Misophonia is a sensory disorder where specific stimuli, usually auditory, trigger the fight-flight-freeze response, causing extreme reactions, typically anger, panic, or anxiety. Research into treatment for misophonia is limited, primarily consisting of case studies applying common methods of therapy. However, research into similar disorders like tinnitus shows that there are many avenues of treatment that should be investigated, including audiological treatment. To apply audiological treatment to misophonia, selective noise cancelling must be used to control specific trigger sounds. In this research, a basic selective noise cancelling algorithm was developed using a convolutional neural network and was evaluated using a survey. Participants rated their reaction to trigger sounds, non-trigger sounds, and trigger sounds that had been selectively cancelled. The misophonic reactions to selectively cancelled sounds were significantly less than to trigger sounds. This shows that selective noise cancelling could be used to apply audiological treatments to misophonia.

博士 / 國立成功大學 / 醫學工程研究所碩博士班 / 94 / Subjective tinnitus is a very common symptom in the medical horizon. The prevalence of tinnitus in adults ranges between 10.1 % and 14.5% and evidence shows that tinnitus is positively correlated with age. Despite a variety of therapeutic modalities, quantitative measurement and consistent effective treatment remain elusive in recent years. The phenomenon that tinnitus could be masked with external sounds was initially applied in tinnitus treatment around 1975. The successful masking rate has been reported from 45 % to 69 %. Later, tinnitus retraining therapy (TRT) was introduced to facilitate the process of tinnitus habituation based on the neurophysiological model of tinnitus and neuroplasticity of auditory nerve system. But there is still uncertainty of these two sound therapies about their long-term effects on auditory system, particularly for these modalities to relieve rather than to cure tinnitus and for their lengthy courses of treatment. 　This research is motivated by the increasing prevalence of tinnitus worldwide and the lack of quantitative evaluation and prescription of tinnitus treatment. With the advent of computer technology, electronics and digital signal processing, new medical techniques are likely to be developed for quantitative evaluation of tinnitus and for quantitative prescription on noise therapy. Therefore, the purpose of this research is to design and develop a clinical useful system for quantitatively investigating the frequency band and intensity of tinnitus noises. More specifically, this research is aimed to (1) design a PC-based platform for evaluation and rehabilitation on tinnitus; (2) develop a prescription program for tinnitus treatment through quantitatively investigating frequency range and intensity parameters of tinnitus characteristics; (3) comparatively evaluate the clinical efficacy of conventional wide-band noises and customized narrow-band noises on tinnitus treatment. This research is to test the hypothesis that through integrated neurophysiological mechanism of tinnitus, auditory neuroplasticity and modern digital signal processing technology, clinical tinnitus can be measured more objectively and treated more effectively. This research is divided into two stages of experiments. Experiment stage I is to design a PC-based tinnitus evaluation system through GUI system programming, which contains a clinical database and four functional modules based on clinical procedure and psychoacoustic reaction of tinnitus. Pure tone threshold functional module is designed to generate pure tones for hearing threshold evaluation. Preset narrow-band noise functional module is designed to provide preset band noises for frequency and loudness matching. Tunable band noise functional module is designed to provide fine tuning for the preset narrow-band noise and Customized noise generator functional module is to generate the digital file of the prescribed noise for tinnitus treatment. System calibration and preliminary clinical application to tinnitus subjects are also conducted. Experiment stage II is to quantitatively investigate the effects of tinnitus parameters on tinnitus. Totally 25subjects suffering from persistent tinnitus were recruited from NCKU Hospital and randomly assigned into the exp. Group (13 subjects) who underwent TRT with sound therapy using customized narrow-band noises and the control group (12 subjects) who underwent TRT with sound therapy using conventional wide-band noises for six months. Two-way ANOVA with one factor repeated measurements is used to statistically analyze the MML and MP of tinnitus psychoacoustic parameters in loudness and THI scores of tinnitus severity from questionnaires. The treatment factor includes exp. and control groups, and the time factor includes 4 levels of before treatment, 2 months, 4 months and 6 months after treatment. The results are used to assess comparatively the clinical efficacy of two groups on tinnitus treatment. 　In experiment stage I, the PC-based prototype of tinnitus evaluation and prescription system has been completely designed. In the tinnitus matching process, the frequency matching rate is 95% (152 out of 160 subjects) and the self-ranked median score is 7 (ranging from 0 to 10). The overall successful matching rate for both frequency and loudness is 83%. The results of regression analysis indicate that the MML is linear to the MP level statistically ( C.C. =0.9 and p< 0.0001). The tinnitus evaluation system is likely to be useful in the tinnitus matching procedure clinically. 　The analytical results of tinnitus psychoacoustic parameters in loudness show that the experiment group has significantly lower both MML and MP dB values than the control group (MML: F=6.7, p=0.016; MP: F= 5.9, p=0.023). The time effects are significant on both MML and MP dB values (p < 0.05). The results from Sheffe’s multiple comparison of post test indicate that the MML dB values of both after four- and six-months treatments are significantly lower than that of before treatment (p < 0.05) for the experiment and control groups. The MP dB value after six-months treatment is significantly lower than that of before treatment in the experiment group, but there is no time effect on the MP value for the control group. There is no interaction between time and treatment factors (MML: F= 0.724, p = 0.541; MP: F= 2.151, p = 0.102). 　The THI score of experiment group is not significantly different from that of control group (p > 0.05). The time effects are significant on the THI scores for both groups. The results from Sheffe’s multiple comparison of post test indicate that the THI scores of both after four- and six-months treatments are significantly lower than that of before treatment (p < 0.05) for the experiment and control groups. There was no interaction between time and treatment factors (F= 0.476, p = 0.7). With the help of a digital tinnitus evaluation system with well-developed matching protocol, subjective tinnitus can be more assessed objectively and quantitatively. This system is proved to be reliable and feasible in clinical use. Derived from tinnitus matching parameters in frequency and intensity, customized noise could be applied to the sound therapy for Tinnitus Retraining Therapy. Conclusively, customized narrow-band noises are more effective in lowering tinnitus loudness and may provide a viable treatment option of tinnitus.

碩士 / 國立臺北護理健康大學 / 聽語障礙科學研究所 / 103 / The purpose of the study is to investigate the tinnitus improvement and its associated factors, such as implant duration and implant age in cochlear implant activated and non-activated situation. We included 26 subjects in their clinic visit day to Taipei branch of Mackay Memorial Hospital; age: 15 to 69 with an average of 37.24±17.49 years old; implanted aged: 3.2 to 68 with an average of 33.34±19.07 years old. The implant duration was 4 months to 16years and 2months with an average of 3.91±4.05 years. The subjects had to complete the Chinese version of tinnitus handicap inventory and Tinnitus Severity Index which cochlear implants (CI) switched on and off mode. The study result showed significantly improved after the cochlear implant. There were significant differences between on and off mode in TSI and THI score. Spearman rank correlation coefficient showed significant moderate correlation between age and tinnitus volume, and significant negative moderate correlation between the duration of implantation, THI and TSI; TSI and THI decreased as the duration of implantation increased. The age at the time of surgery was significantly moderate correlated with tinnitus volume, TSI and THI. The improvement of tinnitus was also correlated with implant age. Cochlear implants are not only an important assistive device to those who has severe to profound hearing impairment, but also a way to treatment tinnitus. Although the tinnitus can be regard as one of consideration when choosing the implanting side, the treatment goal is still to improve hearing ability, not to alleviate tinnitus. To those who has worse cochlea condition and in geriatric population, a reasonable expectation about the reduction of tinnitus after implantation should be built and educated because there are still risks and uncertainty in the nature of medication.

Untersucht wurden 243 Patienten eines neurootologischen Speziallabors einer HNO Praxis. Aus dem Gesamtkollektiv wurden nach der Anamnese mit dem Anamnesesystem NOASC I Unterkollektive nach vorhandenen Symptomen (Vertigo, Tinnitus, Vertigo mit Tinnitus, sowie kein Vertigo/ Tinnitus) und gehäuft vorkommenden Vorkrankungen (Z.n. Kopf-Hals-Schleudertrauma, Z.n. Commotio cerebri, Hypertonus) gebildet. Es folgt die Analyse der unterschiedlichen Testergebnisse einer multisensorischen neurootologischen Diagnostik mittels ENG, Ultraschall-Cranio-Corpo-Graphie (US-CCG), Evozierter Potentiale und Audiometrie. Hier interessierten v.a. die Ergebnisse im Vergleich des ENG mit der Ultraschall-Cranio-Corpo-Graphie des Tret- und des Stehversuches, sowie der Ergebnisvergleich des Tretversuches mit dem Stehversuches zur Ermittlung deren Sensitivität und Spezifität. Die Ergebnisse des ENG und des CCG zeigen deutliche Unterschiede aufgrund unterschiedlicher getesteter Funktionen und Regelkreise in einem Gleichgewichtsnetzwerk. Es zeigt sich der wichtige Beitrag des US-CCG als Screeningmethode bzw. zur Objektivierung neurootologischer Störungen. Es stellte sich jedoch auch ein deutlicher Unterschied in der Sensitivität und Spezifität des Stehversuchs-CCGs als statischem Test heraus, welcher dem Tretversuch-CCG als Lokomotionsprüfung unterlegen ist. Bei sparsamen Einsatz dieses Verfahrens sollte in jedem Fall dem Tretversuch der Vorzug vor dem Stehversuch gegeben werden. Typische Einzelfälle werden in einer Kasuistik vorgestellt. / In an examination of 243 neurootological patients, who reportet problems like vertigo, dizziness, instability, nausea, tinnitus and hearing loss, we did multisensoric neurootological examinations with electronystagmography, ultrasound-cranio-corpo-graphy, audiometry and evoked potentials. The examinations show the importance of the CCG as an screening examination aswell as for objecting neurootological illness.

INTRODUÇÃO: Os Potenciais Evocados Auditivos avaliam a atividade neuroelétrica da via auditiva desde o nervo auditivo até o córtex cerebral. A vectoeletronistagmografia permite analisar os canais semicirculares e/ou nervo vestibular inferior, verificando se existe comprometimento vestibular periférico ou central. A reabilitação vestibular é composta de exercícios físicos ativos e repetitivos de olhos, cabeça e corpo e/ou manobras específicas que visam diminuir a tontura e a instabilidade corporal, aumentar a estabilização no olhar, o controle postural e melhorar o bem-estar na realização das atividades do diaa- dia. Levando-se em conta a escassez de trabalhos na literatura que investiguem a via auditiva central em indivíduos com síndrome vestibular periférica e que sejam submetidos à reabilitação vestibular, torna-se importante conhecer o funcionamento do sistema auditivo central, desde o tronco encefálico até o córtex auditivo, em indivíduos com vestibulopatias periféricas. OBJETIVOS: caracterizar os potenciais evocados auditivos de curta, média e longa latências em indivíduos com vestibulopatias periféricas, bem como verificar a evolução destes potenciais e dos resultados obtidos no Dizziness Handicap Inventory (DHI) frente à reabilitação vestibular. MÉTODOS: Foram submetidos à avaliação eletrofisiológica da audição por meio dos potenciais evocados auditivos de tronco encefálico (PEATE), potencial evocado auditivo de média latência (PEAML) e potencial cognitivo (P300), bem como à aplicação do questionário DHI, antes e após reabilitação vestibular, 20 indivíduos com diagnóstico de Síndrome Vestibular Periférica Irritativa (SVPI) e 17 indivíduos com diagnóstico de Síndrome Vestibular Periférica Deficitária (SVPD), com idades entre 20 e 70 anos. RESULTADOS: Os resultados demonstraram que o grupo com SVPD apresentou maior porcentagem de resultados alterados no PEATE e PEAML. No que diz respeito aos tipos de alterações, pode-se observar no grupo com SVPD, alteração em tronco encefálico baixo no PEATE pré e pós RV; aumento das latências das ondas Na e Pa no PEAML pós RV, aumento da latência da onda Pa pré RV e efeito eletrodo para a amplitude Na- Pa pós RV. No grupo com SVPI, foi observada alteração do tipo outros no PEATE pré RV; aumento da latência da onda Pa no PEAML pré e pós RV e ambas as alterações para a amplitude Na-Pa pós RV. No estudo da evolução dos resultados pré e pós RV, pode-se observar maior porcentagem de resultados semelhantes para os três potenciais, em ambos os grupos avaliados. Na comparação do DHI pré e pós RV, ocorreram melhores resultados para os aspectos físico, emocional e funcional no grupo com SVPI e para os aspectos físico e emocional no grupo com SVPD. Tornam-se necessários mais estudos que avaliem a via auditiva central destes indivíduos para uma melhor caracterização dos achados eletrofisiológicos / INTRODUCTION: The auditory evoked potentials assess the neuroelectrical activity of the auditory pathway from the auditory nerve to the cerebral cortex. The vectoelectronystagmography analyzes the semicircular canals and/or inferior vestibular nerve, checking peripheral or central vestibular involvement. The vestibular rehabilitation therapy consists in active exercises and repetitive eyes exercises, head and body and/or specific maneuvers to reduce the dizziness and body instability, increase gaze stability and postural control and also improve well-being in daily activities. Taking into account the scarcity of studies in the literature that investigate the central auditory pathways in subjects who underwent vestibular rehabilitation therapy, it becames important to know the central auditory system from the brainstem to the auditory cortex, in subjects with peripheral vestibular disorders. OBJECTIVE: To characterize the auditory evoked potentials of short, middle and long latencies in subjects with peripheral vestibular disorders, as well as to evaluate the development of these potentials and the results obtained in the Dizziness Handicap Inventory (DHI) after vestibular rehabilitation therapy (VRT). METHODS: brainstem auditory evoked potential (BAEP), Auditory Middle- Latency Response (AMLR), cognitive potential (P300) and DHI were carried out in 20 subjects with Peripheral Vestibular Hyperfunction Syndrome and 17 subjects with Peripheral Vestibular Hypofunction Syndrome, aged between 20 and 70, before and after vestibular rehabilitation therapy. RESULTS: The results showed that the Peripheral Vestibular Hypofunction Syndrome group, presented higher percentage of altered results on BAEP and AMLR. Comparing the normal and altered results (qualitative analysis) between the groups in the BAEP, lower brainstem was predominantly observed in the Peripheral Vestibular Hypofunction Syndrome group before and after VRT; increased latencies of Na and Pa waves in AMLR after VRT, incresead latency of Pa wave in AMLR before VRT and electrode effect to the Na-Pa amplitude after VRT. The alteration predominantly observed in the Peripheral Vestibular Hyperfunction Syndrome group, was the other type one before VRT; increased latency of Pa wave in AMLR before and after VRT and both changes to the Na-Pa amplitude after VRT. In the study of the evolution before and after VRT, it was observed a higher percentage of similar results for the three potentials in both groups. Comparing results before and after VRT, the DHI greatest improvement occurred for the physical, emotional and functional aspects in the Peripheral Vestibular Hyperfunction Syndrome group and for the physical and emotional aspects in the Peripheral Vestibular Hypofunction Syndrome group. Further studies that evaluate the central auditory pathway of individuals with peripheral vestibular syndrome are needed to better characterize the electrophysiological findings

Introdução: O zumbido é um sintoma que acomete cerca de 10% da população e pode prejudicar bastante a qualidade de vida, sendo considerado um importante problema de saúde pública mundial. Os modelos fisiopatológicos atuais do zumbido consideram que a compensação da perda auditiva poderia prevenir ou reverter mudanças no córtex auditivo central acerca do zumbido. Próteses auditivas com gerador de som integrado têm sido utilizadas como alternativa para potencializar o tratamento do zumbido nos pacientes com perda auditiva associada. Contudo, não existe evidência científica suficiente para suportar a superioridade do uso combinado de ferramentas em relação à amplificação convencional. Objetivo: verificar se o uso combinado de amplificação e gerador de som é mais eficaz do que somente amplificação na redução do incômodo com o zumbido em pacientes com zumbido e perda auditiva neurossensorial bilateral simétrica de grau leve a moderado. Métodos: 49 pacientes com zumbido e perda auditiva participaram de um ensaio clínico cego randomizado. Um grupo foi adaptado bilateralmente com uso combinado de amplificação e gerador de som e o outro grupo foi adaptado somente com amplificação. O incômodo com o zumbido foi medido pelo THI e escala numérica. As medidas psicoacústicas do zumbido também foram realizadas. As avaliações inicial e final foram realizadas por um avaliador cego. Resultados: Após três meses, no grupo da adaptação combinada, 62,5% dos pacientes apresentaram redução do incômodo com o zumbido e no grupo da adaptação simples, 78%, sem diferença estatisticamente significante entre os grupos. Para o THI, escala numérica e intensidade sonora de zumbido, detectou-se efeito do nível mínimo de mascaramento, em que maiores valores de nível mínimo de mascaramento estão associados a maior incômodo e maior intensidade do zumbido. Conclusão: O uso combinado de amplificação e gerador de som e o uso de amplificação convencional foram igualmente eficazes na redução do incômodo com o zumbido / Introduction: Tinnitus is a symptom that affects about 10% of the population and can greatly impair the quality of life. In fact, it is considered as an important public health problem worldwide. The current pathophysiological models of tinnitus consider that the compensation of hearing loss could prevent or reverse changes in the auditory cortex. Hearing aids with an integrated sound generator have been used as an alternative to enhance the treatment of tinnitus in patients with hearing loss. However, there is no sufficient scientific evidence to support the superiority of the combined use of sound generator and amplification compared to conventional amplification alone. Objective: to verify whether the combined use of amplification and sound generator is more effective than amplification alone in reducing bothersome tinnitus in patients with mild to moderate bilaterally symmetrical sensorineural hearing loss. Methods: 49 patients with tinnitus and hearing loss underwent a blind randomized clinical trial. One group was bilaterally fitted with the combined use of amplification and sound generator, and the other group was fitted with amplification alone. The tinnitus annoyance was measured by THI and numerical scale. Psychoacoustic measurements of tinnitus were also performed. The initial and final assessments were performed by a blinded evaluator. Results: After 3 months, 62.5% of patients showed a reduction in tinnitus annoyance in the group of the combined use of amplification and sound generator, and 78% in the group with amplification alone, with no significant difference between the groups. For THI, numeric scale and tinnitus loudness, it was detected an effect of the MML, where higher values of MML are associated with greater discomfort due to tinnitus. Conclusion: The combined use of amplification and sound generator and the use of conventional amplification alone were equally effective in reducing tinnitus annoyance

Book Summary: Tinnitus: A Multidisciplinary Approach provides a broad account of tinnitus and hyperacusis, detailing the latest research and developments in clinical management, incorporating insights from audiology, otology, psychology, psychiatry and auditory neuroscience. It promotes a collaborative approach to treatment that will benefit patients and clinicians alike. The 2nd edition has been thoroughly updated and revised in line with the very latest developments in the field. The book contains 40% new material including two brand new chapters on neurophysiological models of tinnitus and emerging treatments; and the addition of a glossary as well as appendices detailing treatment protocols for use in an audiology and psychology context respectively.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 6 uppsatser.

INTRODUÇÃO: Os Potenciais Evocados Auditivos avaliam a atividade neuroelétrica da via auditiva desde o nervo auditivo até o córtex cerebral. A vectoeletronistagmografia permite analisar os canais semicirculares e/ou nervo vestibular inferior, verificando se existe comprometimento vestibular periférico ou central. A reabilitação vestibular é composta de exercícios físicos ativos e repetitivos de olhos, cabeça e corpo e/ou manobras específicas que visam diminuir a tontura e a instabilidade corporal, aumentar a estabilização no olhar, o controle postural e melhorar o bem-estar na realização das atividades do diaa- dia. Levando-se em conta a escassez de trabalhos na literatura que investiguem a via auditiva central em indivíduos com síndrome vestibular periférica e que sejam submetidos à reabilitação vestibular, torna-se importante conhecer o funcionamento do sistema auditivo central, desde o tronco encefálico até o córtex auditivo, em indivíduos com vestibulopatias periféricas. OBJETIVOS: caracterizar os potenciais evocados auditivos de curta, média e longa latências em indivíduos com vestibulopatias periféricas, bem como verificar a evolução destes potenciais e dos resultados obtidos no Dizziness Handicap Inventory (DHI) frente à reabilitação vestibular. MÉTODOS: Foram submetidos à avaliação eletrofisiológica da audição por meio dos potenciais evocados auditivos de tronco encefálico (PEATE), potencial evocado auditivo de média latência (PEAML) e potencial cognitivo (P300), bem como à aplicação do questionário DHI, antes e após reabilitação vestibular, 20 indivíduos com diagnóstico de Síndrome Vestibular Periférica Irritativa (SVPI) e 17 indivíduos com diagnóstico de Síndrome Vestibular Periférica Deficitária (SVPD), com idades entre 20 e 70 anos. RESULTADOS: Os resultados demonstraram que o grupo com SVPD apresentou maior porcentagem de resultados alterados no PEATE e PEAML. No que diz respeito aos tipos de alterações, pode-se observar no grupo com SVPD, alteração em tronco encefálico baixo no PEATE pré e pós RV; aumento das latências das ondas Na e Pa no PEAML pós RV, aumento da latência da onda Pa pré RV e efeito eletrodo para a amplitude Na- Pa pós RV. No grupo com SVPI, foi observada alteração do tipo outros no PEATE pré RV; aumento da latência da onda Pa no PEAML pré e pós RV e ambas as alterações para a amplitude Na-Pa pós RV. No estudo da evolução dos resultados pré e pós RV, pode-se observar maior porcentagem de resultados semelhantes para os três potenciais, em ambos os grupos avaliados. Na comparação do DHI pré e pós RV, ocorreram melhores resultados para os aspectos físico, emocional e funcional no grupo com SVPI e para os aspectos físico e emocional no grupo com SVPD. Tornam-se necessários mais estudos que avaliem a via auditiva central destes indivíduos para uma melhor caracterização dos achados eletrofisiológicos / INTRODUCTION: The auditory evoked potentials assess the neuroelectrical activity of the auditory pathway from the auditory nerve to the cerebral cortex. The vectoelectronystagmography analyzes the semicircular canals and/or inferior vestibular nerve, checking peripheral or central vestibular involvement. The vestibular rehabilitation therapy consists in active exercises and repetitive eyes exercises, head and body and/or specific maneuvers to reduce the dizziness and body instability, increase gaze stability and postural control and also improve well-being in daily activities. Taking into account the scarcity of studies in the literature that investigate the central auditory pathways in subjects who underwent vestibular rehabilitation therapy, it becames important to know the central auditory system from the brainstem to the auditory cortex, in subjects with peripheral vestibular disorders. OBJECTIVE: To characterize the auditory evoked potentials of short, middle and long latencies in subjects with peripheral vestibular disorders, as well as to evaluate the development of these potentials and the results obtained in the Dizziness Handicap Inventory (DHI) after vestibular rehabilitation therapy (VRT). METHODS: brainstem auditory evoked potential (BAEP), Auditory Middle- Latency Response (AMLR), cognitive potential (P300) and DHI were carried out in 20 subjects with Peripheral Vestibular Hyperfunction Syndrome and 17 subjects with Peripheral Vestibular Hypofunction Syndrome, aged between 20 and 70, before and after vestibular rehabilitation therapy. RESULTS: The results showed that the Peripheral Vestibular Hypofunction Syndrome group, presented higher percentage of altered results on BAEP and AMLR. Comparing the normal and altered results (qualitative analysis) between the groups in the BAEP, lower brainstem was predominantly observed in the Peripheral Vestibular Hypofunction Syndrome group before and after VRT; increased latencies of Na and Pa waves in AMLR after VRT, incresead latency of Pa wave in AMLR before VRT and electrode effect to the Na-Pa amplitude after VRT. The alteration predominantly observed in the Peripheral Vestibular Hyperfunction Syndrome group, was the other type one before VRT; increased latency of Pa wave in AMLR before and after VRT and both changes to the Na-Pa amplitude after VRT. In the study of the evolution before and after VRT, it was observed a higher percentage of similar results for the three potentials in both groups. Comparing results before and after VRT, the DHI greatest improvement occurred for the physical, emotional and functional aspects in the Peripheral Vestibular Hyperfunction Syndrome group and for the physical and emotional aspects in the Peripheral Vestibular Hypofunction Syndrome group. Further studies that evaluate the central auditory pathway of individuals with peripheral vestibular syndrome are needed to better characterize the electrophysiological findings

Introdução: O zumbido é um sintoma que acomete cerca de 10% da população e pode prejudicar bastante a qualidade de vida, sendo considerado um importante problema de saúde pública mundial. Os modelos fisiopatológicos atuais do zumbido consideram que a compensação da perda auditiva poderia prevenir ou reverter mudanças no córtex auditivo central acerca do zumbido. Próteses auditivas com gerador de som integrado têm sido utilizadas como alternativa para potencializar o tratamento do zumbido nos pacientes com perda auditiva associada. Contudo, não existe evidência científica suficiente para suportar a superioridade do uso combinado de ferramentas em relação à amplificação convencional. Objetivo: verificar se o uso combinado de amplificação e gerador de som é mais eficaz do que somente amplificação na redução do incômodo com o zumbido em pacientes com zumbido e perda auditiva neurossensorial bilateral simétrica de grau leve a moderado. Métodos: 49 pacientes com zumbido e perda auditiva participaram de um ensaio clínico cego randomizado. Um grupo foi adaptado bilateralmente com uso combinado de amplificação e gerador de som e o outro grupo foi adaptado somente com amplificação. O incômodo com o zumbido foi medido pelo THI e escala numérica. As medidas psicoacústicas do zumbido também foram realizadas. As avaliações inicial e final foram realizadas por um avaliador cego. Resultados: Após três meses, no grupo da adaptação combinada, 62,5% dos pacientes apresentaram redução do incômodo com o zumbido e no grupo da adaptação simples, 78%, sem diferença estatisticamente significante entre os grupos. Para o THI, escala numérica e intensidade sonora de zumbido, detectou-se efeito do nível mínimo de mascaramento, em que maiores valores de nível mínimo de mascaramento estão associados a maior incômodo e maior intensidade do zumbido. Conclusão: O uso combinado de amplificação e gerador de som e o uso de amplificação convencional foram igualmente eficazes na redução do incômodo com o zumbido / Introduction: Tinnitus is a symptom that affects about 10% of the population and can greatly impair the quality of life. In fact, it is considered as an important public health problem worldwide. The current pathophysiological models of tinnitus consider that the compensation of hearing loss could prevent or reverse changes in the auditory cortex. Hearing aids with an integrated sound generator have been used as an alternative to enhance the treatment of tinnitus in patients with hearing loss. However, there is no sufficient scientific evidence to support the superiority of the combined use of sound generator and amplification compared to conventional amplification alone. Objective: to verify whether the combined use of amplification and sound generator is more effective than amplification alone in reducing bothersome tinnitus in patients with mild to moderate bilaterally symmetrical sensorineural hearing loss. Methods: 49 patients with tinnitus and hearing loss underwent a blind randomized clinical trial. One group was bilaterally fitted with the combined use of amplification and sound generator, and the other group was fitted with amplification alone. The tinnitus annoyance was measured by THI and numerical scale. Psychoacoustic measurements of tinnitus were also performed. The initial and final assessments were performed by a blinded evaluator. Results: After 3 months, 62.5% of patients showed a reduction in tinnitus annoyance in the group of the combined use of amplification and sound generator, and 78% in the group with amplification alone, with no significant difference between the groups. For THI, numeric scale and tinnitus loudness, it was detected an effect of the MML, where higher values of MML are associated with greater discomfort due to tinnitus. Conclusion: The combined use of amplification and sound generator and the use of conventional amplification alone were equally effective in reducing tinnitus annoyance