ABSTRACT
In this report, the authors highlight clinically significant improvements in sound
tolerance observed over the past decade among patients who were enrolled in tinnitus
retraining therapy (TRT) at the University of Maryland Tinnitus and Hyperacusis Center.
Pretreatment and TRT follow-up audiometric threshold, loudness discomfort level (LDL),
and dynamic-range (DR) data are documented for (1) a group of 68 tinnitus patients
who presented with primary complaints of sound intolerance, and (2) a second group
of 70 patients who reported only tinnitus (and no sound tolerance problems). TRT-related
increases in sound tolerance are (1) due to increases in LDLs and occur independently
of changes in audiometric threshold, which were invariant with treatment; (2) statistically
significant in tinnitus patients with and without sound tolerance problems, and with
and without hearing loss; (3) observed among 81% of the patients with sound tolerance
complaints and 44% of the patients who reported primary tinnitus; (4) independent
of audiometric frequency over the range 1000 to 8000 Hz; and (5) seemingly independent
of TRT treatment duration, which is consistent with recent experimental evidence of
a rapid treatment effect (within the first month of TRT). The TRT treatment effects
were clinically meaningful, offering new opportunities for expanding the auditory
DR and improving sound tolerance in the general hearing-impaired population. The mechanism
responsible for the plasticity underlying these treatment effects is uncertain, but
appears consistent with a centrally mediated auditory gain control process. Sound
tolerance problems were overpredicted among the authors' sample of tinnitus-only patients
when existing objective audiometric criteria were used. This finding promoted the
development of a new predictive model for sound tolerance problems, which is described
in a companion report.
KEYWORDS
Tinnitus retraining therapy - loudness discomfort level - auditory dynamic range -
tinnitus - hyperacusis
REFERENCES
Hyperacusis and tinnitus . In: Aran J-M, Dauman R Tinnitus 91: Proceedings of the Fourth International Tinnitus
Seminar. Amsterdam, The Netherlands; Kugler 1992: 245-248 Shifts in dynamic range for hyperacusis patients receiving tinnitus retraining therapy
(TRT) . In: Hazell J Proceedings of the Sixth International Tinnitus Seminar 1999. London,
UK; The Tinnitus and Hyperacusis Centre 1999: 297-301 Changes in loudness discomfort level and sensitivity to environmental sound with habituation
based therapy . In: Hazell J Proceedings of the Sixth International Tinnitus Seminar. London, UK;
The Tinnitus and Hyperacusis Centre 1999: 499-501 The effects of managing hyperacusis with maskers (noise generators) . In: Hazell J Proceedings of the Sixth International Tinnitus Seminar. London, UK;
The Tinnitus and Hyperacusis Centre 1999: 512-514 Incremental shifts in loudness discomfort level among tinnitus patients with and without
hyperacusis . In: Patuzzi R Proceedings of the 7th International Tinnitus Seminar. Crawley, Australia; University of Western Australia
2002: 170-172 Decreased sound tolerance: predisposing factors, triggers and outcomes after TRT . In: Patuzzi R Proceedings of the Seventh International Tinnitus Seminar. Crawley,
Australia; University of Western Australia 2002: 255-261 Hyperacusis: an overview of international literature and clinical experience . In: Patuzzi R Proceedings of the Seventh International Tinnitus Seminar. 2nd ed. Perth,
Australia; University of Western Australia 2003: 218-221 Subjective distress from hyperacusis: a questionnaire on hypersensitivity to sound . In: Patuzzi R Proceedings of the Seventh International Tinnitus Seminar. Crawley,
W.A., Australia; University of Western Australia 2002: 147-149 Epidemiology of tinnitus and hyperacusis in Poland . In: Hazell JWP Proceedings of the Sixth International Tinnitus Seminar. London,
UK; The Tinnitus and Hyperacusis Centre 1999: 569-571 Treatment for hyperacusis . In: Vernon JA Tinnitus Treatment and Relief. Needham Heights, MA; Allyn & Bacon
1998: 223-227 Tinnitus: the method of Pawel J Jastreboff . In: Gates G Current Therapy in Otolaryngology-Head and Neck Surgery. St. Louis;
Mosby-Year Book 1998: 90-95 Audiometric characterization of hyperacusis patients before and during TRT . In: Hazell J Proceedings of the Sixth International Tinnitus Seminar. London, UK;
The Tinnitus and Hyperacusis Centre 1999: 495-498 Audiological evaluation and follow-up . In: Reich GE, Vernon JA Proceedings of the Fifth International Tinnitus Seminar. Portland,
OR; American Tinnitus Association 1996: 485-487 Medical evaluation, diagnosis, and counseling of patients with tinnitus and hyperacusis . In: Reich GE, Vernon JA Proceedings of the Fifth International Tinnitus Seminar. Portland,
OR; American Tinnitus Association 1996: 104-107 Selection and fitting of noise generators and hearing aids for tinnitus patients . In: Reich GE, Vernon JA Proceedings of the Fifth International Tinnitus Seminar. Portland,
OR; American Tinnitus Association 1996: 313-314 Adaptive recalibration of chronic auditory gain: interim findings . In: Patuzzi R VIIth International Tinnitus Seminar Proceedings. Perth, Australia;
University of Western Australia 2002: 165-169 Adaptive recalibration of chronic auditory gain . In: Santi PA Abstracts of the 26th Annual Midwinter Meeting of the Association for Research in Otolaryngology. Mt. Royal,
NJ; Association for Research in Otolaryngology February 23-27, 2003: 221
cformby@as.ua.edu
