NEUROPHYSIOLOGICAL APPROACH TO TINNITUS PATIENTS

The principal postulate of the neurophysiological model of tinnitus is that all levels of the auditory pathways and several nonauditory syst ems play essential roles in each case of tinnitus, stressing the domin ance of nonauditory systems in determining the level of tinnitus annoy ance. Thus it has been proposed to treat tinnitus by inducing and faci litating habituation to the tinnitus signal. The goal is to reach the stage at which, although patients may perceive tinnitus as unchanged w hen they focus on it, they are otherwise not aware of tinnitus. Furthe rmore, even when perceived, tinnitus does not evoke annoyance. Habitua tion is achieved by directive counseling combined with low-level, broa d-band noise generated by wearable generators, and environmental sound s, according to a specific protocol, For habituation to occur, it is i mperative to avoid masking tinnitus by these sounds. Since 1991, >500 tinnitus patients have been seen in our center. About 40% exhibited hy peracusis to varying degrees. A survey of >100 patients revealed >80% of significant improvement in groups of patients treated with the full protocol involving counseling and the use of noise generators. Notabl y, in patients who received counseling only, the success rate was <20% . The improvement in hyperacusis was observed in similar to 90% of tre ated patients.