Use of a Bone-conduction Pillow and an Air-conduction Sound Pillow® Sleep System to Provide
Tinnitus Relief and Promote Sleep
Lisa G. Fox-Thomas, Ph.D.1, Hilary Wisdom, Au.D.2, Sarah Allen, Au.D.3, & Jeffrey Mills, Au.D.4
The University of North Carolina at Greensboro, 2Columbine Audiology & Hearing Aid Center, 3Texas
Children’s Hospital, 4HearUSA
1Introduction
The link between chronic tinnitus and sleep disturbance is well documented in the literature.1,2,3 In
clinical practice, patients often report difficulty falling or staying asleep due to their tinnitus. Addressing
sleep disturbance is an essential element of a patient’s plan of care due to the mental, emotional, andhealth effects of inadequate sleep. Sound therapy commonly is recommended to reduce tinnitus
awareness and can come in many forms including tabletop sound spas, ear-level sound generators, orpillows containing one or more speakers. Use of an air-conduction pillow for tinnitus relief may beprecluded by the severity of the patient’s hearing loss. Thus, a bone-conduction pillow may be an option
if it can provide sufficient stimulation for patients with asymmetric hearing loss or hearing loss with aconductive component. Use of a bone-conduction pillow with patients who have tinnitus has not beenreported to date. The present investigation compared ratings for two pillows, one with air-conduction(AC) speakers and one with a bone-conduction (BC) transducer (see below for a description).

Methods
Ten adult patients volunteered to participate in the study, which was approved by the Institutional
Review Board at the University of North Carolina at Greensboro. All subjects reported significant
tinnitus and sleep disturbance due to tinnitus as measured by baseline questionnaires.
•Tinnitus Reaction Questionnaire (TRQ): mean score = 49 (range: 17-100); 80% of subjects
responded to Question #23 (“My tinnitus has interfered with my sleep.”) with “3” (“a good dealof the time.”) or “4” (“almost all of the time).

4

•Tinnitus Primary Function Questionnaire (TPFQ) – 20-item version: mean total score = 52 (range:21-96); mean score = 58 (range: 20-100) on sleep subscale.

•Sleep Disorder Screening Questionnaire: mean total score = 10 (range: 3-18); 80% of subjects
reporting symptoms consistent with “insomnia” (i.e., a persistent inability to fall asleep or stayasleep).

56In addition, pure-tone hearing thresholds were measured to document severity of hearing loss. The
majority of subjects had a sloping sensorineural hearing loss with normal pure-tone averages(average PTAs = 21 dB HL in right ear and 27 dB HL in left ear). Two subjects had an asymmetrichearing loss, one of which also had a significant air-bone gap consistent with a mixed hearing loss.
Participants were asked to use each pillow for one week (the order was counterbalanced). They
completed the TRQ and TPFQ after using each pillow as well as a satisfaction survey evaluating eachpillow. Upon completion of the study, subjects also completed a survey comparing the two pillows.
One subject did not complete the study or any of the surveys. Results for the remaining nine
participants are reported.
Results
As shown in Figure 1 below, the majority of subjects (7 of 9) rated the AC pillow higher overall on asatisfaction survey. One subject rated the BC pillow higher and one subject rated both pillows equally.
Average ratings on specific aspects of each pillow are provided in Figure 2 (upper right). Only tworatings reached the level of “good” (4): comfort for the AC pillow and audibility of the BC pillow.
Although none of the average ratings approached the level of “excellent” for either pillow, individual
ratings differed among subjects with the AC pillow receiving 23 “5” ratings and the BC pillow receiving
only 10.

Preference for the Sound Pillow Sleep System was largely based on pillow comfort and available soundselections (see Figure 3). Although no clear preference was observed for audibility, two subjects
reported they could not turn up the AC pillow loud enough to hear. When asked whether the volume
was able to mask their tinnitus, half of the subjects reported neither pillow was loud enough. Several
subjects also commented subjectively that the music provided with the BC pillow did not effectively
mask their tinnitus, was distracting, or offered two few sound selections.
When comparing scores on questionnaires before and after pillow use, subjects reported little if any
improvement in tinnitus or sleep disturbance. Some subjects even reported increased tinnitus
disturbance following pillow use. This is possibly due to the short time of the trial (one week per pillow)
and/or increased attention to tinnitus brought about by a change in sleep routine (e.g., perceived
discomfort of the pillow).
Findings suggest the patient’s hearing profile likely influenced pillow selection. One patient with abilateral mixed hearing loss (see Figure 4) was unable to use the air-conduction pillow because it was
not loud enough to hear. However, she was able to use the bone-conduction pillow with success. Thispatient has pulsatile tinnitus causing significant sleep disturbance. She wears a BAHA on one ear and a
receiver-in-the-ear hearing aid on the other. Follow-up with this patient indicates continued usage of
the BC pillow over time; however, she preferred a “waterfall” sound stimulus for better masking of hertinnitus. Subjective feedback about her experience with the BC pillow over ten months is provided
below.

Conclusions
This study has implications for sound therapy recommendations for patients with tinnitus and sleep
disturbance. The AC pillow was preferred by the majority of subjects in this study. However, theBC pillow was preferred by one subject with bilateral mixed hearing loss. More research is needed
comparing bone- and air-conduction pillows with equivalent comfort and sound selections to determine
patient preference. The BC pillow now is available in a variety sizes. A longer trial also may be required
to observe measurable improvements in tinnitus and/or sleep disturbance. Additional benefits of bone-conduction also may be investigated such as whether it elicits a calming effect through stimulation of
the vagal nerve and activation of the parasympathetic nervous system.7

References
Fioretti, A.B., Fusetti, M,, & Eibenstein, A. (2013). Association between sleep disorders, hyperacusis
and tinnitus: evaluation with tinnitus questionnaires. Noise & Health, 63, 91-95.

1Hébert, S. & Carrier, J. 2007. Sleep complaints in elderly tinnitus patients: A controlled study. Ear &Hearing, 28(5), 649-655.

2

Wallhäusser-Franke, E., Schredl, M., & Delb, W. (2013). Tinnitus and insomnia: Is hyperarousal thecommon denominator? Sleep Medicine Reviews, 17(1), 65-74.

3Wilson, P.H., Henry, J., Bowen, M., & Haralambous, G. (1991). Tinnitus reaction questionnaire:
Psychometric properties of a measure of distress associated with tinnitus. Journal of Speech, Language,and Hearing Research, 34, 197-201.

4Tyler, R., Ji, H., Perreau, A., Witt, S., Noble, W., & Coelho, C. (2014). Development and validation of thetinnitus primary function questionnaire. American Journal of Audiology, 23(3), 260-272.
5Sleep Disorder Screening Questionnaire. Retrieved from: https://www.ghs.org/wpcontent/uploads/2016/12/Sleep-Disorder-Screening-Questionnaire.pdf.

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Olson, K. (2014). Pilot Study: Measuring Relaxation Response to the iLs Dreampad. Retrieved from:http://integratedlistening.com/research/olson-hrv-study-sleepimage/.

7Special thanks to R. Scott Armbruster, CEO of Sound Pillow®, who donated 10 Sound Pillow
Sleep Systems toward this project. This study utilized a previous version of the Sound Pillow
Sleep System content, which has been remastered for louder output.
Results of this study were presented in April 2017 at the American Academy of Audiology(AAA) AudiologyNow! Conference held in Indianapolis, IN.