Innovations:Tinnitus is Not Music to Your Ears!

Those in the music industry are no strangers to excessive noise exposure.
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SoundCure’s Serenade medical device provides a new therapy for tinnitus sufferers

SoundCure’s Serenade medical device provides a new therapy for tinnitus sufferers. Those in the music industry are no strangers to excessive noise exposure. Between the need for loud music and amplified voice to fill large audience spaces and the proximity that those generating the music and those controlling the music tend to be to loudspeakers, the industry is full of people who understand noise-induced hearing loss. This article aims to highlight the lesser known—or at least lesser-discussed—condition of tinnitus, or “ringing in the ears.”

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Tinnitus can be caused by a number of factors, including certain medications, trauma, certain diseases or age-related hearing loss. The vast majority of cases, however, are related to damage to the auditory system and the number-one cause is noise exposure. When your ears are exposed to sounds above 85 decibels (dBA SPL), the tiny cells in your inner ear, known as hair cells, are damaged, leading to a loss of hearing and often ringing in your ears.

Typically, these changes are temporary, your hearing returns to normal in a few days and the ringing goes away. Unfortunately, each instance of temporary hearing change and tinnitus is typically accompanied by a small amount of permanent damage that can accumulate over time and lead to chronic tinnitus and noticeable hearing loss.

The most obvious way to prevent tinnitus is to avoid excessive noise exposure. The three ways to limit exposure are through changes to loudness, time or distance. Total damage is related to loudness and time of exposure. The louder the sound, the less time you can safely be exposed before damage occurs. For example, the Occupational Safety and Health Administration (OSHA) has a guideline of eight hours maximum at an SPL of 90 dBA, but 30 minutes or less at 110 dBA.

The National Institute of Occupational Safety and Health (NIOSH) has even more restrictive recommendations of only 85 dBA SPL for eight hours and 97 dBA for 30 minutes. Generally, OSHA recommends reducing the time by half for every five dB increase while NIOSH recommends reducing by half for every three dB increase. The distance is directly related to the sound loudness, with the volume decreasing exponentially with increasing distance.

Often the loudness of a concert, the time of exposure and the distance from the sound source are dictated by the constraints of the job and not of personal preference, so we often have to take other measures to protect our hearing. The most common way is with hearing protection. Many commercially available hearing protectors are inexpensive and effective at blocking out a large amount of sound, such as foam or silicone earplugs.

These protectors attenuate sound differentially across the frequency spectrum, typically pulling out more high-frequency sounds than low. This can make speech difficult to understand and change the timbre of the music, introducing challenges for producing quality audio. One option is to use musician’s ear plugs, or ear plugs with filters that more accurately reduce sounds across the frequency spectrum.

Musician’s plugs are available in both off-the-shelf versions or can be custom made by an audiologist or hearing health care professional. Another option is to use in-ear monitors, which are earphones with a custom ear mold wired to the audio output. The ear mold functions as an ear plug, blocking out the harmful levels while the electronic connection allows the level to be adjusted and the sound quality of the output to be very similar to the venue speaker output.

Many people have tinnitus and are not particularly bothered by it. For those who have not been able to avoid it and find that it affects their quality of life, there are treatment options. Some find that hearing aids are helpful, but typically, this is only true if the person has difficulty hearing sounds and is also bothered by his tinnitus. Hearing aids can amplify background sounds to the point where they cover up some of the tinnitus. For those who don’t need or are not ready for hearing aids, and those who have tried hearing aids without benefit for their tinnitus, the option may be sound therapy.

Sound therapy is the use of a sound to partially interfere with the tinnitus, in combination with appropriate counseling and education. A common sound used in sound therapy is white noise. White noise is effective for some in masking their tinnitus, but many report that to get any interference with their tinnitus, the noise needs to be so loud that they find it more bothersome than the tinnitus itself.

A relatively new type of sound called S-Tones is now available. STones were developed by researchers at the University of California and are available from an audiologist or hearing healthcare provider on a medical device called the SoundCure Serenade. S-Tones are customized to each person’s tinnitus with amplitude modulated tones that are pitch matched to the tinnitus itself.

Researchers believe that the modulation engages neurons in the brain to a greater extent, allowing sounds to be played at softer volumes, while still interfering with the tinnitus. When used as part of a long term habituation program, the intent is to change a patient’s perception of his tinnitus over time allowing both the amount of time the tinnitus is bothersome to be decreased as well as how loud or bothersome the tinnitus seems to reduce.

No single approach to managing or treating tinnitus will be appropriate for everyone, so it is important to discuss treatment options with an audiologist. Often, with the many options to sound therapy, there are not good predictors as to which will be the most appropriate, so trying different options to find the right solution may be necessary.

SoundCure
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Jeff Carroll, Ph.D. is Director of Clinical Services and Engineering for SoundCure. He was the founding Director of the Tinnitus Treatment Center at the University of California, Irvine, and has worked with hundreds of tinnitus patients over the past decade. He is one of the inventors of the S-Tone technology in the SoundCure sound therapy system.