Formby Craig, Sherlock LaGuinn P, Hawley Monica L, Gold Susan L
Department of Communicative Disorders, University of Alabama, Tuscaloosa, Alabama.
Army Hearing Division, United States Army Public Health Center, Aberdeen Proving Ground, Aberdeen, Maryland; National Military Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, Maryland.
Semin Hear. 2017 Feb;38(1):130-150. doi: 10.1055/s-0037-1598069.
Case evidence is presented that highlights the clinical relevance and significance of a novel sound therapy-based treatment. This intervention has been shown to be efficacious in a randomized controlled trial for promoting expansion of the dynamic range for loudness and increased sound tolerance among persons with sensorineural hearing losses. Prior to treatment, these individuals were unable to use aided sound effectively because of their limited dynamic ranges. These promising treatment effects are shown in this article to be functionally significant, giving rise to improved speech understanding and enhanced hearing aid benefit and satisfaction, and, in turn, to enhanced quality of life posttreatment. These posttreatment sound therapy effects also are shown to be sustained, in whole or part, with aided environmental sound and to be dependent on specialized counseling to maximize treatment benefit. Importantly, the treatment appears to be efficacious for hearing-impaired persons with primary hyperacusis (i.e., abnormally reduced loudness discomfort levels [LDLs]) and for persons with loudness recruitment (i.e., LDLs within the typical range), which suggests the intervention should generalize across most individuals with reduced dynamic ranges owing to sensorineural hearing loss. An exception presented in this article is for a person describing the perceptual experience of pronounced loudness adaptation, which apparently rendered the sound therapy inaudible and ineffectual for this individual. Ultimately, these case examples showcase the enormous potential of a surprisingly simple sound therapy intervention, which has utility for virtually all audiologists to master and empower the adaptive plasticity of the auditory system to achieve remarkable treatment benefits for large numbers of individuals with sensorineural hearing losses.
本文提供了病例证据，突出了一种基于新型声音疗法的治疗方法的临床相关性和重要性。在一项随机对照试验中，这种干预措施已被证明在促进感音神经性听力损失患者的响度动态范围扩大和提高声音耐受性方面是有效的。在治疗前，这些个体由于其有限的动态范围而无法有效地利用辅助声音。本文表明，这些有前景的治疗效果在功能上具有重要意义，可带来言语理解能力的提高、助听器效益和满意度的增强，进而提高治疗后的生活质量。治疗后的这些声音疗法效果还显示，在一定程度上可通过辅助环境声音得以维持，并且依赖于专业咨询以最大限度地提高治疗效益。重要的是，该治疗方法似乎对患有原发性听觉过敏（即响度不适阈异常降低）的听力受损者以及患有响度重振（即响度不适阈在正常范围内）的人有效，这表明该干预措施应适用于大多数因感音神经性听力损失而动态范围减小的个体。本文介绍的一个例外情况是，有一个人描述了明显的响度适应的感知体验，这显然使声音疗法对该个体不可闻且无效。最终，这些案例展示了一种令人惊讶的简单声音疗法干预措施的巨大潜力，这种干预措施几乎对所有听力学家都有用，可帮助他们掌握并增强听觉系统的适应性可塑性，从而为大量感音神经性听力损失患者带来显著的治疗效益。
