnitus awareness and no change in their tinnitus coping ability. Subjects receiving low level white noise stimulation reported greater improvement in tinnitus coping ability than subjects who received information and relaxation training, although there was no associated improvement in tinnitus awareness. Subjects' beliefs about tinnitus and preferred coping style may have influenced the reported benefit or otherwise of the differing tinnitus management techniques.

Acoustic Stimulation↗

PubMed1999

The influence of training on tinnitus perception: an evaluation 12 months after tinnitus management training.

Sixty-five subjects were reviewed 12 months after tinnitus management training, which had been comprised variously of information, relaxation training and a therapeutic noise strategy. Seventy-four per cent of subjects reported increased habituation to tinnitus (n = 48), 65% reported reduced tinnitus annoyance (n = 42), and 52% reported an increased ability to cope with tinnitus (n = 34). Twenty-five per cent of subjects reported deterioration in coping ability (n = 16), 23% reported reduced habituation to tinnitus (n = 15) and 8% reported increased tinnitus-related annoyance (n = 5). None of the management strategies were found to be significantly more effective than others in facilitating improved coping or habituation to tinnitus. Subjects who reported reduced coping and habituation to tinnitus experienced greater levels of general life stress than subjects who reported increased habituation and coping ability. The use of relaxation therapies as applied in this study did not appear to influence the level of tinnitus distress or the level of life stress. Thirty-seven per cent of subjects given long-term low-level white noise (LTWN) stimulation reported benefit. However, LTWN stimulation did not significantly alter tinnitus awareness or the minimum masking level (MML) of tinnitus. Long-term low-level white noise stimulation appeared to influence cognitive reaction to tinnitus rather than its physical perception. Subjects who initially had low ability to cope with tinnitus and preferred a more active coping style reported significantly greater benefit from LTWN stimulation than subjects whose primary approach to coping was to regulate the emotional impact of tinnitus.

Adaptation, Psychological↗

PubMed2001

Assessing tinnitus and prospective tinnitus therapeutics using a psychophysical animal model.

Subjective tinnitus is a common and often debilitating disorder that is difficult to study because it is a perceptual state without an objective stimulus correlate. Studying tinnitus in humans is further complicated by the heterogeneity of tinnitus quality, severity, and associated hearing loss. As a consequence, the pathophysiology of tinnitus is poorly understood and treatments are often unsuccessful. In the present study, an animal psychophysical model was developed to reflect several features of tinnitus observed in humans. Chronic tinnitus was induced in rats by a single intense unilateral exposure to noise. The tinnitus was measured using a psychophysical procedure, which required the animals to discriminate between auditory test stimuli consisting of tones, noise, and 0 dB. Tinnitus was indicated by a frequency-specific shift in discrimination functions with respect to control subjects not exposed to noise. The psychophysical consequences of the noise exposure were best explained by a tinnitus hypothesis and could not be explained easily by other consequences of noise exposure such as hearing loss. The qualitative features of the tinnitus were determined and related to the duration of noise exposure and the associated cochlear trauma. The tinnitus was found to persist and intensify over 17 months of testing. Finally, the tinnitus was reversibly attenuated by treatment with gabapentin, a GABA agonist. It was concluded that this model reflected several features of human tinnitus, such as its tonality and persistence, and could be useful as a screen for potential therapeutics as well as a tool to help unravel the pathophysiology of the disorder of phantom auditory perception.

Acetates↗

PubMed1989

Investigation of tinnitus induced by sound and its relationship to ongoing tinnitus.

Tinnitus was temporarily induced by monaurally presented sound, and its level monitored using a dichotic loudness-matching task. The first experiment found no effect of varying the level, bandwidth, or center frequency of an inducing noise on the level or duration of the induced tinnitus; nor was there any difference when tones or different noises were used to induce tinnitus. The rated loudness of the tinnitus, however, increased with the level and decreased with the center frequency of the noise. The second experiment investigated tinnitus induced by a 1-kHz, 95-dB SPL tone in 53 subjects with thresholds in the normal range, but with varying degrees of ongoing tinnitus that ranged from no discernible sound sensation at all, through an apparently normal but usually inaudible noise or ringing, to constant or near-constant tinnitus. Individual differences in induced tinnitus were found that were related to differences in ongoing tinnitus; for example, the levels of induced and ongoing tinnitus were positively correlated. The results suggest that some kinds of ongoing tinnitus may arise from the auditory process responsible for induced tinnitus.

Adolescent↗

PubMed2004

Cognitive tinnitus sensitization: behavioral and neurophysiological aspects of tinnitus centralization.

OBJECTIVE: Acquired centralized tinnitus (ACT) is the most frequent type of chronic tinnitus. We introduce a cognitive neurophysiological ACT hypothesis based on centralized cognitive sensitization processes. MATERIAL AND METHODS: Published cognitive sensitization processes were reviewed using PubMed. Furthermore, a Cochrane analysis was performed. RESULTS: Patients frequently perceive tinnitus as being extremely loud although audiological tinnitus-matching measures reveal that its loudness levels are low. An important principle of central tinnitus processing is that individual tinnitus appraisal is directly linked to neuronal networks in the brain responsible for the production of emotions and cognitions. Cognitive processes may be associated with a reduction in the tinnitus cognition threshold, resulting in hypersensitivity of cognition. The underlying mechanism is known as sensitization and is suggested to be a specific learning process. CONCLUSIONS: ACT may be associated with a specific learning process allowing increased tinnitus awareness and continuous appraisal. The underlying mechanism, the cognitive tinnitus sensitization process, is associated with a decrease in the tinnitus cognition threshold. The sensitization contributes to the extremely loud cognition of the tinnitus signal. The associated audiological cognitive discrepancy can be used clinically and diagnostically to identify patients for cognitive testing. The sensitization model does not require tinnitus hyperactivity.

Attention↗

PubMed2003

Psychologic profile of tinnitus patients using the SCL-90-R and Tinnitus Handicap Inventory.

OBJECTIVE: To correlate the Tinnitus Handicap Inventory and the Symptom Checklist-90-R results on a group of tinnitus patients and to compare the average scores of the Tinnitus Handicap Inventory and SCL-90-R for help-seeking and non-help-seeking patients with tinnitus. STUDY DESIGN: A prospective study in which tinnitus patients were administered the Tinnitus Handicap Inventory and the Symptom Checklist-90-R. SETTING: Tertiary referral center. PATIENTS: Patients with tinnitus seeking audiological services. INTERVENTIONS: Rehabilitative. MAIN OUTCOME MEASURES: Results of Tinnitus Handicap Inventory and Symptom Checklist-90-R. RESULTS: Fifty-three consecutive patients having tinnitus were administered the Tinnitus Handicap Inventory and the Symptom Checklist-90-R. There was a significant correlation between the Symptom Checklist-90-R and the Tinnitus Handicap Inventory (rs = 0.43). Furthermore, 25% of these patients scored abnormally high on the Symptom Checklist-90-R, which is substantially more than the general medical population of patients. CONCLUSIONS: Based on this sample of 53 patients, the Symptom Checklist-90-R does seem to be a useful tool in identifying distress among tinnitus patients. The Global Severity Index of the Symptom Checklist-90-R has a defined cutoff score indicating significant distress levels, which makes it a useful screening tool for identifying those who would benefit from psychologic or psychiatric intervention.

Adult↗

PubMed2006

Tinnitus retraining therapy: a different view on tinnitus.

Tinnitus retraining therapy (TRT) is a method for treating tinnitus and decreased sound tolerance, based on the neurophysiological model of tinnitus. This model postulates involvement of the limbic and autonomic nervous systems in all cases of clinically significant tinnitus and points out the importance of both conscious and subconscious connections, which are governed by principles of conditioned reflexes. The treatments for tinnitus and misophonia are based on the concept of extinction of these reflexes, labeled as habituation. TRT aims at inducing changes in the mechanisms responsible for transferring signal (i.e., tinnitus, or external sound in the case of misophonia) from the auditory system to the limbic and autonomic nervous systems, and through this, remove signal-induced reactions without attempting to directly attenuate the tinnitus source or tinnitus/misophonia-evoked reactions. As such, TRT is effective for any type of tinnitus regardless of its etiology. TRT consists of: (1) counseling based on the neurophysiological model of tinnitus, and (2) sound therapy (with or without instrumentation). The main role of counseling is to reclassify tinnitus into the category of neutral stimuli. The role of sound therapy is to decrease the strength of the tinnitus signal. It is crucial to assess and treat tinnitus, decreased sound tolerance, and hearing loss simultaneously. Results from various groups have shown that TRT can be an effective method of treatment.

Acoustic Stimulation↗