J Am Acad Aud i o l 11 : 138-155 (2000)

Psychoacous t i c Measur es of T i nn i tus

James A. Henr y*
Ma r y B. Me i k l e*

Abs t rac t
Th i s repor t rev i ews research f rom the 1930s to the presen t tha t has ex t ended our under -
s t and i ng by i nvest i ga t i ng the charac ter i st i cs of t inn i tus tha t can be s tud i ed us i ng psychoacous t i c
t echn i ques . Stud i es of t i nn i tus mask i ng and res i dua l inh ib i t ion began in the 1970s , l ead i ng
to the therapeut i c use of t i nn i tus mask i ng and a consequen t i ncrease in research devo t ed to
t i nn i tus measur emen t . In 1981 , the C I BA Founda t i on sympos i um on t i nn i tus advoca t ed gen-
era l adopt i on of four t i nn i tus measures : (1) p i tch, (2) l oudness , (3) maskab i l i ty , and (4) res i dua l
inh ib i t ion . S i nce then , psychoacous t i c research into a l l four top i cs has pro l i fera ted, y i e l d i ng
many va l uab l e i ns i ghts and cont rovers i es concern i ng the de ta i l s of measur emen t t echn i ques .
A consensus has eme rged tha t ne i ther the l oudness nor other psychoacous t i c measur es of
t inn i tus bear a cons i s t ent re l at ion to the sever i ty or perce i ved l oudness of t inn i tus. Never the l ess ,
quant i f i ca t i on is needed in c l ini ca l t r i a l s of proposed t rea tment s and in a var i e ty of other t ypes
of t i nn i tus research . St andard i za t i on of t echn i ques for spec i f y i ng the acous t i c pa rame t e rs of
t i nn i tus thus con t i nues to be an i mpor t ant research goa l .

Key Words : Di sab i l i ty , l oudness , mask i ng , p i tch, psychoacous t i cs , res i dua l inh ib i t ion, sever -
i ty, t i nn i tus

Abbrev i a t i ons : ABLB =a l t erna t i ng b i naura l l oudness ba l ance , DL= d i f f erence l i men , FCDS
= forced-cho i ce doub l e sta i rcase , MML = m i n i mum mask i ng l eve l , PLU = persona l l oudness
uni t , RI = res i dua l i nh i b i t i on

he top i c o f t i nn i tus has ga i ned i ncreas- I n 1982 , t he Na t i ona l Academy of Sc i ences

i ng a t t en t i on t hroughou t th i s cen t ury.
T Th i s is f or tuna t e for t he m i l l i ons o f Ame r -
i cans and t he un t o l d m i l l i ons wor l dw i de who suf -
f er f rom th i s i nv i s i b l e aud i t ory d i sorde r . As we
approach t he t urn o f t he century , t i nn i tus has
a t t a i ned a l eve l o f v i s i b i l i t y h i gh enough to
a t t rac t cons i de rab l e resea rch a t t en t i on and aug-
men t e f for t s to prov i de he l p for t i nn i tus suf f er -
e rs . The r e a r e now v i ab l e t r ea t men t op t i ons
t ha t we r e no t ava i l ab l e 25 yea rs ago , some w i t h
repor t ed l y h i gh ra t es o f success . Ana t i ona l orga -
n i za t i on , t he Ame r i can T i nn i t us Assoc i a t i on , i s
ded i ca t ed to suppor t i ng t he t i nn i tus su f f erer i n
a var i e t y o f wor t hwh i l e ways . Recent l y , t he re has
a l so been i nc reased suppor t for t i nn i tus resea rch
on t he pa r t of t he U.S . Depa r t men t o f Hea l t h and
Human Se rv i ces .
*VA RR&D Na t i ona l Cen t er for Rehab i l i t a t i ve Aud i tory
Resea rch , Por t l and VA Med i ca l Cent er , Por t l and , Or egon
Repr i n t r eques t s : James A. Henry , VA RR&D Na t i ona l
Cen t e r for Rehab i l i t a t i ve Aud i t ory Resea r ch , Por t l and VA
Med i ca l Cen t e r (R&D - NCRAR ) , PO Box 1034 , Por t l and , OR
97207
pub l i shed t he repor t " T i nn i t us - Fac t s , Theo-
r i es and Tr ea t men t s , " pr epa r ed by t he Com-
m i t t ee on Hea r i ng , B i oacous t i cs and
B i omechan i cs of t he Na t i ona l Resea r ch Counc i l
and ed i t ed by Denn i s McFadden (McFadden ,
1982) . I n th i s f a r - reach i ng repor t , t he Comm i t -
t ee emphas i zed t he need for bas i c r esea r ch i nto
psychoacous t i c measur es o f t i nn i tus , say i ng " For
theore t i ca l and prac t i ca l reasons , i t i s i mpor t an t
to ob t a i n cha rac t e r i za t i ons of t i nn i t us - spec -
t ra l l oca t i on , degr ee of comp l ex i t y , magn i t ude ,
e t c . - t ha t a re as accura t e as poss i b l e . " They
i dent i f i ed seve ra l l i nes of re l a t ed resea rch t ha t
we r e " necessa ry as a bas i s for es t ab l i sh i ng a
s t anda rd i zed t es t procedur e . " Those t op i cs
i nc l uded compa r ab i l i t y of t he va r i ous ex i s t i ng
measur emen t procedures , t es t - re t es t re l i ab i l i ty
of t he da t a ob t a i ned , and t he ex t en t to wh i ch d i f -
f erent measur emen t procedures cou l d accura t e l y
re f l ec t i mpor t an t d i f f erences be t ween pa t i en t s .
Un for tuna t e l y , nea r l y 18 yea rs l ater , i t i s st i l l
t he case t ha t s t anda rd i zed t es t procedur es have
no t been un i ve rsa l l y adop t ed . The ava i l ab l e
i n f orma t i on conce rn i ng t es t - re t es t re l i ab i l i t y i s
st i l l re l a t i ve l y spa rse , and e f for t s to de t e rm i ne

138
 Psychoacous t i c Measur es o f T i nn i t us / Henry and Me i k l e
whe t he r d i f f erent t ypes o f pa t i en t s r espond d i f -
f erent l y i n psychoacous t i c t es t s a r e a l so ve ry
f ew. The r e i s some hope , howeve r , t ha t t he
s i tua t i on may be i mprov i ng. The numbe r o f
t i nn i tus- re l a t ed resea rch repor t s con t i nues to
i nc rease yea r by year , and t he re i s a grow i ng
numbe r of r esea r che rs whose wo r k (whe t he r
c l i n i ca l or bas i c) depends on t i nn i tus i dent i f i -
ca t i on and charac t er i za t i on . Many o f t he cur ren t
t i nn i tus eva l ua t i on t echn i ques , such as soph i s-
t i ca t ed bra i n i mag i ng , t es t i ng of aud i t ory bra i n-
s t em responses , measu r emen t of o t oacous t i c
em i ss i ons , and so for th , can bene f i t f rom mo r e
de t a i l ed charac t er i za t i on of sub j ec t s ' t i nn i tus , as
wou l d c l i n i ca l e f for t s to i dent i f y e f f ec t i ve t rea t -
men t moda l i t i es ( t i nn i tus mask i ng as we l l as
" hab i t ua t i on " or " re t ra i n i ng " therap i es , e l ec t r i -
ca l s t i mu l a t i on , drug t r ea t men t s , e t c . ) .
I t i s t he r e f or e t he ob j ec t i ve o f t h i s pape r t o
summa r i ze wo r k t o da t e on t he psychoacous t i c
aspec t s o f t i nn i t us and t o r ev i ew t he ava i l ab l e
i n f orma t i on r e l a t i ng psychoacous t i c measu r es t o
c l i n i ca l conce rns . C l i n i cs t ha t a t t emp t t o prov i de
t r ea t men t f or t i nn i t us pa t i en t s mus t be ab l e t o
ca t egor i ze pa t i en t s accord i ng to t he i r degr ee o f
need f or t r ea t men t , and l i kew i se mus t be ab l e t o
compa r e t he pos t - t r ea t men t t o t he pr e t r ea t men t
s t a t us o f t i nn i t us . I t i s c l ea r t ha t bo t h o f t hese cap i -
b i l i t i es a r e heav i l y dependen t on ca re f u l l y con-
t ro l l ed measu r emen t t echn i ques t ha t a r e f eas i b l e
t o use w i t h a w i de r ange o f c l i n i c pa t i en t s .
EARLY ATTEMPTS AT MEASUREMENT
rom t he out se t , i t has been c l ear t ha t t he
F spec t ra l charac t er i s t i cs o f t i nn i tus a r e o f
f undamen t a l i mpor t ance . As ea r l y as 1821 , i t was
r ecogn i zed t ha t h i gh-p i t ched ve r sus l ow-p i t ched
t i nn i t us was t r ea t ab l e w i t h d i f f e ren t t ypes o f
mask i ng sounds (J . M . G . I t a rd , quo t ed i n
S t ephens , 1987) . W i t h t he adven t o f e l ec t roa -
cous t i c equ i pmen t , i t became t echn i ca l l y f eas i -
b l e t o es t ab l i sh p i t ch and l oudness cha rac t e r i s t i cs
pr ec i se l y ( Jones and Knudsen , 1928) , a l t hough
no desc r i p t i on o f t hose ea r l y me t hods ex i s t s .
The ear l i es t i n f orma t i on on psychoacous t i c me t h -
ods f or desc r i b i ng t i nn i t us appea r s to have been
supp l i ed by Wege l (1931) and Josephson (1931) .
Bo t h i nves t i ga t or s used pur e t ones t o measu r e
t he l oudness and p i t ch o f t i nn i tus , and Wege l a l so
p l o t t ed mask i ng cur ves by pr esen t i ng t ona l
maske r s a t a numbe r o f d i f f e ren t f r equenc i es and
ad j us t i ng t he i r l eve l s t o " cove r " or mask t he t i n-
n i t us . These we r e a l l ground - br eak i ng s t ud i es
t ha t l a i d t he f ounda t i on f or mo r e de t a i l ed wo r k
t o f o l l ow.
The name o f Edmund Pr i nce Fow l e r
dese r ves spec i a l men t i on f or many o f h i s con-
t r i bu t i ons t o t i nn i t us measu r emen t . He was t he
f i rs t t o desc r i be a me t hod for measu r i ng l oud-
ness r ec ru i t men t by ba l anc i ng t he l oudness o f
sounds be t ween ea rs , wh i ch he t e rmed t he A l t e r -
na t i ng B i nau r a l Loudness Ba l ance ( ABLB)
( Fow l e r , 1936 , 1937) . He l a t e r app l i ed t he l oud-
ness ba l ance t echn i que t o measu r e t he " e f f ec t o f
t i nn i t us on hea r i ng acu i t y " ( Fow l e r , 1938) . W i t h
t h i s t es t , t he l oudness o f t i nn i t us i n one ea r was
ba l anced w i t h t he l oudness o f a t one i n t he con-
t r a l a t e r a l ea r . The l eve l o f t he compa r i son t one ,
expr essed i n dB SL , supposed l y i nd i ca t ed t he t i n-
n i t us l oudness as expe r i enced by t he pa t i en t .
Fow l e r (1940) s t a t ed t ha t i t was i mpor t an t
to dup l i ca t e or ma t ch t he l oudness and p i t ch of
t i nn i tus , us i ng con t ra l a t e ra l t ones . For p i t ch
ma t ch i ng , he s t ressed t he i mpor t ance o f pre -
sen t i ng s t i mu l i a t l eve l s equa l to t he t i nn i tus
i n t ens i t y.
Fow l e r (1942 , 1943) no t ed t ha t a l t hough
pa t i ent s desc r i bed the i r t i nn i tus as ve ry l oud , he
f ound i t cou l d usua l l y be ma t ched a t on l y 5 to 10
dB SL . I n h i s op i n i on , t i nn i tus , be i ng an " i l l us i on, "
t ends to be exagge r a t ed. The t yp i ca l l oudness
ma t ches of 5 to 10 dB SL we r e " ve ry f a i nt " and
d i d no t cor respond to t he repor t ed sever i t y. Fow l e r
r ecommended educa t i ng pa t i ent s r ega rd i ng th i s
d i sc repancy to unde rs t and t ha t the i r s t a t emen t s
abou t sever i t y d i d no t cor r espond to " the f ac t s . "
I t i s i nt eres t i ng t ha t Fow l e r , i nven tor of t he l oud-
ness ba l ance me t hod for eva l ua t i ng l oudness
rec ru i tmen t , d i d no t app l y t he concep t of recru i t -
men t to h i s measur emen t s i n t i nn i tus pa t i en t s .
Goodh i l l (1952) no t ed t ha t pa t i en t s have
d i f f i cu l t y desc r i b i ng t he i r t i nn i t us . He be l i eved
t ha t t he va l i d i t y o f a desc r i p t i on depended l a rge l y
upon a pa t i en t ' s f am i l i a r i t y w i t h mus i ca l t e rms ,
commen t i ng t ha t on l y pa t i en t s who we r e " sc i -
en t i f i ca l l y or mus i ca l l y a r t i cu l a t e " cou l d ma t ch
t he i r t i nn i t us t o t ones f rom an aud i ome t e r . He
t he r e f or e deve l oped a " t i nn i t us i den t i f i ca t i on
r ecord i ng , " cons i s t i ng o f 27 d i f f e r en t sounds
des i gned t o m i m i c t he acous t i c sensa t i ons
desc r i bed by pa t i en t s . Pa t i en t s l i s t ened to t he
r ecord i ng and se l ec t ed t he sound( s ) t ha t mos t
c l ose l y r esemb l ed t he i r t i nn i t us .
Reed (1960) conduc t ed t he f i rst l arge -sca l e
s t udy of t i nn i tus measur emen t , us i ng 200 sub-
j ec t s . He acknow l edged t he wor k of Fow l e r and
o t he rs who had deve l oped t i nn i tus measur e -
men t t echn i ques , bu t no t ed t ha t the i r me t hods
had no t been desc r i bed i n suf f i c i ent de t a i l to
pe rm i t rep l i ca t i on . He t he re f ore desc r i bed i n
de t a i l i ns t rumen t a t i on and me t hodo l ogy for
139
Journa l o f t he Ame r i can Academy o f Aud i o l ogy / Vo l ume 11, Numbe r 3, Ma r ch 2000
ma t ch i ng t he " f requency , cont ent , and l oudness "
of t i nn i tus . The equ i pmen t was capab l e of pre -
sen t i ng a spec i f i ed bandw i d t h o f no i se cen t e red
a round a spec i f i c f r equency. The no i seband cou l d
be moved up or down t he f r equency sca l e by
chang i ng t he cent ra l f requency. I f t he pa t i en t had
un i l a t era l t i nn i tus , s t i mu l i we r e pr esen t ed con-
t ra l a t era l l y. W i t h b i l a t era l t i nn i tus , s t i mu l i we r e
pr esen t ed i ps i l a t era l l y. S t i mu l us t r i a l s we r e
repea t ed t hree t i mes . Us i ng th i s me t hod , 76 per -
cen t of t he pa t i en t s se l ec t ed t ones a t >_ 3000 Hz
as a p i t ch ma t ch . The t i nn i tus l oudness was
t hen de t e rm i ned us i ng t he l oudness ba l ance
me t hod o f Fow l e r .
Reed a l so ra t ed each pa t i ent ' s t i nn i tus sever -
i ty as " s l i ght , " " mode ra t e , " or " seve re " accord i ng
to t he i mpac t of t i nn i tus on t he pa t i ent ' s l i fe . T i n-
n i t us seve r i t y d i d no t appea r to be cor re l a t ed
w i t h any o f t he psychoacous t i c t i nn i tus mea -
sur emen t s : cen t ra l f requency , bandw i d t h , or
l oudness .
G r aham and Newby (1962) se t ou t to de t er -
m i ne whe t he r there we r e d i f f erent t i nn i tus char -
ac t er i s t i cs i n four groups o f 25 sub j ec t s each : one
group w i t h norma l ea rs who expe r i enced t i nn i -
t us i n a qu i e t room and t hree groups w i t h hea r -
i ng l oss (sensor i neura l , conduc t i ve , or m i xed) . For
p i t ch ma t ch i ng , a 10 dB SL t one was pr esen t ed
a t each o f 11 t es t f r equenc i es . To measu r e
t i nn i tus l oudness , t hey used monaur a l l oudness
ba l anc i ng. Sub j ec t s we r e asked to j udge t he
l oudness of the i r t i nn i tus and t he l oudness o f a
1- kHz , 20 dB SL tone , us i ng a sub j ec t i ve mag -
n i t ude sca l e .
Some no t ewor t hy conc l us i ons o f G r aham
and Newby ' s s t udy we r e (1) sub j ec t i ve descr i p-
t i ons of t i nn i tus we r e no t re l a t ed to any of t he
psychoacous t i c measur emen t s and (2) t i nn i tus
p i t ch ma t ches i n t he conduc t i ve hea r i ng l oss
group ( t i nn i tus usua l l y desc r i bed as " roar i ng " )
we r e s i gn i f i cant l y l owe r i n f requency t han for t he
o t he r t wo hea r i ng l oss groups .
ADVENT OF T I NN I TUS
MASK I NG STUD I ES
n 1971 , Fe l dmann i n i t i a t ed t he f i rs t sys-
t ema t i c s tud i es of t i nn i tus mask i ng. He no t ed
t ha t conven t i ona l tone -on- tone mask i ng resu l t ed
i n a cha rac t e r i s t i c mask i ng pa t t e rn : when
maske r i n t ens i t y i s p l o t t ed as a f unc t i on of f re-
quency , t he i n t ens i t y o f t he mask i ng t one i s l ow-
es t when i ts f r equency i s c l ose to t ha t o f t he
t one be i ng masked (Wege l and Lane , 1924) .
Fe l dmann hoped t ha t a s i m i l ar s i tua t i on wou l d
preva i l i n t he case of t i nn i tus . I f so, th i s me t hod
140
cou l d supp l y an a l t e rna t i ve me t hod for de t er -
m i n i ng t he p i t ch of t i nn i tus . Fe l dmann deve l oped
a protoco l t ha t succeeded i n es t ab l i sh i ng mask -
i ng pa t t e rns for 200 t i nn i t us pa t i en t s . He
obse rved f i ve d i f f eren t t ypes of mask i ng pa t -
t erns , none of wh i ch r esemb l ed conven t i ona l
mask i ng curves . When mask i ng l eve l s we r e re f -
e r enced to t he sub j ec t ' s hea r i ng thresho l ds a t t he
va r i ous f requenc i es , t hese pa t t e rns cou l d be
desc r i bed as fo l l ows : (1) " congruence , " i n wh i ch
mask i ng occur red a t l ow l eve l s a t a l l f requenc i es ;
(2) "d i s t ance , " w i t h mask i ng a t h i gh l eve l s across
f requenc i es ; (3) " pers i s t ence , " wh i ch i nd i ca t ed
t ha t t i nn i tus cou l d no t be masked ; (4) " conve r -
gence , " when mask i ng occur red a t h i gh l eve l s a t
l ow f requenc i es , conve rg i ng to l ow l eve l s a t h i gh
f r equenc i es -gene r a l l y c l ose to t he t i nn i tus f re-
quency ; and (5) " d i vergence , " t he oppos i t e pa t -
t e rn o f " conve rgence " and gene ra l l y seen w i t h
l ow- f requency , Men i e re ' s - t ype t i nn i tus .
Fe l dmann f ound t ha t t i nn i tus cou l d no t be
masked by any sound i n 11 pe r cen t of h i s sub-
j ec t s and t ha t for 32 pe r cen t any weak sound
cou l d mask i t e f f ec t i ve l y. He a l so demons t r a t ed
t ha t t i nn i tus cou l d be i nh i b i t ed f o l l ow i ng t er -
m i na t i on of a s t i mu l us , an e f f ec t t ha t was l a t er
t e rmed " res i dua l i nh i b i t i on " (Ve rnon , 1977) . He
fur ther demons t r a t ed cont ra l a t era l i nh i b i t i on o f
t i nn i tus . Fe l dmann conc l uded t ha t t he neur a l
ac t i v i t y respons i b l e for t i nn i tus d i f f ered f rom t he
neur a l ac t i v i t y resu l t i ng f rom s t i mu l a t i on w i t h
ex t e rna l sound . Th i s repor t t hus con t a i ns t he
f i rst s t a t emen t t ha t t he pe rcep t i on o f t i nn i tus
does no t seem to fo l l ow t he same psychoacous t i c
pr i nc i p l es t ha t app l y to t he pe rcep t i on of ex t er -
na l sounds .
A QUARTER CENTURY OF RESEARCH
I NTO T I NN I TUS MEASUREMENT
F o l l ow i ng t he p i onee r i ng wo r k done i n t he
ear l y years , the s t age was se t for a rap i d
grow t h of i nt eres t and wor k i n t he a r ea o f t i n-
n i t us . I nves t i ga t i ons i nto psychoacous t i c mea -
sur emen t o f t i nn i tus i nc r eased subs t an t i a l l y
f rom t he 1970s on , w i t h i nc reas i ng emphas i s on
accura t e and re l i ab l e me t hods for quan t i f y i ng
t i nn i tus sensa t i ons . Spur r ed by t he deve l op-
men t o f t i nn i tus mask i ng as a t he rapeu t i c pro-
cedur e , wh i ch b rough t many hund r eds o f
pa t i en t s i n to t ry t he new mask i ng the rapy , a
numbe r o f s t ud i es f ocused on t echn i ques for
spec i f y i ng t he p i t ch and l oudness o f t i nn i tus .
Tes t - r e t es t re l i ab i l i t y became an i mpor t an t
i ssue , and a numbe r o f i nves t i ga tors sough t to
 Psychoacous t i c Measu r es o f T i nn i t us / Hen r y and Me i k l e
unde r s t and t he un i que ways i n wh i ch t i nn i t us
r esponded t o mask i ng .
Ea r l y i n 1981 , t he C I BA Founda t i on i n Lon -
don sponsor ed one o f i ts pr es t i g i ous sc i en t i f i c
sympos i a i n orde r to promo t e i n t e rna t i ona l coop-
e r a t i on i n t i nn i t us r esea r ch . Pa r t i c i pan t s deve l -
oped gene r a l gu i de l i nes for t he c l i n i ca l eva l ua t i on
o f t i nn i t us , wh i ch t hey hoped wou l d be used
w i de l y. The r ecommended measu r es cove r ed
p i t ch ma t ch i ng , l oudness ma t ch i ng , t he mask -
ab i l i t y o f t i nn i t us , and r es i dua l i nh i b i t i on
(Eve r ed and Lawr enson , 1981) . These r ecom-
menda t i ons we r e based on t he t echn i ques p i o-
nee r ed by Fow l e r , Reed , G r aham , Fe l dmann ,
and o t he r s . A se t o f procedur a l de t a i l s f or t hese
t es t s was o f f e r ed by Ve r non and Me i k l e (1981) .
A cen t r a l concep t i n t he C I BA sympos i um was
t ha t s t anda rd i za t i on o f t i nn i t us measu r es wou l d
advance i n t e rna t i ona l unde r s t and i ng and f ac i l -
i t a t e wo r k on t i nn i t us .
S t ud i es o f T i nn i t us P i t ch
Measu r i ng t he p i t ch o f t i nn i t us sounds
s t ra i gh t f orwa rd enough i n theory , bu t i n prac -
t i ce t he re a re seve ra l f ac tors t ha t comp l i ca t e
ma t t e rs . F i rst , abou t 46 pe r cen t o f pa t i ent s have
comp l ex t i nn i tus cons i s t i ng of mor e t han one t ype
o f sound (Me i k l e e t a l , 1995) . A l t hough t hey
may be asked to ma t ch on l y t he pr edom i nan t one
or t wo t i nn i tus sounds , i t may no t a l ways be pos-
s i b l e for t hem to i gnore t he compe t i ng e f f ec t s of
add i t i ona l t i nn i tus sounds . Second , a subs t an-
t i a l numbe r of t i nn i tus pa t i ent s (36%) repor t tha t
the i r t i nn i tus exh i b i t s p i t ch or o t he r va r i a t i ons
of sound qua l i t y - i n some cases , as o f t en as sev-
era l t i mes a day (Me i k l e and Gr i es t , 1991) . I n
s tud i es des i gned to eva l ua t e t he re l i ab i l i ty of par -
t i cu l ar p i t ch ma t ch i ng me t hods , i t i s i mpor t an t
to se l ec t sub j ec t s w i t h cons t an t , unva r y i ng t i n-
n i tus to avo i d excess i ve response var i ab i l i t y due
to f l uc tua t i ons i n t he t i nn i tus . Th i rd , as no t ed
by severa l d i f f erent i nves t i ga tors , t i nn i tus t ha t
i s no t ve ry l oud t ends to be qu i t e l ab i l e and
eas i l y masked by many sounds , i nc l ud i ng aud i o-
me t r i c t es t t ones and t ones pr esen t ed for com-
pa r i son dur i ng p i t ch ma t ch i ng (unpub l i shed
obse rva t i ons o f pr esen t au t hors) . As a resu l t ,
i nd i v i dua l s w i t h m i l d t i nn i tus may no t be ab l e
to pe r f orm p i t ch or l oudness ma t ch i ng w i t h a
h i gh degr ee o f re l i ab i l i ty.
As we a l l know , p i t ch i s t he psycho l og i ca l
pe r cep t cor r espond i ng t o t he f r equency o f
acous t i c s t i mu l i . I t is awkwa rd , howeve r , to keep
r epea t i ng t he t e rm " the f r equency ma t ch i ng t he
p i t ch o f t he t i nn i t us . " Fo r conven i ence , i n wha t
f o l l ows , we w i l l use t he shor t e r t e rms " t he f re -
quency ma t ch i ng t he t i nn i t us " or even " t he t i n-
n i t us f r equency " when d i scuss i ng wo r k on
t i nn i t us p i t ch and l oudness ma t ch i ng.
Gene r a l Commen t s abou t P i t ch Ma t ch i ng
A l t hough t he p i t ch o f t i nn i tus may seem to
be one o f t he eas i es t a t t r i bu t es of t i nn i tus to
quant i f y , i n f ac t , t he r e a re some t r aps for t he
unwa r y. I nexpe r i enced sub j ec t s may t end to
con f use p i t ch and l oudness , caus i ng t hem to
re j ec t a t en t a t i ve f r equency ma t ch for t he t i n-
n i tus on t he bas i s of l oudness d i f f erences or to
accep t an i nappropr i a t e ma t ch because i ts l oud-
ness i s equ i va l en t to t he t i nn i tus (Ve rnon and
Me i k l e , 1981) . I t i s i mpor t an t , there fore , dur i ng
p i t ch ma t ch i ng to ad j us t t he l oudness o f com-
pa r i son s t i mu l i ve ry ca re f u l l y to make t hem
equa l to t he l oudness of t he t i nn i tus (Fow l er ,
1940 ; Ve rnon & Me i k l e , 1981) .
Ano t he r po t en t i a l source o f e r ror i s t he pos-
s i b i l i ty o f " oc t ave con fus i on , " i n wh i ch t he sub-
j ec t may a t f i rst se l ec t t ones an oc t ave above or
be l ow t he f r equency t ha t t hey l a t er i dent i f y as
t he " bes t " t i nn i tus p i t ch ma t ch. Oc t ave con fu-
s i ons occur qu i t e common l y even for norma l -
hea r i ng peop l e mak i ng compa r i sons be t ween
ex t e rna l t ones . The f ac t t ha t p i t ch ma t ches for
t i nn i tus m i gh t be a f f ec t ed by oc t ave con f us i on
came to t he a t t en t i on of c l i n i c i ans wor k i ng w i t h
t i nn i t us pa t i en t s i n t he 1960s ( Gr aham and
Newby , 1962) and was emphas i zed i n t he 1980s
by Ve rnon e t a l (1980a ) . Subsequen t l y , t he t i n-
n i t us t es t i ng procedur es r ecommended i n 1981
by t he C I BA sympos i um on t i nn i tus i nc l uded a
t es t for oc t ave con f us i on as an i nt egra l pa r t o f
t he t es t ba t t e ry (Eve r ed and Lawr enson , 1981) .
The C I BA r ecommenda t i ons advoca t ed use
of t he con t ra l a t e ra l ea r for p i t ch ma t ch i ng i f
t he t i nn i tus is un i l a t era l . The i dea i s t ha t i t i s
l ess con f us i ng to t he pa t i en t i f t he compa r i son
s t i mu l i a r e pr esen t ed to an ea r t ha t is f ree f rom
d i s t rac t i ng sound sensa t i ons (Ve rnon e t a l ,
1980a ) . I n prac t i ce , t he ma j or i t y o f pa t i en t s a r e
f ound to have b i l a t era l t i nn i t us (Me i k l e and
Wa l sh , 1984 ; Me i k l e and Gr i es t , 1991) , and , i n
mos t cases , i t appea rs to be f eas i b l e to ma t ch t he
p i t ch of t he t i nn i tus i n each ea r sepa ra t e l y ( i f
t hey d i f f er ) by presen t i ng t he compa r i son t ones
i ps i l a t era l l y (Ty l er and Conr ad -Armes , 1983b;
Ve rnon and Fenw i ck , 1984) .
Ano t he r t es t i ng cons i de ra t i on is t he des i r -
ab i l i t y o f ad j us t i ng t he l oudness o f compa r i son
t ones by s t a r t i ng be l ow t he sub j ec t ' s t hr esho l d
and i nc reas i ng t he i n t ens i t y i n an ascend i ng
141
 Jou r na l o f t he Ame r i can Academy o f Aud i o l ogy / Vo l ume 11 , Numbe r 3, Ma r ch 2000
ser i es o f sma l l s t eps (e .g . , 1-2 dB) (Ve rnon ,
1982) . An ascend i ng ser i es i s used to m i n i m i ze
t he po t en t i a l for mask i ng or res i dua l i nh i b i t i on
caused by t he t es t t ones ( and such e f f ec t s cou l d
conce i vab l y occur a t l oud sound l eve l s even
when t he compa r i son t ones a r e pr esen t ed con-
t ra l a t era l l y) .
A numbe r o f add i t i ona l me t hodo l og i ca l
de t a i l s have been eva l ua t ed expe r i men t a l l y , as
w i l l be d i scussed be l ow. F i rs t , howeve r , we w i l l
summa r i ze t he body of ev i dence t ha t has accu-
mu l a t ed r ega rd i ng t he r ange o f t i nn i tus p i t ches
obse rved i n c l i n i ca l wor k w i t h t i nn i tus pa t i en t s.
P i t ch Ma t ch i ng Da t a
Mos t wor ke r s agr ee t ha t t he p i t ch of t i nn i -
t us i s t yp i ca l l y re l a t ed i n some way to t he i nd i -
v i dua l ' s aud i ome t r i c con f i gur a t i on . The r e i s ,
howeve r , some ques t i on conce rn i ng t he exac t
na t ur e of t he re l a t i onsh i p . Wege l (1931) , Joseph-
son (1931) , Mor t i me r e t a l (1940) , and Fow l e r
(1942) a l l be l i eved t ha t t he p i t ch o f t i nn i tus cor -
r esponds to a f r equency r eg i on i n wh i ch t he
aud i ogr am shows e i ther a po i n t o f max i mum
hea r i ng l oss or e l se t he t rans i t i on f rom norma l
to abnorma l hea r i ng. I n a recen t d i scuss i on o f
t i nn i tus mechan i sms , p i t ch ma t ch i ng da t a f rom
a samp l e of ove r 1000 t i nn i tus pa t i en t s we r e
summa r i zed to i l l us t ra t e t he po i n t t ha t t he r e i s
grea t var i ab i l i t y i n t he prec i se l oca t i on of t i nn i tus
f requenc i es (c f. F i gs . 14-3 and 14-5 i n Me i k l e ,
1995) . Th i s was a l so seen ear l i er by G r aham and
Newby (1962) . I t is c l ear t ha t p i t ch ma t ches for
t i nn i tus can occur prac t i ca l l y anywhe r e i n f re-
quency reg i ons whe r e t he r e i s hea r i ng l oss .
I n genera l , t he p i t ch of t i nn i tus t ends to be
h i gh . The l arges t ava i l ab l e surveys of t i nn i tus
p i t ch ma t ches show t ha t i n t he ma j or i t y o f
pa t i ent s , t he p i t ch i s a t or above 3000 Hz (Reed ,
1960 ; Me i k l e and Wa l sh , 1984 ; Me i k l e e t a l ,
1995) . H i gh- f r equency hea r i ng l oss i s t he mos t
common aud i ome t r i c con f i gura t i on encoun t e r ed
i n t he t i nn i tus c l i n i c ; t hus , i t i s no t surpr i s i ng
t ha t surveys have f ound re l a t i ve l y l ow pe rcen t -
ages of pa t i en t s w i t h t i nn i tus p i t ches be l ow
1000 Hz (Me i k l e and Wa l sh , 1984 ; Me i k l e , 1995) .
The recen t summa r y of aud i ome t r i c da t a f rom
t he 1000 t i nn i t us pa t i en t s re f e r red to above
i l l us t ra t ed a s t r i k i ng and ve ry orde r l y i nve rse
re l a t i onsh i p be t ween t he p i t ch o f t i nn i tus and
t he sever i t y of hea r i ng l oss (Me i k l e , 1995) . Af t e r
d i v i d i ng t he group i nto f i ve success i ve l y h i ghe r
p i t ch ca t egor i es , t he mean aud i ome t r i c curves
for t he f i ve groups we r e compa r ed . St a t i s t i ca l
ana l ys i s showed t ha t pa t i en t s w i t h t he l owes t
t i nn i tus p i t ch ma t ches t ended to have t he grea t -
142
es t hea r i ng l oss , bo t h i n t e rms o f t he ex t en t of
l oss and t he f r equency r ange a f f ec t ed . Con -
verse l y , t hose w i t h t he h i ghes t p i t ch t i nn i tus
t ended to have t he l eas t hea r i ng l oss . These d i f -
f erences we r e h i gh l y s i gn i f i cant (p < . 0001) . At pre-
sent , howeve r , t he re i s no exp l ana t i on for t he f ac t
t ha t seve re t i nn i tus occurs i n a sma l l numbe r of
pa t i en t s who appea r to have per f ec t l y norma l
hea r i ng (Reed , 1960 ; G r aham and Newby , 1962 ;
Cahan i e t a l , 1983) . Thus , a l t hough i t i s c l ear
t ha t t he p i t ch of t i nn i tus t ends to cor r espond to
f r equency r eg i ons o f s i gn i f i cant hea r i ng l oss ,
t he re a re i mpor t an t excep t i ons to t ha t ru l e .
The p i t ch o f t i nn i tus has been i nves t i ga t ed
i n re l a t i on to causa l f ac tors for t i nn i tus , a l t hough
t he s i tua t i on i s comp l i ca t ed i n many pa t i en t s by
t he pr esence o f mo r e t han one causa l f ac tor
(e .g. , pa t i ent s w i t h no i se - i nduced hea r i ng l oss i n
add i t i on to Men i e r e ' s d i sease ) . Noda r and Gr a -
ham (1965) compa r ed p i t ch ma t ches for sub-
j ec t s w i t h Men i e re ' s d i sease , conduc t i ve hea r i ng
l oss , and sensor i neur a l hea r i ng l oss . A l l
Men i e r e ' s sub j ec t s had p i t ch ma t ches be l ow
1000 Hz (med i an 320 Hz ) , wh i ch agr eed w i t h t he
f i nd i ngs o f Wa l sh (1956) , Caprosa (1963) , and
Day (1963) . The conduc t i ve hea r i ng l oss group
had a med i an p i t ch ma t ch o f 490 Hz ( r ange =
90-1450 Hz ) , wh i ch d i f f ered s i gn i f i cant l y f rom
t he sensor i neur a l group (med i an = 3900 Hz ,
r ange = 545-7500 Hz ) , i n agr eemen t w i t h t he
f i nd i ngs of G r aham and Newby (1962) .
Douek and Re i d (1968) a t t emp t ed to de t er -
m i ne i f a c l i n i ca l aud i ome t e r cou l d be used to
ob t a i n p i t ch ma t ches t ha t had d i agnos t i c va l ue .
They measur ed t i nn i tus p i t ch i n 200 pa t i en t s
us i ng Josephson ' s (1931) me t hod . The pa t i en t s
we r e d i v i ded i nto e i gh t groups accord i ng to c l i n-
i ca l d i agnos i s o f aud i t ory pa tho l ogy , and the i r
p i t ch ma t ches showed gene r a l cor re l a t i ons w i t h
t he va r i ous aud i t ory pa t ho l og i es . The au t hors
no t ed t ha t t hresho l ds seemed e l eva t ed i n t he
r eg i on o f t he t i nn i tus f requency , wh i ch t hey
t e rmed an " aud i ome t r i c ar t i f ac t . "
Us i ng a p i t ch ma t ch i ng procedur e desc r i bed
by G r aham and Newby (1962) , Cahan i e t a l
(1983) de t e rm i ned t he t i nn i tus f requenc i es i n 56
no i se - exposed sub j ec t s w i t h and w i t hou t hea r -
i ng l oss . The 29 norma l -hea r i ng sub j ec t s we r e
f ound to have s i gn i f i cant l y h i ghe r f r equency
t i nn i t us t han t he 27 hea r i ng l oss sub j ec t s .
Because o f t he d i f f erent d i s t r i bu t i ons of p i t ch
ma t ches , t he au t hors sugges t ed t he poss i b i l i t y
of d i f f erent neur a l processes be i ng respons i b l e
f or t i nn i t us gene r a t i on f or no i se - exposed
i nd i v i dua l s w i t h norma l hea r i ng compa r ed to
t hose w i t h hea r i ng l oss.
 Psychoacous t i c Measur es o f T i nn i t us / Henry and Me i k l e
Seve r a l i n t e res t i ng a t t emp t s have been
made i n t he pas t to eva l ua t e t he p i t ch o f t i nn i -
t us i n sub j ec t s exposed expe r i men t a l l y to no i se
l eve l s suf f i c i ent to produce t empor a r y t hresho l d
sh i f t (At he r l ey e t a l , 1968 ; Loeb and Sm i t h ,
1967) . Mos t , i f no t a l l , sub j ec t s expe r i enced t i n-
n i t us . The s t ud i es d i sagr eed as to t he aud i o-
me t r i c f r equency a t wh i ch max i mum t hr esho l d
sh i f ts occur red , and i t i s no t cer t a i n tha t t he mea -
sur emen t me t hods used t hen we r e capab l e o f
y i e l d i ng re l i ab l e p i t ch ma t ches i n t he f ace o f
t hresho l ds t ha t we r e va ry i ng ove r t i me dur i ng
t he pos t exposur e recove ry per i od . For e th i ca l
reasons , such s tud i es a re d i f f i cu l t or i mposs i b l e
to rep l i ca t e .
Me t hodo l ogy o f T i nn i t us P i t ch Ma t ch i ng
Ty l e r and Con r ad - Armes (1983b) eva l ua t ed
t i nn i t us p i t ch us i ng t hr ee psychophys i ca l me t h -
ods (Ad j us t men t , L i m i t s , and Adap t i ve ) for each
o f 10 sub j ec t s . Compa r i ng t he t i nn i t us f re -
quenc i es ob t a i ned us i ng t he t hr ee me t hods , no
s i gn i f i can t d i f f e r ences we r e f ound i n e i t he r t he
group means or t he s t anda rd dev i a t i ons . Fo r
c l i n i ca l use , t he au t hor s r ecommended e i t he r
t he i r Adap t i ve or Ad j us t men t Me t hod , wh i ch
r equ i r ed on l y 1 t o 2 m i nu t es t o ob t a i n a s i ng l e
p i t ch ma t ch. They sugges t ed pr esen t i ng ma t ch -
i ng t ones i n t he i ps i l a t e ra l ea r t o avo i d prob l ems
w i t h b i naur a l d i p l acus i s (d i f f e r ences i n p i t ch
pe r cep t i on be t ween ea r s ) . They a l so r ecom-
mended seven t o n i ne p i t ch ma t ches f rom each
sub j ec t because o f t he l a rge va r i ab i l i t y i n
pa t i en t s ' ab i l i t i es to prov i de r epea t ed ma t ches .
Thus , f or unr e l i ab l e pa t i en t s , i nc r eas i ng t he
numbe r o f p i t ch ma t ches t ended t o i mprove t he
accur acy o f t he f i na l ma t ch .
Ve rnon and Fenw i ck (1984) emphas i zed
t ha t t i nn i tus pa t i en t s eas i l y con f use l oudness
and p i t ch ; thus , i t is necessa ry to pr esen t ma t ch-
i ng t ones a t l eve l s prev i ous l y ma t ched to t he t i n-
n i t us l oudness to m i n i m i ze th i s con f us i on . A
two- a l t e rna t i ve forced- cho i ce procedure , us i ng
d i sc re t e pa i r s o f f r equenc i es sepa r a t ed by
1000 Hz , was advoca t ed for p i t ch ma t ch i ng .
Ma t ch i ng t ones cou l d be pr esen t ed e i ther con-
t ra l a t era l l y or i ps i l a t era l l y to t he t i nn i tus , de t er -
m i ned by pa t i en t pre f erence , bu t t he au t hors
conc l uded t ha t t he f i na l p i t ch ma t ch shou l d be
made i n t he i ps i l a t era l ea r because o f t he po t en-
t i a l for b i naura l d i p l acus i s .
Penne r and B i l ger (1992) i nves t i ga t ed t he
use o f a forced- cho i ce doub l e -s t a i rcase ( FCDS)
procedur e emp l oy i ng 100-Hz s t ep s i zes for
ob t a i n i ng p i t ch ma t ches. Subsequen t l y , t he t ech-
n i que was mod i f i ed (Penne r and K l a f t er , 1992)
because t he s t ep s i zes we r e cons i de r ab l y l a rge r
t han t he f r equency d i f f e r ence l i men (DL ) f or
norma l - hea r i ng sub j ec t s . Penne r and K l a f t e r
t he r e f or e used t he FCDS procedur e w i t h 0 .2
pe r cen t s t ep s i zes f or f r equency and f ound t ha t
t he DL f or t he t i nn i t us ma t ches was compa r a -
b l e t o t ha t for ex t e rna l t ones . The au t hor s sur -
m i sed t ha t t h i s good cor r espondence cou l d have
been due t o t he FCDS procedur e ' s ab i l i t y t o
accur a t e l y measu r e t i nn i t us t ha t i s s t ab l e , or ,
a l t e rna t i ve l y , t ha t sub j ec t s may have ma t ched
t o an " i mag i ned t one . " They eva l ua t ed t h i s l a t -
t e r no t i on w i t h a second expe r i men t and f ound
t ha t abou t ha l f o f t he sub j ec t s had l a rge r DLs
f or ma t ches t o i mag i ned t ones t han t o ex t e rna l
t ones , whe r eas t he o t he r ha l f d i d no t . Th i s resu l t
was d i f f i cu l t t o i n t e rpr e t and may have i nd i ca t ed
t ha t ha l f o f t he sub j ec t s we r e ma t ch i ng to i mag -
i ned t ones and no t t o t he i r t i nn i t us .
An unusua l t echn i que was p roposed by
Ohsak i e t a l (1990) . They no t ed t ha t a s t anda rd
aud i ome t e r cou l d no t ob t a i n an accur a t e t i nn i -
t us p i t ch ma t ch , no r cou l d i t measu r e sma l l
va r i a t i ons i n t i nn i t us p i t ch . They t he r e f or e
deve l oped a nove l t es t i ng dev i ce ca l l ed a " hep-
t achord gene r a t or . " Th i s dev i ce was capab l e o f
pr esen t i ng t ones accord i ng to t he s t anda rd mus i -
ca l sca l e (do- re -m i ) . Two r epea t ed ma t ches a t t he
same f r equency we r e r equ i r ed t o i den t i f y a p i t ch
ma t ch . They f ound t ha t ma t ches r epea t ed w i t h i n
1 week we r e no f ur t he r apa r t t han t he ad j acen t
t es t f r equency f or 95 pe r cen t (18) o f t he 19 ea r s
t es t ed . P i t ch ma t ches made i n t he mo r n i ng and
a f t e rnoon o f one day we r e r epea t ab l e w i t h i n
one f r equency f or 100 pe r cen t o f 10 ea r s . The
au t hor s conc l uded t ha t t he i r hep t a t on i c me t hod
to ob t a i n t i nn i t us p i t ch ma t ches was mo r e accu-
ra t e t han us i ng a conven t i ona l aud i ome t e r . How -
ever , t he p i t ch o f t i nn i t us i n many pa t i en t s i s
above 4000 Hz , t he f r equency a t wh i ch mus i ca l
t ona l i t y beg i ns t o br eak down . Thus , t he use o f
mus i ca l i n t e rva l s wou l d seem t o be d i f f i cu l t t o
app l y i n t es t i ng t he ma j or i t y o f t i nn i t us pa t i en t s .
T i nn i t us Loudness Ma t ch i ng
Loudness Ma t ch i ng a t t he
T i nn i t us F r equency ve rsus a t
a No rma l - Hea r i ng F r equency
Ve rnon (1976) no t ed t he prev i ous f i nd i ngs
o f Reed (1960) , Fow l e r (1942) , and G r aham and
Newby (1962) show i ng t ha t t i nn i t us was
t yp i ca l l y ma t ched to t ones on l y a f ew dec i be l s
above t hresho l d . The ques t i on was how t i nn i tus
o f " such f eeb l e i nt ens i t i es " cou l d be so d i s turb-
i ng. Ve rnon po i n t ed ou t t he obv i ous poss i b i l i t y
143
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t ha t t i nn i tus pa t i en t s m i gh t be expe r i enc i ng
abnorma l l y rap i d l oudness grow t h ( recru i tmen t )
t ha t cou l d accoun t for sounds be i ng pe rce i ved as
much l oude r t han the i r l ow sensa t i on l eve l s
wou l d i nd i ca t e . He proposed a ser i es o f exper i -
men t s to t es t t ha t hypo thes i s , i nc l ud i ng one i n
wh i ch t i nn i tus l oudness ma t ch i ng measur e -
men t s shou l d be made a t bo t h t he t i nn i tus f re-
quency and a t a non t i nn i t us f r equency. Because
of t he i nc r eased poss i b i l i t y o f r ec ru i t men t i n
t he f r equency reg i on o f t he t i nn i tus , he s t a t ed
t ha t " i t i s essen t i a l t ha t t he por t i on of t he ea r
i nvo l ved i n t he t i nn i tus be compa r ed to t he por -
t i on t ha t i s no t " (p . 18) .
Goodw i n and Johnson (1980b) we r e t he f i rst
o f many i nves t i ga tors to eva l ua t e t he e f f ec t o f
r ec ru i t men t by ma t ch i ng t i nn i tus l oudness a t
bo t h t he t i nn i tus f r equency and a t a norma l -
hea r i ng f r equency. For t he i r sub j ec t s , l oudness
ma t ches for t i nn i tus we r e ob t a i ned a t h i ghe r sen-
sa t i on l eve l s when measu r ed a t f r equenc i es
whe r e hea r i ng was norma l (mean = 24 dB SL)
t han when measur ed a t t he t i nn i tus f r equency
(mean = 7 dB SL ) . These resu l t s sugges t ed t ha t
t i nn i t us l oudness i s s i gn i f i can t l y unde res t i -
ma t ed when measur ed a t t he t i nn i tus f r equency.
The au t hors conc l uded t ha t l oudness rec ru i t men t
a t t he t i nn i tus f r equency was probab l y r espon-
s i b l e for t he d i f f erences t hey observed , and there -
fore t ha t measu r emen t of l oudness ma t ches a t
t he t i nn i tus f r equency was no t appropr i a t e .
Ty l e r and Conr ad -Armes (1983a ) a l so con-
duc t ed a s t udy to compa r e l oudness ma t ches
ob t a i ned a t t he t i nn i t us f r equency to t hose
ob t a i ned a t a norma l -hea r i ng f r equency ; resu l t s
o f the i r s t udy we r e s i m i l a r to t hose o f Goodw i n
and Johnson (1980b) . Ty l e r and Conr ad -Armes ,
howeve r , conc l uded t ha t t he l oudness ma t ches
we r e st i l l too sma l l a t t he norma l -hea r i ng f re-
quency re l a t i ve to t he pa t i ent s ' sub j ec t i ve t i n-
n i t us comp l a i n t s . They proposed a me t hod for
t r ans f orm i ng t he l oudness ma t ches f rom dB SL
to sones , as d i scussed i n t he nex t sec t i on be l ow.
Jakes e t a l (1985) we r e i n t e res t ed i n s tudy-
i ng t he re l a t i onsh i p be t ween t i nn i tus l oudness
and d i f f erent d i mens i ons of comp l a i n t s due to t he
t i nn i tus . The i r 1- kHz l oudness ma t ches we r e
unre l a t ed to mos t aspec t s o f t i nn i tus comp l a i n t s ,
excep t s l i ght l y ( r = . 34) w i t h t he " i n t rus i veness
o f t i nn i tus . "
Penne r (1986a ) used a magn i t ude es t i ma t i on
procedur e to measur e s l opes of l oudness grow t h
f unc t i ons for each sub j ec t a t t he t i nn i tus f re-
quency and a t 1 kHz , whe r e hea r i ng was norma l .
For mos t o f t he sub j ec t s , t he mean s l ope a t t he
t i nn i tus f r equency was s t eepe r t han t he mean
144
s l ope a t 1 kHz , i nd i ca t i ng t ha t grow t h o f l oud-
ness for an ex t e rna l t one was mor e r ap i d a t t he
t i nn i tus f r equency t han a t 1 kHz . C i t i ng Rob i n-
son and Dadson ' s (1956) equa l - l oudness con-
t ours i n norma l -hea r i ng sub j ec t s , Penne r no t ed
t ha t th i s " rec ru i t men t " a t h i ghe r f requenc i es
was no t represen t a t i ve o f a pa tho l og i c cond i -
t i on . She conc l uded tha t , for mos t pa t i en t s , t i n-
n i t us l oudness i s no t " pa radox i ca l " i n t ha t i t
m i m i cs t he l oudness o f ex t e rna l h i gh- f r equency
t ones .
R i sey e t a l (1989) emphas i zed t he i mpor -
t ance o f a l oudness ma t ch procedur e f rom wh i ch
resu l t s wou l d cor re l a t e w i t h se l f - repor t ed l oud-
ness and seve r i t y sca l es . They ob t a i ned l oud-
ness ma t ches a t t he t i nn i t us f r equency and a t
1 kHz . T i nn i t us seve r i t y r a t i ngs we r e a l so
ob t a i ned us i ng a 1 to 10 sca l e . Compa r ed to
l oudness ma t ches a t t he t i nn i t us f requency ,
t he 1- kHz ma t ches we r e s i gn i f i cant l y l arger , i n
dB SL , and showed be t t er t es t - re t es t re l i ab i l -
i ty. The 1- kHz ma t ches a l so showed a sma l l bu t
s i gn i f i cant cor re l a t i on w i t h t he t i nn i tus sever i t y
ra t i ngs ( r = . 224 ; p < .05) , whe r eas ma t ches a t
t he t i nn i tus f r equency d i d no t ( r = . 055 ; p > .05) .
I n a second pro j ec t , R i sey e t a l conduc t ed t he
same t i nn i tus eva l ua t i ons i n sub j ec t s who we r e
adm i n i s t e r ed f urosem i de i n t ravenous l y. For t he
sub j ec t s whose t i nn i tus was repor t ed to decrease ,
t he i r 1- kHz l oudness ma t ches we r e r educed an
ave r age of 5 . 75 dB SL , and the i r sever i t y ra t i ngs
dropped an ave r age of 1 . 96 po i nt s . These changes
we r e s i gn i f i cant l y cor re l a t ed ( r = . 78 ; p < . 05) .
The r ema i n i ng sub j ec t s expe r i enced no change
i n the i r t i nn i tus and a l so no changes i n e i ther
the i r l oudness ma t ches or the i r ra t i ng sca l es . The
au t hor s conc l uded t ha t l oudness ma t ches
ob t a i ned a t 1 kHz a r e sens i t i ve to changes i n
l oudness i nduced by pha rmaco l og i c agen t s and
cor re l a t e we l l w i t h se l f - repor t ed ra t i ngs of t i n-
n i t us seve r i t y.
Conve r s i on o f Loudness Ma t ches t o
D i f f e r en t Un i t s o f Measu r emen t
As desc r i bed above , many i nves t i ga t i ons
have cons i s t en t l y demons t r a t ed t ha t t i nn i tus
l oudness ma t ches t end to be l arger i n f r equency
r eg i ons whe r e hea r i ng sens i t i v i t y i s norma l ,
suppor t i ng t he pr em i se t ha t r ec ru i t men t m i gh t
be respons i b l e for t he sma l l s i ze of l oudness
ma t ches ob t a i ned a t t he t i nn i t us f r equency.
Neve r t he l ess , Ty l e r and Conr ad -Armes (1983a )
no t ed t ha t l oudness ma t ches a t t he " norma l "
f requenc i es we r e st i l l cons i de red sma l l re l a t i ve
to pa t i ent s ' comp l a i n t s . Thus , t i nn i tus l oudness
expr essed i n dB SL may no t be mean i ng f u l even
 Psychoacous t i c Measu r es o f T i nn i t us / Hen r y and Me i k l e
when measur ed a t a f r equency whe r e hea r i ng
is norma l . They the re f ore dev i sed a me t hod to
t r ans f orm t he l oudness ma t ches f rom dB SL to
sones , us i ng t he psychophys i ca l equa t i ons deve l -
oped by S t evens (1955) and ad j us t i ng for t he
s l opes o f l oudness grow t h f unc t i ons for pe rsons
w i t h coch l ear hea r i ng i mpa i rmen t . In some sub-
j ec ts , conve rs i on to sones seemed to be i n agree -
men t w i t h t he pe rce i ved l oudness o f t i nn i tus ,
whe r eas i n o t he r sub j ec t s t he re was poor agree -
men t . A l t hough resu l t s we r e i ncons i s t ent , t he
au t hors sugges t ed tha t sones m i gh t be t he mor e
appropr i a t e way to represen t t i nn i tus l oudness .
They acknow l edged tha t t he l oudness grow t h for -
mu l as m i gh t be too gene ra l for app l i ca t i on to spe-
c i f i c i nd i v i dua l s , h i gh l i gh t i ng t he need to
es t ab l i sh i nd i v i dua l i zed f unc t i ons a t each l oud-
ness ma t ch i ng f r equency.
Penne r (1984) a t t emp t ed t o eva l ua t e sub -
j ec t s ' t i nn i t us magn i t ude by de t e rm i n i ng equa l
l oudness measu r emen t s ac ross f r equenc i es and
ob t a i ned r esu l t s t ha t we r e compa r ab l e t o t hose
expec t ed for no rma l l i s t ene rs . These da t a sug-
ges t ed t ha t t i nn i t us l oudness ma t ches expr essed
i n dB SL a r e an i nve r se f unc t i on o f t he abso l u t e
t hr esho l d - t he h i ghe r t he t hr esho l d , t he sma l l e r
t he l oudness ma t ch . Penne r conc l uded t ha t t i n-
n i t us l oudness m i gh t be t t e r be expr essed i n
sones , as sugges t ed by Ty l e r and Con r ad - Armes
(1983a ) , and t ha t t i nn i t us ma t ched t o a sma l l
va l ue i n dB SL m i gh t r easonab l y be expec t ed t o
seem " l oud " t o t he pa t i en t .
H i nchc l i f f e and Chambe r s (1983) po i n t ed
ou t t ha t t ones ca l cu l a t ed to be 1 sone i n l oudness
may be pe rce i ved a t d i f f erent l oudness l eve l s by
d i f f erent i nd i v i dua l s and t ha t a sound pe rce i ved
as t he same l oudness may be accep t ab l e to one
i nd i v i dua l and no t to ano t he r. They the re f ore
a t t emp t ed to cons t ruc t i nd i v i dua l psychophys -
i ca l f unc t i ons t ha t wou l d t ake i nto accoun t i nd i -
v i dua l d i f f erences i n l oudness grow t h and i n
" l oudness accept ab i l i t y. " The i r l oudness func -
t i ons we r e based on a ma t hema t i ca l f unc t i on
desc r i bed by Scha r f and S t evens (1959) to
desc r i be t he grow t h o f l oudness nea r t hr esho l d.
H i nchc l i f f e and Chambe r s used a l oudness
f unc t i on a t 1 kHz as t he re f e rence func t i on , bu t
i ns t ead o f us i ng 40 dB SL as un i t y ( the 1 sone
s t anda rd advoca t ed by St evens) , t hey used t he
" mos t comf or t ab l e l oudness " l eve l . They t e rmed
th i s l eve l one " pe rsona l l oudness un i t " (PLU) and
used i t as t he compa r i son s t anda rd ( "un i t y " ) for
sub j ec t i ve magn i t ude es t i ma t i on . Sub j ec t s
ad j us t ed t he l eve l of an ex t e rna l sound to be one -
ha l f un i t y (0 .5 PLU ) and t w i ce un i t y (2 PLU ) . I n
th i s way , t hey cons t ruc t ed i nd i v i dua l l oudness
f unc t i ons for each sub j ec t . A l t hough t hey sug-
ges t ed t ha t th i s me t hod m i gh t be usab l e for
c l i n i ca l t i nn i tus s tud i es , the i r me t hod has no t
been adop t ed , pe rhaps because i t i s t i me con-
sum i ng and may be d i f f i cu l t for some pa t i en t s .
Ha l l am e t a l (1985) app l i ed t he me t hod of
H i nchc l i f f e and Chambe r s (1983) to ca l cu l a t e
PLUs to r epr esen t t he t i nn i t us l oudness for
the i r sub j ec t s . They de t e rm i ned PLUs a t t he
t i nn i t us f r equency and a t 1 kHz , and a l so
expr essed t he measur emen t s i n dB HL , dB SL ,
and sones . L i ke others , t hey f ound tha t measur es
expr essed i n dB HL or dB SL we r e poor l y cor -
re l a t ed w i t h psycho l og i ca l sca l es of t i nn i tus
seve r i t y. Un l i ke Ty l e r and Con r ad - Armes
(1983a) , t rans f orma t i on to sones d i d no t i mprove
t he cor re l a t i on . Conve rs i on of t he measur es to
PLUs , howeve r , i nc reased t he cor re l a t i ons ( to i s
o f . 30- .42) be t ween t he PLUs and spec i f i c i t ems
f rom t he i r psycho l og i ca l sca l es . I t shou l d be
no t ed , howeve r , t ha t t hese i mprovemen t s we r e
on l y ob t a i ned when ha l f o f t he sub j ec t s we r e
r emoved f rom t he ana l ys i s due to the i r d i f f i cu l -
t i es pe r f orm i ng t he t asks .
Jakes et a l (1986) no t ed t ha t a l t hough con-
s i de rab l e e f for t had been expended to re f i ne
t i nn i tus l oudness ma t ch measur es , l i t t l e wor k
had gone i nto re l a t i ng t hese measur es to se l f -
repor t ed l oudness . Those f ew s t ud i es showed
sma l l cor re l a t i ons , even when s i gn i f i cant (Haze l l ,
1981 ; Ty l e r and Conr ad -Armes , 1983a ; Ha l l am
e t a l , 1985) . W i t hou t such a cor re l a t i on , t he
au t hor s s t a t ed , a l oudness ma t ch me t hod i s
i nva l i d for represen t i ng l oudness . They ob t a i ned
l oudness ma t ches a t t he t i nn i tus f r equency and
a t 1 kHz and expr essed t he l oudness ma t ches i n
dB HL , dB SL , and PLUs , as desc r i bed by H i nch-
c l i f fe and Chambe r s (1983) . Pa t i en t s a l so i nd i -
ca t ed the i r t i nn i tus l oudness us i ng f i ve d i f f erent
se l f - repor t sca l es . On l y m i l d to mode r a t e cor re -
l a t i ons we r e f ound be t ween any o f t he l oudness
ma t ch me t r i cs and t he va r i ous l oudness sca l es .
The PLU me t r i c resu l t ed i n t he bes t cor re l a t i on
( l arges t r = . 44 ; p < .01) . No t surpr i s i ng l y , a l l of
t he cor re l a t i ons we r e " ma r ked l y i mproved " when
sub j ec t s who had d i f f i cu l t i es w i t h t he t es t pro-
cedur es we r e exc l uded ( l arges t r = . 87 ; p < . 001) .
Ma t suh i r a e t a l (1992) proposed a me t hod to
cor rec t t i nn i tus l oudness ma t ches tha t a re unde r -
es t i ma t ed due to t he i n f l uence of l oudness recru i t -
men t , us i ng on l y da t a t ha t wou l d norma l l y be
ob t a i ned dur i ng a s t anda rd c l i n i ca l aud i o l og i c
eva l ua t i on . The i r ob j ec t i ve was to prov i de c l i n i -
c i ans w i t h a me t hod t ha t wou l d mor e accura t e l y
i nd i ca t e t he pe rce i ved l oudness of a pa t i ent ' s
t i nn i tus w i t hou t requ i r i ng add i t i ona l t es t s . They
145
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deve l oped an " ave raged l oudness func t i on , " based
on l oudness grow t h f unc t i ons prev i ous l y de r i ved
by o t he r i nves t i ga tors for t he t yp i ca l coch l ear -
i mpa i r ed ea r. To cor rec t t he s i ze of pa t i ent s ' t i n-
n i t us l oudness ma t ches for abnorma l l y r ap i d
l oudness grow t h , t hey mod i f i ed t he ave r aged
l oudness f unc t i on for each pa t i en t us i ng da t a
ob t a i ned f rom t es t i ng tha t i nd i v i dua l . The resu l ts ,
howeve r , we r e h i gh l y va r i ab l e , as wou l d be
expec t ed because of t he grea t var i ab i l i t y t ha t
ex i s t s i n r ega rd t o abnorma l i t i es o f l oudness
pe rcep t i on . F rom the i r wor k , i t appea rs d i f f i cu l t
or i mposs i b l e to de t e rm i ne an " ave rage l oudness
abnorma l i t y " t ha t cou l d be gene ra l i zed w i de l y.
Hen r y (1996) used t he ABLB t echn i que to
eva l ua t e l oudness grow t h i n un i l a t era l t i nn i -
t us pa t i en t s w i t h norma l or nea r -norma l hea r -
i ng i n t he con t ra l a t era l ea r. T i nn i t us l oudness
ma t ches , as we l l as grow t h o f l oudness for ex t er -
na l sounds us i ng ABLB , we r e ob t a i ned w i t h a
ser i es o f t ones . Ana l ys i s o f group resu l t s showed
t ha t va r i ance i n t he ra t e o f l oudness grow t h
( i .e . , va r i ance i n r ega rd to rec ru i tmen t ) accoun t ed
for on l y abou t 25 pe r cen t o f t he va r i ance i n t he
s i ze o f t he l oudness ma t ches , l eav i ng abou t 75
pe r cen t of t he va r i ance unaccoun t ed for . These
obse rva t i ons sugges t t ha t add i t i ona l f ac tors , as
ye t unknown , i n f l uence t he sma l l s i ze o f t i nn i -
t us l oudness ma t ches .
T i nn i t us Loudness Ma t ch i ng Cu r ves
I n a manne r s i m i l a r to t ha t used by Fe l d-
mann for ob t a i n i ng t i nn i t us mask i ng curves
(1971) , ob t a i n i ng t i nn i tus l oudness ma t ches a t
a ser i es o f t es t f requenc i es y i e l ds seve ra l d i f -
f eren t t ypes o f l oudness ma t ch i ng curves (Ver -
non e t a l , 1980b ; Ve rnon and Me i k l e , 1981) .
Reca l l i ng h i s prev i ous s t a t emen t s , Ve rnon (1976)
no t ed t ha t r ec ru i t men t i s t he probab l e cause o f
t he pa r adox i ca l l y sma l l t i nn i t us l oudness
ma t ches . He po i n t ed ou t tha t t he s i ze of t he l oud-
ness ma t ch , i n dB SL , t ends to dec r ease as a
f unc t i on o f f r equency , up to t he t i nn i t us
f r equency. He t he re f ore sugges t ed t ha t when
l oudness ma t ches gr ea t e r t han 10 dB SL a re
obse rved , i t i s l i ke l y t ha t t he l oudness was
ma t ched i ncor rec t l y ( i .e . , to a f r equency be l ow
t he ac t ua l t i nn i t us f requency) .
Ve rnon and Me i k l e (1981) obse rved t ha t
t he l oudness ma t ches for t i nn i tus c l i n i c pa t i ent s
fe l l i n t o t wo d i s t i nc t groups when l oudness
ma t ches i n dB SL we r e p l o t t ed as a f unc t i on of
t es t f r equency. I n one group , t he l oudness
ma t ches we r e l a rge a t l owe r f requenc i es and
became progress i ve l y sma l l e r as t he f r equency
o f t he t es t t one i nc r eased and approached t he
146
t i nn i tus f r equency. I n t he o t he r group , t he l oud-
ness ma t ches we r e i ndependen t o f f r equency
( and mos t common l y we r e on l y a f ew dB above
t hresho l d) . The r e appea r ed to be no o t he r d i s-
t i ngu i sh i ng charac t er i s t i cs for t he t wo groups .
The au t hor s sugges t ed t ha t t he shape o f t he
l oudness ma t ch i ng curve m i gh t pred i c t an i nd i -
v i dua l ' s t i nn i tus maskab i l i t y cur ve ( reca l l t he
ana l ogous mask i ng curves obse rved by Fe l d-
mann , 1971) . To da t e , no one has t es t ed t ha t
i n t e res t i ng poss i b i l i t y.
Mos t recent l y , Me i k l e e t a l (1996) co l l ec t ed
da t a f rom four sepa ra t e l oudness ma t ch i ng s tud-
i es i n orde r to r ev i ew t i nn i tus l oudness ba l ance
da t a f rom 121 pa t i en t s . A l l f our s tud i es showed
t hree ma j or pa t t e rns of l oudness ma t ch i ng curves
accoun t i ng for 80 pe rcen t of t he sub j ec t s : one pa t -
t e rn was t e rmed " me rg i ng , " one "para l l e l , " and
one " t rans i t i ona l . " They used l i near regress i on
to ca l cu l a t e a best - f i t l i ne for each sub j ec t ' s l oud-
ness cur ve . The s l opes of t he bes t - f i t l i nes we r e
gene ra l l y nega t i ve , f orm i ng a con t i nuum of va l -
ues r ang i ng f rom abou t -6 .0 to 0 i n 80 pe r cen t
of t he sub j ec t s (20% exh i b i t ed l oudness ma t ch i ng
curves t ha t we r e t oo comp l ex to f i t to a s i ng l e
l i ne) . I t i s an i n t e res t i ng con j ec t ure t ha t t he
l oudness ma t ch i ng pa t t e rns m i gh t be re l a t ab l e
to Fe l dmann ' s mask i ng curves . I n any case , t he
va r i ous t ypes of l oudness curves may u l t i ma t e l y
prove use fu l for ca t egor i z i ng c l i n i ca l l y re l evan t
d i mens i ons of t i nn i tus .
Re l i ab i l i t y o f T i nn i t us
P i t ch and Loudness Ma t ches
Mos t i nves t i ga tors agree t ha t p i t ch ma t ches
for t i nn i t us a r e no t as re l i ab l e as l oudness
ma t ches and t ha t t he r e a re l a rge i nd i v i dua l
va r i a t i ons i n r ega rd to t he ab i l i t y of pa t i en t s to
ma t ch t he i r t i nn i t us p i t ch . Exce l l en t p i t ch
ma t ch i ng capab i l i t i es a re t yp i ca l for peop l e w i t h
mus i ca l t ra i n i ng or who wor k i n acous t i cs . A t t he
o t he r ex t r eme a r e pa t i ent s w i t h s i gn i f i cant hea r -
i ng l oss who may have r educed f requency reso l v-
i ng ab i l i t y. I n our own c l i n i ca l expe r i ence , we
have encoun t e r ed pa t i en t s for whom a l l f re-
quenc i es above a cer t a i n va l ue (e .g. , 3000 Hz )
sound s i m i l ar . C l ear l y , such i nd i v i dua l s canno t
make re l i ab l e f r equency j udgmen t s abou t the i r
t i nn i tus p i t ch.
Add i t i ona l sources of unre l i ab i l i t y ex i s t i n
pa t i en t s w i t h mu l t i p l e t i nn i tus sounds or whose
t i nn i tus var i es ove r t i me i n r ega rd to p i t ch , t i m-
bre , or l oudness . Va r i a t i ons of t he sound qua l -
i ty of t i nn i tus occur i n approx i ma t e l y one - t h i rd
o f t he t i nn i tus pa t i en t popu l a t i on (Me i k l e e t a l ,
 Psychoacous t i c Measu r es o f T i nn i t us / Hen r y and Me i k l e
1987) . Such i nd i v i dua l s have mo r e d i f f i cu l t y
mon i t or i ng how the i r pr edom i nan t t i nn i tus p i t ch
r e l a t es to t he ex t e rna l compa r i son t ones .
A l t hough t i nn i tus t ha t exh i b i t s spec t ra l var i a -
t i ons is a c l i n i ca l rea l i t y t ha t canno t be i gnored ,
i nd i v i dua l s w i t h var i ab l e t i nn i tus a re no t appro-
pr i a t e sub j ec t s for resea rch eva l ua t i ng t he re l i -
ab i l i t y of va r i ous p i t ch ma t ch i ng pro toco l s .
Ea r l y i n h i s wo r k w i t h t i nn i tus pa t i en t s , i t
was s t a t ed by Ve rnon t ha t t i nn i tus l oudness
ma t ches we r e " i nord i na t e l y re l i ab l e , " be i ng
reproduc i b l e i n mos t cases to w i t h i n 1 dB when
t es t i ng was repea t ed on t he same day (Ve rnon
e t a l , 1980b) . S i m i l a r resu l t s we r e repor t ed by
Ba i l ey (1979) . I n l a t er wor k , Ve rnon s t ud i ed
t es t - re t es t re l i ab i l i t y i n n i ne t i nn i tus pa t i en t s
se l ec t ed as sub j ec t s because t hey had cons t an t ,
seve re t i nn i tus tha t t hey desc r i bed as tona l and
f ree f rom l oudness f l uc tua t i ons (Ve rnon , 1985) .
They we r e t es t ed four t i mes on each of 4 days
sepa r a t ed by a t l eas t 1 week . Us i ng t he ea r con-
t ra l a t era l to t he pr edom i nan t t i nn i tus , he f ound
t ha t t he sub j ec t s ' l oudness ma t ches va r i ed by no
mor e t han 2 dB when measur es we r e repea t ed
on t he same day. ( In t erva l s o f 10-15 m i nu t es
we r e i n t e rpo l a t ed be t ween t r i a l s .) When l oud-
ness ma t ches we r e r epea t ed a f t er a week or
mor e , t he var i ab i l i t y was gr ea t e r but , i n mos t
cases , t he d i f f erences we r e no l arger t han 5 dB ,
a l t hough a f ew showed d i f f erences up to 10 dB .
Ve rnon has emphas i zed t ha t cons i s t en t mea -
su r emen t o f t i nn i t us l oudness ma t ches depends
on (1) use o f ascend i ng s t i mu l us i n t ens i t i es t o
avo i d produc i ng r es i dua l i nh i b i t i on ; (2) i nc r eas -
i ng t he compa r i son t ones i n sma l l i nc r emen t s
(2 dB t o de t e rm i ne t hr esho l d , a f t e r t ha t 1 dB t o
es t ab l i sh t he l oudness ma t ch ) ; and (3) de t e r -
m i n i ng t he t hr esho l d each t i me t he l oudness
ma t ch i s measu r ed ; " o t he rw i se t he no rma l va r i -
ab i l i t y o f t hr esho l d measu r es w i l l i n t roduce spu -
r i ous d i f f e r ences be t ween t he t hr esho l d and t he
l oudness ma t ch . "
Penne r (1983) and Burns (1984) commen t ed
t ha t t he h i gh re l i ab i l i t y of t i nn i tus l oudness
ma t ches repor t ed by Ve rnon e t a l (1980b) and by
Ba i l ey (1979) was grea t er t han m i gh t be expec t ed
even for norma l -hea r i ng sub j ec t s . They a l so
commen t ed t ha t response ave r ag i ng t echn i ques
used by some i nves t i ga tors (Reed , 1960 ; G r aham
and Newby , 1962 ; Goodw i n and Johnson , 1980a ,
b) , i n wh i ch t i nn i tus p i t ch and l oudness ma t ches
we r e requ i red to fa l l w i t h i n a spec i f i ed r ange a
cr i t er i on numbe r of t i mes , d i d no t t ake i nto
accoun t t he fu l l d i s t r i but i on of responses ou t s i de
o f t he spec i f i ed range , l ead i ng to a f a l se i mpr es -
s i on o f re l i ab i l i ty. Bu rns c i t ed s t ud i es (Voroba ,
1979 ; Penne r et a l , 1981 ; Penne r , 1983) i nd i -
ca t i ng p i t ch ma t ch i ng var i ab i l i t y " severa l orders
o f magn i t ude h i ghe r " t han t ha t ob t a i ned f rom
norma l l i s t eners ma t ch i ng to ex t e rna l t ones .
He men t i oned Penne r (1983) as t he on l y s t udy
prov i d i ng ac tua l da t a on l oudness ma t ch var i -
ab i l i ty , and t ha t he r da t a showed i t to be l a rge .
Burns a l so f ound " ex t r eme l y l arge " var i ab i l i t y
for t he t i nn i tus measur emen t s , espec i a l l y p i t ch
ma t ches , re l a t i ve to ex t e rna l s t i mu l i .
Penne r (1986b) sugges t ed tha t t he re l i ab i l -
i ty of t i nn i tus measur emen t s was poor because
t i nn i tus ac t ed as a f l uc tua t i ng i nt erna l no i se .
She t es t ed tha t i dea by i nves t i ga t i ng t he s l ope of
t he psychome t r i c f unc t i on (probab i l i t y of cor rec t
s i gna l de t ec t i on as a func t i on of s i gna l l eve l ) i n
t hree f requency reg i ons : be l ow , i n , and above t he
t i nn i tus f r equency. The s l opes we r e f l a t t es t i n
t he t i nn i tus reg i on , suppor t i ng he r theory tha t t i n-
n i tus is a source of uns t ab l e i nt erna l no i se , wh i ch
wou l d cause var i ab i l i t y i n t he measur emen t s .
Sm i t h e t a l (1991) ob t a i ned r epea t ed mea -
sures of t i nn i tus p i t ch and l oudness ma t ches and
m i n i mum mask i ng l eve l s ( MMLs ) . Pea r son cor -
re l a t i on coe f f i c i ent s be t ween t he f i rst and sec-
ond rep l i ca t i ons we r e a t l eas t 0 . 95 f or t he
l oudness ma t ches and MMLs . For t he t hr ee
repea t ed p i t ch ma t ches , howeve r , t he cor re l a t i ons
we r e poor be t ween t he f i rst and t he second
ma t ches ( r = .49) , as we l l as t he f i rst and t h i rd
rep l i ca t i ons ( r = .26) , bu t i mproved be t ween t he
second and th i rd ( r = .80) . The au t hors no t ed t ha t
sub j ec t s f ound p i t ch ma t ch i ng to be a d i f f i cu l t
t ask and tha t t he da t a i nd i ca t ed a prac t i ce e f f ec t .
Penne r and B i l ge r (1992) no t ed t ha t (1) pr e -
v i ous procedur es used t o ob t a i n t i nn i t us p i t ch
ma t ches gene r a l l y r esu l t ed i n un r e l i ab l e
ma t ches ; (2) pa t i en t s o f t en r epor t t ha t a s i ng l e
pur e t one does no t s i mu l a t e t i nn i t us ; t hus , p i t ch
ma t ch i ng w i t h pur e t ones may be i nappropr i a t e ;
and (3) because ma t ch i ng t ones i n an ad j us t men t
me t hod a r e pr esen t ed mono t on i ca l l y , b i as due t o
sequen t i a l e f f ec t s may occur ( Woodwo r t h and
Sch l osbe rg , 1954) . The au t hor s i nves t i ga t ed t he
use o f t he adap t i ve FCDS procedur e (Jes t ead t ,
1980) as a me t hod to force pa t i en t s t o choose each
s t i mu l us i ndependen t l y and to a l l ow t he pa t i en t
to c l ass i f y t ones w i t h r espec t to t he i r t i nn i t us
(e . g. , de t e rm i n i ng whe t he r a t one was h i ghe r or
l owe r i n p i t ch t han t he t i nn i t us ) .
The FCDS and a me t hod of ad j us t men t we r e
used to ob t a i n r epea t ed w i t h i n-sess i on t i nn i tus
p i t ch and l oudness measur es . The s t anda rd
dev i a t i ons of p i t ch ma t ches ob t a i ned w i t h t he
FCDS procedur e we r e compa r ab l e to t hose
ob t a i ned w i t h ex t e rna l t ones ( chosen to m i m i c
147
Journa l o f t he Ame r i can Academy o f Aud i o l ogy / Vo l ume 11, Numbe r 3, Ma r ch 2000
t i nn i tus) , bu t t he ad j us t men t me t hod showed re l -
a t i ve l y poor re l i ab i l i t y. For l oudness measur es ,
t he FCDS and ad j us t men t me t hods bo t h pro-
v i ded re l i ab l e r esponses compa r ab l e to use of an
ex t e rna l t one . For a subse t o f sub j ec t s , a l l mea -
sur es we r e r epea t ed ove r 20 sess i ons , and a l l
me t hods prov i ded approx i ma t e l y equ i va l en t
resu l t s . I n par t i cu l ar , t he re l i ab i l i t y of p i t ch
ma t ches was much poor e r be t ween t han w i t h i n
sess i ons . The au t hors conc l uded t ha t t he FCDS
procedur e "of f ers hope t ha t an op t i ma l means o f
t i nn i tus measu r emen t has a t l as t been f ound .
Howeve r , desp i t e t he bes t t echn i que t ha t psy -
choacous t i cs has to of fer , be t ween- sess i on mea -
sur es o f t he t i nn i tus f l uc tua t e " (p . 699) .
M i t che l l e t a l (1993) deve l oped a compu t e r
progr am for sem i au t oma t ed eva l ua t i on o f t i nn i -
t us p i t ch and l oudness ma t ches and m i n i mum
mask i ng l eve l s ( MMLs ) . A l l t es t s t i mu l i we r e
pr esen t ed accord i ng to a l gor i t hms unde r com-
pu t e r cont ro l , and sub j ec t s r esponded by push-
i ng a sw i t ch l oca t ed on t he a rmr es t of the i r cha i r.
Ins t ruc t i ons for r espond i ng we r e prov i ded ver -
ba l l y by t he exam i ne r . The measu r es we r e
ob t a i ned f rom pa t i en t s w i t h t i nn i tus and f rom a
cont ro l group. For t he non t i nn i tus sub j ec t s , a l ow-
l eve l t one a t 2150 Hz was used to s i mu l a t e t i n-
n i t us . Measur es we r e repea t ed ove r t wo sess i ons
to eva l ua t e re l i ab i l i t y because " Re l i ab l e mea -
sures of t i nn i tus a re needed to a l l ow t r ea t men t -
re l a t ed changes i n t i nn i tus to be s tud i ed " (p .
150) . Loudness ma t ch var i ab i l i t y was repor t ed
to be compa r ab l e to prev i ous repor t s show i ng
good re l i ab i l i ty (Ba i l ey , 1979 ; Ve rnon e t a l , 1980b ;
Ty l e r and Conr ad -Armes , 1982) bu t con t ras t ed
w i t h t he resu l t s of Penne r (1983) . The var i ab i l -
i ty of p i t ch ma t ches was compa r ab l e be t ween t i n-
n i t us and ex t e rna l tones , wh i ch a l so d i sagreed
w i t h others ' f i nd i ngs (Penne r , 1983 ; Ty l er , 1991) .
MMLs we r e ob t a i ned on l y i n t he sub j ec t s w i t h
t i nn i tus , and MML re l i ab i l i t y was on l y s l i ght l y
poor e r t han for t he l oudness ma t ches .
Hen r y e t a l (1996b) addr essed t he need to
deve l op s t anda rd i zed t echn i ques for t he c l i n i ca l
quan t i f i ca t i on o f t i nn i tus . They conduc t ed a
p i l o t e f for t to demons t r a t e t he f eas i b i l i t y o f
ob t a i n i ng re l i ab l e t i nn i tus l oudness and p i t ch
ma t ches us i ng a fu l l y au t oma t ed compu t e r i zed
sys t em. W i t h the i r procedure , t he en t i re t es t i ng
protoco l was unde r compu t e r cont ro l , i nc l ud i ng
i ns t ruc t i ons for r espond i ng . The t es t i ng a l go-
r i t hm was des i gned t o c l ose l y rep l i ca t e t he c l i n-
i ca l t es t i ng protoco l for t i nn i tus l oudness and
p i t ch ma t ch i ng , as desc r i bed by Ve rnon (1987) .
Hea r i ng t hr esho l d eva l ua t i on , t i nn i t us l oud-
ness ma t ch i ng , and t i nn i t us p i t ch ma t ch i ng
148
we r e sequenced to ensur e t ha t p i t ch ma t ch i ng
tones we r e presen t ed on l y a t l eve l s tha t we r e pre -
v i ous l y ma t ched to t he t i nn i tus l oudness . Ten
sub j ec t s w i t h t i nn i tus showed good be t ween -
sess i on re l i ab i l i ty for t i nn i tus l oudness ma t ches
(a l l i s >_ . 768 ; p ' s <_ . 0094 for 12 t es t f requenc i es)
and p i t ch ma t ches ( r = . 786 ; p = . 007) .
Be t ween - sess i on re l i ab i l i t y of l oudness
ma t ches a t mu l t i p l e f requenc i es was compa r ed
be t ween t he fu l l y au t oma t ed sys t em and Ve r -
non ' s (1987) manua l procedur e (Henr y e t a l ,
1996a ) . W i t h t he manua l procedure , 22 pa t i ent s
we r e eva l ua t ed ove r t wo sess i ons , and Pea rson i s
we r e >_ . 70 a t a l l t es t f requenc i es (p ' s < . 001) .
W i t h t he au t oma t ed sys t em , 20 sub j ec t s showed
i mproved be t ween- sess i on re l i ab i l i ty as i nd i ca t ed
by Pea r son i s >_ . 89 (a l l p ' s < . 0001) . The au t hors
sugges t ed t ha t an au t oma t ed me t hod such as
the i rs may u l t i ma t e l y prov i de op t i ma l measur e -
men t re l i ab i l i ty for c l i n i ca l purposes because pro-
cedura l var i a t i ons a re r educed w i t h au t oma t i on .
Wo r k w i t h t he au t oma t ed sys t em i s ongo i ng , and
fur ther da t a con f i rm i ng t he re l i ab i l i ty o f l oudness
ma t ches w i t h th i s t echn i que have recen t l y been
repor t ed (Henr y et a l , 1999) .
Psychoacous t i c S t ud i es
o f T i nn i t us Mask i ng
C l i n i ca l use of t i nn i tus mask i ng has i nvo l ved
bands of no i se , pr i ma r i l y because t ona l maske r s
a r e no t we l l to l e ra t ed by mos t t i nn i tus pa t i en t s .
I t shou l d be emphas i zed t ha t mask i ng o f t i nn i -
t us us i ng syn t hes i ze r -gene r a t ed no i se bands
produces comp l e t e " cove rage " of t he t i nn i tus
( i .e . , r ende rs i t i naud i b l e ) i n 90 pe r cen t o f t i n-
n i t us pa t i en t s (Ve rnon and Me i k l e , 1988) . An
add i t i ona l 5 to 6 pe rcen t expe r i ence mask i ng t ha t
i s "par t i a l , " t ha t i s, t he t i nn i tus i s r educed i n
l oudness . These c l i n i ca l obse rva t i ons make i t
c l ear t ha t mask i ng - i nduced reduc t i on or e l i m i -
na t i on o f t i nn i tus pe rcep t i ons i s nea r l y a un i -
versa l phenomenon.
Psychoacous t i c i nves t i ga t i ons of t i nn i tus
have been conce rned ma i n l y w i t h t he use of
t ona l maske r s . Seve r a l l i nes of i nves t i ga t i on
have cha rac t e r i zed such s tud i es , i nc l ud i ng t he
ex t en t to wh i ch t i nn i tus mask i ng exh i b i t s f re-
quency dependence , poss i b l e adap t a t i on phe -
nomena , and d i ot i c ve rsus d i chot i c e f f ec t s .
Lack o f F r equency Dependence
f or T i nn i t us Mask i ng
As d i scussed i n an ear l i er sec t i on , t he f re-
quency re l a t i onsh i ps o f t i nn i tus mask i ng e f f ec t s
rece i ved the i r f i rst sys t ema t i c i nves t i ga t i on by
Fe l dmann (1971) , who eva l ua t ed t i nn i tus mask -
 Psychoacous t i c Measur es o f T i nn i t us / Henry and Me i k l e
i ng i n 200 sub j ec t s . I n mor e recent t i mes , Formby
and G j e rd i ngen (1980) desc r i bed t i nn i tus mask -
i ng curves f rom one i nd i v i dua l , us i ng mask i ng
t ones a t 14 f requenc i es be t ween 521 and 3629 Hz.
The shapes of t he mask i ng curves r esemb l ed
t hose t yp i ca l l y ob t a i ned w i t h tone -on- tone mask -
i ng (Wege l and Lane , 1924) , l ead i ng t he au t hors
to sugges t tha t such t un i ng m i gh t prov i de an ef f i -
c i en t means to i dent i f y t he t i nn i tus f r equency.
These resu l t s , howeve r , con t rad i c t ed mos t o t he r
wor ks , i nc l ud i ng t ha t o f Fe l dmann (1971) , and
have no t been rep l i ca t ed s i nce .
Add i t i ona l s t ud i es addr ess i ng t he f r equency
dependence (or l ack t he r eo f ) o f t i nn i t us mask i ng
we r e conduc t ed by M i t che l l and h i s co l l eagues
( r epor t ed i n Ve rnon e t a l , 1980b ; and i n M i t che l l ,
1983) . A to t a l o f 32 sub j ec t s we r e t es t ed and f ound
t o exh i b i t t he same t ypes o f mask i ng cur ves
desc r i bed ea r l i e r by Fe l dmann . " Conve rgen t "
mask i ng cur ves ( Fe l dmann Type 1) we r e f ound
i n 52 pe r cen t o f M i t che l l ' s sub j ec t s; " congruen t "
cur ves ( Fe l dman Type 3) occur r ed i n 19 pe r cen t ;
cur ves s i m i l a r to Fe l dmann ' s Type 4 ( " d i s t ance "
t ype ) occur r ed i n 22 pe r cen t ; and i n t he r ema i n -
i ng cases , no mask i ng cou l d be ob t a i ned (s i m i l a r
t o Fe l dmann ' s Type 5 , " pe rs i s t ence " t ype ) . S i m i -
l ar obse rva t i ons have a l so been r epor t ed by Haze l l
(1981) , Sha i l e r e t a l (1981) , Ty l e r and Conr ad -
Ar mes (1984) , Penne r (1987) , Penne r and K l a f t e r
(1992) , and M i t che l l e t a l (1993) . A l l i nves t i ga t ors
agr eed t ha t t he usua l ma r ked f r equency depen -
dence seen i n conven t i ona l t one -on- t one mask i ng
i s no t cha rac t e r i s t i c o f mos t a t t emp t s t o mask t i n-
n i t us . The conc l us i on f rom t he va r i ous s t ud i es i s
t ha t t i nn i t us mask i ng appea r s t o be ca t egor i -
ca l l y d i f f e ren t f rom t he conven t i ona l mask i ng o f
one ex t e rna l t one by ano t he r .
A s i m i l ar s t a t emen t app l i es to t he concep t
o f cr i t i ca l bands for mask i ng , as s t a t ed by Sha i l er
e t a l (1981) . I n t ha t s tudy , maske r l eve l s we r e
de t e rm i ned as a f unc t i on o f maske r bandw i d t h
i n 12 t i nn i tus sub j ec t s . An add i t i ona l s i x cont ro l
sub j ec t s we r e pr esen t ed w i t h a 4- kHz t one . The
con t ro l sub j ec t s d i sp l ayed t he t yp i ca l cr i t i ca l
band func t i on , as d i d f our sub j ec t s w i t h tone - l i ke
t i nn i tus . The o t he r t hr ee sub j ec t s w i t h t ona l
t i nn i tus and t he f i ve sub j ec t s w i t h no i se - l i ke
t i nn i tus a l l had masked t hresho l ds t ha t we r e
i ndependen t of bandw i d t h . Thus , for e i gh t o f
t he t i nn i tus sub j ec t s , t he e f f ec t i veness of mask -
i ng was i ndependen t o f t he maske r bandw i d t h .
Howeve r , for t he four sub j ec t s who showed cr i t -
i ca l mask i ng bands for the i r t i nn i tus , the i r t i n-
n i tus seemed to " behave " s i m i l ar l y to an acous t i c
pur e t one when sub j ec t ed to maske r s of d i f f er -
i ng bandw i d t hs .
The l ack o f cr i t i ca l mask i ng bands i n many
cases o f t i nn i t us mask i ng was a l so no t ed by
Johnson and M i t che l l (1984) , who commen t ed :
" The w i d t h o f t he mask i ng s i gna l appea r s no t t o
be a de t e rm i n i ng f ac t or r ega rd i ng t he e f f ec -
t i veness o f mask i ng t i nn i t us . For many pa t i en t s ,
t he t i nn i t us can be masked mo r e e f f ec t i ve l y
w i t h pur e t ones or ve r y na r row bands o f no i se
t han i t can f or broad bands o f no i se . . . "
Ty l e r and Con r ad - Ar mes (1984) had no t ed
t ha t t he abno r ma l mask i ng pa t t e rns t ha t gen -
e r a l l y r esu l t ed f rom t i nn i t us mask i ng expe r i -
men t s m i gh t be a t t r i bu t ab l e t o t he r educed
f r equency r eso l u t i on o f t en assoc i a t ed w i t h hea r -
i ng i mpa i rmen t , as man i f es t ed by b road psy -
choacous t i c t un i ng cu r ves . They t he r e f or e
s t ud i ed whe t he r poor f r equency spec i f i c i t y seen
w i t h t i nn i t us was a prope r t y o f t he t i nn i t us
i t se l f or a r esu l t o f hea r i ng i mpa i rmen t . Us i ng
10 sub j ec t s w i t h t i nn i t us and sensor i neur a l
hea r i ng l oss , mask i ng o f t i nn i t us w i t h pu r e
t ones was compa r ed t o mask i ng o f an ex t e rna l
t one ma t ched i n l oudness and f r equency to t he
t i nn i t us . Resu l t s r evea l ed t ha t mos t sub j ec t s
had poor f r equency r eso l u t i on f or bo t h t ypes o f
mask i ng cur ves and t ha t d i f f e ren t mask i ng pa t -
t e rns eme rged f rom i nd i v i dua l sub j ec t s .
Adap t a t i on o f 7 l i nn i t us Mask i ng
Penne r e t a l (1981) sugges t ed t ha t neur a l
adap t a t i on o f broadband no i se and an ex t e rna l
t one be i ng masked by t he no i se shou l d occur a t
t he same ra t e , wh i ch wou l d i nd i ca t e t ha t t he
l eve l o f no i se wou l d no t have to be ra i sed ove r
t i me to prov i de con t i nuous mask i ng. I n 20 sub-
j ec t s w i t h t i nn i tus , the i r t i nn i tus was t he " tone "
be i ng masked , and t he no i se had to be i nc reased
to con t i nuous l y mask t he t i nn i tus . Penne r con-
c l uded t ha t t i nn i tus r esponds d i f f erent l y f rom
an ex t e rna l t one when masked by broadband
no i se ; thus , t he t one and t he t i nn i tus ope r a t e by
d i f f e ren t neur a l mechan i sms . Penne r l a t e r
hypo t hes i zed t ha t t he no i se m i gh t have exac -
e rba t ed t he t i nn i tus , caus i ng i t to become l oude r
and t hus mor e aud i b l e dur i ng mask i ng (Penne r ,
1988) . She t es t ed th i s hypo t hes i s us i ng a d i f -
f erent t ask i n wh i ch t he mask i ng l eve l was f i xed
and sub j ec t s we r e asked to ad j us t t he l eve l o f a
pu l sed t one so as to r ema i n a t t he same l oudness
as t he t i nn i tus . When t he pu l sed t one was pre -
sen t ed i ps i l a t era l l y , i t had to be i nc r eased sub-
s t ant i a l l y , bu t when pr esen t ed cont ra l a t era l l y ,
t he change was m i n i ma l . Th i s con t rad i c t i on
ra i sed t he i n t e res t i ng ques t i on of wh i ch ma t ch -
i ng t one - i ps i l a t e ra l or con t ra l a t e ra l -bes t rep-
resen t ed t he t i nn i tus l oudness .
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Penne r and B i l ger (1989) a t t emp t ed to de t er -
m i ne whe t he r i nc reases i n maske r l eve l s needed
to " cover " t he t i nn i tus we r e compa r ab l e i n mag -
n i t ude to dec reases i n l oudness due to adap t a -
t i on ( i .e . , t one decay ) . They no t ed t ha t even
mode r a t e t one decay (10-15 dB) obse rved i n
pa t i en t s w i t h sensor i neura l hea r i ng l oss (D i rks
e t a l , 1974) cou l d no t accoun t for t he 30-dB sh i f t
i n maske r l eve l necessa ry to mask t i nn i tus . They
the re f ore t r acked t he i n t ens i t y of a pur e t one
requ i red to mask t i nn i tus i n s i x sub j ec t s . I n t he
same sub j ec t s , t hey a l so measur ed adap t a t i on by
t rack i ng t he i n t ens i t y of a pur e t one requ i red to
ma i n t a i n cons t an t l oudness . I n t hree of t he sub-
j ec ts , s t i mu l us changes requ i red to compensa t e
for adap t a t i on we r e s i m i l ar to changes needed to
ma i n t a i n mask i ng; i n t he r ema i n i ng t hr ee sub-
j ec ts , t he r e we r e l a rge d i f f erences i n t he s t i mu-
l us l eve l s r equ i r ed for ma i n t a i n i ng cons t an t
mask i ng ve rsus cons t an t l oudness .
Johnson and Hughes (1992) addr essed t he
ques t i on o f whe t he r some pa t i ent s can be masked
mor e e f f ec t i ve l y when t he mask i ng no i se i s pre -
sen t ed d i ot i ca l l y ra t he r t han d i chot i ca l l y. They
t es t ed pa t i ent s w i t h b i l a t era l t i nn i tus us i ng spe -
c i a l equ i pmen t t ha t cou l d de l i ver mask i ng no i se
e i ther d i ot i ca l l y ( the same no i se s i gna l de l i v-
e r ed to bo t h ears) or d i chot i ca l l y (d i f f erent no i se
gene ra tors w i t h i dent i ca l spec t ra l charac t er i s t i cs
i ndependen t l y de l i ve r i ng no i se s i gna l s to t he
t wo ears) . Ten of t he pa t i ent s we r e no t cand i da t es
for compa r i ng t he t wo t ypes of no i se ( four cou l d
no t be masked a t a l l and s i x we r e maskab l e on l y
i n one ear ) . O f t he r ema i n i ng 18 pa t i ent s , 3 cou l d
be masked d i chot i ca l l y bu t no t d i ot i ca l l y , 8 cou l d
be masked bo t h d i chot i ca l l y and d i ot i ca l l y , and
7 cou l d on l y mask each ea r monaur a l l y ( i .e . ,
b i l a t era l mask i ng was no t e f f ec t i ve unde r e i ther
cond i t i on) . The r e we r e no sub j ec t s who cou l d be
masked d i ot i ca l l y bu t no t d i cho t i ca l l y. Mea -
sur emen t o f MMLs showed t ha t t he l eve l s o f
no i se needed to accomp l i sh e f f ec t i ve mask i ng
we r e cons i de rab l y grea t e r for t he d i ot i c t han for
t he d i chot i c cond i t i on. The i nves t i ga tors con-
c l uded t ha t t he success of t i nn i tus mask i ng i s
grea t l y i n f l uenced by cen t ra l neur a l i n f l uences
and t ha t t he super i or i t y o f d i chot i c mask i ng was
cons i s t en t w i t h wha t i s known abou t Mask i ng
Leve l D i f f e rences (Je f f ress e t a l , 1952) .
Psychoacous t i c S t ud i es
o f Res i dua l I nh i b i t i on
Some degr ee o f res i dua l i nh i b i t i on (RI ) fo l -
l ow i ng t i nn i t us mask i ng can be obse r ved i n
nea r l y 90 pe r cen t of a l l t i nn i tus pa t i en t s . Such
150
a h i gh preva l ence ra t e sugges t s t ha t R I is a fun-
damen t a l aspec t o f t i nn i tus mask i ng phenom-
ena . W i t h cur r en t mask i ng t echn i ques , R I
exh i b i t s h i gh var i ab i l i t y be t ween sub j ec t s bo t h
i n r ega rd to i ts dur a t i on and magn i t ude . Mea -
sur emen t of R I dura t i ons i n a l arge samp l e of t i n-
n i t us c l i n i c pa t i en t s (Me i k l e e t a l , 1995) y i e l ded
dura t i ons va ry i ng f rom l ess t han a m i nu t e (57%
of sub j ec t s) to mor e t han 10 m i nu t es (3% of sub-
j ec ts) . I f t he dura t i on of R I cou l d be ex t ended ,
i t cou l d prov i de subs t an t i a l re l i e f for many t i n-
n i t us su f f erers . Techn i ques to i nc rease t he mag -
n i t ude o f R I i n sub j ec t s who expe r i ence
i ncomp l e t e suppr ess i on of t i nn i tus ( i . e . , t hose
expe r i enc i ng "par t i a l " R I ) wou l d a l so ex t end t he
t he r apeu t i c bene f i t . For t ha t reason , mos t of
t he psychoacous t i c r esea r ch conce rned w i t h R I
has f ocused on ways to r ende r i t l onge r l as t i ng
and mo r e comp l e t e .
I n h i s p i onee r i ng wo r k on t i nn i tus mask i ng
and res i dua l i nh i b i t i on , Fe l dmann (1971) demon -
s t ra t ed t ha t R I i nduced by shor t burs t s of i nt er -
rup t ed mask i ng s t i mu l i was i n f l uenced by t he
i n t ens i t y of t he maske r i n some sub j ec t s bu t
no t i n o t he rs . La t er , Fe l dmann (1983) showed
tha t pa t i en t s cou l d cont ro l t he dura t i on o f mask -
i ng burs t s and l eng t h o f i n t e rburs t i n t e rva l s so
as to comp l e t e l y e l i m i na t e the i r percep t i on of t i n-
n i t us . Tha t t echn i que for produc i ng R I has no t
been pur sued by o t he r i nves t i ga tors , a l t hough
t he resu l t s c l ear l y pr esen t ed a po t en t i a l l y e f f ec-
t i ve approach to t i nn i tus t r ea t men t .
Pa r ame t r i c s t ud i es of f ac tors i n f l uenc i ng
R I have been unde r t aken by severa l i nves t i ga -
tors . I n 1982 , Ve rnon desc r i bed t he e f f ec t s of
a l t e r i ng t he i n t ens i t y o f t he maske r upon R I
dura t i on us i ng na r row bands o f mask i ng no i se
cen t e red a t t he t i nn i tus f r equency. I n e i gh t sub-
j ec ts , maske r i nt ens i t i es we r e va r i ed i n 5-dB
s t eps f rom MML + 5 dB to MML + 25 dB . I t
appea r ed t ha t i nc reas i ng t he maske r i n t ens i t y
t ended to i nc rease R I dura t i ons , bu t t he i nt er -
sub j ec t var i ab i l i t y was ve ry l arge ( the measur ed
t r end was no t s t a t i s t i ca l l y s i gn i f i cant ) . Man i p -
u l a t i on of maske r i nt ens i t i es was a l so pe r f ormed
by Ba i l ey (1979) us i ng mask i ng t ones a t va r i ous
f requenc i es . He t oo f ound t ha t t he dur a t i on o f
R I i nc reased w i t h i nc reas i ng maske r i nt ens i t y ,
a l t hough t he r epor t ed obse rva t i ons i nvo l ved
on l y a f ew sub j ec t s .
I nc reases i n maske r i n t ens i t y we r e s t ud-
i ed i n a group o f 10 sub j ec t s by Ty l e r e t a l (1984) .
I n genera l , l onge r dura t i ons of R I resu l t ed when
t he maske r i n t ens i t y was e l eva t ed .
Te r r y e t a l (1983) s t ud i ed R I i n 32 sub j ec t s ,
ob t a i n i ng a numbe r o f i n t e res t i ng resu l t s . They
 Psychoacous t i c Measu r es o f T i nn i t us / Hen r y and Me i k l e
f ound s i gn i f i can t e f f ec t s o f va r y i ng t he dur a -
t i on o f mask i ng i n t he r ange o f 10 sec t o 10 m i n ,
w i t h R I dur a t i ons l i nea r l y r e l a t ed t o t he l oga -
r i t hm o f maske r dur a t i on . Ba i l ey (1979) and
Ty l e r e t a l (1984) a l so exam i ned t he e f f ec t o f
ex t end i ng t he maske r dur a t i on . They conc l uded
t ha t l onge r dur a t i ons o f mask i ng t ended t o pro-
duce l onge r l as t i ng R l , a l t hough t he r esu l t s
r epor t ed by Ba i l ey a r e d i f f i cu l t to i n t e rpre t
because i t i s no t c l ear whe t he r group measur es
or da t a f rom a s i ng l e pa t i en t a re pr esen t ed .
The r esu l t s o f va r y i ng t he maske r f r equency
we r e qu i t e d i sc r epan t be t ween t he va r i ous s t ud-
i es c i t ed above . Ty l e r e t a l (1984) and Ve r non
(1985) r epor t ed l i t t l e e f f ec t o f f r equency va r i a -
t i ons ; Ba i l ey (1979) c l a i med t ha t t he r e was a
ve r y sha rp l y t uned dependence o f R I on maske r
f r equency (bu t da t a f rom on l y one sub j ec t we r e
shown ) , and Te r r y e t a l (1983) f ound t ha t t he
op t i ma l f r equency f or produc i ng R I was usua l l y
l owe r t han t he i nd i v i dua l ' s t i nn i t us f r equency.
Ty l e r e t a l (1984) and Ve rnon and Me i k l e
(1988) s t ud i ed t he r ecove r y pa t t e rns o f R I . They
r epor t ed t ha t seve r a l d i f f e ren t r ecove r y pa t t e rns
cou l d be obse r ved as t he t i nn i t us r e t urned t o i t s
no rma l l eve l . I t i s no t c l ea r t o wha t ex t en t t hese
r ecove r y pa t t e rns exh i b i t t es t - r e t es t re l i ab i l i t y.
The r e has been l i t t l e or no sys t ema t i c eva l -
ua t i on o f t he va r i ab i l i t y o f R I measu r es , bu t
t he r e i s some ev i dence t ha t t he r e i s cons i de r ab l e
va r i a t i on f rom t r i a l t o t r i a l w i t h i n one sub j ec t
even when mask i ng pa r ame t e r s a r e he l d con -
s t an t (Me i k l e , unpub l i shed da t a ) . The t op i c o f R I
r ema i ns an i mpo r t an t and cha l l eng i ng one f or
f ur t he r s t udy.
RELAT I NG PSYCHOACOUST I C
MEASURES TO T I NN I TUS SEVER I TY
AND HAND I CAP
F r om t he t i me o f Reed (1960) , i nves t i ga t ors
have no t ed poor cor re l a t i ons be t ween psy -
choacous t i c measur es of t i nn i tus and t he sub-
j ec t i ve d i mens i ons o f t i nn i t us r epor t ed by
t i nn i tus pa t i en t s . G r aham and Newby (1962)
repor t ed t ha t none of the i r psychoacous t i c mea -
sur emen t s re l a t ed to sub j ec t i ve descr i p t i ons of
t i nn i tus . Me i k l e e t a l (1984) ana l yzed psychoa -
cous t i c da t a (p i t ch , l oudness , and maskab i l i t y)
f rom nea r l y 2000 t i nn i tus pa t i en t s . Pa t i en t s
a l so r a t ed t he seve r i t y o f the i r t i nn i tus on a
sca l e f rom 1 to 10, w i t h 10 r epr esen t i ng " ex-
t r eme l y seve re . " The r e we r e no s i gn i f i cant cor -
re l a t i ons be t ween t he psychoacous t i c measur es
of t i nn i tus and t he sub j ec t i ve ra t i ngs of t i nn i tus
sever i t y.
Ha l l am et a l (1984) repor t ed t i nn i tus psy-
choacous t i c da t a on t wo groups of 13 t i nn i tus
pa t i en t s each . For one group , t he t i nn i tus was a
ma i n comp l a i n t , and i n t he o t he r group i t was
i nc i dent a l to e i ther i mpa i red hea r i ng or d i zz i ness .
Measur es of t i nn i tus p i t ch , l oudness , and mask -
ab i l i t y we r e a l mos t i dent i ca l be t ween groups .
Jakes e t a l ( 1985 ) f ound no r e l a t i onsh i p
be t ween measur es o f t i nn i tus l oudness and var -
i ous measur es o f t i nn i tus comp l a i n t , excep t for
a " s l i ght " re l a t i onsh i p ( r = .34) be t ween t he l oud-
ness ma t ch a t 1 kHz and t i nn i tus " i nt rus i veness . "
Haze l l e t a l (1985) repor t ed ou t come mea -
sur es f rom 472 t i nn i tus pa t i en t s f rom t hr ee
hosp i t a l s who we r e f i t t ed w i t h maske r s . Cor -
re l a t i ons be t ween psychoacous t i c measur es o f
l oudness and t he l oudness ra t i ngs we r e l ow.
A l so , t he re l a t i onsh i p be t ween res i dua l i nh i b i -
t i on and maske r e f f ec t i veness was no t s i gn i f i -
can t . I t was gene ra l l y conc l uded t ha t t i nn i tus
t es t s cou l d no t pred i c t t r ea t men t bene f i t , nor d i d
t hey cor re l a t e w i t h measur es of sub j ec t i ve t i n-
n i t us sever i t y .
Ha l l am e t a l (1985) f ound t ha t l oudness
ma t ches expr essed i n dB HL or dB SL we r e
poor l y cor r e l a t ed w i t h t i nn i t us seve r i t y and t ha t
t r ans f orma t i on to sones d i d no t i mp rove t he
cor r e l a t i on. They no t ed modes t i mp r ovemen t
i n t he cor r e l a t i ons when t hese measu r es we r e
conve r t ed t o PLUs , wh i ch t ook i n t o accoun t i nd i -
v i dua l l oudness g row t h.
R i sey e t a l (1989) showed t ha t l oudness
ma t ches a t 1 kHz we r e s i gn i f i cant l y cor re l a t ed
w i t h t i nn i tus sever i t y ra t i ngs , whe r eas t hose
a t t he t i nn i tus f r equency we r e no t . The s i ze of
t he cor re l a t i ons a t 1 kHz we r e r = . 224 i n l i near
regress i on ana l ys i s and r = . 458 when curv i l i n-
ea r regress i on was used . These va l ues revea l tha t
t he l oudness ma t ch accoun t s for rough l y 20 per -
cen t of t he va r i ance i n sub j ec t i ve sever i t y ra t -
i ngs . They a l so demons t r a t ed t ha t when pa t i ent s
r epor t ed a dec r ease i n t he i r t i nn i t us a f t e r
f urosem i de t r ea t men t , t he 1 - kHz l oudness
ma t ches and sever i t y ra t i ngs we r e reduced , and
t hese changes we r e s i gn i f i cant l y cor re l a t ed . I t
shou l d be no t ed , howeve r , t ha t t he i r 1 to 10
sever i t y sca l e i nd i ca t ed " 1" as t he " sof t es t or
m i l des t t i nn i tus i mag i nab l e " and " 10 " as t he
" wors t t i nn i tus i mag i nab l e . " Tha t word i ng may
have l ed sub j ec t s to i n t e rpre t t he sever i t y ra t -
i ngs as a sca l e o f pe rce i ved l oudness and no t of
t i nn i tus- re l a t ed d i sab i l i t y or hand i cap . We have
a l r eady commen t ed on t he amb i gu i t y i nhe r en t
i n t he word " sever i t y. "
The T i nn i tus Hand i cap Ques t i onna i re deve l -
oped by Kuk e t a l (1990) was adm i n i s t e r ed to
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Journa l o f t he Ame r i can Academy o f Aud i o l ogy / Vo l ume 11, Numbe r 3, Ma r ch 2000
pa t i en t s who prov i ded sub j ec t i ve l oudness ra t -
i ngs (on a sca l e f rom 1-100) and psychoacous t i c
measur es ( l oudness ma t ches i n sones , ob t a i ned
a t 500 Hz ) . The r e was a mode r a t e l y h i gh cor re-
l a t i on be t ween t he sub j ec t i ve l oudness ra t i ngs
and t he degr ee o f t i nn i tus hand i cap ( r = . 57;
p = . 0001) bu t a l ow cor re l a t i on be t ween t he
l oudness ma t ches ( i n sones) and t i nn i tus hand-
i cap ( r = . 27; p = .04) . The au t hors sugges t ed t ha t
t he psychoacous t i c measur es and t he sub j ec -
t i ve ra t i ngs d i d no t t es t t he same a t t r i but e(s) o f
t i nn i tus .
Ha l f ord and Ande r son (1991) deve l oped t he
Sub j ec t i ve T i nn i t us Seve r i t y Sca l e , des i gned to
y i e l d a s i ng l e score t ha t re f l ec t ed how " i nt rus i ve ,
prom i nen t and d i s t ress i ng " t i nn i tus was to t he
pa t i en t . T i nn i t us l oudness ma t ches we r e
ob t a i ned f rom t hese pa t i ent s a t 1 kHz and a t t he
t i nn i t us f r equency. Scor es f rom t he Seve r i t y
Sca l e showed modes t bu t s i gn i f i cant cor re l a t i ons
w i t h t he l oudness ma t ches a t 1 kHz , expr essed
i n dB HL ( r = . 48 ; p < .01) and dB SL ( r = . 36;
p < .05) , and w i t h t he l oudness ma t ches a t t he
t i nn i tus f r equency i n dB HL ( r = . 41 ; p < .05) .
D i neen e t a l (1997) ob t a i ned a pro f i l e o f
aud i o l og i c and psycho l og i ca l charac t er i s t i cs i n
pa t i en t s pr i or to i n i t i a t i ng a progr am of t i nn i -
t us managemen t . T i nn i t us measur es i nc l uded
p i t ch ma t ches , l oudness ma t ches a t 1 kHz and
a t t he t i nn i tus f requency , MMLs , and a 10-po i n t
v i sua l ana l og sca l e for t i nn i tus l oudness . The
pa t i en t s we r e d i v i ded i nto t wo groups : t hose
who had prev i ous l y sough t pro f ess i ona l he l p for
t i nn i t us ( and repor t ed l y rece i ved no bene f i t )
and t hose who had no t prev i ous l y sough t he l p .
The r e we r e no s i gn i f i cant d i f f erences be t ween
groups for t he va r i ous psychoacous t i c measur es
o f t i nn i tus . The prev i ous l y he l ped group d i d ,
howeve r , show h i ghe r scores on t he v i sua l ana -
l og sca l e of t i nn i tus l oudness t han t he no-he l p
group . The au t hors conc l uded t ha t a pa t i ent ' s
dec i s i on to seek pro f ess i ona l he l p for the i r t i n-
n i t us i s no t s i gn i f i cant l y a f f ec t ed by t he psy-
choacous t i c charac t er i s t i cs of t i nn i tus .
CONCLUS I ON
F rom th i s rev i ew , i t i s ev i den t t ha t a gr ea t
dea l of i nnova t i ve wo r k has gone i nto t he
deve l opmen t o f psychoacous t i c measur es for t i n-
n i t us . At t emp t s to quan t i f y t he p i t ch , l oudness ,
and maskab i l i t y of t i nn i tus have become i ncreas-
i ng l y soph i s t i ca t ed , as have t he pro toco l s for
eva l ua t i ng t he va l i d i t y and re l i ab i l i t y of such
measur es . Un f or t una t e l y , cur r en t t echn i ques
for t i nn i tus measu r emen t a re a l mos t as nume r -
152
ous as t he i nves t i ga tors who emp l oy t hem , h i gh-
l i ght i ng t he need for s t anda rd i za t i on o f mea -
sur emen t me t hods .
At th i s po i nt , i t m i gh t be he l p fu l to r ev i ew
wha t we know. We know tha t t i nn i tus sensa t i ons
can be desc r i bed i n acous t i c t e rms and t ha t
many a t t emp t s to ma t ch t i nn i tus sensa t i ons
w i t h ex t e rna l acous t i c s t i mu l i have been suc -
cess fu l , a l t hough da t a conce rn i ng t he re l i ab i l i ty
o f t hese measur es have been i ncomp l e t e . We
know t ha t appropr i a t e mask i ng sounds can
r educe or e l i m i na t e t he pe rcep t i on o f t i nn i tus i n
approx i ma t e l y 95 pe r cen t o f a l l pa t i ent s (Ve rnon
and Me i k l e , 1988) . Desp i t e t he h i gh l y i nd i v i d-
ua l i zed na t ur e of t i nn i tus percept i ons , mask i ng
curves revea l t ha t for many i nd i v i dua l s , t he
e f f ec t i veness o f t ona l maske r s i s i ndependen t of
f r equency. We know t ha t t he phenomenon of
res i dua l i nh i b i t i on occurs for t he l a rge ma j or i t y
of t i nn i tus , i nd i ca t i ng a prom i s i ng a r ea for fu ture
r esea r ch i nto t echn i ques t ha t cou l d pro l ong
res i dua l i nh i b i t i on .
The r e is gene r a l agr eemen t t ha t t i nn i tus
does no t behave l i ke ex t e rna l sounds i n seve ra l
ways , desp i t e t he f ac t t ha t t i nn i tus i s cha r ac -
t er i zed by d i mens i ons such as p i t ch , t i mbr e ,
l oudness , and l oca l i za t i on t ha t m i m i c t he per -
cep t ua l d i mens i ons o f ex t e rna l sounds . I t is no t
ye t c l ear whe t he r t he ways i n wh i ch t i nn i tus d i f -
f ers f rom ex t e rna l sound pe rcep t i ons resu l t f rom
hea r i ng i mpa i rmen t and re l a t ed abnorma l i t i es
such as rec ru i t men t , d i p l acus i s , and t one decay
or whe t he r t hey resu l t f rom spec i a l neuro l og i c
mechan i sms , as ye t unknown , t ha t may g i ve
r i se to t i nn i tus .
For a l l t ha t i s known , i t i s t he unknown
and t he i ssues o f d i sagr eemen t t ha t cur ren t l y
pr even t deve l opmen t o f mo r e un i f orm me t hods
for t es t i ng t i nn i t us . An examp l e i s t he d i s-
agr eemen t conce rn i ng t he amoun t of var i ab i l i t y
i n r ega rd to t i nn i tus l oudness ma t ches and p i t ch
measur es . Some o f t he obse rved d i f f e rences
undoub t ed l y re f l ec t t rue d i f f erences i n t he re l i -
ab i l i t y o f t es t i ng t echn i ques . Howeve r , o t he r
d i f f e rences resu l t f rom t he d i f f er i ng ways i n
wh i ch sub j ec t s a r e se l ec t ed - t es t s t ha t c l i n i c
pa t i en t s rece i ve as pa r t o f t he i n t ake procedure ,
for examp l e , a re l i ke l y to revea l mor e r esponse
var i ab i l i t y t han t es t s o f i nd i v i dua l s i nv i t ed to
par t i c i pa t e i n t he mor e r i gorous e f for t s o f a psy-
choacous t i c l abora t ory. O t he r po t en t i a l f ac tors
con t r i bu t i ng to obse rved d i f f e rences i n var i -
ab i l i t y a r e d i f f erences be t ween sub j ec t popu l a -
t i ons (e .g . , seve r e ve r sus m i l d t i nn i t us , or
d i f f erences i n r ega rd to t he na t ur e and ex t en t
o f hea r i ng i mpa i rmen t ) . I t is our hope t ha t by
 Psychoacous t i c Measur es o f T i nn i t us / Henry and Me i k l e
h i gh l i gh t i ng t he t ypes of d i sagr eemen t cha rac -
t er i z i ng pas t resea rch , t he pr esen t r ev i ew w i l l
encour age t i nn i tus resea rche rs to wo r k t oge t he r
to deve l op mor e un i f orm t es t i ng t echn i ques .
Psychoacous t i c i ans a r e j us t i f i ed i n empha -
s i z i ng t he need for gr ea t e r a t t en t i on t o t he mea -
su r emen t t echn i que and a l so f or advoca t i ng
psychoacous t i ca l l y r i gorous t echn i ques . How -
eve r , c l i n i c i ans a r e j us t i f i ed i n emphas i z i ng t he
d i f f i cu l t y o f app l y i ng psychoacous t i c t echn i ques
i n t he c l i n i c , whe r e many pa t i en t s canno t pe r -
f o rm t he t ype o f t es t t ha t wou l d be done i n a psy -
choacous t i cs l abor a t ory , and t i me cons t r a i n t s
pr even t l eng t hy procedur es . We be l i eve t ha t
wor kab l e comp rom i ses can be r eached be t ween
t he psychoacous t i c i ans and t he c l i n i c i ans . I t
shou l d be r eca l l ed t ha t i t a l so t ook some yea r s
f or s t anda rd i za t i on o f aud i ome t r i c t es t s , and i n
some a r eas o f conce rn t o aud i o l og i s t s t he t es t s
a r e st i l l be i ng r e f i ned (e . g. , measu r es o f cen t r a l
aud i t or y process i ng) . T i nn i t us i s abou t 40 yea r s
beh i nd hea r i ng i mpa i rmen t i n r ega rd t o s t an-
da rd i za t i on o f p r i ma r y t es t i ng t echn i ques .
When a pa t i en t seeks a hea r i ng assessmen t
f rom an aud i o l og i s t , a f a i r l y un i f orm t es t i ng
protoco l i s conduc t ed. Tes t resu l t s f rom one c l i n i c
can be read i l y i n t e rpre t ed by an aud i o l og i s t i n
ano t he r c l i n i c - ac ross t he coun t r y and even
a round t he wor l d . Howeve r , when a pa t i en t
comes to t he c l i n i c w i t h t he pr i ma r y comp l a i n t
o f t i nn i tus , t he r e i s no s t anda rd protoco l for t i n-
n i t us eva l ua t i on . Consequen t l y , t he c l i n i cs t ha t
prov i de t i nn i tus serv i ces , wh i ch a re re l a t i ve l y
f ew , do so i n an i ndependen t manne r . Tes t resu l t s
r ema i n propr i e t a ry and o f t en un i n t e rpre t ab l e by
o t he r c l i n i c i ans .
Wha t shou l d be done? F i f t een yea r s ago , a
p l ea was made for s t anda rd i z i ng t es t s o f t i nn i -
tus , and t ha t need has ye t t o be me t . I t i s c l ea r
t ha t t i nn i t us i nves t i ga t or s shou l d s t r i ve f or
s t anda rd i za t i on o f psychoacous t i c t echn i ques
as an i mpor t an t sour ce o f i n f orma t i on needed by
i nves t i ga t ors i n many a r eas o f t i nn i t us r esea r ch
i nc l ud i ng br a i n i mag i ng , deve l opmen t o f an i -
ma l mode l s , and c l i n i ca l t r i a l s o f proposed new
t i nn i t us t he r ap i es . I t i s ou r hope t ha t t hese
t echn i ques can be deve l oped co l l abor a t i ve l y by
l eade r s i n t he f i e l d , t hus p romo t i ng compa r i son
o f r esu l t s be t ween d i f f e r en t l abor a t or i es and
c l i n i cs and prov i d i ng a cons i s t en t se t o f gu i de -
l i nes t ha t can be app l i ed w i de l y i n f ur t he r t i n-
n i t us r esea r ch .
Acknow l edgmen t . Fund i ng was p rov i ded by t he
Ve t e r ans A f f a i r s Rehab i l i t a t i on Resea r ch and
Deve l opmen t Se rv i ce .
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