Tinnitus and Widex Zen

We recently, at the University of California, conducted a study with a new technology that
is available that uses fractal tones. Fractal tones sound a little bit like wind chimes,
and it's a technology that is available in the Widex hearing aids, and it’s called
the Zen programme. Zen is a listening option, it is a programme that is contained within
the hearing aids, that the hearing health care professional can activate or not activate,
depending on how the work with the patient is going. So we wanted to see whether or not
this Zen programme would, number one, be relaxing for patients, and number two, would it have
any effect on the annoyance of their tinnitus? And so we took a number of subjects, we actually
found 14 subjects who were severely impacted by their tinnitus. These were subjects who
were patients over at our university that we had tried lot of different techniques with
in the past, and none of them worked to the point where the patient was feeling okay about
their tinnitus. So we took some pretty difficult subjects into this particular study, and we
had them listen to a variety of the Zen tones, these fractal tones. We had them also listen
to a broadband noise, and we also had them listen to amplification alone, and to amplification
plus the different Zen tones, plus the broadband noise. So there were a number of different
conditions that we asked patients to go through, and then we also had the patients, once they
found particular settings that they were happy with, after we adjusted pitch and tempo and
things like that, we actually had them wear the hearing aids with the Zen programmes in
them for a six-month period, and then assessed how this impacted their reaction to the tinnitus,
once they had gone through this therapeutic programme.
And so, what we found was that relaxation was something that was achieved by the patients.
In fact over 80% of the subjects involved in the study stated that they found it easier
to relax when they were listening to the fractal tones. We also found that there were very
specific preferences, that were individually based, for certain kinds of tempo or rhythm,
certain pitches that came out of the different fractal or Zen tones, and we found those to
be pretty interesting because, generally speaking, the results that we found followed along with
some of the very well-established principles about music. Things like, slow tempo tends
to be more relaxing than a fast tempo. Lower pitches tend to be more calming than higher
pitches. Major musical chords are more relaxing and pleasant to listen to than minor musical
chords. And it was very interesting that almost all of the subjects followed along those guidelines,
although there were absolute individual variations, which told us that it is very important to
allow the patient and the hearing health care professional to be able to make some variants,
or some adjustments, in the tones, or in the Zen programmes, to fit the patient's individual
needs.
So we found that it was relaxing for 80% of the patients. We also found that the majority
of the patients showed that they preferred the Zen tones to a broadband noise. Now, what
was interesting about this was that the broadband noise actually suppressed the tinnitus more
than the Zen tones, but of these 14 subjects, only two of them decided that they would like
to listen to the broadband noise out in the real world on a long-term basis. That was
an interesting finding, because it meant it wasn't simply suppression of the tinnitus
that was important. It was other characteristics as well. So the long-term comfort of the patient,
and the relaxation induced by the fractal tones, seemed to be something that was very
important to patients in terms of their daily listening.
The other thing we found, which had been found by other researchers previously, is that amplification
alone really helps tinnitus patients, because it stimulates the parts of the brain that
were not getting stimulated because of the hearing loss. So amplification was very important,
but then the addition of the Zen tones and the option of also mixing in a background
noise if necessary was what really created some positive success for the patients.
Not every patient succeeded with this, not every subject in this study succeeded. The
majority did, some didn't. But it was for those who did that the success was so significant,
that the change in their reaction to their tinnitus was highly significant. So it's one
of those things that, if you can provide, we always have to provide, counselling to
a patient, we should always provide amplification to a patient if they have any degree of hearing
loss, which most people who have tinnitus do. Once those things are provided, giving
them additional options, particularly options that utilise musical stimuli such as the Zen
tones, that are unpredictable so you don't sit and actively focus on them, because that's
not how you want to try to learn to cope with the tinnitus. You have to kind of do that
in a more passive manner. But if we can provide something that stimulates that part of the
brain, a certain part of the brain that we call the limbic system by the way, if we could
stimulate that part of the brain with a pleasant stimulus, such as music, such as these Zen
tones, they were going to go on a long way into both addressing the acoustic needs as
well as the emotional needs, by helping the patient recognize that there is a strong relationship
between stress, relaxation and the ability to cope with the tinnitus. That's what we
really need to break - that cycle where you have tinnitus and you become more stressed,
and then you become more stressed and so your tinnitus appears louder. That's what we want
to break. And what we found in the study was the use of the Zen tones actually gave us
the ability to break into that cycle.
One of the things that we looked for in our study of the Zen programmes was to determine
whether there were specific patients or subjects for whom this programme would be ideal, this
option would be ideal. And, at least in the course of the study, we were not able to identify
very specific features that would tell us ‘these patients need the Zen’, ‘these
patients don't need the Zen’.
I think from my clinical practice, what I would conclude is this. If the patient finds
that stress exacerbates or triggers their tinnitus - and that, by the way, is most patients
- or if they find that they are not relaxing because of their tinnitus, then the Zen becomes
a useful option. For a lot of the patients that have tried background signals in the
past, particularly background signals that haven't been filtered properly, and who have
not been satisfied with how they are dealing with their tinnitus, I think Zen becomes a
very viable option for them. But I don't think that there is a specific kind of person that
you would automatically look at and say, “Based on this person’s hearing loss, they are
a good candidate for Zen”, or they’re not. It's not really the hearing loss, it's
really the reaction to the tinnitus. If the person is upset because of their tinnitus,
that means they are a candidate for the Zen, and the Zen ought to be offered to them as
an option. Whether they will exercise that option is going to be a result of their interaction
with the hearing health care professional and with how they emotionally deal with the
tinnitus once they have been counselled and once they understand why amplification can
be of assistance to them.
Certainly with tinnitus, there is a major placebo effect involved. There is a significant
number of patients for whom you could just say, “This is going to work” and in fact
it will work. From a clinical perspective that's nice, but from a science perspective,
we want to be able to have evidence. We want to have studies that show that a certain feature
in a hearing aid or a certain type of compression, or things like that, are going to actually
make a difference for the patient. That's the reason why we undertook the study on the
Zen and the fractal tones, because we knew that sounds could help tinnitus patients,
we knew that amplification could help tinnitus patients, and we knew that counselling could
help tinnitus patients. What we wanted to determine what whether or not this new kind
of option, the fractal tones, the Zen tones, would be acceptable to patients. Would they
find them to be relaxing, and, secondly, would they find them to have a positive effect on
their tinnitus, not just when they initially put it on, but six months down the road? And
so that's why we undertook that study, and that's why I think it's important for all
of us to recognize that when we are dealing with patients, whether they be tinnitus patients
or the more basic hearing-impaired patients, that having some evidence to support our reasoning
for doing a certain type of therapy or making certain recommendations is essential, and
is important. We can't simply believe what we’re told by marketing people, or by manufacturers
or by salespeople. We need evidence. And that's where I think the science comes in, and that's
where I think, at least right now, we've got some pretty good evidence on the fractal tones.