Applicability of the real ear measurement for audiological intervention of tinnitus,

Abstract Introduction Tinnitus is present in a large part of chronic health complaints, and it is considered a public health problem injurious to the individual's quality of life. Considering the increase of the world population associated with an increase of life expectancy, tinnitus remains a cause for medical concern, since during aging the occurrence of auditory impairments due to the deterioration of the peripheral auditory structures and central impairs the quality of life. Objective The aim of the present study was to analyze the applicability of real ear measurements for audiological intervention of tinnitus through specific evaluation, selection, verification and validation of the hearing aids combined with the sound generator. Methods Forty individuals of both genders with hearing loss and tinnitus complaints were deemed eligible to compose the sample. They were enrolled according to clinical symptoms and submitted to the following procedures: anamnesis and previous complaint history, high frequency audiometry, immittanciometry and acuphenometry with the research of psychoacoustic thresholds of pitch, loudness and minimum masking threshold, sound generator, in addition to the application of the Tinnitus Handicap Inventory and Visual Analog Scale tools. The entire sample was adapted with Siemens hearing aids and a sound generator, participated in a counseling session with support of digital material and evaluated in two situations: Initial Assessment (before the hearing aids and sound generator adaptation) and Final Assessment (6 months, after adaptation). The statistical analyzes were descriptive and inferential, adopted a significance level of 5% and the T-Paired Test and the Spearman Correlation test were performed. Results The results showed that there was a benefit with the use of hearing aids combined with a sound generator from the statistically significant values and strong correlations between the sound generator verification data regarding acuphenometry and the nuisance/severity questionnaires. Regarding the verification of the sound generator, it is important to highlight that the entire sample selected the effective acoustic stimulation based on the comfort levels, which was proved in the present study to be a sufficient intensity for positive prognosis, whereas the users' noises were found below the psychoacoustic thresholds of acuphenometry. Conclusion The present study concluded that the audiological intervention with any level of sound stimulus is enough to obtain a positive prognosis in the medium term. Data that specifies that the verification of sound generator was effective at the real ear measurements are important in the evaluation and intervention of the complaint. In addition, it points out that the greater the tinnitus perception, the greater its severity, and the greater the nuisance, the higher the psychoacoustics thresholds of frequency and the minimum threshold of masking.

【摘要】
耳鸣是诸多慢性健康主诉的常见类型，被视为损害个体生活质量的公共卫生问题。伴随全球人口增长与预期寿命延长，耳鸣仍是医疗关注的重点：衰老过程中，外周听觉结构退变及中枢听觉功能损伤引发的听觉障碍，会进一步降低生活质量。

【研究目的】本研究旨在通过对联合声发生器的助听器进行针对性评估、选型、验证及确认，分析真耳测量（real ear measurements）在耳鸣听力学干预中的适用性。

【研究方法】本研究纳入40名兼具听力损失与耳鸣主诉的男女受试者，入组标准为符合临床症状。所有受试者接受以下流程：病史采集与既往主诉回顾、高频听力测听、声导抗检测、耳鸣心理声学检测（acuphenometry）——包括音调、响度及最小掩蔽阈值的心理声学阈值测定，以及声发生器调试；此外还应用耳鸣残障量表（Tinnitus Handicap Inventory）与视觉模拟评分量表（Visual Analog Scale）进行评估。全体受试者均验配了西门子（Siemens）助听器联合声发生器，并接受辅以电子材料的咨询辅导，分别在两种情境下开展评估：初始评估（助听器与声发生器验配前）与终末评估（验配后6个月）。统计分析采用描述性分析与推断性分析，设定显著性水平为5%，并实施配对t检验与斯皮尔曼相关分析。

【研究结果】结果显示，助听器联合声发生器的使用具有明确获益：相关统计值具有显著性，且声发生器的耳鸣心理声学检测验证数据与耳鸣困扰/严重程度问卷得分之间存在强相关性。针对声发生器的验证，需重点指出：全体受试者均基于舒适度选择了有效的声刺激参数，本研究证实该参数的强度足以实现良好预后；而受试者自身感知的耳鸣声强度均低于耳鸣心理声学检测的阈值。

【研究结论】本研究得出结论：任何强度的声刺激听力学干预，均可在中期实现良好预后。明确声发生器验证通过真耳测量显示有效的相关数据，对于耳鸣主诉的评估与干预具有重要价值。此外，研究还指出：耳鸣感知强度越高，其严重程度越高；耳鸣困扰程度越高，频率相关心理声学阈值与最小掩蔽阈值亦越高。