A Sound Therapy-Based Intervention to Expand the Auditory Dynamic Range for Loudness among Persons with Sensorineural Hearing Losses: A Randomized Placebo-Controlled Clinical Trial

Craig Formby; Monica L. Hawley; LaGuinn P. Sherlock; Susan Gold; JoAnne Payne; Rebecca Brooks; Jason M. Parton; Roger Juneau; Edward J. Desporte; Gregory R. Siegle

doi:10.1055/s-0035-1546958

Seminars in Hearing, Table of Contents

Semin Hear 2015; 36(02): 077-110
DOI: 10.1055/s-0035-1546958

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Sound Therapy-Based Intervention to Expand the Auditory Dynamic Range for Loudness among Persons with Sensorineural Hearing Losses: A Randomized Placebo-Controlled Clinical Trial

Craig Formby

¹Department of Communicative Disorders, University of Alabama, Tuscaloosa, Alabama

,

Monica L. Hawley

²Department of Otolaryngology, University of Iowa, Iowa City, Iowa

,

LaGuinn P. Sherlock

³Walter Reed National Military Medical Center, Bethesda, Maryland

,

Susan Gold

⁴Retired; previously affiliated with University of Maryland Tinnitus & Hyperacusis Center, Baltimore, Maryland

,

JoAnne Payne

¹Department of Communicative Disorders, University of Alabama, Tuscaloosa, Alabama

,

Rebecca Brooks

¹Department of Communicative Disorders, University of Alabama, Tuscaloosa, Alabama

,

Jason M. Parton

¹Department of Communicative Disorders, University of Alabama, Tuscaloosa, Alabama

,

Roger Juneau

⁵General Hearing Instruments, Harahan, Louisiana

,

Edward J. Desporte

⁵General Hearing Instruments, Harahan, Louisiana

,

Gregory R. Siegle

⁵General Hearing Instruments, Harahan, Louisiana

› Author Affiliations

Abstract

The primary aim of this research was to evaluate the validity, efficacy, and generalization of principles underlying a sound therapy–based treatment for promoting expansion of the auditory dynamic range (DR) for loudness. The basic sound therapy principles, originally devised for treatment of hyperacusis among patients with tinnitus, were evaluated in this study in a target sample of unsuccessfully fit and/or problematic prospective hearing aid users with diminished DRs (owing to their elevated audiometric thresholds and reduced sound tolerance). Secondary aims included: (1) delineation of the treatment contributions from the counseling and sound therapy components to the full-treatment protocol and, in turn, the isolated treatment effects from each of these individual components to intervention success; and (2) characterization of the respective dynamics for full, partial, and control treatments. Thirty-six participants with bilateral sensorineural hearing losses and reduced DRs, which affected their actual or perceived ability to use hearing aids, were enrolled in and completed a placebo-controlled (for sound therapy) randomized clinical trial. The 2 × 2 factorial trial design was implemented with or without various assignments of counseling and sound therapy. Specifically, participants were assigned randomly to one of four treatment groups (nine participants per group), including: (1) group 1—full treatment achieved with scripted counseling plus sound therapy implemented with binaural sound generators; (2) group 2—partial treatment achieved with counseling and placebo sound generators (PSGs); (3) group 3—partial treatment achieved with binaural sound generators alone; and (4) group 4—a neutral control treatment implemented with the PSGs alone. Repeated measurements of categorical loudness judgments served as the primary outcome measure. The full-treatment categorical-loudness judgments for group 1, measured at treatment termination, were significantly greater than the corresponding pretreatment judgments measured at baseline at 500, 2,000, and 4,000 Hz. Moreover, increases in their “uncomfortably loud” judgments (∼12 dB over the range from 500 to 4,000 Hz) were superior to those measured for either of the partial-treatment groups 2 and 3 or for control group 4. Efficacy, assessed by treatment-related criterion increases ≥ 10 dB for judgments of uncomfortable loudness, was superior for full treatment (82% efficacy) compared with that for either of the partial treatments (25% and 40% for counseling combined with the placebo sound therapy and sound therapy alone, respectively) or for the control treatment (50%). The majority of the group 1 participants achieved their criterion improvements within 3 months of beginning treatment. The treatment effect from sound therapy was much greater than that for counseling, which was statistically indistinguishable in most of our analyses from the control treatment. The basic principles underlying the full-treatment protocol are valid and have general applicability for expanding the DR among individuals with sensorineural hearing losses, who may often report aided loudness problems. The positive full-treatment effects were superior to those achieved for either counseling or sound therapy in virtual or actual isolation, respectively; however, the delivery of both components in the full-treatment approach was essential for an optimum treatment outcome.

Keywords

Sound tolerance - loudness discomfort level - hyperacusis - sound therapy

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References

References
1 Hazell JWP, Sheldrake JB. Hyperacusis and tinnitus. In: Aran JM, Dauman R, , eds. Tinnitus 91. Proceedings of the Fourth International Tinnitus Seminar. Amsterdam/New York: Kugler Publications; 1992: 245-248
2 Jastreboff PJ, Hazell JWP. A neurophysiological approach to tinnitus: clinical implications. Br J Audiol 1993; 27 (1) 7-17
3 Jastreboff PJ, Gray WC, Gold SL. Neurophysiological approach to tinnitus patients. Am J Otol 1996; 17 (2) 236-240
4 Jastreboff PJ, Hazell J. Tinnitus Retraining Therapy: Implementing the Neurophysiological Model. Cambridge, UK: Cambridge University Press; 2004
5 Jastreboff PJ, Jastreboff MM. Tinnitus Retraining Therapy (TRT) as a method for treatment of tinnitus and hyperacusis patients. J Am Acad Audiol 2000; 11 (3) 162-177
6 Jastreboff MM, Jastreboff PJ. Decreased sound tolerance and tinnitus retraining therapy (TRT). Aust N Z Audiol 2002; 21: 74-81
7 Sammeth CA, Birman M, Hecox KE. Variability of most comfortable and uncomfortable loudness levels to speech stimuli in the hearing impaired. Ear Hear 1989; 10 (2) 94-100
8 Davis H, Hudgins CV, Marquis RJ , et al. The selection of hearing aids. Laryngoscope 1946; 56: 85-115 , 135–163
9 Silverman SR. Tolerance for pure tones and speech in normal and defective hearing. Ann Otol Rhinol Laryngol 1947; 56 (3) 658-677
10 Formby C, Gold SL. Modification of loudness discomfort level: evidence for adaptive chronic auditory gain and its clinical relevance. Semin Hear 2002; 23 (1) 21-34
11 Schmitz HD. Loudness discomfort level modification. J Speech Hear Res 1969; 12 (4) 807-817
12 Byrne D, Dirks D. Effects of acclimatization and deprivation on non-speech auditory abilities. Ear Hear 1996; 17 (3, Suppl): 29S-37S
13 Lindley G. Adaptation to loudness: implications for hearing aid fittings. Hear J 1999; 52: 50-57
14 Goldstein B, Shulman A. Tinnitus-hyperacusis and the loudness discomfort test—a preliminary report. Int Tinnitus J 1996; 2: 83-89
15 Baguley DM, Andersson G. Hyperacusis: Mechanisms, Diagnosis, and Therapies. Oxford, UK: Plural Publishing; 2007
16 Formby C, Gold SL, Keaser ML, Block KL, Hawley ML. Secondary benefits from tinnitus retraining therapy (TRT): clinically significant increases in loudness discomfort level and in the auditory dynamic range. Semin Hear 2007; 28 (4) 276-294
17 Sheldrake JB, Wood SM, Cooper HR. Practical aspects of the instrumental management of tinnitus. Br J Audiol 1985; 19 (2) 147-150
18 Reich G, Vernon J , eds. Proceedings of the Fifth International Tinnitus Seminar. Portland, OR: American Tinnitus Association; 1995
19 Hazell JWP , ed. Proceedings of the Sixth International Tinnitus Seminar. London, UK: The Tinnitus and Hyperacusis Centre; 1999
20 Patuzzi R , ed. Proceedings of the Seventh International Tinnitus Seminar. Perth, Australia: The University of Western Australia; 2002
21 Formby C , ed. Hyperacusis and Related Sound Tolerance Complaints: Differential Diagnosis, Treatment Effects, and Models. Semin Hear 2007;28(4):(Monograph)
22 Formby C, Sherlock LP, Gold SL, Hawley ML. Adaptive recalibration of chronic auditory gain. Semin Hear 2007; 28 (4) 295-302
23 Formby C, Sherlock LP, Gold SL. Adaptive plasticity of loudness induced by chronic attenuation and enhancement of the acoustic background. J Acoust Soc Am 2003; 114 (1) 55-58
24 Jastreboff PJ. Clinical implication of the neurophysiological model of tinnitus. In: Reich GE, Vernon JA, , eds. Proceedings of the 5th International Tinnitus Seminar. Portland, OR: American Tinnitus Association; 1994: 500-507
25 Carhart R, Jerger JF. Preferred method for clinical determination of pure-tone thresholds. J Speech Hear Disord 1959; 24: 330-345
26 Cox RM, Alexander GC, Taylor IM, Gray GA. The contour test of loudness perception. Ear Hear 1997; 18 (5) 388-400
27 Costa Jr PT, McCrae RR. NEO PI-R Professional Manual. Odessa, FL: Psychological Assessment Resources, Inc.; 1992
28 Munro KJ, Blount J. Adaptive plasticity in brainstem of adult listeners following earplug-induced deprivation. J Acoust Soc Am 2009; 126 (2) 568-571
29 Muller KE, Fetterman BA. Regression and ANOVA: An Integrated Approach Using SAS Software. Cary, NC: SAS Institute Inc.; 2002: 330-333
30 Piantadosi S. Clinical Trials: A Methodologic Perspective. 2nd ed. Hoboken, NJ: John Wiley & Sons; 2005
31 Gordis L. Epidemiology. 4th ed. Philadelphia, PA: Saunders; 2009
32 Dauman R, Bouscau-Faure F. Assessment and amelioration of hyperacusis in tinnitus patients. Acta Otolaryngol 2005; 125 (5) 503-509
33 Noreña AJ, Chery-Croze S. Enriched acoustic environment rescales auditory sensitivity. Neuroreport 2007; 18 (12) 1251-1255
34 McKinney CJ, Hazell JWP, Graham RL. Changes in loudness discomfort level and sensitivity to environmental sound with habituation based therapy. In: Hazell J, , ed. Proceedings of the Sixth International Tinnitus Seminar. London, UK: The Tinnitus and Hyperacusis Centre; 1999: 499-501
35 Jastreboff PJ, Jastreboff MM. Decreased sound tolerance. In: Snow JB, , ed. Tinnitus: Theory and Management. Hamilton, Ontario, Canada: Decker; 2004: 8-15
36 Hazell JWP, Sheldrake JB, Graham RL, Decreased sound tolerance: predisposing factors, triggers and outcomes after TRT. In: Patuzzi R. , ed. Proceedings of the Seventh International Tinnitus Seminar. Crawley, Perth, Australia: University of Western Australia; 2002: 255-261
37 Gu JW, Halpin CF, Nam EC, Levine RA, Melcher JR. Tinnitus, diminished sound-level tolerance, and elevated auditory activity in humans with clinically normal hearing sensitivity. J Neurophysiol 2010; 104 (6) 3361-3370
38 Davis PB, Paki B, Hanley PJ. Neuromonics tinnitus treatment: third clinical trial. Ear Hear 2007; 28 (2) 242-259
39 Gold SL, Formby C, Frederick EA, Suter C. Incremental shifts in loudness discomfort level among tinnitus patients with and without hyperacusis. In: Patuzzi R, , ed. Proceedings of the Seventh International Tinnitus Seminar. Crawley, Perth, Australia: University of Western Australia; 2002: 170-172