Many patients with tinnitus have noticed that their tinnitus varies in severity in different acoustical environments. Tinnitus is more intrusive and bothersome in silent environments, while being less severe in sound-enriched environments, suggesting that therapeutic strategies using sound (sound therapy) may be effective for the relief of tinnitus. Sound therapy has been developed together with directed counseling as tinnitus retraining therapy (TRT), based on the neurophysiological model of tinnitus. The effectiveness of sound therapy using hearing aids is still under investigation, but it has been suggested that it is effective in about 80% of the patients. In this manuscript, we present a review of sound therapy for tinnitus using hearing aids.

　This study was conducted to clarify the difference in the handicap awareness of hearing loss between subjects with and without cognitive impairment, using the HHIE (Hearing Handicap Inventory for the Elderly). A total of 59 patients with moderate hearing loss were divided into two groups by the presence or absence of cognitive impairment, and in the group with cognitive impairment, the difference between the families' perception and the subjects' own perception of the handicap of hearing loss was examined using a questionnaire (Nursing Home Hearing Handicap Index: NHHHI).

　While 54.2% of the subjects with cognitive impairment are included in perceived No Handicap (0-16), only 16.7% of subjects in the group without cognitive impairment perceived No Handicap; the difference between the two groups was statistically significant. In the cognitive impairment group, the subjective perception of handicap diverged from the families' perception and was not in proportion to the severity of the deafness. However, about 40% of the subjects with cognitive impairment continued using hearing aids. Thus, in patients with cognitive impairment, not only subjective evaluation, but also evaluation by the families/caregivers is important for a precise assessment of the handicap of hearing loss.

　We investigated the consonant discrimination scores and consonant recognition errors in adults with cochlear implants using speech recognition test CI2004. The subjects included 22 adults with CIs and 10 persons with normal hearing. The discrimination scores in the subjects with CIs varied from 7% to 88%. The articulation scores for each consonant in the subjects with CIs were as follows: / j / 98%, / k / 92%, / dz / 83%, / w / 82%, / s / 77%, / b / and / h / 68%, / d / 64%, / g / 53%, / n / 51%, / p / 48%, / ɾ / 47%, / m / 43%, / t / 3%. The recognition error rate of / t / for [k] was extremely high (90%). It may be difficult for CI users to recognize a distinctive acoustic signature in the high-frequency region of an alveolar stop / t /.

　We conducted this study in 29 of 202 patients with tinnitus, who were in a depressed state. Of the 29 patients 13 visited our clinic for the treatment for tinnitus in spite of being treated elsewhere for depression at a mental or psychiatric clinic suggesting that tinnitus was not improved by their treatment.

　A total of 17 patients mainly treated by sound therapy (hearing aid with sound generator or sound generator alone) were followed at least 3 months. The severity of tinnitus was measured by the total score on the Tinnitus Handicap Inventory (THI) and the numerical scores for the four items of loudness, annoyance, effects on daily life and severity. Improvement of tinnitus was graded subjectively. The diagnosis of depressed state was based on history taking and the scores on the Hospital Anxiety & Depression (D) Scale (HADS) and MINI-International Neuropsychiatric Interview (MINI).

　The total THI score and numerical scores on the two items, that is tinnitus annoyance and effect on life, were significantly higher in the patients with depressed state compared to those in the patients without depressed state. The tinnitus showed significant improvement in both group with and without depressed state as indicated by the reduction of the THI and numerical scores on the four items, however, the scores for D on HADS and the MINI scores did not improve in parallel with the improvement of tinnitus. There were no significant differences in the total score on the THI or the numerical scores on the four items, improvement rate of THI scores more than 20 between patients with and without history of treatment for depressed state in mental or psychiatry clinic. The duration of tinnitus before visit to our clinic in patients treated for depressed state was longer than those without treatment for tinnitus. Tinnitus patients suffering from depressed state need Tinnitus Retraining Therapy (TRT) simultaneously with psychiatric treatment for depressed state. Collaboration between the treating neurotologists and psychiatrists is mandatory.

　Of the 557 pediatric patients aged 15 years or younger who were followed up at our center for the 5-year period from April 1, 2010, we reviewed the data of 266 patients who were examined for hearing difficulty suspected from finding other than the results of NHS. Most of the children were around 3 years old, indicating that it is difficult to notice hearing difficulty until around this age. The most common chief complaints were delayed speech and poor response to sounds, and differential diagnosis included developmental disabilities. Reexamination following the medical checkup of the 3-year-olds provided the opportunity for detecting unilateral and mild hearing difficulty. The overall number of examinations was decreased year by year, whereas the proportion of patients less than 1 year of age being examined increased, indicating the spread of NHS and recognition of the importance of early intervention. Overall, however, it appears that patients who require early follow-up are not fully covered even by NHS. Early detection of hearing difficulty included children found outside NHS and the construction of a system for subsequent intervention are issues that need to be addressed in the future.

Objective: To investigate the effects of hearing aid (HA) use in elderly persons with hearing loss living in a long-term care facility.

Subjects: A total of 48 persons with hearing loss admitted to a single long-term care facility were randomly allocated to two groups: a hearing aid group (age [y], 84±7.5; hearing threshold, 47±13dB; MMSE score, 16±7.5) and a control group (age [y], 84±7.4; hearing threshold, 45±14dB; MMSE score, 17±7.2)

Methods: The trial period was 4 months. The subjects were evaluated by MMSE prior to being given a HA and again after 3 months of HA use. Speech-language-hearing therapists (ST) observed the changes brought about by the HA use.

Results: According to the pattern of use of the HA, the subjects of the hearing aid group were divided into 6 subgroups, as follows: consistent use group, extended use group, fluctuating use group,low use group and non-use group. Of the 48 subjects, 18 felt some change of their own in their hearing with HA use. Behavioral changes were recognized in 18 subjects by the ST, and in five subjects by the caregiver staff. No significant changes of the MMSE scores were observed in the subjects.

Conclusion: The trial revealed no significant effects of HA use on the cognitive state of the subjects. For more precise clarification of the effects of HA use in the elderly, a similar trial must be conducted in elderly persons living in their own homes.