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Blackman G.A.,MRC Institute of Hearing Research | Hall D.A.,MRC Institute of Hearing Research | Hall D.A.,NIHR National Biomedical Research Unit in Hearing
Journal of Speech, Language, and Hearing Research | Year: 2011

Purpose: The intense sound generated during functional magnetic resonance imaging (fMRI) complicates studies of speech and hearing. This experiment evaluated the benefits of using active noise cancellation (ANC), which attenuates the level of the scanner sound at the participant's ear by up to 35 dB around the peak at 600 Hz. Method: Speech and narrowband noise were presented at a low sound level to 8 listeners during fMRI using 2 common scanning protocols: short ("continuous") and long ("sparse") temporal schemes. Three outcome measures were acquired simultaneously during fMRI: ratings of listening quality, discrimination performance, and brain activity. Results: Subjective ratings and discrimination performance were significantly improved by ANC and sparse acquisition. Sparse acquisition was the more robust method for detecting auditory cortical activity. ANC reduced some of the "extra-auditory" activity that might be associated with the effort required for perceptual discrimination in a noisy environment and also offered small improvements for detecting activity within Heschl's gyrus and planum polare. Conclusions: For the scanning protocols evaluated here, the sparse temporal scheme was the more preferable for detecting sound-evoked activity. In addition, ANC ensures that listening difficulty is determined more by the chosen stimulus parameters and less by the adverse testing environment. © American Speech-Language-Hearing Association. Source

Hall D.A.,NIHR National Biomedical Research Unit in Hearing | Hall D.A.,Nottingham Trent University | Lainez M.J.A.,University of Valencia | Newman C.W.,Cleveland Clinic | And 5 more authors.
BMC Health Services Research | Year: 2011

Background: Tinnitus affects about 10-15% of the general population and risks for developing tinnitus are rising through increased exposure to leisure noise through listening to personal music players at high volume. The disorder has a considerable heterogeneity and so no single mechanism is likely to explain the presence of tinnitus in all those affected. As such there is no standardized management pathway nor singly effective treatment for the condition. Choice of clinical intervention is a multi-factorial decision based on many factors, including assessment of patient needs and the healthcare context. The present research surveyed clinicians working in six Westernized countries with the aims: a) to establish the range of referral pathways, b) to evaluate the typical treatment options for categories of subjective tinnitus defined as acute or chronic, and c) to seek clinical opinion about levels of satisfaction with current standards of practice. Methods. A structured online questionnaire was conducted with 712 physicians who reported seeing at least one tinnitus patients in the previous three months. They were 370 general practitioners (GPs) and 365 ear-nose-throat specialists (ENTs) from the US, Germany, UK, France, Italy and Spain. Results: Our international comparison of health systems for tinnitus revealed that although the characteristics of tinnitus appeared broadly similar across countries, the patient's experience of clinical services differed widely. GPs and ENTs were always involved in referral and management to some degree, but multi-disciplinary teams engaged either neurology (Germany, Italy and Spain) or audiology (UK and US) professionals. For acute subjective tinnitus, pharmacological prescriptions were common, while audiological and psychological approaches were more typical for chronic subjective tinnitus; with several specific treatment options being highly country specific. All therapy options were associated with low levels of satisfaction. Conclusions: Despite a large variety of treatment options, the low success rates of tinnitus therapy lead to frustration of physicians and patients alike. For subjective tinnitus in particular, effective therapeutic options with guidelines about key diagnostic criteria are urgently needed. © 2011Hall et al; licensee BioMed Central Ltd. Source

Gander P.E.,NIHR National Biomedical Research Unit in Hearing | Gander P.E.,University of Nottingham | Hoare D.J.,NIHR National Biomedical Research Unit in Hearing | Hoare D.J.,University of Nottingham | And 7 more authors.
BMC Health Services Research | Year: 2011

Background: In the UK, audiology services deliver the majority of tinnitus patient care, but not all patients experience the same level of service. In 2009, the Department of Health released a Good Practice Guide to inform commissioners about key aspects of a quality tinnitus service in order to promote equity of tinnitus patient care in UK primary care, audiology, and in specialist multi-disciplinary centres. The purpose of the present research was to evaluate utilisation and opinions on pathways for the referral of tinnitus patients to and from English Audiology Departments. Methods. We surveyed all audiology staff engaged in providing tinnitus services across England. A 36-item questionnaire was mailed to 351 clinicians in all 163 National Health Service (NHS) Trusts identified as having a tinnitus service. 138 clinicians responded. The results presented here describe experiences and opinions of the current patient pathways to and from the audiology tinnitus service. Results: The most common referral pathway was from general practice to a hospital-based Ear, Nose & Throat department and from there to a hospital-based audiology department (64%). Respondents considered the NHS tinnitus referral process to be generally effective (67%), but expressed needs for improving GP referral and patients' access to services. 'Open access' to the audiology clinic was rarely an option for patients (9%), nor was the opportunity to access specialist counselling provided by clinical psychology (35%). To decrease the number of inappropriate referrals, 40% of respondents called for greater awareness by referrers about the audiology tinnitus service. Conclusions: Respondents in the present survey were generally satisfied with the tinnitus referral system. However, they highlighted some potential targets for service improvement including 1] faster and more appropriate referral from GPs, to be achieved through education on tinnitus referral criteria, 2] improved access to psychological services through audiologist training, and 3] ongoing support from tinnitus support groups, national charities, or open access to the tinnitus clinic for existing patients. © 2011 Gander et al; licensee BioMed Central Ltd. Source

Hoare D.J.,NIHR National Biomedical Research Unit in Hearing | Hoare D.J.,University of Nottingham | Hall D.A.,NIHR National Biomedical Research Unit in Hearing | Hall D.A.,University of Nottingham | Hall D.A.,Nottingham Trent University
Evaluation and the Health Professions | Year: 2011

Subjective tinnitus is an enigmatic and chronic condition that is predominantly managed as symptomatic. Little high-level evidence exists for the efficacy and specificity of the various tinnitus management strategies currently used, and this is reflected in documents that aim to guide clinicians. As a consequence, there are clear gaps in evidence-based practice linking diagnosis to the most effective management strategies as well as a general lack of consensus about which are appropriate strategies for assessment and management. Several guidelines have been produced from research efforts and from expert opinion. All recommend standardization of assessment and a range of management options but do not yet provide a means to link the two. The authors call for clinicians, scientists, and policy makers to work together to address this barrier to good practice. © The Author(s) 2011. Source

Hoare D.J.,NIHR National Biomedical Research Unit in Hearing | Hoare D.J.,University of Nottingham | Kowalkowski V.L.,NIHR National Biomedical Research Unit in Hearing | Kowalkowski V.L.,University of Nottingham | And 2 more authors.
JARO - Journal of the Association for Research in Otolaryngology | Year: 2012

That auditory perceptual training may alleviate tinnitus draws on two observations: (1) tinnitus probably arises from altered activity within the central auditory system following hearing loss and (2) sound-based training can change central auditory activity. Training that provides sound enrichment across hearing loss frequencies has therefore been hypothesised to alleviate tinnitus. We tested this prediction with two randomised trials of frequency discrimination training involving a total of 70 participants with chronic subjective tinnitus. Participants trained on either (1) a pure-tone standard at a frequency within their region of normal hearing, (2) a pure-tone standard within the region of hearing loss or (3) a high-pass harmonic complex tone spanning a region of hearing loss. Analysis of the primary outcome measure revealed an overall reduction in self-reported tinnitus handicap after training that was maintained at a 1-month followup assessment, but there were no significant differences between groups. Secondary analyses also report the effects of different domains of tinnitus handicap on the psychoacoustical characteristics of the tinnitus percept (sensation level, bandwidth and pitch) and on duration of training. Our overall findings and conclusions cast doubt on the superiority of a purely acoustic mechanism to underpin tinnitus remediation. Rather, the nonspecific patterns of improvement are more suggestive that auditory perceptual training affects impact on a contributory mechanism such as selective attention or emotional state. © 2012 Association for Research in Otolaryngology. Source

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