Patent Application
20090270673
The present invention relates to methods and apparatus for treating tinnitus via oral-based hearing aid appliances. More particularly, the present invention relates to methods and apparatus for treating tinnitus via oral appliances which are positionable within a mouth of a patient for transmitting sound conduction through teeth or bone structures in and/or around the mouth to mask or habituate a patient to sounds or ringing typically associated with tinnitus.
Tinnitus is a condition in which those affected perceive sound in one or both ears or in the head when no external sound is present. Often referred to as “ringing” in the ears, tinnitus can occur intermittently or consistently with a perceived volume ranging from low to painfully high. However, the perceived volume of tinnitus can vary from patient to patient where an objective measure of tinnitus volume in one patient may be perceived as painful but in another patient the same volume may be perceived as subtle.
Generally, tinnitus can be caused by a number of sources. For instance, exposure to loud noises can lead to damage of the cilia within the inner ear. An accumulation of wax within the ear canal can also amplify a person's tinnitus condition. Other factors such as ingestion of certain medications, ear or sinus infections, tumors growing on auditory nerves, as well as trauma to the head or neck can also induce tinnitus. Additionally, a small percentage of tinnitus patients may experience a form of tinnitus known as pulsatile tinnitus where a rhythmic pulsing sound is present which is attuned to the patient's heartbeat. Such a condition may be indicative of a cardiovascular condition such as pulmonary stenosis, hypertension, hardening of the arteries, arterio venous malformations, etc.
Treatments for tinnitus vary greatly. For instance, masking therapy typically involves using a hearing aid device to introduce sounds at a level and frequency that completely or partially cover the sounds of tinnitus in a patient to provide immediate short-term relief. Another similar therapy, tinnitus retraining therapy (TRT) or habituation, is a form of combination treatment that allows the patient to become comfortable with the tinnitus and defocuses their attention by utilizing sound generators such as hearing aids or even desktop devices such as fans to emit sounds at a lower level which still allow the user to hear the tinnitus with the intent of retraining the user's brain to eventually disregard the tinnitus. With habituation, a much lower level of sound therapy which does not mask the sound is delivered to the patient. In combination with therapy, habituation calms the patient and reinforces to them that their tinnitus is not life threatening or dangerous. Moreover, this therapy is meant to prevent the limbic system from increasing their awareness of and focus on Tinnitus. However, masking and TRT therapies may utilize conventional hearing aid devices which may he uncomfortable to the user and/or may carry other psychological stigmas. Additionally, in the case of TRT, such a therapy may take several years to accomplish.
Other devices such as cochlear implants and electrical stimulation, where an electrode array is inserted into the cochlea and a receiver is implanted subcutaneously behind the ear, may also be utilized to mask the tinnitus by ambient sounds and/or electrical stimulation. However, such procedures involve surgery and the complications typically associated therewith. Furthermore, drug therapy such as the use of antidepressants, may be effective in treating tinnitus. However, the typical side effects of ingesting such drugs may be highly undesirable to the tinnitus patient.
Accordingly, there exists a need for methods and devices for non-invasively and efficiently treating tinnitus patients.
Tinnitus is a condition in which sound is perceived in one or both ears or in the head when no external sound is present. Such a condition may typically be treated by masking the tinnitus via a generated noise or sound. In one variation, the frequency or frequencies of the tinnitus may be determined through an audiology examination to pinpoint the range(s) in which the tinnitus occurs in the patient. This frequency or frequencies may then be programmed into a removable oral device which is configured to generate sounds which are conducted via the user's tooth or bones to mask the tinnitus.
An electronic and transducer device may be attached, adhered, or otherwise embedded into or upon the removable oral appliance or other oral device to form a hearing aid and/or sound generating assembly. Such an oral appliance may be a custom-made device fabricated through a variety of different process utilizing, e.g., a replicate model of a dental structure obtained by any number of methods. The oral appliance may accordingly be created to fit, adhere, or be otherwise disposed upon a portion of the patient's dentition to maintain the electronics and transducer device against the patient's dentition securely and comfortably.
The electronic and transducer assembly may be programmed to generate sounds at one or more frequencies depending upon the condition of the user's tinnitus via a vibrating transducer element coupled to a tooth or other bone structure, such as the maxillary, mandibular, or palatine bone structure. Moreover, the assembly may also be optionally configured to receive incoming sounds either directly or through a receiver to process and amplify the signals and transmit the processed sounds. Sound (e.g. any tone, music, or treatment using a wide-band or narrow-band noise) generated via an actuatable transducer is calibrated and equalized to compensate for impedances of the teeth and bone.
One method for treating tinnitus may generally comprise masking the tinnitus where at least one frequency of sound (e.g., any tone, music, or treatment using a wide-band or narrow-band noise) is generated via an actuatable transducer positioned against at least one tooth such that the sound is transmitted via vibratory conductance to an inner ear of the patient, whereby the sound completely or at least partially masks the tinnitus perceived by the patient. In generating a wide-band noise, the sound level may be raised to be at or above the tinnitus level to mask not only the perceived tinnitus but also other sounds. Alternatively, in generating a narrow-band noise, the sound level may be narrowed to the specific frequency of the tinnitus such that only the perceived tinnitus is masked and other frequencies of sound may still be perceived by the user.
Another method may treat the patient by habituating the patient to their tinnitus where the actuatable transducer may be vibrated within a wide-band or narrow-band noise targeted to the tinnitus frequency perceived by the patient overlaid upon a wide-frequency spectrum sound. This wide-frequency spectrum sound, e.g., music, may extend over a range which allows the patient to periodically hear their tinnitus through the sound and thus defocus their attention to the tinnitus.
In enhancing the treatment for tinnitus, a technician, audiologist, physician, etc., may first determine the one or more frequencies of tinnitus perceived by the patient. Once the one or more frequencies have been determined, the audiologist or physician may determine the type of treatment to be implemented, e.g., masking or habituation. Then this information may be utilized to develop the appropriate treatment and to compile the electronic treatment program file which may be transmitted, e.g., wirelessly, to a processor coupled to the actuatable transducer such that the transducer is programmed to vibrate in accordance with the treatment program.
In use, an oral appliance containing the transducer may be placed against one or more teeth of the patient and the transducer may be actuated by the user when tinnitus is perceived to generate the one or more frequencies against the tooth or teeth. The generated vibration may be transmitted via vibratory conductance through the tooth or teeth and to the inner ear of the patient such that each of the frequencies of the perceived tinnitus is masked completely or at least partially.
The oral appliance may be programmed with a tinnitus treatment algorithm which utilizes the one or more frequencies for treatment. This tinnitus treatment algorithm may be uploaded to the oral appliance wirelessly by an external programming device to enable the actuator to vibrate according to the algorithm for treating the tinnitus. Moreover, the oral appliance may be used alone for treating tinnitus or in combination with one or more hearing aid devices for treating patients who suffer not only from tinnitus but also from healing loss.
In one particular variation for treating tinnitus, the oral appliance may utilize an audio signal, such as music and in particular music having a dynamic signal with intensities varying over time with multiple peaks and troughs throughout the signal. Other audio signals such as various sounds of nature, e.g., rainfall, wind, waves, etc., or other signals such as voice or speech may alternatively be used so long as the audio signal is dynamic. This audio signal may be modified according to a masking algorithm and applied through the device and to the patient to partially mask the patient's tinnitus. In particular, U.S. Pat. No. 6,682,472 (Davis), which is incorporated herein by reference in its entirety, shows and describes a tinnitus method which may utilize software to spectrally modify the audio signal in accordance with a predetermined masking algorithm which modifies the intensity of the audio signal at selected frequencies. The described predetermined masking algorithm provides intermittent masking of the tinnitus where the tinnitus is completely masked during peaks in the audio signal and where the perceived tinnitus is detectable to the patient during troughs in the audio signal. Such an algorithm provides for training and habituation by the patient of their tinnitus.
An example of a method for habituating a patient to tinnitus may generally comprise providing the audio signal which is spectrally modified via the masking algorithm which modifies at least a portion of the audio signal at selected frequencies whereby the tinnitus is completely masked to the patient during a peak of the audio signal and the tinnitus is perceived by the user during a trough of the audio signal, further modifying the audio signal whereby the audio signal accounts for a bone conductance profile measured from a patient, and actuating at least one transducer such that the audio signal modified for the bone conductance profile is transmitted via vibratory conductance through a bone of the patient to an inner ear of the patient such that the tinnitus is masked via the audio signal in an intermittent manner.
A system for utilizing this method may generally comprise a housing sized for secure placement against a surface of a bone or tooth of a patient, one or more transducers attached to the housing and coupled in vibratory communication with the surface of the bone or tooth, the audio signal which is spectrally modified via the masking algorithm which modifies at least a portion of the audio signal at selected frequencies whereby tinnitus is completely masked to the patient during a peak of the audio signal and the tinnitus is perceived by the user during a trough of the audio signal, and wherein the audio signal is further modified to account for a bone conductance profile measured from the patient, and a processor in communication with the transducer, wherein the processor is configured to actuate the transducer according to the audio signal such that the audio signal is transmitted via vibratory conductance through the surface of the bone or tooth and to an inner ear of the patient.
Another tinnitus treatment system which may be utilized for relief or adaptation or habituation therapy is described in detail in U.S. patent application Ser. No. 11/970,469 filed Jan. 7, 2008 entitled SIGNAL PROCESS FOR THE DERIVATION OF IMPROVED DIM DYNAMIC TINNITUS MITIGATION SOUND, which is incorporated herein by reference in its entirety. As described, this system combines at least one recorded natural sound known to partially mask tinnitus with computer-generated sound that emulates at least one natural sound where the combined sound produces a more dynamic amplitude envelope (greater ratios between minimum and maximum envelope amplitudes) and more effective tinnitus masking than that of either the natural sound or the computer-generated sound individually.
Specific parameters for any step of the above signal processes may be altered, one or more steps may be excluded, additional steps may be added, and/or the type of emulated sound may be varied, in each case, although having a corresponding effect on the character of the sound. The resulting improved tinnitus masking sound exhibits a highly dynamic amplitude envelope and enhanced high frequency impulse intensity which may provide effective tinnitus masking. The various signal processes are more fully described in U.S. Pat. No. 11/970,469 which has been incorporated above.
In utilizing any of the tinnitus treatment methods described herein, a processor may be programmed by a physician, technician, audiologist, and/or user to optimize the treatment device or processor for an individual user. Moreover, because of the various treatment approaches, e.g., tinnitus habituation, masking, etc., the processor may be programmed to optimize treatment approaches utilizing a programming interface. Such programming devices may utilize graphical user interfaces in the form of an extra-buccal transmitter assembly or base unit in the form of, e.g., a personal digital assistant, cell phone, digital music player such as an IPOD device (Apple, Inc., Cupertino, Calif.), etc.
A device may be programmed to start upon actuation and the user may be prompted to select one of two modes, e.g., a “Play” mode where the device may function as a digital music player such as an MP3 player or where the device may be initiated to provide immediate relief of tinnitus to the user and a “Set Up” mode where the device may be calibrated and/or adjusted to optimize the tinnitus therapy for an individual user. In the event the user selects the “Play” mode, the user may use the device as a player for music and/or speech. The user may also optionally select a tinnitus relief or adaptation therapy which may be played to the user alone or overlaid upon a music selection selected by the user. As used herein, adaptation therapy may be used interchangeably with habituation therapy in the context of tinnitus treatment.
In the event that the user wishes to optimize the device for tinnitus relief or adaptation therapy, the user may select the “Set Up” mode to calibrate and/or adjust the various settings on the device. During set up, the user may first undergo calibration testing to calibrate the device settings to account, for parameters such as an individual's bone sensitivity threshold profile to facilitate vibratory conductance from the transducer to the user's middle and/or inner ear. The user may then adjust settings on the device once calibration testing has been completed. Alternatively, the user may first adjust the device settings and then undergo calibration testing. In other alternatives, calibration testing or the adjustment of settings may be omitted entirely if so desired. In either case, once calibration testing and/or adjustment of settings has been completed, the device may then allow for the selection of relief or adaptation therapy. Once selected, the user may then use the device.
In selecting between relief and adaptation therapy, the selection of relief therapy gives the user a choice to select between one of a number of various sounds (e.g., various nature sounds such as birds, crickets, etc.; shower sounds such as rain, etc.) through which the tinnitus relief may be provided as described above. Because relief therapy is utilized to provide immediate relief to the user, the generated sounds may be used to mask the tinnitus at least temporarily so that the device may be used immediately. In selecting adaptation therapy, the user may similarly select between one of a number of various sounds (e.g., various nature sounds such as birds, crickets, etc.; shower sounds such as rain, etc.) With a sound selected, such as nature, relief therapy may be transmitted and uploaded, for example, from the programming device to the one or more transducers in the device which may then be actuated to vibrate against the patient's bone surface and/or against one or more of the patient's teeth to transmit the uploaded signal via vibratory conductance through the bone and to one or both inner ears. With the adaptation therapy selected, the adaptation settings may then be adjusted and the device may be used.
In the event that adaptation therapy is selected, an interface may be presented to the user which allows the user to optionally adjust parameters such as the adaptation therapy dose (e.g., 1 to 4 or more hours/day, minutes/day, etc.), adaptation level (e.g., 5 dB. 10 dB, 15 dB, 20 dB, etc.), or adaptation cycle time (e.g., 1 min., 3 min., 5 min., 10 min., etc.). Once any adjustments are completed, the device may then be utilized. If adaptation therapy settings are not adjusted, the device may be directly utilized bypassing any of the adjustment features.
In setting up the device for individual use, the processor may undergo calibration testing and/or adjustment of settings. In calibration testing the device, in the event that the user bypasses calibration, any settings may be saved and the device may be directly utilized. In the event calibration testing is initiated, an interface may be presented to allow the user to select between automated calibration testing or direct calibration adjustment by the user or practitioner, as described in further detail below.
Prior to or after calibration testing, any number of settings may be adjusted by the programming device for optimizing the oral device. If no adjustments are made, then the device may be utilized directly. Otherwise, a number of various adjustment may be optionally made, e.g., contrast adjustment or a sleep timer function may be set to have the oral device automatically turn off after a predetermined period of time (e.g., 15 min., 30 min., 60 min., 10 min., 90 rain., 120 min., etc.). Yet another adjustment may optionally include the use of a shuffle feature for music if the oral device is used as a music player. Yet another feature may include the option to manually adjust the pitch of the tinnitus treatment in the range of. e.g., >7 kHz, 5 to 7 kHz, 3 to 5 kHz, or <3 kHz depending upon the frequency range of the user's tinnitus to optimally adjust the pitch of the tinnitus treatment signals.
Another adjustment feature may be limited to enable access by a professional practitioner such as a physician, audiologist, technician, etc. involved with treating the user for tinnitus. Optional selection of this feature may be limited by entry of a password known to the professional. Entry by a practitioner may be optionally enabled to allow for the practitioner to adjust a number of features which may be normally inaccessible to the user. Additionally, the programming device may be utilized to record a number of parameters relating to patient use which allows for the practitioner to optionally record and track the usage of the device and to monitor tinnitus treatment progress. Some of the options the practitioner may review and/or revise may include parameters such as compliance data, setup information, prescription information, calibration, the degree of patient control allowed, etc.
Accessing therapy settings may allow a practitioner to enable or disable certain aspects of the oral device such as the ability to activate the device for relief therapy, adaptation therapy, monitor compliance, etc. Moreover, the practitioner may also manually alter the treatment signal to optimally match the tinnitus pitch (e.g., >7 kHz, 5 to 7 kHz, 3 to 5 kHz, or <3 kHz, as described above) of the user. In adjusting adaptation settings, the practitioner may adjust the allowed dose (e.g., 1 to 4 or more hours/day, minutes/day, etc.), adaptation level (e.g., 5 dB, 10 dB, 15 dB, 20 dB, etc.), or adaptation cycle time (e.g., 1 min., 3 min., 5 min., 10 min., etc.). Likewise, the practitioner may also optionally download the patient record, e.g., to a computer, where the data may be reviewed and/or manipulated at a later time.
Additionally and/or optionally, the practitioner may also reset or restart the calibration test and/or manually adjust the calibration. Aside from calibration, the practitioner may also adjust the patient control access to adjust the degree of control which the user may have over the device. For instance, the practitioner may adjust features such as whether the oral device may be utilized as a music/MP3 player, whether the user is able to make adjustments to the pitch, sleep mode timer, and also parameters such as whether the user may utilize features such as a separate headset, external microphone, external music or MP3 player, or any other number of features.
Because tinnitus is a condition in which sound is perceived in one or both ears or in the head when no external sound is present, such a condition may typically be treated by masking the tinnitus via a generated noise or sound. In one variation, the frequency or frequencies of the tinnitus may be determined through an audiology examination to pinpoint the range(s) in which the tinnitus occurs in the patient. This frequency or frequencies may then be programmed into a removable oral device which is configured to generate sounds which are conducted via the user's tooth or bones to mask the tinnitus, as described in further detail below.
An electronic and transducer device may be attached, adhered, or otherwise embedded into or upon the removable oral appliance or other oral device to form a hearing aid and/or sound generating assembly. Such an oral appliance may be a custom-made device fabricated through a variety of different process utilizing, e.g., a replicate model of a dental structure obtained by any number of methods. The oral appliance may accordingly be created to fit, adhere, or be otherwise disposed upon a portion of the patient's dentition to maintain the electronics and transducer device against the patient's dentition securely and comfortably.
The electronic and transducer assembly may be programmed to generate sounds at one or more frequencies depending upon the condition of the user's tinnitus via a vibrating transducer element coupled to a tooth or other bone structure, such as the maxillary, mandibular, or palatine bone structure. Moreover, the assembly may also be optionally configured to receive incoming sounds either directly or through a receiver to process and amplify the signals and transmit the processed sounds. Any tone, music, or treatment using a wide-band and or narrow band noise is calibrated and equalized to compensate for impedances of the tooth and bone and then that sound is generated via the actuatable transducer. Calibration and equalization can be done using several approaches. One approach is to use average impedance among a group of subjects representative of the targeted population. Another approach is to customize the calibration and equalization by obtaining the teeth and bone impedances for each patient.
Moreover, the electronic and transducer assembly may be configured to provide several different tinnitus treatments. For instance, the assembly may be configured to provide tinnitus masking therapy by providing sounds through bone conduction at a level and frequency that completely or partially cover the sounds of tinnitus to provide immediate short-term relief. Any tone, music, or treatment using a wide-band or narrow-band noise may be generated via the actuatable transducer positioned against at least one tooth such that the sound is transmitted via vibratory conductance to an inner ear of the patient, whereby the sound completely or at least partially masks the tinnitus perceived by the patient.
Alternatively, the assembly may be configured to provide habituation treatment, where the assembly provides sounds which may not mask the tinnitus but allows the patient to defocus their attention. As used herein, adaptation therapy may be used interchangeably with habituation therapy in the context of tinnitus treatment. The actuatable transducer may be vibrated within a wide-band or narrow-band noise targeted to the tinnitus frequency perceived by the patient overlayed upon a wide-frequency spectrum sound. This wide-frequency spectrum sound, e.g., music, may extend over a range which allows the patient to periodically hear their tinnitus through the sound and thus defocus their attention to the tinnitus.
Typically, this involves having a patient or treatment provider select a pleasant monaural piece of music having large fluctuations. The level fluctuations are preferably chosen to allow for the intermittent perception of the tinnitus by the patient, i.e., the tinnitus may be perceived by the patient during quiet passages in the music. A broadband, e.g., 14 kHz, white noise may be added or overlayed upon the music at a level that just masks the tinnitus yet still allows the music to be heard. The treatment provider may add amplification to the music and/or broadband white noise, e.g., via a graphic equalizer, to compensate for any hearing loss by the patient.
Taking this music and overlayed broadband white noise, an electronic stereo file may be produced from the monaural file where the same monaural file is used in each channel to equalize the phase. This treatment file may then be played by the patient, e.g., through an electronic music player and/or transmitted through the transducer.
In any of the treatment mechanisms or devices, either masking or habituation treatment may be effected by the assemblies described herein.
In yet another tinnitus treatment method similar to acoustic echo cancellation, an audiologist or physician may determine the tinnitus frequency perceived by a patient. With the frequency or frequencies known, a treatment signal may be generated, e.g., 5 kHz at 6 dB, which is shifted out-of-phase from the tinnitus frequencies, e.g., ideally 180° out-of-phase. This shifted treatment signal may be transmitted to a processor which actuates the transducer to vibrate the out-of-phase treatment signal through the patient's tooth, teeth, or bone structures such that the summation of the treatment signal with the tinnitus results in a cancellation of the tinnitus noise as perceived by the patient. Examples and further details of signal cancellation methods are described in U.S. patent application Ser. No. 11/672,239 filed Feb. 7, 2007, which is incorporated herein by reference in its entirety.
As shown in
Generally, the volume of electronics and/or transducer assembly 16 may be minimized so as to be unobtrusive and as comfortable to the user when placed in the mouth. Although the size may be varied, a volume of assembly 16 may be less than 800 cubic millimeters. This volume is, of course, illustrative and not limiting as size and volume of assembly 16 and may be varied accordingly between different users.
In one variation configured as a hearing aid device, with assembly 14 positioned upon the teeth, as shown in
The transmitter assembly 22, as described in further detail below, may contain a microphone assembly as well as a transmitter assembly and may be configured in any number of shapes and forms worn by the user, such as a watch, necklace, lapel, phone, belt-mounted device, etc.
Alternatively in another variation, transmitter assembly 22 may be configured as a transmitter for sending programming signals to electronics and/or transducer assembly 16 for programming specified frequencies or duration times for the transducer to vibrate, as described in further detail below.
In either case, in this and other variations, the transducer assembly 16 may generally be configured to have a frequency response of, e.g., 125 Hz to 20 kHz at 100 dB sound pressure level (SPL) peak and a frequency response of, e.g., 125 Hz to 1000 Hz based on uncomfortable vibration (UCV).
With respect to microphone 30, a variety of various microphone systems may be utilized. For instance, microphone 30 may be a digital, analog, and/or directional type microphone. Such various types of microphones may be interchangeably configured to be utilized with the assembly, if so desired.
Power supply 36 may be connected to each of the components in transmitter assembly 22 to provide power thereto. The transmitter signals 24 may be in any wireless form utilizing, e.g., radio frequency, ultrasound, microwave. Blue Tooth® (BLUETOOTH SIG, INC., Bellevue, Wash.), etc. for transmission to assembly 16. Assembly 22 may also optionally include one or more input controls 28 that a user may manipulate to adjust various acoustic parameters of the electronics and/or transducer assembly 16, such as acoustic focusing, volume control, filtration, muting, frequency optimization, sound adjustments, and tone adjustments, etc.
The signals transmitted 24 by transmitter 34 may be received by electronics and/or transducer assembly 16 via receiver 38, which may be connected to an internal processor for additional processing of the received signals. The received signals may be communicated to transducer 40, which may vibrate correspondingly against a surface of the tooth to conduct the vibratory signals through the tooth and bone and subsequently to the middle ear to facilitate hearing of the user. Transducer 40 may be configured as any number of different vibratory mechanisms. For instance, in one variation, transducer 40 may be an electromagnetically actuated transducer. In other variations, transducer 40 may be in the form of a piezoelectric crystal having a range of vibratory frequencies, e.g., between 250 Hz to 14,000 Hz.
Power supply 42 may also be included with assembly 16 to provide power to the receiver, transducer, and/or processor, if also included. Although power supply 42 may be a simple battery, replaceable or permanent, other variations may include a power supply 42 which is charged by inductance via an external charger, e.g., every 24 hours. Additionally, power supply 42 may alternatively be charged via direct coupling to an alternating current (AC) or direct current (DC) source. Other variations may include a power supply 42 which is charged via a mechanical mechanism, such as an internal pendulum or slidable electrical inductance charger as known in the art, which is actuated via, e.g., motions of the jaw and/or movement for translating the mechanical motion into stored electrical energy for charging power supply 42. Moreover, the power supply 42 may be disposable where either the power supply 42 itself (if removable) or the entire assembly 16 may be disposed and replaced by a new assembly periodically, e.g., every 4 weeks.
In another variation of assembly 16, rather than utilizing an extra buccal transmitter, hearing aid assembly 50 may be configured as an independent assembly contained entirely within the user's mouth, as shown in
The removable oral appliance 18 may be fabricated from various polymeric or a combination of polymeric and metallic materials using any variety of methods. For instance, in one variation of fabricating an oral appliance, a three-dimensional digital scanner may be used to image the dentition of the patient, particularly the tooth or teeth upon or about which the oral appliance is to be positioned. The scanned image may be processed via a computer to create a three-dimensional virtual or digital mode of the tooth or teeth.
Various three-dimensional scanning modalities may be utilized to create the three-dimensional digital model. For instance, intra-oral cameras or scanners using. e.g., laser, white light, ultrasound, mechanical three-dimensional touch scanners, magnetic resonance imaging (MRI), computed tomography (CT), other optical methods, etc., may be utilized.
Once the three-dimensional image has been captured, the image may then be manipulated via conventional software to create a direct three-dimensional print of the model. Alternatively, the image may be used to directly machine the model. Systems such as computer numerical control (CNC) systems or three-dimensional printing processes, e.g., stereolithography apparatus (SLA), selective laser sintering (SLS), and/or other similar processes utilizing three-dimensional geometry of the patient's dentition may be utilized.
In another alternative, a mold may be generated from the print to then allow for thermal forming of the appliance directly upon the created mold. And yet in other variations, the three-dimensional image may be used to create an injection mold for creating the appliance.
In another variation of the device configured to additionally treat tinnitus instead of or in combination with treating hearing loss, sound generating assembly 60 may optionally contain a receiver 62 for receiving programming signals 24 from transmitter 34. Receiver 62 may be in electrical communication with processor 64, powered by power supply 68, which in turn is electrically coupled to transducer 66, as shown in the schematic representation of
Power supply 68 may provide power to the receiver 62, transducer 66, and/or processor 64. Although power supply 68 may be a simple battery, replaceable or permanent, other variations may include a power supply 68 which is charged by inductance via an external charger. Additionally, power supply 68 may alternatively be charged via direct coupling to an alternating current (AC) or direct current (DC) source. Other variations may include a power supply 68 which is charged via a mechanical mechanism, such as an internal pendulum or slidable electrical inductance charger as known in the art, which is actuated via, e.g., motions of the jaw and/or movement for translating the mechanical motion into stored electrical energy for charging power supply 68.
In the variation where the sound generating assembly 60 is configured to function solely as a sound generating device to mask tinnitus, receiver 62 may be omitted from assembly 60 and transducer 66 may be configured to vibrate at a predetermined frequency or over a range of predetermined frequencies, e.g., anywhere from 250 Hz to 14,000 Hz, for a predetermined period of time, e.g., on the order of a few minutes up to several hours, as desired. The assembly may be accordingly actuated by the user on demand when desired to mask the tinnitus such that the transducer 66 vibrates, e.g., anywhere from 250 Hz to 14,000 Hz, for a specified preset time period or until deactivated by the user.
In the variation illustrated in
Additionally, user input controls 30 may also include a feature to program and control the automatic activation or de-activation of the transducer 66 at preset times throughout the day, e.g., such as an alarm feature to automatically awake the user at a selected time or to automatically activate the transducer 66 at a selected time prior to or during the user's bedtime to automatically mask completely or partially the tinnitus.
In an alternative variation, the assembly 60 may be configured to receive programming signals received by receiver 62. In such a variation, the device may be specifically programmed to vibrate the transducer 66 at specified frequencies and/or for specified periods of time which may be customized to patient-specific tinnitus conditions. Accordingly, the patient, may be examined, e.g., by a technician, audiologist, physician, etc., to initially determine the frequency or frequencies of the tinnitus perceived by the patient 70, as indicated in
Once the patient-specific tinnitus frequency or frequencies have been determined, these frequency values may be programmed for an oral appliance 72 such that the transducer 66 may vibrate at the specified frequency or frequencies to optimally mask, or at least partially mask, the tinnitus. Alternatively, if the detected frequency or frequencies of tinnitus fall within certain frequency ranges, the oral appliance assembly 60 may be configured simply to vibrate the transducer 66 within preset frequency ranges rather than specific targeted frequency values.
In order to program the electronics and/or transducer assembly 16 with patient-specific tinnitus frequency or frequencies, several alternative methods may be utilized to appropriately program the assembly 16, as illustrated in
Alternatively, a user may directly input 82 patient-related frequency information via a computer 80 to transmit the programming information 86 to assembly 16 via transmitter 84. In yet another variation, computer 80 may be connected to the internet 88 through which a technician, audiologist, physician, etc. 90 may input and/or access patient-specific frequency information for transmission to computer 80, which may then be used to transmit the information via transmitter 84 to assembly 16. Transmitter 84 may also be utilized as a receiver to optionally receive patient-specific information from assembly 16, in which case a transmitter may be incorporated into assembly 16.
In another variation for treating tinnitus, the electronics may be separated from the transducer assembly 16 to provide for a potentially smaller and less intrusive device 14 for delivering a masking treatment to the patient. As schematically illustrated in
In other variations, rather than utilizing a device 14 which is placed within the mouth of a patient, assembly 16 may comprise an adhesive-backed assembly which may be temporarily attached at the entrance to the patient's ear canal and removed after use and disposed, in either case, the assembly 16 may be used by the patient at night prior to sleeping where base unit 92 may generate and wirelessly transmit the programming to the patient via device 14.
In one particular variation for treating tinnitus, device 14 may utilize an audio signal, such as music and in particular music having a dynamic signal with intensities varying over time with multiple peaks and troughs throughout the signal. Other audio signals such as various sounds of nature, e.g., rainfall, wind, waves, etc., or other signals such as voice or speech may alternatively be used so long as the audio signal is dynamic. This audio signal may be modified according to a masking algorithm and applied through the device 14 and to the patient to partially mask the patient's tinnitus. An example of how an audio signal may be modified is described in detail in U.S. Pat. No. 6,682,472 (Davis), which is incorporated herein by reference in its entirety and describes a tinnitus treatment which utilizes software to spectrally modify the audio signal in accordance with a predetermined masking algorithm which modifies the intensity of the audio signal at selected frequencies. The described predetermined masking algorithm provides intermittent masking of the tinnitus where the tinnitus is completely masked during peaks in the audio signal and where the perceived tinnitus is detectable to the patient during troughs in the audio signal. Such an algorithm provides for training and habituation by the patient of their tinnitus.
Accordingly, the intensity of the audio signal may be modified across the spectrum of the signal and may also be modified to account for any hearing loss that the patient may have incurred. An example is illustrated in the chart 100 of
According to the description of U.S. Pat. No. 6,682,472, the predetermined masking algorithm for modifying the audio signal may take the form in the following equation:
REQ=M (SPL+ELC(0.25,0.5,1,2,3,4,6,8,10,12 kHz)−Baseline)
Baseline=0.5(A−B)+B
This algorithm as well as other variations thereof as described may be utilized to modify the intensity of the audio signal to account for varying hearing levels specifically for treating tinnitus by spectrally modifying the signal. An example of the process of utilizing the algorithm is shown in further detail in
Because the audio signal is to be applied to a surface of the patient's bone (e.g., the palatal bone, mandible, etc.) and/or to one or more of the patient's teeth utilizing the oral appliance described above, the audio signal is to be transmitted via the surface and through the patient's bone structure, such as the skull, and to one or both of the patient's inner ear. Accordingly, the bone conductance profile of the patient may be measured 124 utilizing any number of techniques and the resulting profile may be accounted for by further modifying the audio signal 126 to adjust the spectrum in view of the audio signal being transmitted through bone structures.
With the audio signal modified accordingly via the algorithm for tinnitus treatment as well as to account, for any hearing loss and vibratory conduction through bone to the patient's inner ear, the audio signal may be transmitted or uploaded, e.g., wirelessly or via cable, to processor 128 which may be within or attached to the oral appliance or which may be separated from the housing, as described above. The one or more transducers may then be actuated by the user to vibrate against the patient's bone surface and/or against one or more of the patient's teeth to transmit the audio signal via vibratory conductance through the bone and to one or both inner ears 130. The tinnitus treatment signal may be thus applied on an as-needed basis by the patient and/or continuously for a predetermined period of time, e.g., anywhere from a few minutes to several hours, which may be preset or selected by the user. Additionally and/or optionally, the processor may be configured to also record 132 the patient's usage of the device to track, e.g., user compliance, times and/or duration of use, etc. This information may be recorded (in the device or remotely) and accessible to the patient or health care provider at a later time.
Another tinnitus treatment system which may be utilized for relief or adaptation therapy is described in detail in U.S. patent application Ser. No. 11/970,469 filed Jan. 7, 2008 entitled SIGNAL PROCESS FOR THE DERIVATION OF IMPROVED DTM DYNAMIC TINNITUS MITIGATION SOUND, which is incorporated herein by reference in its entirety. As described, this system combines at least one recorded natural sound known to partially mask tinnitus with computer-generated sound that emulates at least one natural sound where the combined sound produces a more dynamic amplitude envelope (greater ratios between minimum and maximum envelope amplitudes) and more effective tinnitus masking than that of either the natural sound or the computer-generated sound individually.
In generating the tinnitus masking signal, the natural sound, computer-generated sound, or combined natural and computer-generated sound may have one of the following functions applied: (1) high frequency dynamic amplitude expansion, (2) broad band dynamic amplitude expansion, (3) digital frequency shifting to higher frequency range(s), (4) selectable ones of a family of high frequency equalization curves, or (5) at least one band pass filter having a Q of at least 2 and preferably 10 to 100 at a center frequency in a high audio frequency range, typically between 1 kHz and 10 kHz, where such filter provides a peak response that is summed with a broad band response in such a manner as to provide at least one of (i) a substantially flat response curve substantially above such center frequency, or (ii) a substantially fiat response curve substantially below such center frequency. In other variations, at least one of the above-mentioned functions may be repetitiously modulated in at least one of a short time period between about 1 ms and 100 ms and a long-time period between about 1 sec and 1 hour as a method to enhance long-term masking efficacy.
In certain variations, the computer-generated sound may emulate a natural flowing water or cricket sound (which is suitable for partial masking of tinnitus). In other variations, the computer generated sound and corresponding signal may be configured to emulate, e.g., natural flowing water sound, broadband white noise signals, etc. For instance, the broadband white noise signal may be processed by a high-pass filter having a cut-off frequency of about 100 Hz to create the signal. Moreover, the filtered white noise signal may be amplitude modulated by a subsonic waveform signal to create a first amplitude modulated filtered white noise signal. Generating the subsonic waveform signal may also comprise generating an ultra-low frequency random pulse signal in which pulse intervals may vary-between about 100 ms and about 10 s and where pulse durations vary between substantially 1 ms and 100 ms.
Specific parameters for any step of the above signal processes may be altered, one or more steps may be excluded, additional steps may be added, and/or the type of emulated sound may be varied, in each case, although having a corresponding effect on the character of the sound. The resulting improved tinnitus masking sound exhibits a highly dynamic amplitude envelope and enhanced high frequency impulse intensity which may provide effective tinnitus masking. The various signal processes are more fully described in Ser. No. 11/970,469 which has been incorporated above.
In utilizing any of the tinnitus treatment methods described herein, processor 128 may be programmed by a physician, technician, audiologist, and/or user to optimize the treatment device or processor 128 for an individual user. Moreover, because of the various treatment approaches, e.g., tinnitus habituation, masking, etc., the processor may be programmed to optimize treatment approaches utilizing a programming interface. Such programming devices may utilize graphical user interfaces in the form of extra-buccal transmitter assembly 22 or base unit 92 in the form of e.g., a personal digital assistant, cell phone, digital music player such as an IPOD device (Apple, Inc., Cupertino, Calif.), etc. Thus, the programming device may not only be used for tinnitus therapy, but it may also be utilized as a dual music player, such as a digital MP3 music player. Moreover, the programming device may run on a customized or conventional computer operating platform such as WINDOWS (Microsoft Corp., Redmond, Wash.).
One example for programming such a device is shown in the flowchart 140 of
In utilizing the dual-channel feature of the device, the volume control may be adjusted in several different ways. For instance, a single volume control may be used to adjust the volume level for both channels simultaneously where a single adjustment may alter both channels. Alternatively, each channel may be independently controlled exclusively of one another where, e.g., the first channel having the tinnitus treatment may be increased in volume while the second channel having another audio signal such as music may be maintained or decreased in volume, or any other combination of volume control. In yet another variation, a volume difference between each of the channels may be maintained at a constant differential (e.g., +3 dB, +6 dB, etc.) where an increase in the volume of the first channel may also increase the volume of the second channel in a corresponding manner but at a level which is consistently less (or greater) by the predetermined differential amount.
In the event that the user wishes to optimize the device for tinnitus relief or adaptation therapy, the user may select the “Set Up” mode to calibrate and/or adjust the various settings on the device. During set up, the user may first undergo calibration testing 150 to calibrate the device settings to account for parameters such as an individual's bone sensitivity threshold profile to facilitate vibratory conductance from the transducer to the user's middle and/or inner ear. The user may then adjust settings 152 on the device once calibration testing 150 has been completed. Alternatively, the user may first adjust the device settings 152 and then undergo calibration testing 150. In other alternatives, calibration testing 150 or the adjustment of settings 152 may be omitted entirely if so desired. In either case, once calibration testing 150 and/or adjustment of settings 152 has been completed, the device may then allow for the selection of relief or adaptation therapy 146. Once selected, the user may then use the device 148.
As shown in
In selecting between the relief and adaptation therapy 146, the user interface on the programming device may present the user with a graphical interface as shown in the example of interface 146a in
In the event that adaptation therapy 162 is selected, a similar interface 162a may be presented, as shown in
As mentioned above, in setting up the device 14 for individual use, the processor may undergo calibration testing 150 and/or adjustment of settings 152. In calibration testing 150 the device, in the event that the user bypasses calibration, any settings may be saved 180 and the device may be directly utilized 148, as illustrated in the flowchart of
In either case, once calibration testing is initiated, an interface 182a such as that illustrated in
The transducer may be actuated to emit a number of tones to match the user's tinnitus sound level and frequency by listening to tones at different frequencies generated through the device 14 to first establish the tinnitus frequency, if not previously established, to customize the calibration and equalization for obtaining the teeth and bone impedances for each patient. The interface may accordingly prompt the user during calibration to indicate whether a tone or sound was perceived 188. If not, the frequency level may be gradually increased to match the tinnitus level perceived by the patient. With this correlated information, the device 14 and/or external programming device may be programmed accordingly with the patient's hearing loss profile and adjusted for appropriate gain at each frequency during tinnitus treatment.
A certain number of patients who suffer from tinnitus also suffer from hearing loss. Upwards of 80% of the patients with tinnitus also have some form of hearing loss which is a significant issue in treating the tinnitus with a sound therapy device that is meant to provide tinnitus therapy while also allowing the patient to continue with his/her normal daily activities. One approach to compensating for the hearing loss while also treating tinnitus. The oral appliance device 14 may also compensate for the sensorineural hearing loss by increasing the tinnitus treatment signal itself by up to 40 dB for treating the tinnitus without increasing for the input hearing. Any tone, music, or treatment using a wide-band and or narrow band noise may also be calibrated and equalized to compensate for impedances of the tooth and bone as well as for the sensorineural hearing loss and then that sound may be generated via the actuatable transducer. Further examples of tinnitus calibration and compensation are described in further detail in U.S. patent application Ser. No. 11/845,712 filed Aug. 27. 2007, which is incorporated herein by reference in its entirety.
With the device preliminarily calibrated, the user may be prompted to verify the calibration test results 190. In so doing, the user may be prompted to compare an original track (e.g., Sound A) and an equalized track 192 (e.g., Sound B) which may be the same track as the original but which has been equalized using the equalization parameters from the calibration test, as shown in the interface 192a of
In yet another variation where a separate headset is utilized, loudness balancing may be performed to determine the bone conductance profile of a user regardless of any hearing loss that the user may be suffering as part of the calibration testing 150. Generally, with the use of an external headset and the oral appliance positioned within the user's mouth, a signal may be transmitted alternating between the headset and the oral appliance, e.g., beginning at 125 Hz and up to 20 kHz. The user may be asked to match the levels between the signal transmitted through the oral appliance via bone conduction and the sound perceived through the headset via air conduction at multiple frequencies. With the levels correlated between bone conduction and air conduction at multiple frequencies, the user's bone conduction profile may be determined regardless of any hearing loss. Another method for performing loudness balancing may include the use of signals generated by an external audiometer and transmitted via the oral appliance through the auxiliary audio input. These generated signals may be compared by the user in conjunction with the audio signals perceived by air conduction through a headset.
As described above, prior to or after calibration testing 150, any number of settings may be adjusted 152 by the programming device for optimizing the oral device 14. As illustrated in the flowchart of
Yet another adjustment may optionally include the use of a shuffle feature for music 204 if the oral device 14 is used as a music player. The interface 204a illustrates an example for turning the music shuffle feature on or off in
Another adjustment feature may be limited to enable access by a professional practitioner 208 such as a physician, audiologist, technician, etc. involved with treating the user for tinnitus. Optional selection of this feature may be limited by entry of a password known to the professional, as indicated in interface 208a of
In reviewing compliance data, parameters such as the number of hours per day that the oral device 14 is used for tinnitus relief therapy, tinnitus adaptation therapy, music playback, etc. may be monitored and/or downloaded, as illustrated in interface 210a in
In reviewing and/or revising prescription information 214 for tinnitus therapy, various settings such as therapy settings, adaptation settings, record download settings, etc., may be adjusted or modified, as shown in interface 214a in
In adjusting adaptation settings 222, the practitioner may adjust the allowed dose (e.g., 1 to 4 or more hours/day, minutes/day, etc.), adaptation level (e.g., 5 dB, 10 dB, 1.5 dB, 20 dB, etc.), or adaptation cycle time (e.g., 1 min., 3 min., 5 min., 10 min., etc.), as described above and as shown in interface 222a in
Additionally and/or optionally, the practitioner may also reset or restart the calibration test 226 and/or manually adjust the calibration 228, as shown and described above. Aside from calibration, the practitioner may also adjust the patient control access 230 to adjust the degree of control which the user may have over the device. For instance, as illustrated in interface 230a in
Particularly, a microphone may be included on the device, as described above, to detect audio signals such as a person's voice that the user may wish to listen to. The detected audio signal level may be increased to provide a hearing assist feature such that the gained audio signal may be perceived by the user over any tinnitus treatment signals that the user may also be listening to.
The applications of the devices and methods discussed above are not limited to the treatment of tinnitus and/or hearing loss but may include any number of further treatment applications. Moreover, such devices and methods may be applied to other treatment sites within the body. Modification of the above-described assemblies and methods for carrying out the invention, combinations between different variations as practicable, and variations of aspects of the invention that are obvious to those of skill in the art are intended to be within the scope of the claims.
