Notched Noise Therapy for Suppression of Tinnitus: A Randomized Controlled Trial

耳鸣是退伍军人最常见的与服务相关的残疾。许多退伍军人都有健全的- 旨在改变耳鸣感觉和/或对耳鸣的反应的耳鸣基础(听觉)疗法 以一种对临床有益的方式。各种声疗方法正在使用中，公司正在推广 不同的产品。目前尚不清楚；然而，某些声学参数如何可能比 其他。最近的研究表明，其中一种名为缺口噪音疗法的声学疗法的好处是 呈现宽带声音，耳鸣频率区域被切开，理论上是横向分布的 抑制进入陷波频率区域，以抑制据信导致耳鸣的神经活动。 以前的研究通常涉及日常短暂的暴露，这不太可能重塑神经 处理潜在的耳鸣是持续的“沉浸”在背景声中，这是这里采用的。这个 拟议的研究将进行一项随机对照试验，以评估凹槽噪音治疗的疗效。 (NNT)。我们研究计划的长期目标是开发一种可获得的、基于证据的治疗方法， 减少耳鸣的响度，并能够通过经过验证的行为方法来评估治疗 和生理学临床工具。CDA-2研究计划的总体目标是下一步 为了实现我们的长期目标，是系统地评估功能、心理声学、 以及电生理措施，以揭示患有慢性耳鸣的退伍军人的整体健康影响。 这项试验将招募108名参与者，他们将被随机分成三种声音疗法之一： 放大+陷波噪声、放大+无陷波噪声和仅放大。这三个小组将 被要求佩戴耳平设备(提供扩音器和1-10 kHz的组合设备 可整形噪音)在醒着的时候尽可能多。所有参与者将接受为期8年的听觉疗法 并将完成结果测量(即耳鸣功能指数、心理声学响度和 基音匹配、AEP和EEG测量)在基线、4周和8周。他们会重复结果 在12周时进行评估，以评估在未接受4次听力治疗的情况下维持任何效果的情况 几周。(因听力损失而需要佩戴助听器的参与者将在四周的禁区内继续使用助听器- 治疗期)。我们假设，NNT通过将侧向抑制分布到脑组织来抑制耳鸣感觉。 因此，耳鸣会降低耳鸣的响度。在完成时 在CDA-2计划中，预期的结果包括NNT作为耳鸣的治疗方法和贡献 它可能对耳鸣感知以及为成功的退伍军人事务部研究奠定坚实的训练基础 职业生涯。这些结果预计将产生重要的积极影响，因为它们不仅将提供 洞察干预的真正反作用力和知觉益处，但治疗评估方案 将被确定，最终为基于证据的声学疗法的发展提供基础 治疗耳鸣，这是老兵耳鸣护理的关键组成部分和目标。

Tinnitus is the most prevalent service-connected disability for Veterans. Many Veterans are offered sound- based (acoustic) therapy for tinnitus that is intended to alter the tinnitus perception and/or reactions to tinnitus in a clinically beneficial way. Various methods of acoustic therapy are in use and companies are promoting different products. It remains unknown; however, how certain acoustic parameters may be more effective than others. Recent research has shown the benefit of one such acoustic therapy, Notched Noise Therapy, that presents wideband sound with the tinnitus frequency region notched out, theorized to distribute lateral inhibition into the notched frequency region to suppress neural activity believed to cause the tinnitus percept. Previous studies have typically involved brief daily exposures, which are not as likely to remodel neural processes underlying tinnitus as is continuous “immersion” in background sound, which is adopted here. The proposed study will conduct a randomized controlled trial to evaluate the efficacy of notched noise therapy (NNT). The long-term goal of our research program is to develop an accessible, evidence-based treatment that reduces tinnitus loudness and to be able to assess that treatment through a validated method of behavioral and physiological clinical tools. The overall objective for this CDA-2 research plan, which is the next step toward attainment of our long-term goal, is to systematically evaluate the utility of functional, psychoacoustic, and electrophysiologic measures to reveal the overall whole-health impact in Veterans with chronic tinnitus. The trial will enroll 108 participants, who will be randomized to one of three acoustic therapy methods: amplification + notched noise, amplification + noise without notch, and amplification-only. The three groups will be asked to wear ear-level devices (combination instruments that provide both amplification and 1-10 kHz shapeable noise) as much as possible during waking hours. All participants will undergo acoustic therapy for 8 weeks and will complete outcome measures (i.e., Tinnitus Functional Index, Psychoacoustic loudness and pitch matches, AEP, and EEG measures) at baseline and at 4 and 8 weeks. They will repeat outcome assessment at 12 weeks to evaluate for maintenance of any effects while not receiving acoustic therapy for 4 weeks. (Participants requiring hearing aids for hearing loss will continue to use their aids during the 4-week no- treatment period). We hypothesize that NNT suppresses tinnitus perception by distributing lateral inhibition into the notched frequency region and will therefore, reduce the perception of tinnitus loudness. At the completion of this CDA-2 program, the expected outcomes include a NNT as a therapy for tinnitus and the contributions that it may have on tinnitus perception as well as a solid training foundation for a successful VA research career. These results are expected to have an important positive impact because they will not only provide insight into the true reactionary and perceptual benefit of an intervention, but a treatment evaluation protocol will be determined, ultimately providing a foundation for the development of evidence-based acoustic therapies to treat tinnitus, a critical component and goal of Veteran tinnitus care.