Maximizing Tinnitus/Hyperacusis Sound Therapy with Real Ear Measures
JW, a 70-year-old female, was seen for an audiometric evaluation with the primary complaint of severe bilateral hyperacusis and continuous tinnitus, but was more prominent and bothersome in the left ear. JW reported that in a recent motor vehicle accident the air bag deployed and impacted, with significant force, on the left side of her head. A Pressure Equalization (PE) tube was inserted into her left tympanic membrane following the accident to reportedly relieve a buildup of pressure behind her tympanic membrane secondary to the head trauma. JW arrived at the audiometric evaluation with a recently purchased left Receiver-In-the-Canal (RIC) hearing aid coupled to an open dome (i.e., maximum venting). JW’s hearing aid included a tinnitus/hyperacusis sound therapy program that she reported provides “very little benefit in improving hearing or providing relief of my tinnitus/hyperacusis.” The therapy sound in her hearing aid was a continuous broadband noise with a high-frequency emphasis that was not patient controllable. It was noted by JW that the hearing aid was not verified to meet a valid prescriptive target using Real Ear Measures (REM). Also, it was believed by the audiologist that due to the severity of the hearing in the low frequencies a more occluding dome should have been used. This concern, along with the reported lack of benefit for JW’s hearing and relief from her tinnitus/hyperacusis, suggested the hearing aid may not have been appropriately fitted.