Beltone TrueTM with Tinnitus Breaker Pro
Beltone True Tinnitus Breaker Pro
tinnitus datasheet
How to use tinnitus test results
It is important to remember that tinnitus is a symptom, not a disease. It is always recommended that a full
medical evaluation be obtained before fitting Beltone True with Tinnitus Breaker Pro to rule-out, or otherwise
treat, any underlying tinnitus-related pathology.
Once it has been established that there are no underlying tinnitus-related pathologies, there are a number of
baseline assessments one can use in the measuring and characterizing tinnitus that can be useful in fitting a
tinnitus sound generator (TSG) device, such as Beltone True with Tinnitus Breaker Pro.
Case History/Consultation
A thorough case history is vital in identifying and understanding the primary issues related to one’s tinnitus.
This can involve onset of the tinnitus, description of the tinnitus, how it affects their daily lives, sound
tolerance issues, psychological issues and many other factors that are important in helping to manage and
counsel a tinnitus patient.
Questionnaires
Questionnaires are useful tools to evaluate the severity of one’s tinnitus, and to get more information about
specific areas affected for that person. Some of the more common questionnaires are the Tinnitus Handicap
Inventory (THI) and Tinnitus Reaction Questionnaire (TRQ). Questionnaires can be measured as pre-therapy
and post-therapy measures, providing insight as to the effectiveness of a therapy/counseling method, or to
monitor changes or improvements in one’s tinnitus perception.
Audiometric Evaluation
The basic audiometric evaluation is useful in determining basic hearing status, as well as recommendations
for hearing instruments, TSG devices or further medical evaluation. Most audiometric tests are appropriate
for tinnitus patients, although careful consideration should be made for acoustic reflex or decay testing, as
the presentation level of these signals can exceed tolerance levels for many tinnitus sufferers. Often times
extended high-frequency threshold testing (> 8kHz) is recommended to better understand and characterize
the tinnitus, although a specialized high-frequency audiometer is needed to do this. Otoacoustic emission
(OAEs) can also be tested to investigate the function of the cochlea.
Pitch Matching
Pitch matching is where you match the tinnitus to a specific frequency, using a pure tone or narrow band noise.
Pitch matching can be useful in helping to characterize the psychoacoustic properties of the tinnitus, but may
not tell you much about the tinnitus itself. Recording and monitoring these results can help identify changes to
the perception of the tinnitus, but consider there may be test/retest reliability issues. Pitch matching results can
help with the TSG settings, should frequency shaping the TSG noise signal be preferred over a narrow band
noise signal.
FOLLOW UP
Loudness Matching
Loudness matching is where you match the tinnitus to a specific intensity. Loudness matching can be useful
in helping to characterize the psychoacoustic properties of the tinnitus, but is not highly relevant to the severity
of the tinnitus. Recording and monitoring these results can help identify changes to the perception and/or
habituation of the tinnitus, but consider there may be test/retest reliability issues. Loudness matching results can
be helpful with the TSG volume settings.
Questionnaires
Administer as post-therapy measures. By comparing pre- and post-therapy scores, a therapy/counseling
method, or changes/improvements in one’s tinnitus perception can be monitored.
Loudness Discomfort Level (LDL)
LDLs indicate a person’s tolerance for a signal. This measure is important for setting the TSG instrument,
especially for those with hyperacusis and tolerance issues, as high level sounds can be uncomfortable and
counterproductive.
Minimum Masking Level (MML)
MMLs indicate the least amount of noise needed to mask the tinnitus. This measure is important for identifying
the preferred volume of the TSG instrument and can help monitor changes throughout therapy/counseling. A
reduction of the MML (requiring less noise to mask the tinnitus) over time can imply improvement to tinnitus
perception and detuning of neural patterns from tinnitus detection.
Mixing Point
The mixing point is where the tinnitus and noise generated from the TSG instrument are perceived to mix or
blend together, without overmasking/completely masking the tinnitus. This measure is important for identifying
the preferred volume of TSG instrument.
Residual Inhibition
Residual inhibition is when the tinnitus is lessened or disappears for a period of time after some sound exposure.
The length of time that residual inhibition can last will vary from person to person. The reduction of tinnitus
perception is the result of decreased neural activity, where the level of spontaneous activity is decreased after
some sound stimulation. If residual inhibition occurs, it could indicate good candidacy for sound therapy (and
a TSG device), as it suggests the tinnitus can be altered by some sound stimulation. Caution should be taken
when testing for residual inhibition, as an increase in tinnitus perception can occur.
After a period of sound therapy/counseling (results can vary), habituation to one’s tinnitus might occur, and
the symptoms might lessen. Therefore, it is important to follow up on the perceived severity of the tinnitus and
reestablish some of the initial described baseline measurements to monitor one’s progress, and set the TSG
instrument to new preferred settings if necessary. Retesting of all baseline measures can be undertaken to
monitor the effectiveness of the tinnitus management program.
Pitch Matching
Reestablishing pitch matching results can help with frequency shaping the TSG noise signal,
if this is preferred over a narrow band noise signal. It can also be helpful in identifying perceptual changes to
one’s tinnitus.
Loudness Matching
Reestablishing loudness matching results can be helpful with resetting the TSG volume settings. It can also be
helpful in identifying perceptual changes to one’s tinnitus.
Minimum Masking Level (MML)
MMLs can be reestablished for identifying the preferred volume of the TSG instrument and can be used to reset
the TSG volume setting. Follow the same steps as the initial MML identification procedure to compare preand post-therapy measurements. A reduction of the MML (requiring less noise to mask the tinnitus) can imply
improvement to tinnitus perception and detuning of neural patterns from tinnitus detection.
Mixing Point
If using the mixing point method, reestablish the mixing point, using the same initial procedure, to identify where
the tinnitus and noise generated from the TSG instrument are perceived to mix or blend together, without
overmasking/completely masking the tinnitus. This measure can be important for identifying the preferred
volume of TSG instrument. Similar to the MML, if a reduction of the mixing point is established,
this can imply improvement to tinnitus perception.
Name:
DOB:
Serial Number(s):
Date:
R:
Gender:
M
F
L:
Use a 2-alternative forced choice method to determine a matched pitch. Present tones at 10dB SL to ensure
audibility. Begin by presenting a 500 Hz tone followed by a 1000 Hz tone and determine which tone subject
perceives as being closer in pitch to their tinnitus. Then use selected tone to compare to successive frequencies
until subject selects the first tone presented in series twice. See Table 1 below for illustration of this method.
Case history (can be filled out by patient alone, or during consultation):
How long have you experienced tinnitus? Triggers? Onset? Has it gotten worse or remained the same?
Comparison Tone
Tone Judged to be Closest
Trial 1
1000 Hz vs. 2000 Hz
2000 Hz
Trial 2
2000 Hz vs. 3000 Hz
3000 Hz
Trial 3
3000 Hz vs. 4000 Hz
3000 Hz
Trial 4
3000 Hz vs. 6000 Hz
3000 Hz
FINAL
3000 Hz
Table 1. Comparison Method example
Is your tinnitus in your Right Ear, Left Ear, or Both? (circle one)
Record the frequency which is described as closest to tinnitus:
Right ear
Describe the characteristics of your tinnitus:
(e.g. high vs. low pitch, multi-tonal, constant, fluctuating, pure-tone or rushing)
Left ear
Loudness Matching:
Using the pitch measured during the previous procedure, or 1000 Hz if there is significant hearing loss, or
tolerance issues may be present at the pitch matched frequency, present a pure-tone or narrow band of noise
in the same ear used for the previous procedure. Present the signal at threshold and increase intensity in 5dB or
1dB steps. Loudness is determined when the test tone is equal in loudness to the tinnitus.
Record the loudness level which is equal to the tinnitus:
Previously worn hearing instrument/tinnitus devices? How many years?:
Questionnaires:
Tinnitus Handicap Inventory (THI)
Record score
Tinnitus Handicap Questionnaire (THQ)
For scoring the THQ go to:
http://www.uihealthcare.com/depts/med/otolaryngology/clinics/tinnitus/questionnaires/index.html
Record score Factor 1
Record score Factor 2
Record score Factor 3
Record total score
Pitch Matching:
In an audiometric test booth, present pure-tones or narrow bands of noise to the contralateral ear if tinnitus is
unilateral or perceived as louder in one ear. If hearing is asymmetrical use the better ear. If hearing and tinnitus
are symmetrical then randomly select the ear.
Right ear
Left ear
Beltone True with Tinnitus Breaker Pro fitting measurements:
Establish the tinnitus sound generator (TSG) threshold. This is the lowest level where TSG noise can be
heard.
Recorded TSG level (Threshold) R:
L:
If using the Threshold of Audibility method, set the TSG volume 5-10dB above the TSG threshold.
Recorded TSG level R:
L:
If using the mixing point method, from the TSG threshold, increase in 1-2dB increments until the mixing
point is established. The mixing point is where the TSG noise and tinnitus start to blend.
Recorded TSG level (mixing point) R:
L:
rom the mixing point, adjust 1-4dB below the mixing point for the preferred level of the TSG.
F
Recorded TSG level (preferred level of TSG) R:
L:
Establish the minimum masking level (MML). This is the lowest level where the TSG noise begins to mask
the tinnitus.
Recorded TSG level (MML) R:
L:
Note:
The above measures are suggested fitting methods for Beltone True with Tinnitus Breaker Pro, but patient
comfort should be always be considered. All these measures can be re-administered to monitor the status of
tinnitus therapy/counseling, as well as perceptual improvements of the tinnitus itself.
M200567-GB 11.01 Rev.A
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