Ohrgeräusche zutreffend begutachten: Möglichkeit, Plausibilität und Wahrscheinlichkeit

2021 ◽  
Vol 100 (09) ◽  
pp. 698-706
Author(s):  
Olaf Michel
Keyword(s):  
Tinnitus Masking

ZusammenfassungOhrgeräusche als subjektive, individuelle Empfindung entziehen sich einem objektiven Nachweis. In der Begutachtungssituation sind sie zudem von physiologischen oder spontanen Hörsensationen abzugrenzen.In Bezug auf die neue Königsteiner Empfehlung und auf die Rechtsprechung des letzten Jahres ist vor dem Hintergrund der unterschiedlichen Kausalitätsbegriffe in der Gesetzlichen und Privaten Unfallversicherung eine stringente Prüfung zur Feststellung, ob eine ausreichend hohe Wahrscheinlichkeit eines unfallbedingten subjektiven Ohrgeräusches vorliegt, bei der Begutachtung erforderlich. Um eine nachvollziehbare und vergleichbare Grundlage zu schaffen, wurde der Vorschlag einer Plausibilitätsprüfung mit der Erfassung von 5 Kriterien – angemessenes Ereignis, Unmittelbarkeit, Reproduzierbarkeit auf der Basis der heutigen Untersuchungsmethoden von Tinnitus-Masking und -Matching, Fortdauer und Fixierung und die Erfassung mit nichtsuggestiven Fragen – einer Überprüfung unterzogen.Die Übersichtsarbeit zeigt, dass sich die Anforderungen an den jeweiligen Beweismaßstab mit den angegebenen Nachweisschritten erfüllen lassen. Die einfache Möglichkeit des Vorliegens von Ohrgeräuschen kann über die Plausibilitätskriterien, die psychoakustische Verfahren beinhalten, sowie offene Fragen systematisch zur Wahrscheinlichkeit des Vorliegens geführt werden. Damit sind die Voraussetzungen für eine nachvollziehbare Kausalbetrachtung zwischen Ereignis und angegebenen Tinnitus nach aktuellen medizinisch-wissenschaftlichen Erkenntnissen geschaffen.

Assessment and Treatment of Tinnitus Patients Using a "Masking Approach"

2002 ◽  
Vol 13 (10) ◽  
pp. 545-558 ◽  
Author(s):  
Martin A. Schechter ◽  
James A. Henry
Keyword(s):  
Hearing Aids ◽  
Historical Review ◽  
Evaluation Process ◽  
Direct Patient Care ◽  
Tinnitus Questionnaire ◽  
Care Experience ◽  
Treatment Services ◽  
Assessment And Treatment ◽  
Retraining Therapy ◽  
Tinnitus Masking

Audiology clinics are increasingly being asked to provide tinnitus treatment services to patients who are severely distressed by tinnitus. It is unclear what levels of tinnitus care are available at different audiology clinics across the nation. Some clinics have staff who are experienced with the tinnitus masking technique or with tinnitus retraining therapy (TRT), whereas other clinics may limit their care to the provision of hearing aids. This article is an attempt to provide some basic information for those clinicians who would like to provide at least a minimum level of care for their tinnitus patients using the tinnitus masking approach. The most important requirement is a commitment by the clinician to assemble some basic resources and to structure the clinical schedule so that adequate time is available for historical review, evaluation, trial and selection of devices, and tinnitus counseling. A minimum set of measurements is recommended for inclusion in the tinnitus evaluation process. This informal review summarizes a variety of clinical observations culled from years of direct patient care experience. A tinnitus questionnaire is provided to help clinicians review potentially relevant issues.

Comparison of Tinnitus Masking and Tinnitus Retraining Therapy

2002 ◽  
Vol 13 (10) ◽  
pp. 559-581 ◽  
Author(s):  
James A. Henry ◽  
Martin A. Schechter ◽  
Stephen M. Nagler ◽  
Stephen A. Fausti
Keyword(s):  
Clinical Application ◽  
Basic Component ◽  
Tinnitus Retraining Therapy ◽  
Basic Approach ◽  
Sound Therapy ◽  
The World ◽  
Considerable Confusion ◽  
International Attention ◽  
Retraining Therapy ◽  
Tinnitus Masking

Two methods for treating tinnitus are compared. Tinnitus masking has been used for over 25 years, and although this method is used in clinics around the world, there are many misconceptions regarding the proper protocol for its clinical application. Tinnitus retraining therapy has been used clinically for over 12 years and has received considerable international attention. Although these methods are distinctive in their basic approach to tinnitus management, certain aspects of treatment appear similar. These aspects of treatment have created considerable confusion and controversy, especially regarding the use of "sound therapy" as a basic component of treatment. It is the objective of this article to clarify the major differences that exist between these two forms of treatment.

Does tinnitus originate from hyperactive nerve fibers in the cochlea?

1984 ◽  
Vol 98 (S9) ◽  
pp. 38-44 ◽  
Author(s):  
Richard S. Tyler
Keyword(s):  
Basilar Membrane ◽  
Tuning Curve ◽  
Nerve Fibers ◽  
Frequency Resolution ◽  
Signal Frequency ◽  
Physiological Data ◽  
Pitch Matching ◽  
Category Scaling ◽  
Tinnitus Masking ◽  
Peripheral Origin

AbstractThis paper discusses the possibility of a localized peripheral origin of tinnitus. A working hypothesis is that tinnitus represents either aperiodic or periodic hyperactivity in the spontaneous activity of nerve fibers originating from a restricted place on the basilar membrane. The limited physiological data available support both hyperactive and hypoactive nerve fiber. Psychophysical data are not easy to interpret. Subjective descriptions and category scaling are too dependent on individual experience. Pitch matching can be reliable, but cannot distinguish between peripheral or central tinnitus. In one experiment we compared the masking of tinnitus to the masking of a pure tone, where the signal frequency and level were obtained from the tinnitus pitch and loudness matching. The results indicate that the broad tinnitus masking patterns are not typically due to the poor frequency resolution observed in sensorineural hearing loss. However, in a few subjects there was some correspondence between the shape of the tuning curve and the tinnitus masking pattern. In another study, we masked tinnitus with narrowband noises of different bandwidths. In some patients, there was a ‘critical bandwidth’ effect; wider masker bandwidths required greater overall sound pressures to mask the tinnitus. We conclude that the results from these studies taken together indicate that there are different types of tinnitus, some of which may have a localized peripheral origin.

Prescription of binaural hearing aids in the United Kingdom: a knowledge, attitude and practice (KAP) study

2002 ◽  
Vol 116 (S28) ◽  
pp. 2-6 ◽  
Author(s):  
Sunil N. Dutt ◽  
Ann-Louise McDermott ◽  
Richard M. Irving ◽  
Ivor Donaldson ◽  
Ahmes L. Pahor ◽  
...  
Keyword(s):  
United Kingdom ◽  
Hearing Aids ◽  
Otitis Media With Effusion ◽  
Hearing Aid ◽  
Binaural Hearing ◽  
Unilateral Deafness ◽  
Attitudes And Practices ◽  
The United Kingdom ◽  
Paediatric Age ◽  
Tinnitus Masking

The purpose of this questionnaire study was to evaluate the existing knowledge of binaural hearing and the attitudes and practices of prescribing bilateral hearing aids amongst otolaryngologists in the United Kingdom. Of the 950 questionnaires sent to the current members of the British Association of Otolaryngologists and Head and Neck Surgeons (BAO-HNS), there were 591 respondents (62 per cent). The true response rate with completed questionnaires was 59 per cent. Eighty-one per cent of the respondents were aware of the importance of binaural hearing and had a positive attitude towards binaural fitting. The practice of bilateral hearing aid prescriptions was found to be poor amongst all grades on the NHS (less than 10 per cent of all hearing aid prescriptions). This practice in the private sector was variable, dependent largely on patient preference and affordability. The practice of binaural prescription was higher for patients in the paediatric age group than amongst adults. Two common indications for hearing aid prescriptions for unilateral deafness were otitis media with effusion in children (23 per cent of respondents) and for tinnitus masking in adults (12 per cent of respondents). Many otolaryngologists believed that there was not enough evidence to support bilateral bone-anchored hearing aid implantation and bilateral cochlear implantation. Ninety-four per cent of the respondents believed that binaural hearing was as important as binocular vision.

scholarly journals Comparing Tinnitus Tuning Curves and Psychoacoustic Tuning Curves

2019 ◽  
Vol 23 ◽  
pp. 233121651987853 ◽  
Author(s):  
Philippe Fournier ◽  
Malgorzata Wrzosek ◽  
Michel Paolino ◽  
Fabien Paolino ◽  
Anne Quemar ◽  
...  
Keyword(s):  
Related Activity ◽  
Tuning Curves ◽  
Sound Levels ◽  
Tinnitus Masking ◽  
Narrowband Noise

Tinnitus masking patterns have long been known to differ from those used for masking external sound. In the present study, we compared the shape of tinnitus tuning curves (TTCs) to psychophysical tuning curves (PTCs), the latter using as a target, an external sound that mimics the tinnitus characteristics. A secondary goal was to compare sound levels required to mask tinnitus to those required to mask tinnitus-mimicking sounds. The TTC, PTC, audiometric thresholds, tinnitus pitch, and level matching results of 32 tinnitus patients were analyzed. Narrowband noise maskers were used for both PTC and TTC procedures. Patients were categorized into three groups based on a combination of individual PTC–TTC results. Our findings indicate that in 41% of cases, the PTC was sharp (V shape), but the TTC showed a flat configuration, suggesting that the tinnitus-related activity in that subgroup does not behave as a regular stimulus-induced activity. In 30% of cases, V-shape PTC and TTC were found, indicating that the tinnitus-related activity may share common properties with stimulus-induced activity. For a masker centered at the tinnitus frequency, the tinnitus was more difficult to mask than the mimicking tone in 72% of patients; this was particularly true for the subset with V-shape PTCs and flat TTCs. These results may have implications for subtyping tinnitus and acoustic therapies, in particular those targeting the tinnitus frequency.

Comparison of Custom Sounds for Achieving Tinnitus Relief

2004 ◽  
Vol 15 (08) ◽  
pp. 585-598 ◽  
Author(s):  
James A. Henry ◽  
Betsy Rheinsburg ◽  
Tara Zaugg
Keyword(s):  
Pilot Study ◽  
White Noise ◽  
Auditory Stimulus ◽  
Broadband Noise ◽  
The Other ◽  
Research Center ◽  
Hearing Research ◽  
Group Data ◽  
Clinically Significant ◽  
Tinnitus Masking

Tinnitus masking has been a widely used method for treating clinically significant tinnitus. The method, referred to herein as "sound-based relief," typically uses wearable ear-level devices ("maskers") to effect palliative tinnitus relief. Although often effective, this approach is limited to the use of broadband noise with the maskers. We hypothesized that the effectiveness of treatment can be improved by expanding the auditory-stimulus options available to patients. A pilot study was conducted to determine for each of 21 subjects the most effective of custom sounds that are designed to promote tinnitus relief. While sitting in a sound booth, subjects listened to white noise and to custom sounds that are available commercially for providing tinnitus relief. Three sound formats ("E-Water," "E-Nature," and "E-Air") were provided by the Dynamic Tinnitus Mitigation (DTM-6a) system (Petroff Audio Technologies, Inc.). Additionally, seven sounds were provided by the Moses/Lang CD7 system (Oregon Hearing Research Center). Considering group data, all of the sounds provided a significant reduction in tinnitus annoyance relative to the annoyance of tinnitus alone. Two of the commercial sounds (DTM E-Nature and E-Water) were judged significantly more effective than the other sounds.

Clinical trial to compare tinnitus masking and tinnitus retraining therapy

2006 ◽  
Vol 126 (sup556) ◽  
pp. 64-69 ◽  
Author(s):  
J.A. Henry ◽  
M.A. Schechter ◽  
T.L. Zaugg ◽  
S. Griest ◽  
P.J. Jastreboff ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Tinnitus Retraining Therapy ◽  
Retraining Therapy ◽  
Tinnitus Masking

scholarly journals Neuromagnetic Indicators of Tinnitus and Tinnitus Masking in Patients with and without Hearing Loss

2012 ◽  
Vol 13 (5) ◽  
pp. 715-731 ◽  
Author(s):  
Peyman Adjamian ◽  
Magdalena Sereda ◽  
Oliver Zobay ◽  
Deborah A. Hall ◽  
Alan R. Palmer
Keyword(s):  
Hearing Loss ◽  
Tinnitus Masking

Masking of Tinnitus Compared to Masking of Pure Tones

1984 ◽  
Vol 27 (1) ◽  
pp. 106-111 ◽  
Author(s):  
Richard S. Tyler ◽  
David Conrad-Armes
Keyword(s):  
Tuning Curve ◽  
Low Frequency ◽  
Frequency Resolution ◽  
Signal Frequency ◽  
Frequency Range ◽  
Apparent Relationship ◽  
Pure Tones ◽  
Frequency Threshold ◽  
High Level ◽  
Tinnitus Masking

In 10 subjects with sensorineural tinnitus (associated with a sensorineural hearing loss and no apparent source for a tinnitus originating elsewhere), the minimum level required to mask the tinnitus was determined for tonal maskers at several masker frequencies. This tinnitus masking pattern was compared to a psychoacoustical tuning curve (PTC) in which the signal frequency and level were determined from tinnitus pitch and loudness matching. Different patterns emerged. One subject showed a near-normal PTC but required high-level maskers across the frequency range to mask the tinnitus. Another subject showed some frequency resolution in the PTC but required low-level maskers across the frequency range to mask the tinnitus. For the remaining eight subjects, the masker levels required to mask the tone were generally higher than those levels required to mask the tinnitus. In addition, it was noted that the tinnitus pitch-match frequency was sometimes associated with an increase or a decrease in threshold sensitivity, or it was found at the low-frequency edge of a steep high-frequency threshold loss. In other subjects there was no apparent relationship between the tinnitus pitch and the audiogram shape.

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