title: Neuromonics Tinnitus Treatment: third clinical trial.
abstract: OBJECTIVE
  The Neuromonics Tinnitus Treatment combines the use of a novel approach to acoustic stimulation with a structured program of counseling and support by a clinician specifically trained in tinnitus rehabilitation. The distinctive acoustic component has been designed to provide stimulation to auditory pathways deprived by hearing loss, engage positively with the limbic system, and allow intermittent, momentary tinnitus perception within a pleasant and relaxing stimulus, thereby facilitating desensitization to the tinnitus signal. The purposes of this study were (1) to demonstrate the efficacy of the treatment, when enhanced with various modifications since previously reported trials and (2) to test the relative clinical effectiveness of two variations of the approach. In the first, intermittent tinnitus perception was facilitated throughout treatment through the use of a stimulus in which intensity peaks allowed the patients' tinnitus perception to be completely covered up, whereas in the intensity troughs their tinnitus was briefly discernible. In the second, subjects experienced little tinnitus perception while listening to the treatment for the first 2 mo, then experienced intermittent perception.
  
  
  METHODS
  Thirty-five subjects with a predominantly moderate to severe level of tinnitus-related distress before treatment were randomly allocated into one of two treatment groups, corresponding to the two stage-based variations of the Neuromonics Tinnitus Treatment. Participants were provided with a high-fidelity personal sound player with earphones and an acoustic stimulus that had been spectrally modified according to their individual audiometric profile. They were instructed to use the acoustic stimulus for at least 2 hr per day, particularly at those times when their tinnitus was usually disturbing. Each group had equal amounts of clinician time for education, monitoring, and support.
  
  
  RESULTS
  At 2, 4, 6, and 12 mo after commencing treatment, both groups displayed clinically and statistically significant improvements in tinnitus distress, awareness, and minimum masking levels as well as loudness discomfort levels. Improvements increased with time over the first 6 mo of therapy, at which time 91% of all subjects across the two groups reported an improvement in tinnitus disturbance (as measured by the Tinnitus Reaction Questionnaire) of at least 40%, with a mean improvement of 65%. Also, 80% of subjects at 6 mo reported a level of tinnitus disturbance that was no longer clinically significant. There was some indication of a more consistent benefit over 12 mo for the group that was provided initially with a high level of tinnitus interaction; however, inter-group differences were not statistically significant. A relation between reported treatment usage (hours per day) and clinical outcomes was observed, suggesting that a "dosage effect" may apply with the stimulus provided.
  
  
  CONCLUSIONS
  This study found that the Neuromonics Tinnitus Treatment provides rapid and profound improvements to the severity of tinnitus symptoms and their effect on the subject's quality of life. This was a consistent effect, provided by a treatment that subjects reported as being pleasant to use. Both of the stage-based variations of the treatment that were tested in this study were shown to be successful in achieving these outcomes.
authors.affiliation: Division of Health Sciences, Curtin University of Technology, Perth, Australia. p.b.davis@curtin.edu.au
authors.forename: Paul B
authors.initials: PB
authors.lastname: Davis
authors.forename: Bardia
authors.initials: B
authors.lastname: Paki
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hanley
mesh_terms: D000161:Acoustic Stimulation / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001306:Auditory Pathways / Q000503:physiopathology; D003056:Cochlear Nerve / Q000503:physiopathology*; D005260:Female; D006310:Hearing Aids; D006319:Hearing Loss, Sensorineural / Q000453:epidemiology / Q000628:therapy; D006320:Hearing Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014012:Tinnitus / Q000453:epidemiology / Q000503:physiopathology* / Q000534:rehabilitation*