(12) Patent Application Publication (10) Pub. No.: US 2010/ A1

Transcription

1 (19) United State US A1 (12) Patent Application Publication (10) Pub. No.: US 2010/ A1 Hochmair et al. (43) Pub. Date: May 13, 2010 (54) TINNITUS SUPPRESSING COCHLEAR IMPLANT (75) Inventor: Ingeborg Hochmair, Axam (AT); Martin Zimmerling, Patch (AT); Clemen M. Zierhofer, Kundl (AT); Katrien Vermeire, Meiming (AT) Correpondence Addre: Suntein Kann Murphy & Timber LLP 125 SUMMER STREET BOSTON, MA (US) (73) Aignee: (21) Appl. No.: 12/615,731 (22) Filed: Nov. 10, 2009 MED-ELElektromediziniche Geraete GmbH, Innbruck (AT) Related U.S. Application Data (63) Continuation-in-part of application No. 1 1/671,636, filed on Feb. 6, (60) Proviional application No. 60/765,775, filed on Feb. 7, Publication Claification (51) Int. Cl. A61N L/36 ( ) A6IF II/00 ( ) (52) U.S. Cl /55 (57) ABSTRACT An implantable device and correponding method for Sup preion of tinnitu are decribed. An implantable ignal pro ceing module develop a timulation ignal for application to audio ening tiue of the uer. The ignal proceing module include a tinnitu Suppreion mode in which the timulation ignal i unrelated to environmental ound near the uer. : ex-x- 8:

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6 US 2010/ A1 May 13, 2010 pani and/or the cala vetibuli of the uer. The electrical timulation ignal may be applied uing an atraumatically inerted electrode which preerve reidual hearing in the implanted ear Embodiment may alo include providing acoutic mechanical timulation to the implanted ear, uch that the implanted ear receive both an electrical timulation ignal and an acoutic-mechanical timulation ignal. Applying the electrical timulation ignal may include applying equence of electric pule having amplitude according to a CIS trategy, for example, at rate between 10 and 10,000 pule per econd In ome embodiment, the timulating may be pro duced by a braintem implant or by a middle ear implant Such a a floating ma tranducer or a bone conducting device The timulating may be uer controllable and/or oftware controllable, for example, to be time dependent. The timulation ignal may further provide Sound localization information In accordance with an embodiment of the invention, an implantable device for Suppreion of tinnitu include an implantable imulator module for developing a timulation ignal for application to audio ening tiue of a uer. The timulator module include at leat a tinnitu Suppreion mode in which the timulation ignal include a tinnitu Sup preion ignal, the timulator module including a memory device for toring at leat one parameter of the tinnitu Sup preion ignal. The timulator module generate the tinnitu Suppreion ignal a a function of the at leat one parameter tored in the memory device, independent of data received Subtantially imultaneouly by the timulator module, if any In accordance with related embodiment of the invention, the timulator module may generate the tinnitu Suppreion ignal without contemporaneouly interfacing with an external device. The timulator module may generate the tinnitu Suppreion ignal independent of acoutic ig nal of the nearby environment In accordance with other related embodiment of the invention, the implantable device may include a ignal pro ceing module operatively coupled to the timulator module, the ignal proceing module proceing an input acoutic audio ignal repreentative of environmental Sound to form a proceed audio ignal for providing to the timulator mod ule. The timulator module may include at leat one mode where the timulation ignal i developed baed, at leat in part, on the proceed audio ignal, wherein the timulator module generate the tinnitu Suppreion ignal independent of data received from the ignal proceing module. The ignal proceing module may be adapted to be worn external to the uer, or may be adapted for implantation into the uer In accordance with till further embodiment of the invention, the device may be a cochlear implant and the timulation ignal i an electrical timulation ignal. The tin nitu Suppreion ignal may include biphaic pule for equentially timulating at leat one electrode, wherein the biphaic pule are non-overlapping in time. The device may further include an electrode array, wherein the tinnitu Sup preion ignal include pule for imultaneouly timulat ing two or more electrode. The tinnitu Suppreion ignal may include Stimulation pule having a time varying enve lope baed on a noie modulation function In accordance with yet further embodiment of the invention, the device may be a braintem implant, a middle ear implant, or a bone conducting implant. The tinnitu Sup preion ignal may not be ignificantly perceptible to the uer, or may be maked by the natural ignal proceing of the USC In accordance with another embodiment of the invention a method of Suppreing tinnitu include generat ing, by a timulator module of an implanted prothei, a timulation ignal for application to audio ening tiue of a uer. The timulator module include at leat a tinnitu Sup preion mode in which the timulation ignal include a tinnitu Suppreion ignal. The timulator module generate the tinnitu Suppreion ignal a a function of at leat one parameter tored in Stimulator memory, independent of any data received Subtantially imultaneouly by the timulator, if any In accordance with related embodiment of the invention, generating the tinnitu Suppreion ignal may occur without contemporaneouly interfacing with an exter nal device. The tinnitu Suppreion ignal may be unrelated to acoutic ignal of the nearby environment In accordance with further related embodiment of the invention, generating the tinnitu ignal may occur inde pendent of data received by the timulator from a ignal proceing module, the ignal proceing module proceing an audio ignal repreentative of environmental Sound to form a proceed audio ignal for providing to the timulator mod ule. The timulator module may include at leat one mode where the timulation ignal i developed baed, at leat in part, on the proceed audio ignal. The ignal proceing module may be external to the uer, or may be implanted into the uer In accordance with till further embodiment of the invention, the tinnitu Suppreion ignal may include bipha ic pule for equentially timulating at leat one electrode, the biphaic pule are non-overlapping in time. The tinnitu Suppreion ignal may include pule for imultaneouly timulating two or more electrode. The tinnitu Suppreion ignal may include timulation pule having a time varying envelope baed on a noie modulation function. The tinnitu Suppreion ignal when applied to the audio ening tiue of the uer may or may not be ignificantly perceptible. The tinnitu Suppreion ignal may be maked by the natural ignal proceing of the uer. The prothei may be a cochlear implant, a braintem implant, a middle ear implant and/or a bone conducting implant In accordance with another embodiment of the invention, a computer program product in a computer read able torage medium i preented. The product include pro gram code for producing a data ignal for an implanted audio prothei including program code for generating, in a timu lator module of the implanted prothei, a timulation ignal for application to audio ening tiue of a uer. The timula tor module include at leat a tinnitu Suppreion mode in which the timulation ignal include a tinnitu Suppreion ignal. The tinnitu Suppreion ignal i generated a a func tion of at leat one parameter tored in timulator memory, independent of any data received ubtantially imulta neouly by the timulator module, if any In accordance with related embodiment, the pro gram code for generating the timulation ignal may generate the tinnitu Suppreion ignal without contemporaneouly interfacing with an external device. The program code for generating the timulation ignal may generate the tinnitu ignal independent of data received by the timulator from a ignal proceing module, the ignal proceing module pro

7 US 2010/ A1 May 13, 2010 ceing an audio ignal repreentative of environmental Sound to form a proceed audio ignal for providing to the timulator module. The timulator module may include at leat one mode where the timulation ignal i developed baed, at leat in part, on the proceed audio ignal. BRIEF DESCRIPTION OF THE DRAWINGS 0030 FIG. 1 how the ear tructure of a human ear and a typical cochlear implant ytem according to the prior art FIG. 2 how an implantable ytem according to one pecific embodiment of the preent invention, tarting from the prior art ytem of FIG FIG. 3 how a braintem implant according to an alternative embodiment of the preent invention. DETAILED DESCRIPTION OF SPECIFIC EMBODIMENTS A ued herein, the term hearing implant include any type of hearing ytem having implantable part, uch a, without limitation, cochlear implant (CI), braintem implant, bone conducting implant, and middle ear implant (MEI) When timulating, hearing implant can Suppre Some form of tinnitu Such a peripheral origin-tinnitu, i.e. tinnitu connected to hearing problem. Both mechanical (acoutic) and electrical timulation have been found to pro vide uch benefit. Specifically, unilateral tinnitu reulting from unilateral cochlear profound enory-neural hearing lo (SNHL) can be treated with cochlear implantation, which alo typically improve the overall quality of hearing in a ignificant way. A explained above, unilateral deafne ha not previouly been an indication for a cochlear implant. Thu, embodiment of the preent invention include a cochlear implant that retore hearing by changing cortical activity by electrical timulation of the auditory cortex or auditory nerve. Tinnitu Suppreion may be realized by ue of comparatively low level timulation ( background timu lation') at or near the hearing threhold. The timulation may or may not be at a perceptible level. If the timulation i perceptible, it may be faded and/or maked by the uer' natural ignal proceing In pecific embodiment, a cochlear implant may provide a timulator ignal that timulate the cala tympani and/or cala vetibuli of the uer. One pecific embodiment can be explained with reference to the cochlear implant y tem hown in FIG. 2. A timulation ignal i developed by an implantable timulator module 208. An electrode array 210 i coupled to the timulator module 208 for applying the timu lation ignal to audio ening tiue of a uer Such a the Scala vetibuli 105 and cala tympani 106 of the cochlea 104. The timulator module 208 may have variou operating mode which may or may not include a normal operation mode in which the timulation ignal applied to the audio ening tiue i repreentative of the environmental ound around the uer Whether or not a normal mode i available, embodi ment of the preent invention include a tinnitu Suppreion mode in which the timulation ignal include a tinnitu Sup preion ignal that i unrelated to environmental ound near the uer. In ome pecific embodiment, it may not be nece ary to generate pecific hearing enation for tinnitu Sup preion, rather ome low-level background timulation appear to be ufficient. Thu, the tinnitu Suppreion mode in pecific embodiment may be the reult of witching off the microphone input, and/or providing ome background timu lationator near ome threhold detection level of timulation, Such a provided by a CIS-type trategy a implemented, for example, in the Pular and Sonata implant by MED-EL of Innbruck, Autria. The electrical timulation ignal may be in the form of CIS-type pule, for example, at a rate of 10 to 10,000 pule per econd, at a pule amplitude near the CIS threhold The electrode array 210 may be inerted relatively deeply in order to reach the low frequency repone region of the cochlea 104 and thereby cover the entire frequency range. Thi may be epecially important if the tinnitu effect occur in the low frequencie. In addition, ue of Such a deep iner tion electrode array 210 in a cochlear implant for a unilater ally deaf peron may alo provide ound localization infor mation o to retore or partially retore directional hearing for thoe peron in which the working ear i confined to low frequencie. In addition or alternatively, the electrode array 210 may alo be uitable for atraumatic inertion o a to preerve ome or all of the reidual hearing in the implanted ear, which i often not a conideration in a cochlear implant for a totally deaf patient Some embodiment not only provide tinnitu Sup preion, but may alo fully or partially retore bilateral hear ing. Thi advantage i related to the ue of an electrode array 210 adapted for deep inertion, in order to efficiently exploit the input from the normal ear and from the timulator 208. The improvement in bilateral hearing may in turn improve peech undertanding in noiy environment. In addition, directional hearing may be fully or partially retored. Thee effect generally may improve over time a the uer accumu late experience with the device, epecially if hearing on the non-implanted ear i alo compromied Since tinnitu can be epecially annoying during leep time, a totally implantable cochlear implant can be of great advantage (albeit not abolutely neceary) to timulate without having to wear an external part, which would have to be ecurely fatened and which might be uncomfortable. The tinnitu Suppreion mode may be uer controllable and/or oftware controllable. For example, an embodiment could include a clock function to witch off ound input for a elected time (while retaining background timulation for tinnitu Suppreion) Such a at night for leeping, or to optionally witch off timulation after ome time, and/or to et an alarm In illutrative embodiment, an implantable device for Suppreion of tinnitu i preented that i operable with out contemporaneouly interfacing with an external device. The implant may erve, without limitation, to function a a fully implantable cochlear implant, while in other embodi ment the implant may erve only to Suppre tinnitu Sup preion. For example, in many cae patient receiving a cochlear implant on one ear have normal or almot normal hearing on their contralateral ear. Thu, electrotimulation may erve excluively for tinnitu Suppreion, and not for retoration of hearing. In Such cae, tinnitu electrotimula tion may be achieved uing an artificial timulation pattern that doe not rely on acoutic ignal from the environment, and which doe not require complex tage for audio ignal proceing. A a conequence, a ytem for tinnitu Suppre ion may be implemented much impler and with ignifi cantly reduced power conumption a compared to a tandard cochlear implant. For example, the electrode array fortinnitu

8 US 2010/ A1 May 13, 2010 Suppreion may require le active electrode in the cochlea a compared to a tandard cochlear implant A in above-decribed embodiment, the implant may include a timulator module for timulating an electrode array. The timulator module may include, without limitation, a microproceor, variou circuitry and/or Software. The implant may include an inductive link for trancutaneouly interfacing with an external device when deired. The induc tive link may be ued to end and/or receive data, power or control ignal. The implant may further include a micro phone and/or a rechargeable battery that may be recharged via the inductive link In illutrative embodiment, the timulator module include a memory device for toring at leat one parameter aociated with the tinnitu Suppreion pattern. The memory device may be, without limitation, Read Only Memory (ROM), Eraable Programmable Read-Only Memory (EPROM), Random Acce Memory (RAM), EEPROM and/ or Flah-Programmable RAM. The parameter() tored in memory i ued by the timulator module to generate timu lation ignal for tinnitu treatment which do not depend on the acoutic ignal from the Surrounding environment. Fur thermore, the timulation ignal generated by the timulator may be generated independent of any data received Subtan tially imultaneouly by the timulator module, uch a from, without limitation: an external device; or a ignal proceing module of a totally implantable cochlear implant that, at leat in part, procee an audio ignal, for example, received from an internal microphone The timulation parameter ued to generate the tinnitu Suppreion ignal may be, for example, downloaded into memory at the factory, and/or previouly downloaded from an external device via the inductive link (when the patient i wearing the external device). In variou embodi ment, the implant i not operatively coupled to an external device when generating the tinnitu Suppreion ignal. Alter natively, the patient may be relying on, and wearing, the external device for purpoe other than generating the tinnitu Suppreion ignal (uch a power tranmiion) when gen erating the tinnitu Suppreion ignal In variou embodiment, the tinnitu uppreion ignal may be automatically generated by periodic equence of biphaic timulation on each electrode. For each electrode, the pule amplitude may be adjuted for maximum tinnitu Suppreion In further embodiment, the envelope of the auto matically generated Stimulation pule in each channel are not contant, but time varying according to particular ampli tude modulation function. Such function include, without limitation, inuoid and rectangle In till other embodiment, the envelope of the automatically generated Stimulation pule in each channel are not contant, but time varying according to noie-like modulation function. The amplitude denity function of the noie function may be adjuted for maximum tinnitu Sup preion The tinnitu uppreion ignal decribed above may be applied non-overlapping in time, imilar to the pule ued for CIS. In till another embodiment, the tinnitu Sup preion ignal may be applied uing, at leat in part, imul taneou timulation pule, a decribed, for example, in U.S. Pat. No. 6, , which i incorporated herein by reference it it entirety. Simultaneou timulation generally allow for an increae in the phae duration of the pule and alo a reduction in pule amplitude. Thu a better timulation effi cacy can be achieved If the ubject retain ome reidual hearing in the implanted ear, the device alo can be ued together with an acoutic-mechanical timulation module 214 to reult in improved hearing quality and improved ound localization capability baed on the application of both an electrical timulation ignal from the electrode carrier 210 and an acoutic mechanical timulation ignal from the acoutic mechanical timulation module 214. The acoutic mechani cal timulation module 214 mechanically drive the oicular chain, which in turn timulate the cochlea 104. An acoutic mechanical timulation module 214 in the pecific form of a middle ear implant baed on a floating ma tranducer i further decribed, for example, in U.S. Pat. No. 5,913,815; 5,897,486; 5,624,376; 5,554,096; 5,456,654; 5,800,336; 5,857,958; and 6,475,134, each of which i incorporated herein by reference An alternative embodiment may have an acoutic mechanical timulation module 214 with a tinnitu Suppre ion mode, without any implanted electrode timulation y tem. So that only acoutic-mechanical timulation i provided. Thu, pecific embodiment may be in the form of a bone conduction ytem or a Middle Ear Implant (MEI) uch a a Soundbridge' (and it derivation) in which the timulation i acoutic-mechanical via a floating ma tranducer. The advantage gained by the patient are imilar to a cochlear implant embodiment, and built-in feature could be very imilar a well. An MEI i often deigned for moderately hearing impaired patient, who uually try to ue conven tional hearing aid thu avoiding Surgery neceary for the MEI. However, becaue of the improved ound quality and the ability to uppre tinnitu during leep. Sucha device may be more readily accepted FIG. 3 how another embodiment for tinnitu Sup preion in the pecific form of a braintem implant 301. In other embodiment, intead of a deep inertion Scala tympani electrode, other timulating mean may be ued. Such a plit electrode (to timulate the cala vetibuli), braintem elec trode, floating ma tranducer (at the oicle or at the round window), and/or a bone bridge The preent invention may be embodied in many different form, including, but in no way limited to, computer program logic for ue with a proceor (e.g., a microproce Sor, microcontroller, digital ignal proceor, or general pur poe computer), programmable logic for ue with a program mable logic device (e.g., a Field Programmable Gate Array (FPGA) or other PLD), dicrete component, integrated cir cuitry (e.g., an Application Specific Integrated Circuit (ASIC)), or any other mean including any combination thereof Computer program logic implementing all or part of the functionality previouly decribed herein may be embod ied in variou form, including, but in no way limited to, a Source code form, a computer executable form, and variou intermediate form (e.g., form generated by an aembler, compiler, linker, or locator.) Source code may include a erie of computer program intruction implemented in any of Variou programming language (e.g., an object code, an aembly language, or a high-level language Such a Fortran, C, C++, JAVA, or HTML) for ue with variou operating ytem or operating environment. The ource code may define and ue variou data tructure and communication

9 US 2010/ A1 May 13, 2010 meage. The ource code may be in a computer executable form (e.g., via an interpreter), or the ource code may be converted (e.g., via a tranlator, aembler, or compiler) into a computer executable form The computer program may be fixed in any form (e.g., ource code form, computer executable form, or an intermediate form) either permanently or tranitorily in a tangible torage medium, Such a a emiconductor memory device (e.g., a RAM, ROM, PROM, EEPROM, or Flah Programmable RAM), a magnetic memory device (e.g., a dikette or fixed dik), an optical memory device (e.g., a CD-ROM), a PC card (e.g., PCMCIA card), or other memory device. The computer program may be fixed in any form in a ignal that i tranmittable to a computer uing any of variou communication technologie, including, but in no way lim ited to, analog technologie, digital technologie, optical technologie, wirele technologie, networking technolo gie, and internetworking technologie. The computer pro gram may be ditributed in any form a a removable torage medium with accompanying printed or electronic documen tation (e.g., hrink wrapped oftware or a magnetic tape), preloaded with a computer ytem (e.g., on ytem ROM or fixed dik), or ditributed from a erver or electronic bulletin board over the communication ytem (e.g., the Internet or World WideWeb.) 0054 Hardware logic (including programmable logic for ue with a programmable logic device) implementing all or part of the functionality previouly decribed herein may be deigned uing traditional manual method, or may be deigned, captured, imulated, or documented electronically uing variou tool, uch a Computer Aided Deign (CAD), a hardware decription language (e.g., VHDL or AHDL), or a PLD programming language (e.g., PALASM. ABEL, or CUPL.) 0055 Although variou exemplary embodiment of the invention have been dicloed, it hould be apparent to thoe killed in the art that variou change and modification can be made which will achieve ome of the advantage of the invention without departing from the true cope of the inven tion. What i claimed i: 1. An implantable device for Suppreion of tinnitu, the device compriing: an implantable imulator module for developing a timu lation ignal for application to audio ening tiue of a uer, the timulator module including at leat a tinnitu Suppreion mode in which the timulation ignal include a tinnitu Suppreion ignal, the timulator module including a memory device for toring at leat one parameter of the tinnitu Suppreion ignal, wherein the timulator module generate the tinnitu Sup preion ignal a a function of the at leat one parameter tored in the memory device, independent of data received ubtantially imultaneouly by the timulator module, if any. 2. The device according to claim 1, wherein the timulator module generate the tinnitu Suppreion ignal without con temporaneouly interfacing with an external device. 3. The device according to claim 1, further compriing a ignal proceing module operatively coupled to the timula tor module, the ignal proceing module proceing an input acoutic audio ignal repreentative of environmental Sound to form a proceed audio ignal for providing to the timu lator module; the timulator module including at leat one mode where the timulation ignal i developed baed, at leat in part, on the proceed audio ignal, wherein the timulator module generate the tinnitu Suppreion ignal independent of data received from the ignal proceing module. 4. The device according to claim 3, wherein the ignal proceing module i adapted to be worn external to the uer. 5. The device according to claim 3, wherein the ignal proceing module i adapted for implantation into the uer. 6. The device according to claim 1, where the timulator module generate the tinnitu Suppreion ignal independent of acoutic ignal of the nearby environment. 7. The device according to claim 1, wherein the device i a cochlear implant and the timulation ignal i an electrical timulation ignal. 8. The device according to claim 7, wherein the tinnitu Suppreion ignal include biphaic pule for equentially timulating at leat one electrode, wherein the biphaic pule are non-overlapping in time. 9. The device according to claim 7, further compriing an electrode array, wherein the tinnitu Suppreion ignal include pule for imultaneouly timulating two or more electrode. 10. The device according to claim 7, wherein the tinnitu Suppreion ignal include timulation pule having a time varying envelope baed on a noie modulation function. 11. The device according to claim 1, where the device i a braintem implant. 12. The device according to claim 1, wherein the device i a middle ear implant. 13. The device according to claim 1, wherein the device i a bone conducting implant. 14. The device according to claim 1, wherein the tinnitu Suppreion ignal i not ignificantly perceptible to the uer. 15. The device according to claim 1, wherein the tinnitu Suppreion ignal i maked by the natural ignal proceing of the uer. 16. A method of Suppreing tinnitu, the method compri ing: generating, by a timulator module of an implanted pro thei, a timulation ignal for application to audio en ing tiue of a uer, the timulator module including at leat a tinnitu Suppreion mode in which the timula tion ignal include a tinnitu Suppreion ignal, the timulator module generating the tinnitu Suppreion ignal a a function of at leat one parameter tored in timulator memory, independent of any data received Subtantially imultaneouly by the timulator module, if any. 17. The method according to claim 16, wherein generating the tinnitu Suppreion ignal occur without contempora neouly interfacing with an external device. 18. The method according to claim 16, wherein generating the tinnitu ignal occur independent of data received by the timulator module from a ignal proceing module, the ig nal proceing module proceing an audio ignal repreen tative of environmental ound to form a proceed audio ignal for providing to the timulator module; the timulator module including at leat one mode where the timulation ignal i developed baed, at leat in part, on the proceed audio ignal. 19. The method according to claim 18, wherein the ignal proceing module i external to the uer. 20. The method according to claim 18, wherein the ignal proceing module i implanted into the uer.

10 US 2010/ A1 May 13, The method according to claim 16, wherein the tinnitu Suppreion ignal i unrelated to acoutic ignal of the nearby environment. 22. The method according to claim 16, wherein the tinnitu Suppreion ignal include biphaic pule for equentially timulating at leat one electrode, the biphaic pule are non-overlapping in time. 23. The method according to claim 16, wherein the tinnitu Suppreion ignal include pule for imultaneouly timu lating two or more electrode. 24. The method according to claim 16, wherein the tinnitu Suppreion ignal include timulation pule having a time varying envelope baed on a noie modulation function. 25. The method according to claim 16, wherein the tinnitu Suppreion ignal when applied to the audio ening tiue of the uer i not ignificantly perceptible. 26. The method according to claim 16, wherein the tinnitu Suppreion ignal when applied to the audio ening tiue of the uer i not ignificantly perceptible to the uer. 27. The method according to claim 16, wherein the tinnitu Suppreion ignal i maked by the natural ignal proceing of the uer. 28. The method according to claim 16, where the prothei i a braintem implant. 29. The method according to claim 16 wherein the pro thei i a middle ear implant. 30. The method according to claim 16, wherein the pro thei i a bone conducting implant. 31. A computer program product in a computer readable torage medium, the product including program code for producing a data ignal for an implanted audio prothei, the product compriing: program code for generating, in a timulator module of an implanted prothei, a timulation ignal for applica tion to audio ening tiue of a uer, the timulator module including at leat a tinnitu Suppreion mode in which the timulation ignal include a tinnitu Suppre ion ignal, the tinnitu Suppreion ignal generated a a function of at leat one parameter tored in timulator memory, independent of any data received ubtantially imultaneouly by the timulator module, if any. 32. The computer program product according to claim 31, wherein the program code for generating the timulation ig nal generate the tinnitu Suppreion ignal without contem poraneouly interfacing with an external device. 33. The computer program product according to claim 31, wherein the program code for generating the timulation ig nal generate the tinnitu ignal independent of data received by the timulator module from a ignal proceing module, the ignal proceing module proceing an audio ignal rep reentative of environmental ound to form a proceed audio ignal for providing to the timulator module; the timulator module including at leat one mode where the timulation ignal i developed baed, at leat in part, on the proceed audio ignal.