A brief history of hearing A brief history of hearing aids and tinnitus sound aids and tinnitus sound

enrichment devices.enrichment devices.

By James StibbardsBy James StibbardsAudiologistAudiologist

Aintree Tinnitus Support GroupAintree Tinnitus Support Group33rdrd March 2010 March 2010

Early daysEarly days

The 1The 1stst written account of medical written account of medical treatment of tinnitus is all the way back to treatment of tinnitus is all the way back to the Egyptians.the Egyptians.

For the “Bewitched ear and humming in For the “Bewitched ear and humming in the ears” they would infuse oil, the ears” they would infuse oil, frankincense, tree sap, herbs and soil; and frankincense, tree sap, herbs and soil; and they would administer it using a reed stalk they would administer it using a reed stalk placed in the external ear.placed in the external ear.

ThisThis is Enki, is Enki, the god of the god of

water.water.

The Mesopotaminans The Mesopotaminans used to chant to get rid of used to chant to get rid of the whispering or singing the whispering or singing in their ears.in their ears.

““Whoever thou may be, Whoever thou may be, may Enki restrain me”may Enki restrain me”

Another incantation was Another incantation was “It hath flown against me. “It hath flown against me. It hath attacked me. O It hath attacked me. O seven heavens, seven seven heavens, seven earths, seven winds, earths, seven winds, seven fires, by heaven be seven fires, by heaven be ye exorcisedye exorcised

The Greeks and RomansThe Greeks and Romans Early Greco-Roman medicine defined the Early Greco-Roman medicine defined the

treatment of tinnitus based on the cause of treatment of tinnitus based on the cause of the disease.the disease.

Later, the works of Hippocrates and Later, the works of Hippocrates and Aristotle really were the first to introduce Aristotle really were the first to introduce the idea of masking. They were fond of the idea of masking. They were fond of saying, "Why is it that buzzing in the ear saying, "Why is it that buzzing in the ear ceases if one makes a sound. Is it because ceases if one makes a sound. Is it because a greater sound drives out the less?" a greater sound drives out the less?"

Middle agesMiddle ages Welsh treatment Welsh treatment

recommended to take recommended to take a loaf of hot bread, a loaf of hot bread, divide it in two, and divide it in two, and put it in each ear as put it in each ear as hot as you could take hot as you could take it and thus perspire it and thus perspire and by the help of and by the help of God you would be God you would be cured.cured.

The RenaissanceThe Renaissance They thought that They thought that

wind would become wind would become entrapped in the ear entrapped in the ear and circle around and circle around inside it, and so they inside it, and so they would trephinate the would trephinate the mastoid to allow the mastoid to allow the wind to escape.wind to escape.

1919thth Century Century The French physician, Itard, is widely The French physician, Itard, is widely

recognized as the father of audiology.recognized as the father of audiology. He argued that the role of the physician He argued that the role of the physician

was to make the tinnitus bearable.was to make the tinnitus bearable. A technique that rarely failed was to cover A technique that rarely failed was to cover

the internal sound by an external one. The the internal sound by an external one. The sound should be matched as far as sound should be matched as far as possible to the tinnitus. For example, a possible to the tinnitus. For example, a roaring fire should mask a roaring tinnitus roaring fire should mask a roaring tinnitus

The 20The 20thth Century Century

In 1903 a doctor named Spaulding used a In 1903 a doctor named Spaulding used a piano to match the frequency of tinnitus.piano to match the frequency of tinnitus.

He would increase the volume of the note He would increase the volume of the note until the tinnitus became inaudible for his until the tinnitus became inaudible for his patient. patient.

The 20The 20thth Century Century In 1928, two researchers, Jones and In 1928, two researchers, Jones and

Knudsen bombarded the auditory system Knudsen bombarded the auditory system with an outside sound similar to tinnitus with an outside sound similar to tinnitus but louder. but louder.

They developed a large instrument that They developed a large instrument that could be placed on a bedside table for could be placed on a bedside table for patients experiencing difficulty sleeping. patients experiencing difficulty sleeping. This became the very first bedside This became the very first bedside masker.masker.

The 1The 1stst wearable devices wearable devices In 1973, Jack Vernon, In 1973, Jack Vernon,

Ph.D. led a research Ph.D. led a research group that was the only group that was the only group in the US formally group in the US formally studying tinnitus.studying tinnitus.

One day he received a One day he received a visitor, Dr. Charles Unice, visitor, Dr. Charles Unice, who travelled from who travelled from California to visit him California to visit him regarding his severe regarding his severe tinnitus.tinnitus.

As they passed an outdoor fountain, Dr. As they passed an outdoor fountain, Dr. Unice came to an abrupt stop. Reluctant to Unice came to an abrupt stop. Reluctant to leave the soothing sounds of the fountain leave the soothing sounds of the fountain he told Dr. Vernon, “Standing right here I he told Dr. Vernon, “Standing right here I cannot hear my tinnitus. It’s the first time cannot hear my tinnitus. It’s the first time I’ve been unable to hear that I’ve been unable to hear that unconscionably wretched sound since it unconscionably wretched sound since it began over two years ago. This is began over two years ago. This is wonderful!” After several more wonderful!” After several more discussions, Dr. Vernon formed the idea of discussions, Dr. Vernon formed the idea of using a wearable masking device as a using a wearable masking device as a method of providing relief from tinnitus. method of providing relief from tinnitus. The rest, as they say, is history.The rest, as they say, is history.

Wearable Sound GeneratorsWearable Sound Generators WSG may be prescribed to patients who WSG may be prescribed to patients who

do not have significant hearing loss.do not have significant hearing loss. The devices are similar to hearing aids The devices are similar to hearing aids

except that they do not amplify sound; except that they do not amplify sound; they produce white noisethey produce white noise

The brain can very easily learn to ignore The brain can very easily learn to ignore external sound, especially if it’s at a external sound, especially if it’s at a constant level and frequencyconstant level and frequency

Desk top devicesDesk top devices

Produce a variety of environmental soundsProduce a variety of environmental sounds

Can be linked to a “pillow speaker”Can be linked to a “pillow speaker”

Should be switched on all dayShould be switched on all day

Benefits of sound enrichmentBenefits of sound enrichment Weakens the tinnitus signal by decreasing Weakens the tinnitus signal by decreasing

the difference between tinnitus and the the difference between tinnitus and the background soundbackground sound

The sounds should be non-intrusive, The sounds should be non-intrusive, pleasant and relaxing to listen topleasant and relaxing to listen to

They should not cover the tinnitus (i.e. They should not cover the tinnitus (i.e. they must not mask the tinnitus sound)they must not mask the tinnitus sound)

Hearing aidsHearing aids Hearing aids can help people with hearing Hearing aids can help people with hearing

loss and in many cases they also reduce loss and in many cases they also reduce tinnitus symptoms.tinnitus symptoms.

First, tinnitus is exacerbated by silence First, tinnitus is exacerbated by silence because the brain turns up its sensitivity because the brain turns up its sensitivity by seeking the neural stimulation it’s being by seeking the neural stimulation it’s being deprived of due to hearing loss.deprived of due to hearing loss.

Second, hearing aids amplify enough Second, hearing aids amplify enough background noise to partially mask tinnitus background noise to partially mask tinnitus sounds for many people.sounds for many people.

The 1The 1stst hearing aids hearing aids

Concealed Hearing Concealed Hearing Devices of the 19th Devices of the 19th

CenturyCentury

Acoustic chairsAcoustic chairs Acoustic Chairs were Acoustic Chairs were

a clever example of a clever example of incorporating a incorporating a hearing device within hearing device within an everyday objectan everyday object

Perhaps the most Perhaps the most ingenious design of ingenious design of an acoustic throne an acoustic throne was created by F. C. was created by F. C. Rein for King John VI Rein for King John VI of Portugal of Portugal

Beard ReceptacleBeard Receptacle

Hair ReceptorHair Receptor

Electrical devicesElectrical devices During the 20th century, aids for hearing evolved During the 20th century, aids for hearing evolved

from mechanical to electrical devices. Using an from mechanical to electrical devices. Using an external power source, sounds could now be external power source, sounds could now be made louder than was possible with earlier made louder than was possible with earlier mechanical designs mechanical designs

Early Electrical Hearing Aids were based on Early Electrical Hearing Aids were based on telephone technology invented by Alexander telephone technology invented by Alexander Graham Bell in the late 19th century Graham Bell in the late 19th century

Acousticon Model 28, Acousticon Model 28, 1927 1927 This hearing aid This hearing aid is typical of early is typical of early electrical hearing aids. electrical hearing aids. It was large and not It was large and not easily transportable – easily transportable – the batteries were the batteries were cumbersome and the cumbersome and the carbon components carbon components were highly sensitive to were highly sensitive to heat and cold.heat and cold.

Hearing aid Hearing aid glassesglasses

Internal workings of an analogue Internal workings of an analogue BTE hearing aid.BTE hearing aid.

Digital Digital hearing aidshearing aids

In the ear aidsIn the ear aids

Otarion ECA (ear canalOtarion ECA (ear canalaid) 1961aid) 1961

Oticon 1978Oticon 1978

Oticon 1987Oticon 1987

Bernafon ITC (in theBernafon ITC (in thecanal) 1997canal) 1997

The futureThe future

Who knows!Who knows!

Main ReferencesMain References

Tinnitus Retraining Therapy. Jastreboff PJ, Hazell JWP. Cambridge University Press Tinnitus Retraining Therapy. Jastreboff PJ, Hazell JWP. Cambridge University Press 20042004

Subjective TinnitusSubjective TinnitusJayson S. Greenberg, M.D.Jayson S. Greenberg, M.D.March 12, 1998 March 12, 1998 Baylor College of MedicineBaylor College of MedicineBobby R. Alford Department of Otolaryngology-Head and Neck SurgeryBobby R. Alford Department of Otolaryngology-Head and Neck Surgery

Tinnitus Tinnitus Elizabeth Willingham, M.D Elizabeth Willingham, M.D July 22, 2004 July 22, 2004

Baylor College of MedicineBaylor College of MedicineBobby R. Alford Department of Otolaryngology-Head and Neck SurgeryBobby R. Alford Department of Otolaryngology-Head and Neck Surgery

Tinnitus Masking by Barry Keate Tinnitus Masking by Barry Keate http://www.tinnitusformula.com/infocenter/articles/treatments/mask.aspxhttp://www.tinnitusformula.com/infocenter/articles/treatments/mask.aspx

How Hearing Aids Work by Stephanie Watson http://health.howstuffworks.com/hearing-aid6.htmhttp://health.howstuffworks.com/hearing-aid6.htm

References cont.References cont.

The History of Hearing Aids – From Seashells to Mini-computersThe History of Hearing Aids – From Seashells to Mini-computers09/11/2008 Matt Jacks @ thehistoryof.net09/11/2008 Matt Jacks @ thehistoryof.net

Looking at the History of Hearing Aids: The Past, Present, and Future of Hearing Aid TechnologyLooking at the History of Hearing Aids: The Past, Present, and Future of Hearing Aid Technologyhttp://hearing-aids.americahears.com/aid-technology.htmlhttp://hearing-aids.americahears.com/aid-technology.html

Speech-Language Pathology and Audiology at Kent State UniversitySpeech-Language Pathology and Audiology at Kent State UniversityHearing Aid Museum Online http://ehhs.kent.edu/spa/museum.cfmHearing Aid Museum Online http://ehhs.kent.edu/spa/museum.cfm

Deafness in Disguise:Deafness in Disguise:Concealed Hearing Devices of the 19th and 20th CenturiesConcealed Hearing Devices of the 19th and 20th CenturiesWashington University School of Medicine, St. Louis, Missouri Washington University School of Medicine, St. Louis, Missouri Published by the Bernard Becker Medical LibraryPublished by the Bernard Becker Medical Libraryhttp://beckerexhibits.wustl.edu/did/index.htmhttp://beckerexhibits.wustl.edu/did/index.htm

Google images http://images.google.co.ukGoogle images http://images.google.co.uk