OBJECTIVES: to verify the occurrence and the effect of transient otoacoustic emissions (TEOAE), existence of association between: tinnitus degrees and hyperacusis degrees, TEOAE suppressive effect and laterality, tinnitus and hyperacusis degrees, and verify the characteristics of normal hearing individuals with complaints of tinnitus and hyperacusis. MATERIALS AND METHODS: The study included 25 normal hearing subjects having complaints of tinnitus and hyperacusis, with 16 female and nine male. About tinnitus, the subjects were asked about the location and tinnitus type and they completed the Tinnitus Handicap Inventory (THI), used for the classification of tinnitus degrees. A developed hyperacusis questionnaire and the questionnaire on handedness The assessment and analysis of handedness: The Edinburgh Inventor were completed too. They were tested about the research of Loudness Discomfort Level (degrees of hyperacusis), Acuphenometry and the suppression effect of otoacoustic emissions (TEOAE) in the frequencies of 1, 1.5, 2, 3 and 4 KHz. We used descriptive and statistical analysis of the data (Fisher exact test, Kruskal Wallis and Mann Whitney U and Spearman correlation). RESULTS: The occurrence of TEOAE ranged from 33 to 88%. We observed the presence of TEOAE suppression effect on 63.7% in the right ear and 81.7% in the left ear. There was no association between tinnitus degrees and hyperacusis degrees, and between the TEOAE suppression effect and laterality, degrees of tinnitus and hyperacusis degrees. About tinnitus, the most subjects reported acute pitch, in anamnesis and in Acuphenometry, bilateral location and mild degree. Women had degree of tinnitus statistically superior than men. The sounds considered uncomfortable were the high intensity ones and the reaction to the sounds most often cited were irritation, anxiety and need to depart from the sound. The difficulty in speech understanding at noise was mentioned. CONCLUSION: We conclude that the occurrence of TEOAE in these subjects was lower than that found in normal hearing subjects. A higher percentage of presence of TEOAE suppression effect has been found in both ears. Degrees of tinnitus and hyperacusis degrees were not correlated in normal-hearing individuals with complaints of tinnitus and hyperacusis, and there was no association between the TEOAE suppression effect and laterality and degrees of tinnitus and hyperacusis. The sample presented acute pitch, bilateral location and mild bilateral tinnitus.High intensity sounds were reported as uncomfortable and irritation was the most cited reaction of the sound. / OBJETIVO: verificar a ocorrência e o efeito de supressão das emissões otoacústicas transientes (EOAT), a existência de associação entre: graus de zumbido e de hiperacusia, efeito supressor das EOAT e lateralidade, graus de zumbido e graus de hiperacusia, e analisar as características audiológicas de indivíduos normo-ouvintes com queixas de zumbido e hiperacusia. MATERIAIS E MÉTODOS: A amostra foi composta por 25 indivíduos normo-ouvintes, com queixas de zumbido e hiperacusia, sendo 16 do gênero feminino e nove do masculino. Em relação ao zumbido, os indivíduos foram questionados sobre o pitch e localização e preencheram o Tinnitus Handicap Inventory brasileiro (THI), utilizado para avaliar o grau de zumbido. O questionário de hiperacusia e o questionário sobre lateralidade manual The assessment and analysis of handedness: The Edinburgh Inventory também foram preenchidos. Os indivíduos foram submetidos a pesquisa do Loudness Discomfort Level (grau de hiperacusia), a acufenometria e a pesquisa e do efeito de supressão das emissões otoacústicas transientes (EOATs) nas frequências de 1, 1,5, 2, 3 e 4 KHz. Utilizou-se análise descritiva e estatística dos dados (testes exato de Fisher, Kruskal Wallis, U de Man Whitney e correlação de Spearman). RESULTADOS: A ocorrência das EOAT variou de 33 a 88%. Houve 63,7% de presença de efeito de supressão na orelha direita e 81,7% na orelha esquerda. Não ocorreu associação significativa entre os graus de zumbido e os graus de hiperacusia, e entre o efeito supressor das EOAT e lateralidade, graus de zumbido e graus de hiperacusia. Em relação ao zumbido, a maioria dos indivíduos apresentou pitch agudo, tanto na anamnese quanto na acufenometria, localização bilateral e grau leve no THI. As mulheres apresentaram grau de zumbido estatisticamente superior ao dos homens. Os sons considerados desconfortáveis foram os de alta intensidade e as reações aos sons mais citadas foram a irritação, ansiedade e necessidade de afastar-se do som. A dificuldade de compreensão de fala na presença de ruído foi referida pela maioria dos indivíduos.CONCLUSÃO: Conclui-se que a ocorrência de EOAT foi inferior a encontrada em sujeitos normo-ouvintes sem esses sintomas. Obteve-se maior percentual de presença do efeito de supressão das EOATs em ambas as orelhas analisadas. Os graus de zumbido e os graus de hiperacusia não apresentaram correlação em indivíduos normo-ouvintes com queixas de zumbido e hiperacusia, bem como não ocorreu associação entre o efeito de supressão das EOAT e lateralidade, graus de zumbido e de hiperacusia. A amostra estudada apresentou predomínio de zumbido de pitch agudo, localização bilateral e grau leve. Os sons considerados desconfortáveis foram os de alta intensidade e a reação de irritação aos sons foi a mais citada.

Introdução: O zumbido pode ser definido como a percepção consciente de um som ou ruído, sem a presença de estimulação acústica externa. Levando em consideração o prejuízo causado pelo zumbido, a falta de tratamentos definitivos e eficientes para todos os casos de zumbido, além da dificuldade de uso da Tinnitus Retraining Therapy - TRT, por ser onerosa e longa, fica evidente a necessidade da proposição de alternativas para reabilitação de pessoas com este problema. Sendo assim, a hipótese deste estudo é que o uso do treinamento auditivo formal pode causar uma reorganização plástica no sistema auditivo dos portadores de zumbido, promovendo uma melhora do sintoma, em virtude do fortalecimento das sinapses da via auditiva, bem como da sincronia de disparo dos neurônios envolvidos no processamento auditivo. Esta modificação seria observada por meio da avaliação comportamental, eletrofisiológica e por meio do questionário THI - Tinnitus Handcap Inventory. Objetivo: O objetivo do referido estudo foi verificar o efeito de um programa de treinamento auditivo formal em portadores de zumbido na percepção deste sintoma. Método: Participaram do estudo 13 indivíduos portadores de zumbido divididos em dois grupos randomizados, sendo seis no Grupo Estudo (GE) e sete no Grupo Controle (GC). Todos os indivíduos realizaram os seguintes procedimentos: anamnese; audiometria tonal e vocal; imitanciometria; avaliação eletrofisiológica da audição; acufenometria; aplicação do THI; avaliação do processamento auditivo reduzida (GIN - Gaps In Noise, Teste de Padrão de Frequência e Fala com Ruído). Após a avaliação dos indivíduos foram iniciados os treinamentos de acordo com cada grupo. O GE foi submetido ao treinamento auditivo formal, realizado em cabina acústica, por aproximadamente 40 minutos, em oito sessões, uma vez por semana, cujas atividades enfocavam principalmente habilidades auditivas temporais e de atenção auditiva. O GC foi submetido a oito sessões de treinamento visual de 40 minutos cada, realizadas uma vez por semana, com atividades como palavras cruzadas, caça palavras, jogo dos 7 erros e Sudoku. Para a análise estatística foram utilizados o teste pareado de Wilcoxon, técnica de modelos de medidas repetidas e modelos lineares múltiplos, com nível de significância de 0,05. Resultados: Na caracterização dos grupos, não foram observadas diferenças estatisticamente significantes para as variáveis gênero, idade, pitch e loudness do zumbido, bem como para os limiares auditivos na audiometria convencional e altas frequências. Foi realizada a comparação entre os grupos, pré e pós terapia auditiva e visual, dos testes eletrofisiológicos, comportamentais e THI. A análise dos dados, utilizando um ajuste do modelo de medidas repetidas para cada variável, mostrou que não houve diferenças estatisticamente significantes entre os grupos, quando comparadas as condições pré e pós treinamento, para nenhuma das avaliações realizadas. Conclusão: O presente estudo teve o objetivo de verificar o efeito de um programa de treinamento auditivo em portadores de zumbido, na percepção deste sintoma. Nossos achados não mostraram diferenças estatisticamente significantes entre os instantes pré e pós treinamento auditivo ou treinamento placebo, bem como entre os grupos (GC e GE), tanto para os achados eletrofisiológicos, quanto para a avaliação comportamental do processamento auditivo e para o THI / Introduction: Tinnitus may be defined as the conscious perception of sound or noise in the absence of external acoustic stimulation. Considering the damage caused by tinnitus, the lack of effective and efficient treatment for all cases of tinnitus and further the difficulty of using the Tinnitus Retraining Therapy - TRT, as it is costly and overlong, it is evident the need of proposing alternatives to rehabilitation of people with such problem. Thus, the hypothesis of the present study is that the formal auditory training may lead to reorganization in the auditory system of patients with tinnitus, promoting a decrease in the symptoms, due to the strengthening of synapses in the auditory pathway, and further a best synchronism of the fire neurons involved in auditory processing. This modification would be observed by assessing behavioral and electrophysiological through the THI questionnaire - Tinnitus handcap Inventory. Objective: The aim of this study was to investigate the effect of a formal auditory training program on patients with tinnitus perception of this symptom. Method: The study included 13 subjects with tinnitus who were divided into two randomized groups, six in the Study Group (SG) and seven in the control group (CG). All subjects performed the following procedures: interview; tonal and vocal audiometry, tympanometry, electrophysiological assessment of hearing; acuphenometry; application of THI; auditory processing assessment reduced (GIN - Gaps In Noise Test Pattern Frequency and Speech in Noise). After such procedures all subjects went through the auditory training according to each group. The experimental group was subjected to formal auditory training, performed in an acoustic cabin for aproximately 40 minutes in eight sessions, once a week; the activities were mainly focused on both temporal auditory skills and auditory attention. The CG underwent eight sessions of visual training that lasted 40 minutes each, held once a week, with activities such as crossword puzzles, word search puzzles, play Sudoku and the 7 mistakes. For statistical analysis we used the Wilcoxon matched pairs test, technical models for repeated measures and multiple linear models, with a significance level of 0.05. Results: In the characterization of the groups, there was found no statistically significant differences for the variables gender, age, pitch and loudness of tinnitus as well as hearing thresholds in conventional audiometry and high frequencies. Comparisons were performed between groups, pre and post auditory training and visual, electrophysiological testing, behavioral and THI. Data analysis, using the model of repeated measures for each variable, showed no statistically significant differences between groups when comparing the situations before and after training for any of the evaluations. Conclusion: The present study aimed to verify the effect of an auditory training program in patients with tinnitus, that is, in their perception of this symptom. Our findings showed no statistically significant differences before and after the auditory training and training placebo between the groups (CG and EG) and also for the electrophysiological findings, the behavioral assessment of auditory processing and THI

INTRODUÇÃO: na tentativa de elucidar alguns aspectos relacionados ao zumbido, levantou-se a hipótese de alteração nas vias auditivas centrais. Diante disso, os potenciais evocados auditivos podem representar uma alternativa para detectar possíveis alterações auditivas centrais que possam estar presentes nesta população e que indiquem o provável sítio gerador desse sintoma. OBJETIVO: caracterizar os potenciais evocados auditivos de curta, média e longa latências em indivíduos com e sem queixa de zumbido e expostos a ruído ocupacional. MÉTODO: foram avaliados 60 sujeitos expostos a ruído de origem ocupacional com níveis de pressão sonora elevados (maior que 85 dBA), tanto do gênero masculino quanto feminino, na faixa etária entre 29 e 50 anos de idade, sendo 30 com queixa de zumbido (grupo pesquisa) e 30 sem queixa de zumbido (grupo controle). Foram realizados os potenciais evocados auditivos de curta, média e longa latências. RESULTADOS: na análise dos potenciais de curta latência, foi observado um aumento predominante das latências das ondas I e III, bem como, alteração de tronco encefálico baixo em 16 indivíduos do grupo pesquisa. Quanto aos potenciais de média latência, observou-se médias maiores para a latência da onda Na nas modalidades C4/A1 e C3/A2 no grupo pesquisa, evidenciando oito indivíduos com alteração. Por sua vez, para a latência da onda Pa e amplitude Na-Pa, tal aumento foi encontrado em todas as modalidades analisadas (C3/A1, C4/A1, C3/A2, C4/A2), sendo o efeito eletrodo o tipo de alteração mais frequentemente observado para a amplitude Na-Pa, e o aumento de latência para as ondas Na e Pa. Com relação aos potenciais de longa latência, constatou-se que o grupo pesquisa apresentou valores médios das latências das ondas N1, P2 e P300 e amplitude N1-P2 maiores que o grupo controle. Observou-se, também, um maior número de indivíduos alterados para o grupo pesquisa nos componentes N1(18 indivíduos) e P2 (20 indivíduos), sendo que o mesmo não pôde ser observado para o componente P300. Para esses potenciais, o aumento de latência foi tipo de alteração mais evidente. No estudo da associação entre lado da alteração nos potenciais evocados auditivos e localização do zumbido, verificou-se uma maior associação entre zumbido bilateral e alteração bilateral nos potenciais evocados auditivos de tronco encefálico e nos componentes N1, P2 e P300. CONCLUSAO: com base nos achados descritos, os resultados mostraram homogeneidade dos dois grupos quanto à faixa etária e tempo de exposição ao ruído. Apesar da inexistência de significância em algumas análises realizadas, as medidas dos potenciais de curta, média e longa latências mostraram que a maior parte dos indivíduos avaliados do grupo pesquisa apresentou alteração ao serem comparados com o grupo controle. Portanto, poder-se-ia supor a existência de uma possível disfunção no Sistema nervoso auditivo central desde o nervo auditivo até a região cortical em indivíduos com queixa de zumbido expostos a níveis de pressão sonora de origem ocupacional / INTRODUCTION: attempting to elucidate some aspects related to tinnitus, the hypothesis of alteration in the central auditory pathways was raised. Thus, auditory evoked potentials may represent an alternative to detect possible central auditory disorders that may be present in this population and that indicate the probable generator site of such symptom. AIM: to characterize short, middle and long latencies auditory evoked potentials in individuals with and without tinnitus complaint and exposed to occupational noise. METHOD: sixty subjects exposed to occupational noise with elevated sound pressure level (greater than 85 dBA), male and female, ranging in age from 29 to 50 years old took part in this study; 30 of them had tinnitus complaint (study group) and 30 did not have tinnitus complaint (control group). Short, middle and long latencies auditory evoked potentials were performed. RESULTS: analyzing the short latency potentials it was observed a predominant increase of the latency of waves I and III, as well as alteration in the lower brainstem in 16 individuals of the study group. Concerning the middle latency potentials it was observed higher averages for the latency of wave Na in the modalities C4/A1 and C3/A2 in the study group, evidencing eight individuals with altered results. Such increase was found in all modalities analyzed (C3/A1, C4/A1, C3/A2, C4/A2) for the latency of wave Pa and amplitude Na-Pa; the electrode effect was the most frequent type of alteration observed for the amplitude Na-Pa and the latency increase, for waves Na and Pa. Concerning the long latency potentials it was observed that the study group presented greater mean values of latencies of waves N1, P2 and P300, and amplitude N1-P2 than the control group. It was also observed in the study group a greater number of altered results concerning the components N1 (18 individuals) and P2 (20 individuals); the same was not observed for the component P300. For these potentials, the latency increase was the most evident type of alteration. Studying the association between the side of the altered auditory evoked potentials and the localization of the tinnitus it was verified a higher association between bilateral tinnitus and bilateral alteration in the brainstem auditory evoked potentials and in components N1, P2 and P300. CONCLUSION: based on the findings described, results showed homogeneity in both groups concerning the age and the time of noise exposure. Despite the inexistence of statistical significance in some of the analysis performed, measures of short, middle and long latencies potentials showed that most of the individuals analyzed in the study group presented alteration when compared to the control group. Therefore, the existence of a possible dysfunction in the central auditory nervous system from the auditory nerve until the cortical region in individuals with tinnitus complaint, exposed to sound pressure levels of occupational origin could be supposed

Le diagnostic de l’acouphène repose sur le rapport verbal du patient. Cependant, les paramètres psychoacoustiques, tels que la hauteur et la sonie de l’acouphène, sont essentiels pour l’évaluation et pour discriminer les fausses plaintes. Quantifier le percept de l’acouphène reste un objectif de recherche important. Nous avons cherché à: (1) évaluer la précision d'une nouvelle méthode d'évaluation des acouphènes du type « likeness rating » avec une méthode de présentation continue de la hauteur, en considérant la formation musicale, et (2) vérifier si les mesures psychoacoustiques de l’acouphène ont la sensibilité et la spécificité pour détecter les personnes simulant un acouphène. Nous avons recruté des musiciens et des non-musiciens souffrant d'acouphènes et des simulateurs sans acouphènes. La plupart d’entre eux ont été testés une seconde fois quelques semaines plus tard. La hauteur de l’acouphène a d’abord été évaluée en utilisant la méthode « likness rating ». Des sons purs ont été présentés de manière aléatoire de 0.25 kHz à 16 kHz et les participants devaient coter la ressemblance de chaque son par rapport à leur acouphène, et en ajuster son volume de 0 à 100 dB SPL. La hauteur a ensuite été évaluée par une méthode, où les participants devaient apparier la hauteur de leur acouphène en déplaçant leur doigt sur une bande tactile générant des sons purs en continu de 0.5 kHz à 20 kHz par pas de 1 Hz. Les capacités à apparier des sons externes ont été évaluées en utilisant cet appareil. La hauteur prédominante de l’acouphène était similaire entre les deux méthodes pour les musiciens et les non-musiciens, bien que les musiciens montraient de meilleures capacités d’appariement face à des sons externes. Les simulateurs ont coté la sonie bien au-dessus que les autres groupes avec un grand degré de spécificité (94,4%), et ont été inconsistants dans l’appariement de cette sonie (pas de la hauteur) d’une session à une autre. Les données de la seconde session montrent des réponses similaires pour l’appariement de la hauteur pour les deux méthodes ainsi que pour tous nos participants. En conclusion, la hauteur et la sonie correspondent au percept de l’acouphène et doivent en plus être utilisées avec des échelles visuelles analogiques, qui sont plus corrélées avec la gêne et la détresse. Enfin, l’appariement de la sonie est sensible et spécifique à déterminer la présence de l’acouphène. / The diagnosis of tinnitus relies on self-report. Psychoacoustic measurements of tinnitus pitch and loudness are essential for assessing and discriminating true claims from false. For this reason, the quantification of tinnitus remains a challenging research goal. We aimed to: (1) assess the precision of a new tinnitus likeness rating procedure with a continuous pitch presentation method, controlling for music training, and (2) test whether tinnitus psychoacoustic measurements have the sensitivity and specificity required to detect people faking tinnitus. Musicians and non-musicians with tinnitus, and simulated malingerers without tinnitus were tested. Most were retested several weeks later. Tinnitus pitch matching was first assessed using the likeness rating method: Pure tones between 0.25 to 16 kHz were presented randomly to participants who had to rate the likeness of each tone to their tinnitus, and to adjust its loudness from 0 to 100 dB SPL. Tinnitus pitch matching was then assessed with a continuous pitch method. Participants had to match the pitch of their tinnitus by moving their finger across a touch sensitive strip, which generated a continuous pure tone from 0.5 to 20 kHz in 1 Hz step. Pitch matching abilities to external tones were assessed using this device. The predominant tinnitus pitch was consistent across the two methods for both musicians and non-musicians, although musicians displayed better external tone pitch matching abilities. Simulated malingerers rated loudness much above the other groups with a high degree of specificity (94.4%) and were unreliable in loudness (not pitch) matching from one session to the other. Retest data showed similar pitch matching responses for both methods for all participants. In conclusion, tinnitus pitch and loudness reliably corresponds to the tinnitus percept and psychoacoustic loudness matches are sensitive and specific to the presence of tinnitus. Furthermore, this novel method should be used along with visual analog scales, which are more correlated to mood and distress.

Tinnitus ist eine Erkrankung mit hoher Prävalenz, welche häufig psychische Störungen nach sich zieht, Mit der Studie sollte untersucht werden, in welchen konkreten Dimensionen die gesundheitsbezogene Lebensqualität bei Tinnituspatienten eingeschränkt ist, und wie sich diese Einschränkungen während und nach Therapie, einschließlich hyperbarer Sauerstofftherapie, ändern. 120 ambulant oder stationär behandelte Patienten mit Tinnitus wurden zu drei Zeitpunkten untersucht. Eingesetzt wurden die Hospital Anxiety and Depression Scale, das Multidimensinal Fatigue Inventory und der Lebensqualitätsfragebogen EORTC QLQ-C30. Im Vergleich zu Personen der Allgemeinbevölkerung waren die Tinnituspatienten in allen Bereichen beeinträchtigt, am stärksten in den Skalen Soziale, Kognitive, Emotionale und Rollen-Funktionsfähigkeit sowie im Bereich finanzielle Schwierigkeiten. Im Laufe der Therapie verbesserten sich die Werte, so dass sich der Abstand zum Niveauder Allgemeinbevölkerung etwa halbierte.

Syftet med studien är att göra en kartläggning över hur svenska skådespelares fysiska och psykiska hälsostatus ser ut hösten 2009. De områden som undersöks är depression, ångest, sömn, stress, arbetslöshet och hälsopåverkan, hörselproblem och tinnitus, samt alkohol- och droganvändning. En länk till en webbenkät med frågor från Hospital anxiety and depression scale, Perceived stress scale, Nationell undersökning om hörsel, yrsel och tinnitus samt Swedish longitudinal occupational survey of health 2006 skickades till medlemmar i Teaterförbundets skådespelaravdelning. 533 deltagare svarade på de inledande frågorna och 425 deltagare slutförde hela enkäten. Resultaten visar på förekomst av depression och ångest av klinisk betydelse, förekomst av sömnbesvär, samt förekomst av hög till mycket hög upplevd stress och prestationsbaserat självförtroende. Deltagarna upplever negativa konsekvenser av arbetslöshet. Det förekommer hörselproblem och tinnitus hos deltagarna samt, riskbruk gällande alkohol och droganvändning. En slutsats är att ibland de skådespelare som svarat på studien uppvisas ångestsymptom av klinisk betydelse hos mer än var tredje deltagare.

碩士 / 國立臺北護理健康大學 / 語言治療與聽力研究所 / 107 / Previous studies about listening effort of population with hearing impairment demonstrated that under a quiet condition there is no significant difference in speech recognition between listeners with normal and impaired hearing, but under noisy conditions the performance of listeners with impaired hearing is worse than that of listeners with normal hearing. In addition, previous studies about listening effort of population with tinnitus showed that the performance of speech recognition in listeners with tinnitus is worse than that of listeners with normal hearing under both quiet and noisy conditions. This suggests that listeners with tinnitus may have higher listening effort even in a quiet condition, and less attentional resource can be used. Many studies have explored changes of listening effort in speech recognition under different listening conditions for population with hearing impairment, and some studies have started to explore tinnitus effect on speech recognition. Relatively little, however, is known about the relationship between tinnitus and listening effort, and the tinnitus effect on listening effort. Through conducting experiments with different listening conditions, the present study aims (1) to compare the performance of speech recognition, and differences of listening effort under noisy conditions between listeners with tinnitus, and without tinnitus, and (2) to examine the relationship between tinnitus and listening effort. The present study adopts a cross-sectional and comparative research design (1) to observe the relationship between changes in listening effort, and degree of severity in conscious tinnitus under different listening conditions for experimental and control groups, (2) to determine whether listening effort of subjects with tinnitus is higher than that of subjects without tinnitus, and (3) to explore whether changes in listening effort of subjects with tinnitus are higher when intensity of noise increases. Total 90 subjects are recruited from the Taipei Veterans General Hospital ear department. The subjects are divided into two groups, control group for subjects without tinnitus and experimental group for tinnitus, 45 for each. The changes of listening effort in speech recognition tests under both quiet and different noisy conditions will be used to compare the performance between two groups, and the Tinnitus Handicap Index will be used to explore the relationship between listening effort and different degree of severity in tinnitus. Dual task will be adopted to measure listening effort. The results showed that tinnitus had no significant effect on listen effort at different signal-to-noise ratios, indicating that tinnitus may not be the main influencing factor of the listen effort.

碩士 / 國立高雄師範大學 / 特殊教育學系 / 105 / Abstract Literature showed that hearing related professionals play an important role in helping people who were bothered by tinnitus. A self-composed 15-item questionnaire was used as a tool in this study. Subjects were hearing-related professionals (audiologists and hearing-aid dispensers). The purposes were to uncover the current status of tinnitus services, as well as the professionals’ thinking toward several issues in tinnitus services. 387 questionnaires were sent out, whereas 241 were sent back. Among them, five was invalid and 236 were valid. The return rate was 62.3%. The results showed the following: (1) Audiologists have longer years of working than hearing-aid dispensers. (2) Close to 60% of the audiologists worked in hospitals. (3) Very low proportion of hearing-related professionals engaged in tinnitus services (audiologists 25.14% vs. hearing-aid dispensers is 14.29%). (4) A significantly higher proportion of audiologists took part in tinnitus workshops than hearing-aid dispensers (audiologists 71.58% vs. hearing-aid dispensers 24.49%). (5) More than 85% of the hearing-related professionals considered that tinnitus-related resources (books, study, certification) were insufficient. (6) More than 95% of the hearing-related professionals would like to participate in tinnitus-related workshops. (7) Close to 80% of hearing-related professionals agreed that a standardized protocol of tinnitus assessment and treatment was required in this field. (8) The self-rated scores of audiologists in their knowledge toward tinnitus assessment and treatment were significantly higher than those of hearing-aid dispensers. (9) In terms of the scope of practice in tinnitus, both audiologists and hearing-aid dispensers favored audiologists to do the practice. Based on the results, several recommendations were made. First, hearing-related professionals need to engage in tinnitus management. They also need to enhance their knowledge and skills in tinnitus management. Second, tinnitus-related resources needs to be enriched and more workshops in tinnitus is waited to be hold. Third, audiologists need to improve their knowledge and skills in fitting hearing aids. Fourth, tinnitus related health insurance payment system needs to be modified. Key words: tinnitus, questionnaires, tinnitus assessment, tinnitus treatment

Denna artikel undersöker hur man kan skapa ökad förståelse för hörselskador i vardagliga ljudmiljöer med hjälp av en realtidssimulation. Den producerade simulationen är binaural, och innefattar olika element av hörselskador såsom hörselnedsättning och tinnitus, samt sköter uppspelning av producerade ljudmiljöer i ett 4.0-surroundformat. Artikeln tar avstamp i tidigare forskning, beskrivningar av hörselskador i vetenskaplig litteratur, samt självbedriven etnografi med hörselskadade individer. Processen för framtagningen av simulationen beskrivs, och de olika steg som tagits för att anlända vid en fullständig slutprodukt redogörs. Upplevelsen utvärderas med hjälp av kvalitativa användartester med 13 deltagande studenter, där resultatet pekar på att simulationen har bidragit till en ökad förståelse för hörselskador i vardagliga ljudmiljöer. / This article explores how a real-time simulation can contribute to better understanding regarding hearing impairments in everyday sound environments. The produced simulation is binaural, and includes different elements of hearing impairment such as hearing loss and tinnitus, and handles playback of produced sound environments in a 4.0-surround format. The article is built upon previous research, descriptions of hearing impairments in scientific literature, as well as self-executed ethnography with hearing impaired individuals. The process of designing the simulation is described, as well as the different steps taken in order to arrive at a final product. The experience is evaluated through qualitative user testing with 13 participating students, where the results indicate that the simulation has contributed to a better understanding of hearing impairments in everyday sound environments.

Objectif: Cette thèse avait pour objectif principal la mise en oeuvre et la validation de la faisabilité, chez l'humain, du paradigme de modulation du réflexe acoustique de sursaut par un court silence (GPIAS) afin de l'utiliser comme mesure objective de l'acouphène. Pour ce faire, trois expériences ont été réalisées. L'expérience 1 avait pour objectif de valider l'inhibition du réflexe de sursaut par un court silence chez des participants humains normo-entendants (sans acouphène) lors de la présentation d'un bruit de fond centré en hautes et en basses fréquences afin de déterminer les paramètres optimaux du paradigme. L'expérience 2 avait pour objectif de valider la précision et la fidélité d'une méthode de caractérisation psychoacoustique de l'acouphène (appariement en intensité et en fréquence). Finalement, l'expérience 3 avait pour objectif d'appliquer le paradigme d'objectivation de l'acouphène par le réflexe de sursaut à des participants atteints d'acouphènes chroniques en utilisant les techniques développées lors des expériences 1 et 2. Méthodologie : L'expérience 1 incluait 157 participants testés dans l'une des conditions de durée du court silence (5, 25, 50, 100, 200 ms) et dans l'un des deux paradigmes (court silence à l'intérieur du bruit de fond ou suivant celui-ci) à l'aide de bruits de fond en hautes et en basses fréquences. L'expérience 2 incluait deux groupes de participants avec acouphène, l'un musicien (n=16) et l'autre sans expérience musicale (n=16) ainsi qu'un groupe de simulateur sans acouphène (n=18). Ils tous ont été évalués sur leur capacité d'appariement en fréquence et en intensité de leur acouphène. Les mesures ont été reprises chez un sous-groupe de participants plusieurs semaines plus tard. L'expérience 3 incluait 15 participants avec acouphène et 17 contrôles évalués à l'aide du paradigme d'inhibition du réflexe de sursaut à l'aide d'un court silence (GPIAS). Les paramètres psychoacoustiques de l'acouphène ont également été mesurés. Toutes les mesures ont été reprises plusieurs mois plus tard chez un sous-groupe de participants. Résultats : Expérience 1 : le paradigme d'inhibition du réflexe acoustique de sursaut par un court silence est applicable chez l'humain normo-entendant. Expérience 2 : les mesures psychoacoustiques informatisées de l'acouphène incluant l'appariement en fréquence et en intensité sont des mesures précises et fidèles du percept de l'acouphène. Expérience 3 : un déficit d'inhibition au paradigme du GPIAS a été retrouvé chez le groupe de participants avec acouphène pour les bruits de fond en hautes et en basses fréquences au test et au retest. Les mesures d'appariement en fréquence ont révélé un acouphène dont la fréquence prédominante était d'environ 16 000 Hz chez la plupart des participants. Discussion : Il est possible d'appliquer le paradigme d'inhibition du réflexe acoustique de sursaut par un court silence à des participants humains atteints d'acouphène, tel qu'il est utilisé en recherche animale pour « objectiver » la présence d'acouphène. Toutefois, le déficit d'inhibition mesuré n'est pas spécifique à la fréquence de l'acouphène lorsque validé à partir des données d'appariement psychoacoustique. Nos résultats soulèvent des questions quant à l'interprétation originale du paradigme pour détecter la présence d'un acouphène chez les animaux. / Objective: The main objective of this thesis was the implementation and validation of applying the gap prepulse inhibition of the acoustic startle reflex (GPIAS) paradigm in humans, in order to objectively measure tinnitus. To do this, three experiments were carried out. Experiment 1 was designed to validate the inhibition of the acoustic startle reflex by using a short gap within high and low frequency narrowband noise in normal hearing humans (without tinnitus) to determine the optimal paradigm parameters. Experiment 2 was designed to validate the accuracy and the test-retest fidelity of a tinnitus psychoacoustic characterization method (intensity and frequency matching). Finally, Experiment 3 applied the GPIAS paradigm to participants with chronic tinnitus using the techniques developed in experiments 1 and 2. Methods: Experiment 1 included 157 participants tested with only one gap duration (5, 25, 50, 100, 200 ms) and with one of the two paradigms (gap imbedded in the background noise or following it) including high and low frequencies background noise. Experiment 2 included two groups of participants with tinnitus, one group consisting of musicians (n=16) and one group without musical experience (n=16). A third group consisted of adults who were instructed to simulate having tinnitus (n = 18). Tinnitus pitch and intensity matching abilities were assessed for all participants. A subgroup of participants was retested several weeks later. Experiment 3 included 15 participants with tinnitus and 17 controls assessed with the GPIAS. The psychoacoustic parameters of tinnitus were also measured. A subgroup of participants was retested several weeks later. Results: Experiment 1: the GPIAS is applicable in humans with normal hearing. Experiment 2: psychoacoustic measurements of tinnitus frequency and intensity using a computerized matching procedure produced precise and accurate measurements of the tinnitus percept. Experiment 3: an inhibition deficit was found using the GPIAS paradigm in the tinnitus group for background noise of high and low frequency compared to the control group, at test and retest. The frequency matching measurements revealed a 16,000 Hz tinnitus predominant frequency for most tinnitus participants. Discussion: It is possible to apply the gap prepulse inhibition of the startle reflex paradigm on human participants with tinnitus, as used in animal research to "objectify" the presence of tinnitus. However, the inhibition deficit found in the tinnitus group was not specific to their tinnitus frequency. This was validated by psychoacoustic tinnitus pitch matching. Our results question the original interpretation of the GPIAS paradigm for objectifying the presence of tinnitus.