Category: Tinnitus Devices

Widex Zen Therapy (WZT) combines the use of counseling, amplification, fractal tones, relaxation strategies, sleep management, and many elements associated with Tinnitus Retraining Therapy (TRT) and Cognitive Behavioral Therapy (CBT) for an individualized comprehensive tinnitus management program. The distress associated with tinnitus has complex roots that are characterized by a diverse activation of neural structures. The components comprising tinnitus distress include the phantom auditory perception, the hyper-vigilance and excessive attention paid to the tinnitus, and the negative emotional element. In addition, major issues contributing to the anguish experienced by tinnitus patients include hearing loss, sleep deprivation, maladaptive thoughts and behaviors, and excessive stress. Robert W. Sweetow, PhD, is a professor in the Dept of Otolaryngology at the University of California, San Francisco and was Director of Audiology at the UCSF Medical Center Audiology Clinic for 20 years (1991-2011). He also serves as a parttime consultant for Widex A/S. Anne Mette Kragh Jeppesen, MA, is an audiologist at the Audiological Research Dept at Widex A/S, Lynge, Denmark. Correspondence can be addressed to Dr Sweetow at: Dozens of counseling and sound therapies have been proposed over the past two decades. While each of these approaches has been reported to be beneficial for certain patients, none are universally effective, and only a few have survived the test of time. Furthermore, none of the existing tinnitus therapies directly address all of the problems listed above that contribute to the distress experienced by tinnitus patients. Inattention to any of these issues can lead to failure. In this paper, we describe a new integrated approach to tinnitus patient management that incorporates not only the optimal segments of existing therapies, but novel acoustical stimuli and relaxation exercises, as well. The overall objective of Widex Zen Therapy (WZT) is to ensure that the tinnitus does not negatively impact the patient’s quality of life. It does not purport to be a cure, or to suppress tinnitus. The four main components of WZT, as shown in Figure 1, are: Counseling. This is both instructional and adjustment based,to educate the patient and assist the limbic system to alter or reclassify the negative interpretation of the tinnitus. For patients with high tinnitus distress levels, the use of Cognitive Behavioral Intervention (CBI) is recommended. Amplification. This stimulates the ears and brain in order to minimize increases in central activity (overcompensation) and maladaptive cortical reorganization. Fractal tones. A novel, proven acoustic stimulus—filtered in accordance with the hearing loss and delivered dichotically in a discreet, inconspicuous, and convenient manner—designed to both relax and provide acoustic stimulation. Relaxation strategy program. Highlighted by behavioral exercises and sleep management. The general rationale for inclusion of these elements is based on the following beliefs: Figure 1. Main elements of WZT. Counseling contributes greatly to the reduction of distress related to tinnitus and to the facilitation of habituation. The most popular counseling approaches are those incorporated into Tinnitus Retraining Therapy (TRT)1 and Cognitive-Behavioral Therapy (CBT).2,3 Critics of these approaches have argued that they are too restrictive.4 TRT focuses on helping the patient reclassify tinnitus as a non-salient stimulus to emphasize the brain’s natural ability to habituate. A different focus is used in CBT, which teaches the patient coping strategies, distraction techniques, and methods of identifying and correcting maladaptive thoughts and behaviors. Combining the two approaches, however, has the advantage of addressing all three primary aspects of tinnitus distress (auditory, attentional, and emotional). While it is possible for tinnitus to occur in the absence of a measurable hearing loss, the vast majority of individuals with chronic tinnitus show at least some degree of hearing deficit.5 It is believed that, when a peripheral hearing deficit exists, a cascade of reorganizational and physical changes occurs, leading to increased neural activity in the central auditory pathways.6,7 Specifically, the central nervous system reacts to the lack of appropriate neural stimulation from the ear by increasing its “attentiveness” to the auditory signals that do reach it, with consequent awareness of sounds arising from previously subconscious abnormal neural activity in the system. One of the reasons hearing aids have been successfully used to provide a certain degree of relief from tinnitus8-11 is that they provide increased neural stimulation, which in turn may decrease the central auditory system’s need to “overcompensate” for the peripheral attenuation. It has been demonstrated that sound enrichment can prevent maladaptive cortical tonotopic reorganization following noise exposure.12 Existing sound therapies, while helpful, have limitations. Masking might provide a degree of immediate relief, but in the long term may be perceived as being little more than the substitution of one annoying sound for another. Perhaps even more important is the belief that masking is counterproductive to habituation, because in order for habituation to occur, the person must be repeatedly exposed to that stimulus.13 The concept of masking thus has largely been replaced by the use of low-level broadband noise. But these steady-state signals may not foster stress reduction and relaxation, and, like masking, do not address the long-term emotional issues related to tinnitus. Also, some sound therapies require headphones, and thus may be intrusive, uncomfortable, or impractical for use during the work day. Other therapies employ a limited number of pre-recorded stimuli that can become predictable or boring, or promote active, rather than passive, listening. Furthermore, unless the sound therapy provides a correction for any existing hearing loss, the increase in central auditory gain is not being addressed. Stress is one of the most significant exacerbating factors for tinnitus.14 A recent investigation15 concluded that, while noise exposure and stress were both important contributors to tinnitus, stress was the more important factor for the transition from mild to severe distress. It has been reported that listening to music can result in physiological changes correlated with relaxation and stress relief.16 Patterns of musical elements, such as slower tempo, lower pitch, some degree of repetition, and lack of emotional content, have been established as having a calming, rather than alerting, effect.17,18 However, other articles have suggested that music can be less effective if it creates cognitive stimulation or has a negative emotional attachment.19,20 A recent survey21 indicated that, of nine tinnitus treatment methods assessed (hearing aids, music, medication, relaxation exercises, counseling, non-wearable sound generators, herbs and dietary supplements, wearable sound generators, and psychological counseling), the most substantial tinnitus amelioration was achieved with hearing aids (34%), followed closely by the use of music (30%). No other single treatment achieved an efficacy of more than 10%. More than 50% of tinnitus patients list sleep problems among their main complaints.22,23 A more detailed rationale and description of how each element of WZT is applied is presented below. Counseling. TRT and CBT both contain useful and successful counseling strategies. However, TRT does not directly address emotional issues or teach coping strategies, despite the fact that anxiety and depression are extremely common in tinnitus patients. A potential shortcoming of CBT is that it is commonly administered by psychologists who may not have an understanding of the auditory mechanism or the relationship between tinnitus, hearing loss, and sound enrichment. Additionally, both approaches may not satisfy the patient’s immediate need for gratification. For example, patients may become frustrated or reject the concept when informed that habituation via TRT may require as long as 18-24 months. Table 2. The pitch, tonality, dynamic range, and default tempo of the five Zen tones. A broadband noise is also available. All Zen programs are set in accordance with the patient’s hearing thresholds. WZT counseling integrates elements of both approaches. Instructional counseling incorporates TRT directive counseling. The objectives are to provide the patient with an understanding of the habituation process and to help the patient reclassify the tinnitus. It is intended to educate the patient about aspects of the tinnitus itself. For example, it addresses: The basic anatomy and physiology of the auditory (and central nervous) system; Why the tinnitus is present (particularly when it is a normal consequence of having a hearing loss); What the logical course of the tinnitus might be; and. How the limbic system affects the tinnitus perception and how the patient’s reaction impacts the ability to cope with or habituate to the tinnitus. Adjustment-based counseling expands these concepts and is designed to help the patient recognize aspects about how the tinnitus is affecting him or her, as well as the cognitive and behavioral ramifications. For example, it is intended to: Figure 2. Basic fitting parameters for Zen + settings. Address the emotional consequences of tinnitus, including fear, anxiety, and depression; Identify and correct maladaptive thoughts and behaviors; and. Foster understanding of the relationship between tinnitus, stress, worry, behaviors, negative thoughts, and quality of life. For some patients, instructional and general adjustment-based counseling might not be sufficient. In these cases, Widex Zen Therapy recommends the use of cognitive behavioral intervention to help the patient identify barriers to achieving natural...