Hello, I'm Doctor Roland Zeh, chief physician at the Kaiserberg Clinic in Bad Nauheim. This is a rehabilitation clinic for people with hearing disorders and tinnitus, and I would like to warmly welcome you to the seventh tinnitus day of the German hearing care professionals and I am pleased that I can speak to you here for the first time using this new video format. I myself have been hearing impaired since I was seven. I have two cochlea Implants and am also President of the German Cochlear Implant Society. Our The topic today is acoustic simulation for tinnitus, and here you have to say there are two principles. The first is what is known as acoustic defocusing. In order to it means that one can distract one's attention by external noises and thereby away from tinnitus. And the second principle is marking, which means concealment of tinnitus from external noise. Tinnitus is almost always concealable, It is of course presupposed that there is still some residual hearing at all; and you usually need about 30 decibels above the threshold to cover up the tinnituss.
The For example, you can use the matching and masking measurement to determine how loud the masking level is got to. But whether a tinnitus can be covered by hearing systems depends primarily on the person The course of the hearing curve, as I would like to show later using a few examples. First of all, tinnitus and hearing loss: according to the neurophysiological tinnitus model, we now know that tinnitus mainly develops when certain sounds are no longer sufficiently perceived become. We know that around 60 to 80 percent of patients have proven hearing loss in the audiogram we have, for example, also in this example audiogram in this one See and we also know that tinnitus is practically always in the frequency range who has a hearing loss. It is not scientifically proven but from experience it is very well known that tinnitus can occur when in a hearing loss of 30 or more decibels is visible in certain frequency ranges, because then the quiet ambient noises can no longer be heard.
So when we're here look at this sample audiogram, then you will see it down to … it down goes and there it says in this frequency range four kilohertz can be heard in a quiet environment no more outside noise, and this can lead to tinnitus. The cochlea is so tonotopic The high notes are built up in the outer part of the cochlea and the low notes are in the inner part of the Cochlea localized. That means if we have such a sloping audiogram here, then it is so, that these tones are then also represented tonotopically in the central cortex. This means A hearing loss in the high frequency range would then cause tinnitus in this high frequency range And we imagine today that tinnitus is a deafferentation phenomenon, i.e. the Afferents are the feeding nerve fibers in contrast to the efferents are the motor fibers that control something, and here is a comparison between tinnitus and phantom pain. And you see here this is called the homunculus, which is a map of the human body surface as well represents the central representation, for example if someone has a leg amputation, then it would mean that here where the leg is, no more efferents arrive, This means that these areas in the cortex that no longer receive any information are uninhibited and this creates phantom pain and that is too similar with tinnitus that is when high notes can no longer be heard, there are no more borders here in the yellow area and then arise a disinhibition and then it comes to tinnitus in exactly this area which is no longer correct one can hear here and therefore one can say it depends mainly on the curve which tones are used Sieger tus can be heard, for example, here with broadband hearing loss you do not determine an item in the sense of matching but you will hear a broadband tone will sound more like a humming sound while if you are up here like here which reaches its maximum here at six kilohertz then you will hear a more tonal tinnitus that means you can hear the tinnitus of the Bergstädter around six kilohertz then it is important to pay attention to the notorious because a process in the notorious cortex is a neural activity in the brain cortex and we can hear that from Normal belong passive process is one does not have to increase the attention to anything but understand if you have a hearing loss or if acoustic conditions are unfavorable When there is background noise or when the power is on, or when the distance is great, you have to speak higher attention increases ie the activity in listening interest to what we also stress more what is called and neurophysiological can be imagined in such a way that with an increase the higher attention a kind of central amplifier is switched on to be able to hear better above and that is when it is too so that you do not have to concentrate very hard to listen the tinnitus is reinforced, it follows that tinnitus is then perceived louder when not takes care of the hearing loss and in acoustically unfavorable conditions here again on the principle the acoustic of the focus so we said yes, the topic is acoustic stimulation and if you now make a thick focus he says no cover but one diversion of attention that can be done with music or simply with outside noises but should be perceived as pleasant and thus the acoustic perception has the possibility to concentrate on an external device and thus get away from the task at hand, it is important that you This principle of focusing should only be applied when you don't have to listen, i.e.
When you is not in a conversation otherwise the higher level of attention must be increased if i have music in the background somewhere and i have to talk then it is the music is a disturbing noise i have to concentrate more on my entertainment what the ts would rather reinforce the new are the one possibility this acoustic the to apply focus, however, I'm honest enough to say that I'm not new users myself I recommend it simply because it is also a rather unpleasant noise so I like that white rushing water not at all and so I replace an unpleasant aftermath protected by another equally unpleasant noise that does what you think you are sure of you can only apply a new revision if you have absolutely normal cousins because if i have a slight hearing loss then i make me houses an annoying noise what then again your team sits he reinforced and as previously said you would have to be in a Then switch off the conversation again to listen and not produce any disturbing noises now i come to the accumulation at normal heard so what do i do since i have an example here brought autograph this young man has an autograph on the zero line but he has here eight kilos of heart from a beginning up and down and left we also have with This young man also makes a college sluggish that went even further at 10 and 12 kilohertz down and left also which is why what is considered a very high country and very disturbing optimism that the patient noted that before what came to us in the clinic, maus tried it out But he couldn't take advantage of it.
He said the new ones destroy him as well as the tinnitus and then he has noises the sound of low humming and the other the high-quality tus and that's why he didn't wear it anymore and our recommendation was simply distracting and through music and everyday noises other people should be able to do such a higher curve acoustic stimulation hardly improves the situation here we have a second program that not no normal hearing but one of several that represent normal hearing seen these patients 54 years old has paid a slight high revving sink almost within the age norms it If there is no hearing aid indication, especially language, but not the passers-by wanted to test hearing aids because she heard about other parties at our clinic that hearing aids are well done and then she got us to test them and was so enthusiastic it was practically gone that is now essential and hearing aids also want to create and if that Checkout is not paid because she said to herself so here are an example that you can use for A good tip with hearing aids does not necessarily cover up according to the health insurance guidelines the guidelines in the private cash register are somehow arbitrary and here looks you are already suitable for the very slight hearing damage so that you can go through the tinnitus and buyers should already be able to and the patient said yes, she can now hear again which makes the quiet noises better again here i have an autograph and is always worse than the previous one and here we can see that here a speech auto metrically also a hearing aid there is an indication and this patient came to us in the clinic and has not yet been treated but here on our recommendations hearing aids have been tested and this patient has also done very well benefits from hearing aids he barely noticed the teams and much more clearly Heard better now and understood better and this patient too will now feel hearing aids at home then I had this patient a relatively young patient 40 years old had meningitis and so not as a child but only recently and he has when casting tus right he has a high whistle that can be seen on this high and drop of yes to almost 100 db goes down and left in it rather broadband titus is interesting that although the courtyard lucy on the left is clearly more pronounced than on the right that the titus is much worse would probably be felt because a high chiquita stone is perceived as uncomfortable like a broadband out we have these patients a case on their left ear in fact to let it do that we also do it and right on the other hand it is difficult he has Tried a hearing aid with us on the right so that he could understand speech better reach you can see here that the right language comprehension is already clearly impaired Pay here and in silver and he also benefited from it, but at most I can do this frequency range up to two kilos of heart amplify what that was ultimately him But that's where I don't have this high loss with the hearing aid that means In this case we cannot cover the high pitch Achieve loss and that's what I turn an ungrateful higher if hearing systems weren't really helpful here then I have an autograph of a 64 year old patient who is right on a broadband hearing loss has around 50 gb and left it in full swing and also indices without rubbish she has already brought hearing aids with her when it was built, but practically no benefit any more you can see it here below here is the free field measurement shown here you can see that it is at 15 degrees times ten percent of the former understood better and on the left she has a good one Speech comprehension but there is no masking in the high frequencies possible here on the left because that until the 90s go down and on the right there is no longer any profit from the hearing aid either here the bottom broadband higher curve it looks as if one is well supplied with a hearing aid The problem can be that due to the pronounced recruitment, only a limited one reinforcement is possible and through this I achieve a good understanding of the language again and still I get a tegra chips cover here we have an autograph that is a little better than the previous one you see here she is about 60 and here it is a bit better but also this one patient 450 years old has no benefit from the hearing aid, although she still has a slightly better one speech comprehension at 65 dB but the problem is with this patient she has a completely normal left ear and additional rhythms that of course you always come with his help here the phenomenon of not listening to wearing, that is, if you increase the gain too much then she hears the whole thing in her left ear and she did not tolerate that, so we did too this patient is missing in a World Cup, the right ear will be given whether she will do that I don't know that's still relatively good, but as I said, traditional hearing aids speak only to a limited extent and titus not covered up so car seen it in such a situation to you the only one possibility to achieve a good acoustic result is important because that is not possible in reckrod one still knows a overheard that arises, yes, here I have a broadband again hearing loss which in this case is a bit worse than the two now the hearing threshold is already at 70 the patient already has a ci on his left ear and he has no tattoos that is with the lake completely covered and on the right it also has here you can see that free falls has here he also no longer benefits with the hearing aid 0 1 silver at 64 db and no tattoos concealment and the patient will now be provided with a cochlear implant on the right because he is on the left side I have had very good experiences with it then I have a passerby here a patient was already 81 years old, she is provided with a micro system, you can see that left ear is really the right ear is also difficult but with the micro system it can you can still hear it here quite well you can see the gripping field here we only have the right one So microsystem direct amplification measured and you can see how it comes to 95 percent a glue here with the hearing aid there it also has a good coverage so this one is almost audible on the left with the bios, of course, no hearing perception is possible, even for listening and therefore she has Also none of this coverage we have recommended you what you don't want to do says she is so old I don't know another way to get your tips here on this ear I don't see that it can be influenced acoustically in any way, at the moment I can see it here I will have already spoken several times about the ci to summarize again with ci there is no recruitment, so higher volume is possible without the sand subjectively more important than louder and if you assume that an amplification of about 30 db over thresholds is necessary to cover a tgs then you can simply do the math so that at a threshold of 50 db the limit is where hearing aids are still possible because when 50 60 db hearing threshold is 30 gb exuberant then I am more tolerated at 80 to 90 gw Hardly anyone in the long term and that's why dbt over 50 is sexy here and that applies even if only certain frequency ranges are affected super game with patients who are very strong high-speed steep fall you can still hear the low tones on your normal, but in the high frequency range up to 100 db steeper fall also benefit well from the ci where one here then in such cases rather an rs system would take and the second advantage of ti me I already mentioned that there is no no listening and that's why you are now mainly with Unilateral hearing loss is always an important option if the hearing threshold is worse than around 60 dB yes, and then i wanted to briefly go into the principle of concealment that is a very important one important thing that many are not known, so after covering up what does that mean you can do it yourself try it out, for example, by putting on headphones and listening to music or some other pleasant sound turns on and then adjust the volume so that you can make yourself that jesus is covering usually if the origin is within the normal range you need about 90 db for jesus production and that you walk alone so that you can find it now the tinnitus did not work higher when one is covered and then you turn off the music and then you are up to the time to the recurrence of the tinnitus that can that can be that comes again immediately then it is Demand is high since 0 but it can also take a few seconds, minutes or even hours the music reports again and that is important this after production time is a good measure of how well people are complicated and also how well they are adapted to their hearing systems, for example for people who, for example, have more than half an hour on the night before the wedding many people say that I have a cochlear implant so that is enough despite decreasing hearing systems To be able to fall asleep in peace before you start again, so it makes sense for patients to let try out the time to cover where that is not a constant, depending on how good you are, when you are very excited you become so under stress the post-masking time will be shorter, if you are relaxed it will tend to be longer.
Yes so far for today on my remarks on acoustic stimulation in tinnitus. I hope you could take something with you. Unfortunately, I can't answer any questions in this format, but I can there will also be written feedback. Thank you for your attention!.