The purpose of the present study was to determine whether the perceived severity of chronic tinnitus in a geriatric population increased, decreased, or remained constant with the passage of time. A questionnaire was designed to ascertain the subjects' perceived severity at time of onset and the perceived severity of their current tinnitus. The subjects were asked to rate their past and present tinnitus severity according to how much it bothered them. They were also asked questions pertaining to noise exposure history, hearing aid use, and tinnitus sound parameters for purposes of comparison with other groups previously studied.

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The phenomenon of residual inhibition, whereby the phantom sensation of tinnitus is suppressed following the presentation of a masking stimulus, has significant implications for understanding the neural basis of tinnitus itself. By using novel psychoacoustic techniques and three computer-based tools developed and applied specifically to measure tinnitus sensation and residual inhibition, a pattern emerges in which the depth and duration of tinnitus suppression relates to the center frequency of the band-passed noise masking stimulus. A correspondence between the region of hearing loss, the tinnitus spectrum and the masking stimuli most effective in suppressing tinnitus is revealed. These results suggest that cortical reorganization observed in animal models of tinnitus is not the principal basis of tinnitus, and provide a baseline for optimizing residual inhibition in individual cases and for further experiments. / Note: Pages 17-23 in this thesis were replaced with a citation due to copyright issues. / Thesis / Master of Science (MSc)

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Thesis (Au.D.)--James Madison University, 2010. / Includes bibliographical references.

TITLE: The possibilities of rehabilitation for people suffering from tinnitus AUTHOR: Bc. Petra Dvořáková DEPARTMENT: Department of Special Education SUPERVISOR: Mgr. Miroslava Kotvová ABSTRACT: The increasing phenomenon of tinnitus, the perception of noise caused by permanent damage to the cochlear hair cells, lately resulted in growing focus towards this problem. The main objective of this thesis is to evaluate, which of the available therapies for tinnitus is mostly sought by patients. The work presents insights of this phenomenon through its classification, provided aetiology and mainly focuses on possibilities of available therapies. Henceforth, the chapter with focus on the impact of tinnitus on the daily life of people suffering from tinnitus is one of the core chapters of this thesis. The practical part evaluates the already realised qualitative and quantitative research. Further, the quantitative method used is the questionnaire construction. The resulting values are summarised and presented with their absolute and relative abundance in tables and graphs. Following, the resulting values are complemented by three independent casuistry of persons suffering from tinnitus. The research questions focus on the general public awareness, what therapy method is mostly used, what are the main causes for the...

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Tinnitus is a highly prevalent health condition creating moderate or severe interference on mood, sleep and daily functioning for a group of those affected. The aims of this thesis were 1) to explore the role of acceptance and psychological flexibility in understanding tinnitus interference both experimentally and with a longitudinal design 2) to evaluate the immediate and long-term outcomes of an acceptance based behaviour therapy (Acceptance and Commitment Therapy; ACT) in the treatment of people with tinnitus and, 3) to investigate the relationship between treatment outcome and processes assumed to be the active ingredients of treatment (acceptance and cognitive defusion). Study I (n=47) was an experiment comparing the impact of acceptance to that of thought suppression or a neutral instruction on the ability to maintain attention on an imagery task. Results indicated that participants could benefit from an acceptance strategy when performing the task. Study II (n=47) was a longitudinal trial studying the mediating role of acceptance on the relationship between tinnitus interference at baseline and tinnitus interference, anxiety, life quality, and depression at a seven-month follow-up. Full mediation was found for life quality and depression, and partial mediation for tinnitus interference. Study IV (n=64) was a randomised controlled trial evaluating the immediate and long-term effects of ACT in comparison to those of Tinnitus Retraining Therapy (TRT) and to a wait list control. Results showed that ACT had large immediate effects on tinnitus interference in comparison to wait list, and medium long-term effects in comparison to TRT. Results were also seen on secondary outcome. Self-reported tinnitus acceptance significantly mediated the immediate outcome of ACT. Study III (n=24) was a process study where the video recorded sessions of ACT from study IV were observed and rated with regard to client behaviour. Results showed that in-session acceptance and defusion behaviours rated early in therapy were predictors of sustained positive treatment effects of ACT. These associations continued to be substantial even when controlling for the prior improvement in outcome. This whereas prior symptom change could not predict process variables rated late in therapy. Participants in all trials were chronic tinnitus patients, mainly from different departments of audiology. These findings implicate that 1) acceptance and psychological flexibility may contribute to the understanding of tinnitus interference 2) ACT can reduce tinnitus interference in a group of normal hearing tinnitus patients and 3) acceptance and cognitive defusion are important processes in ACT, related to outcome. / Tinnitus är ett mycket vanligt hälsoproblem där en grupp av de drabbade upplever påtagliga besvär såsom påverkan på sömn, välbefinnande och funktionsnivå. Denna avhandlings syften var att 1) utforska den roll acceptans och psykologisk flexibilitet har för förståelsen av tinnitusbesvär såväl experimentellt som med en longitudinell design 2) utvärdera de omedelbara och långsiktiga effekterna av en acceptansinriktad beteendeterapi (Acceptance and Commitment Therapy; ACT) vid behandling av personer med tinnitus samt 3) undersöka relationen mellan behandlingsutfall och processer som antas utgöra behandlingens aktiva komponenter (acceptans och kognitiv defusion). Studie I (n=47) var ett experiment där man jämförde förmågan att bibehålla uppmärksamheten på en mental bild vid tre olika betingelser: acceptans, tankesuppression eller en neutral betingelse. Resultaten indikerade att deltagarna som slumpats till acceptans var hjälpta av denna strategi i genomförandet av uppgiften. Studie II (n=47) var en självrapportstudie med longitudinell design där det undersöktes om acceptans fungerade som en mediator i sambandet mellan tinnitusbesvär i baslinjen och livskvalitet, depression, ångest och tinnitusbesvär vid en uppföljning efter sju månader. För variablerna livskvalitet och depression visade resultaten en fullständig mediation och för tinnitusbesvär en partiell mediation. Studie IV (n=64) var en randomiserad kontrollerad prövning av de omedelbara och långsiktiga effekterna av ACT i jämförelse med Tinnitus Retraining Therapy (TRT) och en väntelistekontrollgrupp. Resultaten visade att ACT hade en stor omedelbar effekt på tinnitusbesvär i jämförelse med väntelistan och en medelstor effekt i jämförelse med TRT. Även sekundära utfallsmått visade på effekter. Utfallet i ACT medierades av självrapporterad acceptans av tinnitus. Studie III (n=24) studerade processer i ACT-behandlingen genom observation och skattning av klientbeteenden under de videoinspelade sessionerna. Resultaten visade att klienternas acceptans- och defusionbeteende under sessioner tidigt i terapin predicerade det långsiktiga utfallet i behandlingen. Dessa samband kvarstod även när man kontrollerade för symtomförbättring fram till den skattade sessionen. Detta medan tidigare symtomförbättring inte predicerade klientbeteende senare i behandling. Deltagare i samtliga studier var patienter med kronisk tinnitus, huvudsakligen rekryterade från reguljär hörselvård. Resultaten från dessa studier indikerar att 1) acceptans och psykologisk flexibilitet kan bidra till förståelsen av tinnitusbesvär 2) ACT kan minska tinnitusbesvär hos en grupp normalhörande patienter 3) acceptans och kognitiv defusion är viktiga processer i ACT vilka är relaterade till behandlingutfallet.