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Effectiveness of unilateral usage of the sound generator for Tinnitus Retraining Therapy. (Abstract of ARO Meeting Denver, Colorado) Nobumichi Maeyama1, Atsuhiko Uno1, Miki Okubo1, Yuko Takai1, Kazuyasu Baba2, Seiji Shibata2, Kouhei Kawamoto2, Hiromichi Kuriyama2, Katsumi Doi3, Masato Nishimura1 1Department of Otolaryngology, KKR Otemae Hospital, 2Osaka Kita Japan Post Hospital, 3Osaka Univer- sity

Tinnitus Retraining Therapy (TRT) developed by Jastreboff and his colleagues, is a world-widely sprea- ding treatment for tinnitus. TRT consists of directive counseling and sound therapy that typically the pa- tient uses a sound (noise) generator to reduce awareness of tinnitus distinguished from the background noise. Generally the sound generator is recommended to use on the bilateral ears. However, because of the reasons such as the cost, appearance and difficulty in daily conversation, we usually begin with the unilateral use, following repeated counseling and explanation of TRT itself. To assess the effectiveness of the sound therapy using the sound generator on one side, we retrospec- tively examined the results of 27 patients who underwent TRT at KKR Otemae Hospital and at Osaka Kita Japan Post Hospital from November 2004 to April 2006. Two kinds of questionnaires including Tinnitus Handicap Inventory and Visual Analogue Scale were used to evaluate the results at 6 and 12 months. Even for the patients complaining of bilateral tinnitus, TRT with unilateral sound therapy showed signi- ficant improvements at 6 months. We think that the sound therapy can begin with one sound generator on the one side, then after 6 months, the results should be evaluated. For the patient who did not show clear improvements, bilateral usage of the sound generator may be suggested.

Intervention for Restricted Dynamic Range and Reduced Sound Tolerance: Clinical Trial Update. (Abstract of ARO Meeting Denver, Colorado) Monica Hawley, LaGuinn Sherlock, Susan Gold1, Allyson Segar, Christine Gmitter, Justine Can- navo, Craig Formby University of Maryland School of Medicine, Baltimore

Hyperacusis is the intolerance to sound levels that normally are judged acceptable to others. The pres- ence of hyperacusis (diagnosed or undiagnosed) can be an important reason that some persons reject their hearing aids. Tinnitus Retraining Therapy (TRT), originally proposed for the treatment of persons with debilitating tinnitus, offers the significant secondary benefit of increased Loudness Discomfort Le- vels (LDLs) in many persons. TRT involves both counseling and the daily exposure to soft sound from bilateral noise generator devices (NGs). We implemented a randomized, double-blind, placebo-cont- rolled clinical trial to assess the efficacy of TRT as an intervention for reduced sound tolerance in hea- ring-aid eligible persons with hyperacusis and/or restricted dynamic ranges. Subjects were assigned to one of four treatment groups: 1) NGs with counseling, 2) placebo NGs with counseling, 3) NGs without counseling, and 4) placebo Ngs without counseling. They were evaluated at least monthly, typically for five months or more, on a variety of audiometric tests, including LDLs, the Contour Test for Loudness for tones and speech, word recognition measured at each session‘s comfortable and loud levels, and on electrophysiological measures. Success for the treatment is defined as a tolerance increase by more than 10 dB as measured by either LDLs or Contour Test for Loudness. For the subjects in Group 1 (NGs and counseling), there was a high rate of success (5/6 subjects). A lower success rate was observed for the partial treatment options: Group 2 (placebo NGs with counseling): 1/5 subjects; Group 3 (NGs without counseling): 4/7 subjects; and Group 4 (placebo NGs without counseling): 0/2 subjects. In some subjects who initially had poor word recognition at comfortable levels, the increased tolerance allowed them to increase the level of their comfortable speech allowing a marked improvement in word recogniti- on at comfortable levels. The interim results are very promising and support the hypothesis of this

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