Question
What mixing point or noise setting do you recommend for the tinnitus noise generator for a new patient who is using ReSound Live™TS?
Answer
Where to set the noise with ReSound Live™TS is dependent on the professional's particular approach or method and we don't recommend one method over another. Professionals have to use the method or approach they're most comfortable with and find most effective. With the Aventa software, you have a volume slider and you can adjust that in dB SPL. While the patient is wearing the instruments, you can simply turn that up until they start to hear the white noise, and go from there.
One common method is TRT, Tinnitus Retraining Therapy, which sometimes does talk about the mixing point. The mixing point is where the white noise of the tinnitus sound generator starts to blend with the actual tinnitus. You want to be careful, though, that you don't completely mask the tinnitus. If you mask the tinnitus, you never allow the brain to habituate to it, and with any type of treatment plan, you want the brain to learn to habituate to the tinnitus. If the person can't hear the tinnitus because you've masked it, then you never allow the brain to do that.
There are some newer strategies out there now like Progressive Tinnitus Management, called PTM. It has some similarities to TRT. It has a five-step hierarchical approach, whereas you take each step and then depending on the particular individual, you might go to the next step. There are other approaches as well that use a low level of effective masking.
In sound therapy the main goal is to decrease the contrast of the tinnitus to the background. For example, someone might say their tinnitus is worse in a quiet situation because there's nothing contrasting the tinnitus, so they can hear it very easily. Whereas if they go into a restaurant and there's' a lot of background noise, they typically will say that they don't hear the tinnitus as much because the contrast between the tinnitus and the background has been decreased.
Where you set the device is really up to the individual's needs and ReSound Live™TS is flexible enough to accommodate your approach to those needs. For example, you may want to start about 5 to10 dB above the threshold of the white noise. That means establishing the threshold of the white noise first, and then setting the noise about 5 dB -10 dB above that. Or, if you're using the mixing point method, then by all means, you can set this device using the mixing point. ReSound Live™TS was designed to give professionals the option to set it up the way that they think is most appropriate, based upon their sound therapy philosophy and fitting protocol.
For more information about ReSound, visit www.gnresound.com or the ReSound web channel on AudiologyOnline.
Michael Piskosz, M.S., CCC-A is an Audiologist at GN Resound, where he is responsible for the development of training and marketing materials based on research and development activities. He has also developed a focus on tinnitus. He earned his M.S. from Syracuse University and is board certified in Audiology.
