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Tinnitus & Hyperacusis Glossary

The American Tinnitus Association (ATA) is pleased to provide our readers with a glossary of terms pertaining to tinnitus and hyperacusis. It has been adapted with permission from a document published with the Progressive Tinnitus Management program developed by researchers and clinicians at the Veterans Health Administration. The ATA Tinnitus & Hyperacusis Glossary was edited by members of the Tinnitus Today Editorial Advisory Panel.

The terminology used to describe any condition is of vital importance to diagnosis and treatment of the condition. Without a commonly understood set of terms, we could not effectively communicate a diagnosis, direct treatment for conditions, or expect patients to understand and follow those treatments accurately.

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Acceptance and Commitment aminoglycoside antibiotics: Any by neural networks that respond to Therapy (ACT): A psychotherapeutic of a group of antibiotics derived from different levels of sound. approach similar to Cognitive Behav- various species of Streptomyces that auditory hallucinations: Usually ioral Therapy (CBT), and sometimes is inhibit bacterial protein synthesis and perceived as voices or music (and referenced as part of the third wave of are active against gram-negative bac- sometimes as environmental sounds, CBT approaches. ACT involves mind- teria, in particular. Aminoglycosides e.g., a barking dog), and have been fulness, which is aimed at reducing include streptomycin, gentamicin, studied primarily in the context of psychological distress, depressive amikacin, kanamycin, tobramycin, and mental health. Some individuals who symptoms, and anxiety by focusing on neomycin, among others. All can be experience auditory hallucinations do the present moment. Effects of ACT highly toxic and should require moni- not have discernible mental illness. have been investigated in different toring for early signs of toxicity—par- The prevalence of auditory halluci- populations, including patients with ticularly ototoxicity and nephrotoxicity. nations is unknown, although small different psychological disorders (e.g., annoyance: An unpleasant nuisance studies have reported rates of 2- to anxiety and depression), and chronic that causes irritation and word that 32-percent. Auditory hallucinations health conditions (e.g., chronic fatigue often is used to describe negative without mental illness are more com- and chronic pain), as well as with oth- emotional reactions to tinnitus. An- mon in women than men and increase erwise healthy individuals. Third-wave noyance level can be rated on a scale with age and with hearing loss. The CBT approaches have been making of, e.g., 1-10, where one represents most common manifestation is hear- their way into tinnitus intervention no annoyance and 10 represents the ing repetitive musical patterns, with or research as well. most annoyance imaginable. without lyrics (musical hallucinations). acute tinnitus: Also referred to as audiobook: Audio recording of a auditory imagery: A normal phe- “recent-onset” or “new-onset” tinni- book or magazine that can be lis- nomenon that occurs for all people tus, acute tinnitus has been exper- tened to as an alternative to visual that generally refers to the imagination ienced either persistently or recur- reading. Audiobooks can be used of sound, such as repeating a phone rently for less than six months. Most as sound-based therapy for tinnitus number in one’s head or recalling a clinicians and researchers identify six management, especially for distract- musical song or passage. months as the point in time when ing attention away from the tinnitus. acute tinnitus becomes chronic augmentative sound: Any sound Audiobooks may be accessed as CDs, tinnitus, although there is a used therapeutically for tinnitus MP3 files, or downloaded from vari- range of opinion regarding management, exclusive of sound from ous subscription services. the point at which tinni- ear-level devices. tus becomes chronic, auditory gain: The auditory sys- augmentative sound device: Any from three to 24 tem has “gain control,” similar to the device (other than ear-level device) that months. volume control on a stereo, and the produces sound that can be used ther- level of gain determines the degree apeutically for tinnitus management. to which environmental sounds are These can include TV, radio, MP3 amplified, or enhanced. The level of player, fan, satellite radio, smartphone, gain changes automatically to adjust and tabletop sound generators. to the level of sound. As the sound level decreases, the gain increases, autonomic nervous system: and vice versa. Gain is controlled Controls basic bodily functions, such partially by the outer hair cells as heartbeat, blood pressure, breath- of the inner ear, which ing, body temperature, sweating, etc. mechanically amplify These are automatic functions that we sounds, and partially cannot normally control; to an extent,

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these functions can be modified by clinical research. Its earliest use was to exercising or relaxing; also, techniques treat mood disorders, such as depres- such as biofeedback and hypnosis can sion and anxiety. CBT for tinnitus was provide a certain amount of control first described by an audiologist who over the autonomic nervous system; adapted CBT, as used for pain manage- complete the method of Tinnitus Retraining ment. Since then, numerous studies of masking of Therapy (TRT) describes the autonom- CBT for tinnitus have been published, tinnitus: Use ic nervous system as part of the neu- as well as a detailed text outlining the of sound to com- rophysiologic model of tinnitus, which components and relevant exercises for pletely suppress the is essential to TRT counseling. implementing CBT for tinnitus. CBT perception of tinnitus. now is viewed as a psychotherapy Although complete masking Baroque music: Style of classical offered only by mental health clinicians was originally the intent of Dr. music composed between 1600 and specifically trained to provide this Jack Vernon’s method of Tinnitus 1750. A commercial wearable device particular intervention. The primary Masking, it soon became clear that uses Baroque music configured spe- components of CBT for tinnitus include partial masking also was effective for cifically for tinnitus management. education, cognitive restructuring, at- patients. Bluetooth: Utilization of shortwave tention control, and training in the use coping skills: Any strategy, such radio frequencies to permit wireless of imagery and relaxation techniques. as using soothing sound, designed communication between computers, chronic tinnitus: Tinnitus experi- to benefit a person with respect to cell phones, printers, audio devices, enced either persistently or recurrent- reducing reactions to tinnitus; coping and a variety of other applications. It ly over a long duration of time is con- skills that are taught in CBT include enables wireless streaming of audio sidered chronic. The VA and numerous stress management, distraction, and signals from Bluetooth-enabled devic- entities define chronic as lasting more cognitive restructuring (changing es to some hearing aids. than six months, although the transi- thoughts and feelings). broadband noise: Wide band of tional time point from acute to chronic decreased sound tolerance: sound, configured such that each fre- tinnitus lacks consensus. See acute Inability to tolerate everyday sounds quency within the band produces com- tinnitus. that most people tolerate easily. See parable output. It often is referred to as cisplatin: A chemotherapeutic drug related terms hyperacusis, misopho- masking noise for purposes of deliver- used to treat a variety of cancers, nia, and phonophobia. ing sound-based therapy for tinnitus. which has the highest ototoxic poten- distraction: General approach of brown noise: A broadband noise tial of all the platinum compounds in directing one’s attention away from a where the sound pressure level drops clinical use. See ototoxic drug. disturbing symptom or problem and as the frequency rises; with brown combination instrument: An is a technique that can be helpful in noise the sound pressure level drops ear-level device, either custom in-the- managing reactions to tinnitus. faster than it does with pink noise. ear or behind-the-ear, containing both Brown noise is perceived by a normal ear-level device: In-the-ear or behind- an amplification circuit and a separate human ear to have more low-frequency the-ear instrument used for amplifica- circuit for production of a generally than high-frequency energy and some- tion and/or tinnitus management. An broadband or filtered noise. These times is used to manage reactions to ear-level device may be a hearing aid, instruments are used when patients tinnitus. masker, or combination instrument. require amplification for hearing loss Cognitive Behavioral Therapy and also experience tinnitus. The fight-or-flight response: The (CBT): Method of psychotherapy noise may usually be shaped and can autonomic nervous system be- that has undergone three decades of be beneficial to patients for tinnitus comes strongly activated when there development based on theoretical and management. is danger or fear; specifically, the

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sympathetic part of the autonomic structures, common to all mammals, perceived loudness of their tinnitus. nervous system induces changes in and involved in olfaction, emotion, Although this testing is commonly the body that prepare it for fight or motivation, behavior, and various au- performed, the results of loudness flight. These changes include release tonomic functions. The limbic system matching are of little value with re- of adrenaline into the bloodstream, is explained as part of the structured spect to assessment of the problem, increased muscle tension, increased counseling for Tinnitus Retraining determining a course of therapy for heart rate, increased rate of respira- Therapy (TRT). Bothersome tinnitus is tinnitus management, or outcomes of tion, and shutting down of digestive thought to activate the limbic system, intervention. processes. Tinnitus Retraining Ther- which further activates the autonomic loudness recruitment: Condition apy (TRT) refers to the fight-or-flight nervous system. that naturally results from sensorineu- phenomenon as part of its structured loudness contrast: Relative differ- ral (cochlear) hearing loss. With senso- counseling. ence in loudness between different rineural hearing loss, sound becomes habituation: Conscious or uncon- acoustic percepts in a particular just-perceptible (i.e., hearing thresh- scious decrease in response to a stim- acoustic environment. With respect to old) at a louder level than it does for ulus after being repeatedly exposed to tinnitus, there may be a clear loudness people with normal hearing. However, it. The stimulus can be auditory, visual, contrast between the tinnitus and the level at which sound becomes un- or tactile. The main goal of treatment the ambiance of a quiet environment. comfortably loud usually remains with- with Tinnitus Retraining Therapy (TRT) Adding any sound to the environment in the same range as for people with is habituation of the reactions to tinni- will reduce the contrast between the normal hearing. This means that the tus, while the secondary goal is habit- sound of the tinnitus and the ambient range in perceived loudness between uation of the perception of tinnitus. sound, and is often accomplished the hearing threshold and the level at simply by the use of hearing aids. which sound becomes uncomfortably Hyperacusis: Condition of physical loud is narrowed. Consequently, the discomfort or pain in response to sound loudness discomfort level (LDL): perception of loudness grows more at levels that are easily tolerated by The level at which sound becomes rapidly in this range than for people most people. People with hyperacusis uncomfortably loud. Commonly with normal hearing. Thus, loudness find all sounds uncomfortable once they measured clinically in a sound booth recruitment per se does not indicate reach a certain level of loudness. The using pure tones and/or speech as the decreased tolerance to sound. level at which sound becomes un- stimuli, although there is no standard- comfortable for someone with ized procedure for measuring LDLs. masker: Most generally refers to hyperacusis varies from This can be problematic, because an ear-level sound-generating device; person to person. procedures for measuring LDLs can the method of Tinnitus Masking can significantly affect test results. Of utilize any device that presents sound limbic system: note, patients often find this testing to to the ear, and, if such a device pro- A group of in- be aversive, and no research evidence vides relief—whether or not it totally terconnect- supports LDL test results as a good eliminates that patient’s perception of ed deep indicator of a patient’s ability to toler- tinnitus—it is referred to as a masker. brain ate everyday sound outside of the test Thus, even hearing aids and combina- environment. tion instruments are each referred to as maskers, when their main purpose is loudness matching: A perceptual to provide relief for the tinnitus patient. task, usually administered by an audiologist, in which patients masking of tinnitus: Conventional are asked to match the (sound-on-sound) masking obeys a loudness of an externally number of rules that are consistent presented tone to the between individuals; such effects

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have received extensive investigation term masking, however, continues in and the rules are well defined. Many common use. studies have been conducted to New misophonia: Term coined by Dr. determine if these same rules apply Age Pawel Jastreboff to describe dislike to the masking of tinnitus, and these music: of sound. In cases of misophonia, it studies have generally concluded Umbrella is not the loudness of a sound that that there are many dissimilarities term for style of dictates whether or not the listener between masking a tinnitus signal and various down-tem- finds the sound to be uncomfortable conventional sound-on-sound mask- po music intended to (as is the case with hyperacusis), ing. Patients vary widely with respect induce relaxation, in which but, rather, it is an emotional reac- to their tinnitus maskability. For some, the melodies are often repet- tion to the sound that causes it to be almost any sound will mask their tinni- itive to create a hypnotic feeling, experienced as uncomfortable. With tus, while for others almost no sound and sometimes recordings of nature misophonia, it is common for a patient will produce masking; some patients sounds are used as an introduction to find particular sounds to be uncom- do apparently experience optimal to a track or throughout the piece. fortable at a relatively low level, but to masking when the masking sound ap- New Age music is sometimes used in find other sounds at the same level to proximates the sound of their tinnitus. sound-based therapy tinnitus devices be acceptable. See complete masking of tinnitus and and used for relaxation as part of a partial masking of tinnitus. musical hallucinations: See audi- tinnitus treatment process. tory hallucinations. mindfulness: See Acceptance and new-onset tinnitus: See acute Commitment Therapy. musicians earplugs: Custom tinnitus. or non-custom hearing protective minimum masking level (MML): noise generators: See sound gen- earplugs that also permit percep- In the clinic, minimum masking erating devices. tion of clear sound to enable verbal level refers to the minimum level of communication or accurate musical non-psychiatric auditory halluci- broadband noise required to render perception. Custom-fit musicians nations: Auditory hallucinations that a patient’s tinnitus inaudible. Clinical earplugs may be the optimal choice of are not associated with psychopathol- measurement of minimum masking protection from loud sound, especially ogy; non-psychiatric auditory halluci- level has involved bands of noise, for people with hyperacusis, because nations are typically experienced by primarily because tonal maskers are they allow for near-normal hearing those who are hard of hearing or are not well tolerated by most patients. while providing protection from aver- socially isolated, as well as elderly Clinical data suggest that tinnitus is sive or dangerous sounds. If properly people who also may have tinnitus. easily masked for most patients; other cared for, they will last for years. See auditory hallucinations. reports, however, suggest that many patients with bothersome tinnitus per- neurophysiological model of tin- objective tinnitus: See secondary ceive it most of the time, even in loud nitus: Developed by Dr. Pawel Jas- tinnitus. environments. treboff; the model depicts tinnitus as ototoxic drug: A drug that has the neural activity in the auditory nervous minimum suppression level capability of damaging the eighth system, with other parts of the central (MSL): Dr. Pawel Jastreboff coined cranial (vestibulocochlear) nerve or the nervous system (cortical, limbic, and the term minimum suppression level organs of hearing and balance. The autonomic nervous systems) involved (as a replacement for minimum mask- most common ototoxic drugs that can in those persons for whom tinnitus ing level) to describe the suppression cause irreversible hearing loss and/ becomes annoying or intrusive. The of neural activity that results in elim- or tinnitus are the aminoglycoside neurophysiological model is the focus ination of the perception of tinnitus antibiotics and the cancer chemother- for TRT counseling. as a result of an external sound. The apeutic cisplatin.

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overuse of hearing protection partial masking of tinnitus: awareness and increased sensitivity (overprotection): Some patients Occurs when external sound causes to everyday sounds. who have reduced tolerance to sound spectral changes in the tinnitus and/ pink noise: Broadband noise in (hyperacusis and/or misophonia) will or the external sound reduces the which the intensity of sound decreas- begin using hearing protection even perceived loudness of tinnitus (con- es as a function of increasing fre- when unnecessary—often due to a fear sistent with psychoacoustics, i.e., quency. Because of how the human that environmental sound will become presentation of one sound can reduce auditory system processes sound, uncomfortably loud (i.e., phonopho- the perceived loudness of a second pink noise is perceived by normal bia). Wearing hearing protection when sound). human ears to have relatively equal sounds are not uncomfortably loud is permanent tinnitus: Persistent tin- energy across the frequency range very likely to make a sound tolerance nitus experienced for a duration of at when compared to white noise that is problem worse. Therefore, it is import- least six to 12 months, at which time perceived to have more high-frequen- ant for patients with decreased sound it is not expected to resolve. Similar cy energy. Pink noise sometimes is tolerance to understand the importance to chronic tinnitus, although the point recommended for use by people with of using hearing protection only when at which tinnitus becomes permanent hyperacusis to improve the condition. needed either to protect from danger- cannot be known with any certainty. It also is sometimes used to manage ously loud sound or to allow oneself The longer a person has had tinnitus, reactions to tinnitus. to be around sounds that otherwise the more likely it is to be a permanent would be uncomfortably loud. pitch matching: Perceptual task condition. in which patients match the pitch of parasympathetic nervous sys- personal listening device: General- an externally presented tone to the tem: Part of the involuntary nervous ly portable, electronic audio devices in- perceived pitch of their tinnitus. There system that serves to slow the heart clude devices like an iPod, MP3 player, is no standardized clinical method for rate, increase intestinal and glandular smartphone, or any personal listening obtaining a pitch match, and research activity, and relax the sphincter mus- device that potentially can be used for has shown that very often when pitch cles. The parasympathetic nervous sound-based therapy for tinnitus. match procedures are repeated, sub- system, together with the sympa- stantial variability in the pitch match is thetic nervous system, constitutes phantom auditory sensation seen within a single patient (typically the autonomic nervous system. (PAS): An internally generated sound over a range of two-to-three octaves). Tinnitus Retraining Therapy (TRT) can be termed a phantom auditory counseling includes descrip- sensation, because no corresponding podcast: A multimedia digital file tions of the sympathetic sound source exists in the listener’s made available on the internet for and parasympathetic environment. A PAS can include all downloading to a portable media player, nervous systems to manifestations of auditory hallucina- computer, etc. Examples of podcasts help explain the tions and tinnitus. include ATA’s Conversations in Tinnitus, neurophys- talk radio programs, audio books, web phonophobia: Fear that normal iological TV shows, and web movies. levels of sound will be uncomfortably model. loud, damage hearing, make tinnitus primary tinnitus: Tinnitus that is louder, or cause other problems. idiopathic (has no known cause); may People with phonophobia may use or may not be associated with senso- hearing protection in anticipation rineural hearing loss; primary tinnitus of loud sound (even when loud is by far the most common type of sounds are not present). Such tinnitus (relative to secondary tinnitus). overprotection can result Progressive Tinnitus Manage- in increased tinnitus ment (PTM): A stepped-care

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approach designed to be maximally quinine: An ototoxic drug primarily efficient to have the least impact used as an antimalarial agent, quinine on clinical resources, while still is therapeutically available as sulfate addressing the needs of all patients or hydrochloride. It can cause tempo- who complain about tinnitus. PTM rary hearing loss and/or tinnitus, but secondary consists of five levels that offer a these effects are generally reversible tinnitus: systematic framework for providing once the quinine delivery is stopped. Also referred to only the level of services required as somatosounds recent-onset tinnitus: See acute by the individual patient: Level 1 (sometimes historically tinnitus. Referral; Level 2 Audiologic Evalua- referred to as somatic tion; Level 3 Skills Education; Level recruitment: See loudness recruit- tinnitus), secondary tinnitus 4 Interdisciplinary Evaluation; Level ment. refers to the perception of sound 5 Individualized Support. The PTM that originates within the body—in reduced contrast: Tinnitus in a very method was developed by research- vascular, muscular, skeletal, or respira- quiet environment would represent ers and clinicians who work for the tory structures, or in the temporoman- maximum contrast, while tinnitus in a Veterans Health Administration, but is dibular joint. These “body sounds” background of sound that decreases adaptable to any clinic that provides have an internal acoustic source, and perception of tinnitus would be de- tinnitus services. patients suspected of having second- scribed as reduced contrast. The com- ary tinnitus should undergo an assess- psychiatric auditory hallucina- monly used visual analogy is a light ment by an otologist/otolaryngologist. tions: Auditory hallucinations that source in a dark room as compared are associated with psychopathology. with a light source in a brightly lit self-management: Deliberate use They are a sign of mental illness and room, an idea that may have originat- of learned methods, skills, and strat- have nothing to do with the auditory ed with the counseling for Tinnitus Re- egies to maintain or modify one’s system. See auditory hallucinations. training Therapy (TRT) that describes own attitudes and actions. Strategies “the candle in the dark room.” include goal setting, self-monitoring, post-traumatic stress disorder self-correction, and self-solicitation of (PTSD): Also known as shell shock reduced sound tolerance: See feedback toward the achievement of and combat stress. People who decreased sound tolerance. objectives. In terms of tinnitus, the have experienced severe trauma or residual inhibition (RI): Phenom- goal of self-management is to provide a life-threatening event may devel- enon in which prolonged exposure to tools and education to patients to op PTSD. If PTSD is comorbid with broadband noise (clinically one minute effectively self-manage their reactions tinnitus, it can exacerbate reactions to of broadband noise is presented at 10 to tinnitus. tinnitus. dB above the minimum masking level) sensorineural hearing loss: pulsatile tinnitus: Perception of results in complete or partial elimina- Hearing loss that is caused by loss or abnormal pulsing sounds in the ears tion of the perception of tinnitus for a damage of the hair cells in the inner or head. Pulsatile tinnitus usually is short period of time after cessation of ear (cochlea). Exposure to loud sound caused by blood flow disturbance, a the broadband noise. The effect usually is the most common cause of sensori- blood vessel abnormality, or, more un- lasts less than one-to-three minutes. neural hearing loss. commonly, a vascular tumor. Pulsatile salicylate: Class of pain relief drug that tinnitus pulses in synchrony with the somatosounds / somatic tinni- can be ototoxic in large doses. Aspirin is heartbeat, and is the most common tus: See secondary tinnitus. an example of a salicylate, and auditory type of secondary tinnitus. Patients effects can include reduced hearing sound generating devices: Wear- suspected of having pulsatile tinnitus sensitivity and tinnitus. These effects, able, portable, or stationary devices should be referred for an assessment however, are generally temporary. capable of producing various types of by an otologist or otolaryngologist.

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sound and mitigating tinnitus aware- stationary listening devices: Also exposure to loud sound, however, ness by (1) reducing contrast between referred to as tabletop devices. See temporary tinnitus can become per- tinnitus and the acoustic environment, sound generating devices. manent tinnitus. (2) providing interesting sound, or (3) stress response: Constellation of timbre: Combination of qualities of providing soothing sound. Examples physiological responses on a contin- a sound that distinguish it from other include (but are not limited to) elec- uum of intensity, with fight or flight sounds of the same pitch and volume; tric fan, tabletop fountain, radio, CD being the extreme of these combined tinnitus can be described as having player, MP3 player (e.g., iPod), smart- responses. The physical effects of acoustic parameters of loudness, phone (e.g., iPhone), sound machine, severe tinnitus are best understood in pitch, and timbre, which also can be and/or sound pillow. Note: any of the context of the stress response. thought of as the spectral quality of these devices are suitable for tinnitus tinnitus. sound therapy depending on the par- sympathetic nervous system: ticular tinnitus-problem situation. The autonomic nervous system tinnitus: The perception of sound in becomes strongly activated when the ears or head where no external sound-based therapy: Also there is danger or fear. Specifically, source is present. It is distinguished referred to as sound therapy and the sympathetic part of the autonomic from transient ear noise and auditory acoustic therapy, this is any use of nervous system induces changes in hallucinations, and it can be primary or sound to mitigate negative reactions the body that prepare it for fight or secondary. to tinnitus. Sound-based therapy can flight, including release of adrena- include any type of sound that is Tinnitus Activities Treatment line into the bloodstream, increased presented at a safe and comfortable (TAT): A clinical management pro- muscle tension, increased heart rate, level and that does not cause any gram for tinnitus developed at the increased rate of respiration, and shut- degree of annoyance or discomfort. University of Iowa; it utilizes coun- ting down of digestive processes. The Increasing numbers of companies seling and sound therapy to provide fight-or-flight response is so powerful provide devices that utilize a very spe- habituation and decrease in negative it can be sustained for only a brief cific sound-stimulus protocol. Other reactions to tinnitus; TAT provides period of time. methods that primarily use sound as education in four areas: 1) thought and therapy are Tinnitus Masking and Tin- systematic desensitization: emotion; 2) hearing and communica- nitus Retraining Therapy (TRT). In The key to treating hyperacusis is to tion; 3) sleep; and 4) concentration. addition, Progressive Tinnitus desensitize the auditory system to TAT uses partial masking of tinnitus at Management teaches how sound, which involves systematic the lowest level that provides relief. to use sound in a variety exposure to sounds that cause no tinnitus impact: The influence or of ways to address annoyance. Over time, this process effect that tinnitus has on an individu- specific situations results in the ability to listen comfort- al’s quality of life. when tinnitus ably to sounds that are gradually loud- is problem- er. In fact, improvement in loudness tinnitus instrument: Another term atic. tolerance can be observed in as little for a combination instrument (hearing as a few weeks. aid that contains a sound generator); this term was used by proponents of temporary tinnitus: Tinnitus the Tinnitus Masking method. induced, usually by loud sound or ototoxic drugs, that is reversible. Tinnitus Masking (TM): Method Temporary tinnitus usually lasts of tinnitus management developed by up to one week following the Dr. Jack Vernon and colleagues in the exposure. With repeated 1970s and ’80s that involves the use

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of wearable ear-level devices (mask- ment evaluation to determine efficacy ers) that deliver sound to a patient’s of a particular intervention and are ear(s). The objective of the sound commonly used for clinical research head. presentation is to produce a sense of purposes. Some- relief from the annoyance caused by Tinnitus Retraining Therapy times the tinnitus sound; the relief is accom- (TRT): Method of clinical manage- patients are plished by covering up the tinnitus ment for tinnitus, developed by Dr. aware of tinnitus sound or by changing the sound of the Pawel Jastreboff in the late 1980s. in one ear only, but tinnitus in some way, usually by reduc- TRT is a clinical implementation of his upon masking the tinni- ing its perceived loudness. These two neurophysiological model of tinnitus, tus, they notice it at a lower objectives are referred to respectively which conceptualizes tinnitus as a level in the contralateral ear. as complete and partial masking. The neural signal that can have varying sense of relief from tinnitus technically vestibular schwannoma: Also effects on the central nervous system. can be accomplished using any form known as acoustic neuroma, acoustic The major components of this tech- of sound that the patient chooses to neurinoma, or acoustic neurilemoma, nique involve structured TRT counsel- provide the greatest degree of relief. vestibular schwannoma is a benign, ing and sound enrichment to accom- Ideally, the sound should be presented usually slow-growing tumor that de- plish habituation to the tinnitus signal to the ears on a continual basis, which velops from the balance and hearing and habituation to the tinnitus reaction can only be accomplished by wear- nerves supplying the inner ear. The and to mitigate any activating effects able tinnitus maskers, hearing aids, or tumor comes from an overproduction to the limbic system. combination hearing aids/maskers (the of Schwann cells, which are the cells latter termed tinnitus instruments by transient ear noise: A normal that normally wrap around nerve Vernon and his group). auditory event experienced by almost fibers like onion skin to help support everyone that is typically described as and insulate nerves. tinnitus pitch match: See pitch a sudden whistling sound accompanied match. wearable listening devices: See by the perception of hearing loss. A sound generating devices. tinnitus psychoacoustic assess- transient auditory event—or transient ment: Battery of measures intended ear noise—is unilateral and seems to white noise: Broadband noise with to characterize the percept of tinnitus occur completely at random without equal sound pressure levels across and to assess the effects of sound anything precipitating the sudden the frequency range. Because of on tinnitus. A tinnitus psychoacoustic onset of symptoms. Often the ear feels the way the human auditory system assessment commonly includes pitch blocked during the episode, and all processes sound, true white noise is matching, loudness matching, mea- symptoms generally dissipate within perceived by a normal human ear to suring minimum masking levels, and about a minute. Although sometimes have more high-pitched than low- testing for residual inhibition. referred to as “spontaneous tinnitus,” pitched energy. The term white noise transient ear noise should not be con- often is used to describe broadband tinnitus questionnaires: A generic fused with tinnitus. noise that isn’t technically white noise, term describing quantitative or qualita- which is commonly used to manage tive self-reported measures designed uncomfortable loudness level reactions to tinnitus. to determine the subjective impact (UCL): See loudness discomfort that tinnitus has on an individual and level. wideband noise: See broadband whether tinnitus-specific intervention noise. unilateral tinnitus: Tinnitus that is is warranted. Tinnitus questionnaires perceived only in one ear or tinnitus can be used for pre- and post-treat- that is lateralized to one side of the

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