In this case study, a clinical audiologist used Neuromod’s Lenire to treat a problem with tinnitus in a patient with acoustic neuroma.

By Helen MacMahon – Clinical Audiologist

This case occurred through Ótologie Clinic, based in Dublin’s Hermitage Medical Clinic. At Ótologie, tinnitus patients are seen by qualified and experienced Clinical Audiologists.

Although Ótologie only sees patients with tinnitus, these patients frequently present with other complaints, e.g., hearing loss or hyperacusis. Patients undergo initial audiological and tinnitus assessments, device fitting appointments, and all follow-up appointments through the clinic, either in-person or remotely via video call.

An initial assessment consists of a comprehensive case history and otoscopy, tympanometry, and audiometry conducted according to the procedures outlined by the British Society of Audiology (BSA).

Audiometry typically consists of pure tone audiometry (air conduction and bone conduction, if necessary) and Minimum Masking Level testing.

Any tests conducted at the follow-up appointments are at the discretion of the Audiologist and must always comply with the BSA standards.

The clinic provides Lenire and Tinnitus Therapy (integrated psychotherapy approach) as possible treatment solutions. Ótologie Clinic may refer patients to other professionals for alternative treatments (e.g., hearing aids) if the clinician deems it necessary.

Initial Evaluation

The 65-year-old patient is a former engineer diagnosed with acoustic neuroma, a benign brain tumor, two years before visiting Ótologie. All appointments were attended remotely via video call.

Due to the slow-growing and benign nature of the tumor, the management plan would involve monitoring the tumor with bi-yearly MRI scans. Due to the position of the acoustic neuroma, the patient’s symptoms included unilateral hearing loss and tinnitus in the left ear.

The patient explained that although he is aware of his unilateral hearing loss in certain difficult listening environments, his tinnitus was causing significant distress.

The patient was recommended for Lenire treatment by an Ear, Nose, and Throat Doctor (ENT) as a suitable management plan.

The patient’s case history showed no history of medical conditions of the ear outside of the acoustic neuroma, no family history of tinnitus, and no tinnitus prior to the tumor diagnosis.

The patient described that when he is busy and focused on specific tasks, his tinnitus is less bothersome. However, quiet environments and before sleep were the most difficult. The patient describes how overall, he is psychologically coping well with tinnitus. However, in times of stress or when he needs to get a good night’s sleep, the tinnitus is very irritable.

The patient had previously trialed a hearing aid and felt no benefit in relation to tinnitus.

Clinically, the patient presented with constant, unilateral tinnitus, described as high-pitched and pure tone in sound.

The patient’s audiogram was conducted two months prior to his appointment by a clinic outside of Ótologie Clinic. The audiogram showed right normal hearing with a mild hearing loss in high frequencies and left mild sensorineural hearing loss across all frequencies.

The patient’s THI score was 36/100, with a visual analog scale of the loudness of tinnitus rated as 3/10 and a visual analog scale of the annoyance of tinnitus rated as 4/10.

It was decided that the patient was suitable for treatment with Lenire.

Treatment

Once a patient is deemed suitable for Lenire, treatment is typically broken into three phases; the device fitting appointment, a first follow-up assessment, and a second follow-up assessment once treatment is completed.

Lenire Fitting

The patient was informed that the cause of the patient’s tinnitus makes it difficult to determine the efficacy of treatment with Lenire. If the underlying cause of the tinnitus is due to structures near the ear, the treatment is unable to rectify this.

However, if there are other subjective aspects of the patient’s tinnitus, for instance, it is stress-induced, or due to a compensatory response to the mild hearing loss detected from an audiogram in the left ear, then the treatment may offer benefit.

The patient understood the risk involved and decided to start treatment. His device was configured to PS1 at the default volume for his hearing (i.e., no volume or background noise reduction activated).

 
First Follow Up

The patient complied with recommendations and carried out the Lenire treatment for an hour a day at approximately the same time. Lenire was used before sleeping (around 10:00 pm) as this was the most relaxing time with minimal distractions.

The patient described how, since using Lenire, he felt more relaxed, noticed his tinnitus less, and was determined to seek further benefit from the treatment. The patient also described how his sleep had improved, and this, in turn, improved his mood.

The patient’s THI score had improved to 28/100 (down from 36/100), with the loudness of tinnitus rated as 2/10 (down from 3/10) and annoyance of tinnitus rated as 3/10 (down from 4/10).

As per protocol, the settings on his device were changed to PS4, with default background noise level and 0dB volume reduction.

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