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Alashram AR. Effects of tinnitus retraining therapy on patients with tinnitus: a systematic review of randomized controlled trials. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08907-3. [PMID: 39153142 DOI: 10.1007/s00405-024-08907-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE This review aims to explore the influences of tinnitus retraining therapy (TRT) on patients with tinnitus. METHODS PubMed, MEDLINE, EMBASE, CINAHL, PEDro, SCOPUS, and Web of Science were screened for randomized controlled trials (RCTs) that explored the effects of TRT on patients with tinnitus from inception to June 30, 2024. The methodological quality of the included RCTs was evaluated using the physiotherapy evidence database (PEDro) scale. RESULTS Fifteen studies met our eligibility criteria. A total of 2069 patients with tinnitus (mean age 52.93 years; 66% male) were involved in the present review. The quality of the selected studies ranged from 5 to 8 on the PEDro scale, with a median score of 7. TRT did not provide superior effects in treating patients with tinnitus compared to tinnitus masking (TM), tinnitus educational counselling (TED), TRT with open ear hearing aids, Tailor-made notched music training (TMNMT), partial TRT, usual care, and smart TRT. CONCLUSIONS TRT intervention is considered a treatment option for patients with tinnitus. Combining TRT with other interventions, such as cognitive-behavioral therapy, pharmacotherapy, or tDS, may show even greater efficacy. Additional studies are strongly required to recognize the long-term effects of TRT on tinnitus, determine who most likely would benefit from the intervention regarding tinnitus type and severity, and identify the optimal treatment protocol.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Airport Road 1666, Amman, Jordan.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
- Centre of SpaceBio-Medicine, Department of Systems Medicine, Faculty of Medicine and Surgery, University of Rome "Tor Vergata", 00133, Rome, Italy.
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Kleinjung T, Peter N, Schecklmann M, Langguth B. The Current State of Tinnitus Diagnosis and Treatment: a Multidisciplinary Expert Perspective. J Assoc Res Otolaryngol 2024:10.1007/s10162-024-00960-3. [PMID: 39138756 DOI: 10.1007/s10162-024-00960-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 07/31/2024] [Indexed: 08/15/2024] Open
Abstract
Tinnitus, the perception of sound without an external source, affects 15% of the population, with 2.4% experiencing significant distress. In this review, we summarize the current state of knowledge about tinnitus management with a particular focus on the translation into clinical practice. In the first section, we analyze shortcomings, knowledge gaps, and challenges in the field of tinnitus research. Then, we highlight the relevance of the diagnostic process to account for tinnitus heterogeneity and to identify all relevant aspects of the tinnitus in an individual patient, such as etiological aspects, pathophysiological mechanisms, factors that contribute most to suffering, and comorbidities. In the next section, we review available treatment options, including counselling, cognitive-behavioral therapy (CBT), hearing aids and cochlear implants for patients with a relevant hearing loss, sound generators, novel auditory stimulation approaches, tinnitus retraining therapy (TRT), pharmacological treatment, neurofeedback, brain stimulation, bimodal stimulation, Internet- and app-based digital approaches, and alternative treatment approaches. The evidence for the effectiveness of the various treatment interventions varies considerably. We also discuss differences in current respective guideline recommendations and close with a discussion of how current pathophysiological knowledge, latest scientific evidence, and patient perspectives can be translated in patient-centered care.
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Affiliation(s)
- Tobias Kleinjung
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Nicole Peter
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Bezirksklinikum, Universitätsstr. 84, 93049, Regensburg, Germany
- Multidisciplinary Tinnitus Clinic, University of Regensburg, Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Bezirksklinikum, Universitätsstr. 84, 93049, Regensburg, Germany.
- Multidisciplinary Tinnitus Clinic, University of Regensburg, Regensburg, Germany.
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Awais M, Kassoul K, Omri AE, Aboumarzouk OM, Abdulhadi K, Brahim Belhaouari S. Graph-Based Electroencephalography Analysis in Tinnitus Therapy. Biomedicines 2024; 12:1404. [PMID: 39061978 PMCID: PMC11274277 DOI: 10.3390/biomedicines12071404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/02/2024] [Accepted: 06/06/2024] [Indexed: 07/28/2024] Open
Abstract
Tinnitus is the perception of sounds like ringing or buzzing in the ears without any external source, varying in intensity and potentially becoming chronic. This study aims to enhance the understanding and treatment of tinnitus by analyzing a dataset related to tinnitus therapy, focusing on electroencephalography (EEG) signals from patients undergoing treatment. The objectives of the study include applying various preprocessing techniques to ensure data quality, such as noise elimination and standardization of sampling rates, and extracting essential features from EEG signals, including power spectral density and statistical measures. The novelty of this research lies in its innovative approach to representing different channels of EEG signals as new graph network representations without losing any information. This transformation allows for the use of Graph Neural Networks (GNNs), specifically Graph Convolutional Networks (GCNs) combined with Long Short-Term Memory (LSTM) networks, to model intricate relationships and temporal dependencies within the EEG data. This method enables a comprehensive analysis of the complex interactions between EEG channels. The study reports an impressive accuracy rate of 99.41%, demonstrating the potential of this novel approach. By integrating graph representation and deep learning, this research introduces a new methodology for analyzing tinnitus therapy data, aiming to contribute to more effective treatment strategies for tinnitus sufferers.
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Affiliation(s)
- Muhammad Awais
- Department of Creative Technologies, Air University, Islamabad 44000, Pakistan;
| | - Khelil Kassoul
- Geneva School of Business Administration, University of Applied Sciences Western Switzerland, HES-SO, 1227 Geneva, Switzerland
| | - Abdelfatteh El Omri
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (A.E.O.); (O.M.A.)
- Vice President for Medical and Health Sciences Office, QU-Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Omar M. Aboumarzouk
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (A.E.O.); (O.M.A.)
- Department of Clinical Science, College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar
- School of Medicine, Dentistry and Nursing, The University of Glasgow, Glasgow G12 8QQ, UK
| | - Khalid Abdulhadi
- Audiology and Balance Unit, Hamad Medical Corporation (HMC), Doha P.O. Box 3050, Qatar;
| | - Samir Brahim Belhaouari
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha P.O. Box 5825, Qatar
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Cherri D, Formby C, Secor CA, Eddins DA. Counseling Protocol for a Transitional Intervention for Debilitating Hyperacusis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1886-1902. [PMID: 38718266 PMCID: PMC11192559 DOI: 10.1044/2023_jslhr-23-00353] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/31/2023] [Accepted: 12/18/2023] [Indexed: 06/07/2024]
Abstract
INTRODUCTION This clinical focus article describes a structured counseling protocol for use with protected sound management and therapeutic sound in a transitional intervention for debilitating hyperacusis. The counseling protocol and its associated visual aids are crafted as a teaching tool to educate affected individuals about hyperacusis and encourage their acceptance of a transitional intervention. DESCRIPTION OF COUNSELING COMPONENTS The counseling protocol includes five components. First, the patient's audiometric results are reviewed with the patient, and the transitional intervention is introduced. An overview of peripheral auditory structures and central neural pathways and the concept of central gain are covered in the second and third components. Maladaptive hyper-gain processes within the auditory neural pathways, which underlie the hyperacusis condition, and associated connections with nonauditory processes responsible for negative reactions to hyperacusis are covered in the fourth component. Detrimental effects from misused hearing protection devices (HPDs) and the necessity to wean the patient from overuse of HPDs are also discussed. In the fifth component, the importance of therapeutic sound is introduced as a tool to downregulate hyper-gain activity within the auditory pathways; its implementation in uncontrolled and controlled sound environments is described. It is explained that, over the course of the transitional intervention, recalibration of the hyper-gain processes will be ongoing, leading to restoration of normal homeostasis within the auditory pathways. In turn, associated activation of reactive nonauditory processes, which contribute to hyperacusis-related distress, will be reduced or eliminated. As recalibration progresses, there will be less need for protected sound management and sound therapy. Sound tolerance will improve, hyperacusis will subside, and daily activities in typical healthy sound environments will again become routine. RESULTS AND CONCLUSION The combination of counseling with protected sound management and therapeutic sound is highlighted in companion reports, including a summary of the outcomes of a successful trial of the transitional intervention.
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Affiliation(s)
- Dana Cherri
- Auditory & Speech Sciences Laboratory, University of South Florida, Tampa
| | - Craig Formby
- Auditory & Speech Sciences Laboratory, University of South Florida, Tampa
- The University of Alabama, Tuscaloosa
| | - Carrie A. Secor
- Auditory & Speech Sciences Laboratory, University of South Florida, Tampa
| | - David A. Eddins
- Auditory & Speech Sciences Laboratory, University of South Florida, Tampa
- University of Central Florida, Orlando
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Formby C, Cherri D, Secor CA, Armstrong S, Juneau R, Hutchison P, Eddins DA. Results of a 6-Month Field Trial of a Transitional Intervention for Debilitating Hyperacusis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1903-1931. [PMID: 38718263 PMCID: PMC11192563 DOI: 10.1044/2024_jslhr-23-00360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/31/2023] [Accepted: 02/29/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE We present results from a 6-month field trial of a transitional intervention for debilitating primary hyperacusis, including a combination of structured counseling; promotion of safe, comfortable, and healthy sound exposure; and therapeutic broadband sound from sound generators. This intervention is designed to overcome barriers to successful delivery of therapeutic sound as a tool to downregulate neural hyperactivity in the central auditory pathways (i.e., the maladaptive mechanism believed to account for primary hyperacusis) and, together with the counseling, reduce the associated negative emotional and physiological reactions to debilitating hyperacusis. METHOD Twelve adults with normal or near-normal audiometric thresholds, complaints consistent with their pretreatment loudness discomfort levels ≤ 75 dB HL at multiple frequencies, and hearing questionnaire scores ≥ 24 completed the sound therapy-based intervention. The low-level broadband therapeutic sound was delivered by ear-level devices fitted bilaterally with either occluding earpieces and output-limiting loudness suppression (LS; to limit exposure to offensive sound levels) or open domes to maximize comfort and exposure to sound therapy. Thresholds for LS (primary outcome) were incrementally adjusted across six monthly visits based on treatment-driven change in loudness judgments for running speech in sound field. Secondary outcomes included categorical loudness judgments, speech understanding, and questionnaires to assess the hyperacusis problem, quality of life, and depression. An exit survey assessed satisfaction with and benefit from the intervention and the counseling, therapeutic sound, and LS components. RESULTS The mean change in LS (34.8 dB) was highly significant (effect size = 2.045). Eleven of 12 participants achieved ≥ 16-dB change in LS, consistent with highly significant change in sound-based questionnaire scores. Exit surveys indicated satisfaction with and benefit from the intervention. CONCLUSION The transitional intervention was successful in improving the hyperacusis conditions of 11 of 12 study participants while reducing their sound avoidance behaviors and reliance on sound protection.
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Affiliation(s)
- Craig Formby
- Auditory and Speech Sciences Laboratory, University of South Florida, Tampa
- The University of Alabama, Tuscaloosa
| | - Dana Cherri
- Auditory and Speech Sciences Laboratory, University of South Florida, Tampa
| | - Carrie A. Secor
- Auditory and Speech Sciences Laboratory, University of South Florida, Tampa
| | | | | | - Peter Hutchison
- Auditory and Speech Sciences Laboratory, University of South Florida, Tampa
| | - David A. Eddins
- Auditory and Speech Sciences Laboratory, University of South Florida, Tampa
- University of Central Florida, Orlando
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Henry JA, Thielman EJ, Zaugg T, Griest S, Stewart BJ. Assessing Meaningful Improvement: Focus on the Tinnitus Functional Index. Ear Hear 2024; 45:537-549. [PMID: 38351518 DOI: 10.1097/aud.0000000000001456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Many studies have attempted to determine methodology for interpreting change on outcome instruments that result from an intervention. The objective of these studies has been to devise methods to identify the minimal level of change that would be consistent with actual benefit perceived by the patient, and not just statistically significant change. With respect to intervention for bothersome tinnitus, the authors of the original study to develop and validate the Tinnitus Functional Index (TFI) suggested that a minimum 13-point reduction in the TFI score was likely to reflect a change perceived as meaningful to an individual. The 13-point estimation of meaningful change for an individual is appropriate for use with any adult seeking care for tinnitus. However, it cannot be relied upon in isolation to determine if an individual believes that there has been a noticeable, or meaningful improvement in their quality of life. It is important to use subjective impressions elicited from the patient to assist in interpreting the meaning of TFI data for an individual. For clinicians engaging in care for tinnitus, we recommend using the TFI and pairing it with the patient's belief/impression as to whether they are doing better than they were before care for tinnitus was provided. Ideally, the outcome assessment would be conducted by someone other than the clinician who provided the intervention.
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Affiliation(s)
- J A Henry
- Veterans Affairs Rehabilitation Research and Development, National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - E J Thielman
- Veterans Affairs Rehabilitation Research and Development, National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | - T Zaugg
- Veterans Affairs Rehabilitation Research and Development, National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | - S Griest
- Veterans Affairs Rehabilitation Research and Development, National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | - B J Stewart
- School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
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Portmann D, Esteve-Fraysse MJ, Frachet B, Herpin F, Rigaudier F, Juhel C. AUDISTIM ® Day/Night Alleviates Tinnitus-Related Handicap in Patients with Chronic Tinnitus: A Double-Blind Randomized Placebo-Controlled Trial. Audiol Res 2024; 14:359-371. [PMID: 38666902 PMCID: PMC11047585 DOI: 10.3390/audiolres14020031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 04/29/2024] Open
Abstract
The aim of this study is to evaluate the efficacy of taking a daily supplement based on active compounds (AUDISTIM® Day Night: A D/N) in alleviating tinnitus-related disability, as suggested by previous real-life studies. This double-blind randomized placebo-controlled study was conducted in adults with mild to severe tinnitus receiving a 3-month supplementation with A D/N (magnesium, vitamins, phytochemicals) or placebo (excipients without active ingredients). Tinnitus-related handicap (THI), psychological stress (MSP-9), and sleep quality (PSQI) were assessed at baseline and during intervention, perceived impression of tinnitus improvement at the end of the follow-up. The full set analysis included 114 patients (59 A D/N, 55 placebo) aged 53.8 ± 11.4 years, 58% women, with fluctuating (45%) or permanent (55%) tinnitus from 9.3 ± 9.4 years. A D/N supplementation led to greater changes in THI (-13.2 ± 16.0 vs. -6.2 ± 14.4, p = 0.0158,Cohen's d =0.44) at 3 months (primary outcome), especially with continuous tinnitus (-15.0 ± 16.3 vs. -4.6 ± 12.8, p = 0.0065), and, to a lesser extent, at 1 month (-9.8 ± 13.1 for A vs. -4.3 ± 12.1, p = 0.0213). PSQI significantly improved over time in both groups, but MSP-9 only with A D/N. In lines with previous observational studies, both clinical (THI score > 7 pts) and statistical (vs. placebo) improvement, more pronounced in permanent tinnitus, demonstrate the effectiveness of the combination of active compounds and support its use in the management of mild to severe tinnitus.
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Affiliation(s)
- Didier Portmann
- Institut G PORTMANN, 114, Avenue d’Arès, 33000 Bordeaux, France;
| | | | - Bruno Frachet
- Hospital Rothschild-AP-HP, 5, rue Santerre, 75012 Paris, France;
| | - Florent Herpin
- CEN, 18, rue P. Kergomard, 21000 Dijon, France; (F.H.); (F.R.)
| | | | - Christine Juhel
- CEN, 18, rue P. Kergomard, 21000 Dijon, France; (F.H.); (F.R.)
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Gu D, Wu L, Tang D. Development of a Prognostic Nomogram for Modified Tinnitus Relieving Sound Therapy for Subjective Tinnitus. Otolaryngol Head Neck Surg 2024; 170:1066-1073. [PMID: 38091373 DOI: 10.1002/ohn.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/16/2023] [Accepted: 11/24/2023] [Indexed: 03/24/2024]
Abstract
OBJECTIVE We aimed to develop a modified tinnitus-relieving sound system and establish a model for predicting its treatment effects. STUDY DESIGN Retrospective study. SETTING Tinnitus Specialist Clinic of Eye & ENT Hospital, Fudan University. METHODS We recruited 107 patients undergoing modified tinnitus-relieving sounds between August 2020 and May 2021. Patients were divided into training (n = 75) and validation (n = 32) cohorts in a 7:3 ratio. The treatment outcome was Tinnitus Handicapped Inventory scores. Features were established using a least absolute shrinkage and selection operator-derived logistic regression model, where the selected clinical risk factors were included in the multivariate logistic regression, and a nomogram was established based on the model. The discrimination and calibration abilities of the nomogram were evaluated using the Hosmer-Lemeshow test and calibration curves. Decision curve analysis (DCA) was used to evaluate the net benefit of predictive efficacy. RESULTS Multivariate logistic analysis indicated that the initial Tinnitus Handicapped Inventory score (odds ratio [OR]: 1.13 [1.07-1.19], P < .001) and treatment duration (OR: 3.4 [1.34-8.62], P < .001) were positive factors for improved tinnitus. The nomogram model that included baseline Tinnitus Handicapped Inventory score and treatment duration achieved a better concordance index of 0.880. DCA revealed that the nomogram model could lead to net benefits and exhibited a wider range of threshold probabilities for the prediction of therapeutic effects. CONCLUSION Our study suggests that the nomogram model, including baseline Tinnitus Handicapped Inventory score and treatment duration, could achieve optimal performance in the preoperative prediction of the therapeutic effect of modified tinnitus-relieving sound.
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Affiliation(s)
- Dantong Gu
- Clinical Research Unit of Eye, ENT Hospital, Fudan University, Shanghai, PR China
| | - Lingjie Wu
- Department of Otorhinolaryngology, ENT Institute, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, PR China
| | - Dongmei Tang
- Department of Otorhinolaryngology, ENT Institute, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, PR China
- Shanghai ZEHNIT Medical Technology Co., Ltd., Shanghai, PR China
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Lee HY, Jung DJ. Recent Updates on Tinnitus Management. J Audiol Otol 2023; 27:181-192. [PMID: 37872753 PMCID: PMC10603282 DOI: 10.7874/jao.2023.00416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/25/2023] Open
Abstract
In this comprehensive review, we discuss recent updates on tinnitus evaluation and treatment. Tinnitus evaluation commences with comprehensive medical history taking and audiological evaluation, which can provide valuable insight into the nature and extent of auditory disturbances. Additionally, tinnitus evaluation includes investigation of psychosomatic comorbidities to determine the intricate interplay between psychological factors and tinnitus perception. Various therapeutic approaches are available to minimize the burden of tinnitus. Cognitive behavioral therapy reshapes negative thought patterns and behaviors that are closely associated with tinnitus-induced distress. Acceptance and commitment therapy fosters mindfulness and value-aligned actions to address emotional effects. Tinnitus retraining therapy combines counseling and sound therapy for habituation. Tailor-made notched music therapy offers customized auditory experiences for symptom relief. Hearing aids and cochlear implants compensate for hearing loss and associated stress. Both neuromodulation and neurofeedback may be potentially useful. The role of pharmacotherapy and dietary supplements remains uncertain. Physiotherapy and head-neck manipulation relieve tinnitus associated with orofacial factors. Virtual reality, smartphone applications, and photobiomodulation may serve as novel therapeutic avenues. Although promising interventions are available, further research is warranted to confirm their effectiveness and long-term effects.
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Affiliation(s)
- Ho Yun Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Ewha Womans University School of Medicine, Seoul, Korea
| | - Da Jung Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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Rodriguez CR, Piccirillo JF, Rodebaugh TL. Acceptability of Cognitive Behavioral Therapy for Tinnitus: A Study With Veterans and Nonveterans. Am J Audiol 2023; 32:593-603. [PMID: 37566882 PMCID: PMC10558150 DOI: 10.1044/2023_aja-23-00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/18/2023] [Accepted: 05/25/2023] [Indexed: 08/13/2023] Open
Abstract
PURPOSE Cognitive behavioral therapy (CBT) is a gold standard yet underutilized treatment for tinnitus, and tinnitus is especially highly prevalent among veterans. The aims of this study were twofold: to determine (a) if CBT for tinnitus is underutilized because participants find it less acceptable than other behavioral treatments for tinnitus and (b) if veterans and nonveterans rate behavioral treatments for tinnitus differently. METHOD This cross-sectional study was conducted online with a sample of 277 adults in the United States who self-reported at least some level of bothersome tinnitus in the past week. The sample for this study consisted of 129 veterans and 148 nonveterans. Participants read descriptions of CBT, tinnitus retraining therapy (TRT), and mindfulness-based stress reduction (MBSR). For each treatment, presented to them in random order, they provided credibility, expectancy, and acceptability ratings. RESULTS Among 277 participants, 147 (53.07%) reporting gender were women, 216 (77.98%) reporting race/ethnicity were White, and 129 (46.57%) were veterans of any branch of the U.S. Armed Forces. Veteran ratings of credibility, expectancy, and acceptability were significantly lower than nonveteran ratings across treatments. There were differences in credibility, expectancy, and acceptability ratings across treatments, and post hoc testing revealed that TRT was consistently rated higher than CBT or MBSR. CONCLUSIONS Despite strong research support, CBT was rated as less acceptable than a different, less widely empirically supported treatment. Veterans' ratings of acceptability were lower than those of nonveterans across all treatments.
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Affiliation(s)
- Chavez R. Rodriguez
- Department of Psychiatry, University of Michigan, Ann Arbor
- Addiction Center, University of Michigan, Ann Arbor
| | - Jay F. Piccirillo
- Clinical Outcomes Research Office, Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St. Louis, MO
| | - Thomas L. Rodebaugh
- Department of Psychological & Brain Sciences, Washington University in St. Louis, MO
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Sanfins MD, Donadon C, Gos E, Serra AP, Rezende A, Ferrazoli N, Skarżyński PH. Skarzynski Tinnitus Scale: Cultural Adaptation and Validation to Brazilian Portuguese. Int Arch Otorhinolaryngol 2023; 27:e400-e406. [PMID: 37564479 PMCID: PMC10411171 DOI: 10.1055/s-0042-1742351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/03/2021] [Indexed: 08/12/2023] Open
Abstract
Introduction Tinnitus is a prevalent condition among many different populations. Since tinnitus is subjective, self-report questionnaires are one way of assessing how much the condition interferes with the quality of life of an individual. Objective The aim of the present study was to translate and cross-culturally adapt the Skarzynski Tinnitus Scale (STS) into Brazilian Portuguese and validate its psychometric properties. Methods The STS was translated and cross-culturally adapted using five main steps. Fifty-eight individuals who had continuous tinnitus were invited to complete the questionnaire. Pure tone audiometry (air and bone conduction) were also done. Results No major changes were necessary in translating the scale. The overall score was 1.3 (range 0-4). Internal consistency was tested by Cronbach α, which ranged from 0.54 to 0.85. Differences between genders and between subscales and the total score were not significant. A statistically significant difference was only found in the coping subscale, in which normal hearing subjects had higher scores than those with hearing loss. Conclusion The translation and adaptation of the STS established linguistic and cultural equivalence with the original. In addition, it exhibited good internal consistency. Our results suggest that the STS is suitable for use in a clinical setting.
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Affiliation(s)
- Milaine Dominici Sanfins
- Postgraduate Program in Audiology, Albert Einstein Instituto Israelita de Ensino e Pesquisa, São Paulo, SP, Brazil
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Caroline Donadon
- Postgraduate Program in Child and Adolescent Health, Universidade de Campinas, Campinas, SP, Brazil
| | - Elżbieta Gos
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Ana Paula Serra
- Department of Otorhinolaryngology, Clínica Ouvire, Campinas, SP, Brazil
| | - Adriano Rezende
- Department of Otorhinolaryngology, Clínica Ouvire, Campinas, SP, Brazil
| | - Natalia Ferrazoli
- Postgraduate Program in Health, Interdisciplinary Practice and Rehabilitation School of Medical Sciences, Campinas, SP, Brazil
- Departament of Audiology, Clinica Ouvire, Campinas, SP, Brazil
| | - Piotr Henryk Skarżyński
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
- Department of Heart Failure and Cardiac Rehabilitation, Institute of Sensory Organs, Warsaw, Poland
- Department of Otorhinolaryngology, Institute of Sensory Organs, Kajetany, Poland
- ENT Departament, Maria Curie-Sklodowska University, Lublin, Poland
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12
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Tang D, Wang J, Yu X, Yu H. The clinical effects of modified tinnitus relieving sound (MTRS) for chronic tinnitus: protocol for a randomized controlled trial. Trials 2023; 24:372. [PMID: 37268971 DOI: 10.1186/s13063-023-07389-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/18/2023] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION Chronic subjective tinnitus has become an increasingly serious hazard that affects the health-related quality of life for millions of people. Due to the lack of curative treatment strategies, this study aims to introduce a novel acoustic therapy named the modified tinnitus relieving sound (MTRS) for tinnitus and to evaluate the efficacy of MTRS in comparison with unmodified music (UM) which served as a control. METHODS AND ANALYSIS A randomized, double-blinded, controlled, clinical trial will be carried out. Sixty-eight patients with subjective tinnitus will be recruited and randomly allocated into two groups in 1:1 ratio. The primary outcome is Tinnitus Handicapped Inventory (THI); the secondary outcomes are the Hospital Anxiety and Distress Scale (HADS; HADS subscales for Anxiety (HADS-A) and Depression (HADS-D)), Athens Insomnia Scale (AIS), the visual analog scale (VAS) for tinnitus, and tinnitus loudness matched by sensation level (SL). Assessment will be performed at baseline and at 1, 3, 9, and 12 months post-randomization. The sound stimulus will be persistent until 9 months after randomization, and be interdictory in the last three months. Data collected during the intervention process will be analyzed and compared to baseline. ETHICS AND DISSEMINATION This trial received ethical approval from the Institutional Review Board (IRB) of Eye & ENT Hospital of Fudan University (No. 2017048). The study results will be disseminated via academic journals and conferences. FUNDING This study is supported by the Shanghai Shenkang Development Program (SHDC12019119), the Excellent Doctors-Excellent Clinical Researchers Program (SYB202008), the Shanghai Rising-Star Program (23QC1401200), the Shanghai Rising Stars of Medical Talent Youth Development Program (2021-99), the National Natural Science Foundation of China (81800912), and the National Natural Science Foundation of Shanghai (21ZR1411800). TRIAL REGISTRATION ClinicalTrials.gov NCT04026932. Registered on 18 July 2019.
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Affiliation(s)
- Dongmei Tang
- ENT Institute and Otorhinolaryngology Department of Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200031, People's Republic of China.
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, 200031, People's Republic of China.
| | - Jinghan Wang
- ENT Institute and Otorhinolaryngology Department of Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200031, People's Republic of China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, 200031, People's Republic of China
| | - Xiaopei Yu
- ENT Institute and Otorhinolaryngology Department of Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200031, People's Republic of China
| | - Huiqian Yu
- ENT Institute and Otorhinolaryngology Department of Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, 200031, People's Republic of China.
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, 200031, People's Republic of China.
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Chhaya V, Patel D, Shethia F, Manchaiah V, Khambholja K. Current Therapeutic Trends for Tinnitus Cure and Control: A Scoping Review. Indian J Otolaryngol Head Neck Surg 2023:1-9. [PMID: 37362110 PMCID: PMC10237063 DOI: 10.1007/s12070-023-03910-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
The present scoping review assessed knowledge updates in tinnitus management. We included randomized trials, non-randomized studies, systematic reviews, meta-analyses, and observational studies in last 5 years on patients with tinnitus using Population, Concept, and Context mnemonic. We excluded studies on tinnitus epidemiology, technique-specific comparative studies for tinnitus assessment, review articles, or case reports. We used an artificial intelligence-powered tool MaiA for overall workflow management. Data charting elements included study identifiers, study design, population, interventions used, their outcomes on tinnitus scales, and treatment recommendations if any. Charted data from selected sources of evidence was presented using tables and a concept map. We also identified five evidence-based clinical practice guidelines (CPGs) [from the United States, Europe, and Japan regions] in our review of total 506 results, 205 underwent screening based on eligibility criteria and 38 were included for the final charting. We found three major categories of interventions in our review: Medical technology therapies; Behavioural/habituation therapies; and Pharmacological, herbal/complementary, and alternative medicine therapies. Although evidence-based guidelines on tinnitus therapy did not recommend stimulation therapies, majority of the tinnitus research to date is focused on stimulation. It is highly recommended that clinicians consider CPGs when making treatment recommendations and make the distinction between established management approaches with good evidence and emerging treatment approaches for tinnitus management. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03910-2.
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Affiliation(s)
| | - Divya Patel
- Genpro Research Pvt Ltd, Baroda, Gujarat India
| | | | - Vinaya Manchaiah
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado Hospital, Aurora, CO USA
| | - Kapil Khambholja
- Genpro Research Pvt Ltd, Baroda, Gujarat India
- Genpro Research Inc, Boston, USA
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14
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Langguth B, Kleinjung T, Schlee W, Vanneste S, De Ridder D. Tinnitus Guidelines and Their Evidence Base. J Clin Med 2023; 12:jcm12093087. [PMID: 37176527 PMCID: PMC10178961 DOI: 10.3390/jcm12093087] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/17/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Evidence-based medicine (EBM) is generally accepted as the gold standard for high-quality medicine and, thus, for managing patients with tinnitus. EBM integrates the best available scientific information with clinical experience and patient values to guide decision-making about clinical management. To help health care providers and clinicians, the available evidence is commonly translated into medical or clinical guidelines based on a consensus. These involve a systematic review of the literature and meta-analytic aggregation of research findings followed by the formulation of clinical recommendations. However, this approach also has limitations, which include a lack of consideration of individual patient characteristics, the susceptibility of guideline recommendations to material and immaterial conflicts of interest of guideline authors and long latencies till new knowledge is implemented in guidelines. A further important aspect in interpreting the existing literature is that the absence of evidence is not evidence of absence. These circumstances could result in the decoupling of recommendations and their supporting evidence, which becomes evident when guidelines from different countries differ in their recommendations. This opinion paper will discuss how these weaknesses can be addressed in tinnitus.
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Affiliation(s)
- Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
- Interdisciplinary Tinnitus Clinic, University of Regensburg, 93053 Regensburg, Germany
| | - Tobias Kleinjung
- Department of Otorhinolaryngology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
- Interdisciplinary Tinnitus Clinic, University of Regensburg, 93053 Regensburg, Germany
- Institute for Information and Process Management, Eastern Switzerland University of Applied Sciences, 9001 St. Gallen, Switzerland
| | - Sven Vanneste
- Trinity Institute for Neuroscience, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, D02 PN40 Dublin, Ireland
- School of Psychology, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Dirk De Ridder
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin 9016, New Zealand
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15
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Grundfast KM, Jamil TL. Evaluation and Management of Tinnitus: Are There Opportunities for Improvement? Otolaryngol Head Neck Surg 2023; 168:45-58. [PMID: 35349391 DOI: 10.1177/01945998221088286] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/02/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review current information about diagnosis and management of tinnitus aiming to identify opportunities for achieving a cost-effective, efficient, evidence-based approach that meets the needs of tinnitus sufferers. DATA SOURCES PubMed/MEDLINE. REVIEW METHODS In total, 249 relevant published reports were reviewed. Pertinent keywords and MeSH terms identified reports via PubMed and EMBASE. Acknowledged experts were consulted on ways to improve tinnitus management. CONCLUSIONS There may be opportunities to improve evaluation and management of patients with tinnitus using modern modes of communication and a multidisciplinary therapeutic approach. IMPLICATIONS FOR PRACTICE Tinnitus can adversely affect quality of life while being time-consuming and costly to evaluate and manage. Based on both personal experience and the reports of others, patients with tinnitus who choose to see a physician primarily want to know two things: (1) that the tinnitus that is so distressing will not remain at the same level of severity forever and (2) that something can be done to help cope with the tinnitus that is so annoying. Recent advancements in internet communications, social media, information technology, artificial intelligence, machine learning, holistic medical care, mind-body integrative health care, and multidisciplinary approaches in medical therapeutics may be possibly making new ways of meeting the needs of patients with tinnitus.
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Affiliation(s)
- Kenneth M Grundfast
- Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Otology Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Taylor L Jamil
- Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, Massachusetts, USA
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Yuan H, Lu PH, Chen JW, Ma PW, Wang WL, Ding XR, Lun YQ, Gao W, Lu LJ. Correlation between clinical characteristics and tinnitus severity in tinnitus patients of different sexes: an analytic retrospective study. Eur Arch Otorhinolaryngol 2023; 280:167-173. [PMID: 35701540 DOI: 10.1007/s00405-022-07480-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/30/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE This study aimed to explore whether sex is influences tinnitus severity and whether the risk factors for tinnitus severity are the same in tinnitus patients of different sexes. METHODS This was a retrospective study of data from 1427 patients complaining of tinnitus in a local hospital otolaryngology clinic from November 2019 to January 2022. All patients were interviewed and assessed by otoscopy, pure-tone audiometry, tinnitus handicap inventory (THI), visual analogue scale (VAS), and tinnitus refinement test. RESULTS THI values were higher in females than in males (P = 0.00). Types of tinnitus sounds (OR 0.667, P = 0.000) and degree of hearing loss (OR 1.318, P = 0.000) were risk factors for tinnitus severity in males. Types of tinnitus sounds (OR 0.789, P = 0.005), sensation level (OR 1.023, P = 0.037), tinnitus types (OR 1.163, P = 0.041), tinnitus location (OR 1.198, P = 0.026), and the degree of hearing loss (OR 1.303, P = 0.000) were risk factors for tinnitus severity in females. Sex was an influencing factor for tinnitus severity. There were different risk factors for the tinnitus severity in different sexes. CONCLUSION The risk factors for tinnitus severity differed according to sex in tinnitus patients, and the risk factors for tinnitus severity were greater in women than in men. These findings add to the literature on sex differences in tinnitus and suggest that medical and psychological screening of affected individuals and customized tinnitus treatment for each individual with tinnitus are needed. TRIAL REGISTRATION NUMBER/DATE OF REGISTRATION ChiCTR2200057958, 2022/3/24 (retrospectively registered trials).
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Affiliation(s)
- Hao Yuan
- Department of Otolaryngology Head and Neck Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Pei-Heng Lu
- Department of Otolaryngology Head and Neck Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jia-Wei Chen
- Department of Otolaryngology Head and Neck Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Peng-Wei Ma
- Department of Otolaryngology Head and Neck Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Wei-Long Wang
- Department of Otolaryngology Head and Neck Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Xue-Rui Ding
- Department of Otolaryngology Head and Neck Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yu-Qiang Lun
- Department of Otolaryngology Head and Neck Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Wei Gao
- Department of Otolaryngology Head and Neck Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Lian-Jun Lu
- Department of Otolaryngology Head and Neck Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
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Efficacy of Tailor-Made Notched Music Training Versus Tinnitus Retraining Therapy in Adults With Chronic Subjective Tinnitus: A Randomized Controlled Clinical Trial. Ear Hear 2022:00003446-990000000-00083. [PMID: 36534646 DOI: 10.1097/aud.0000000000001318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Chronic subjective tinnitus can have a serious effect on daily life, even causing serious psychological disorders. Currently there are no specific effective solutions or cures. Tailor-made notched music training (TMNMT) is a recently proposed sound therapy that has simpler processes and a higher compliance rate than tinnitus retraining therapy (TRT), a widely used treatment for chronic subjective tinnitus. This study explores the therapeutic effect of TMNMT in comparison to TRT to highlight its clinical value. DESIGN The study was a randomized controlled, single-blinded clinical trial. One hundred twenty eligible participants were randomly assigned to receive TMNMT (n = 60) or TRT (n = 60) for 3 mo with concurrent follow-up. It should be noted that the duration of sound treatment in TRT was modified to 2 hr per day for better feasibility in practice. The primary outcome was mean change in tinnitus handicap inventory (THI) measured at baseline ( T0 ), 1 mo ( T1 ) and 3 mo ( T2 ) after intervention. Change in visual analog scale (VAS) was measured as a secondary outcome. A comparison of therapeutic effectiveness between TMNMT and TRT was evaluated by repeated measure analysis of variance. RESULTS One hundred and twelve (93%) of participants took part in the study, of which 64 were men and 48 women. Mean (SD) age was 42.80 (12.91) years. Fifty-eight were allocated to receive TMNMT and 54 to receive TRT. The between-group difference in primary outcome was -6.90 points (95% confidence interval [CI], -13.53 to -0.27) at T1 and -6.17 points (95% CI, -13.04 to 0.71) at T2 . These results closely reached to clinical significance of tinnitus-related effective relief. For the secondary outcome, the mean value in the TMNMT group was 0.83 points (95% CI, 0.12 to 1.54), significantly lower than the mean value of the TRT group. The differences in THI and VAS between the two groups were statistically significant after intervention. Further analysis showed that age and baseline THI and VAS scores were associated with change in THI and VAS scores after interventions. CONCLUSIONS Both TMNMT and TRT were able to alleviate chronic subjective tinnitus effectively after a 3 month intervention. When the two forms of therapy were compared TMNMT appeared to be more effective and consequently potentially superior to TRT for reducing tinnitus loudness and functional and emotional disturbance associated with chronic subjective tinnitus.
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Molnár A, Mavrogeni P, Tamás L, Maihoub S. Correlation Between Tinnitus Handicap and Depression and Anxiety Scores. EAR, NOSE & THROAT JOURNAL 2022:1455613221139211. [PMID: 36346819 DOI: 10.1177/01455613221139211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This study aimed to analyse the correlation between depression, anxiety, and tinnitus handicap in patients with primary tinnitus. METHODS A total of 102 patients (41 men, 61 women; mean age ± SD: 56.8 ± 11.6 years) were examined. They completed the Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI), and Symptom-Checklist-90-Revised (SCL-90-R). Correlations were analysed using Pearson's and Spearman's tests. Logistic regression analysis was performed. RESULTS The demographic data suggested a slight female predominance. The THI questionnaires indicated a worsening handicap in 73.5% of the patients, of which the 'mild' category was the most frequent, followed by severe handicaps. According to BDI, 69.6% of individuals fell in the normal category, with mild cases being the most frequent. Of the two psychiatric symptoms, depression (BDI) and tinnitus were strongly correlated (rho= 0.579, P < .0001*). The correlation was also significant according to the SCL-90-R depression questions (rho= 0.523, P < .0001*). Upon comparing the depressive scores and the THI subscores (i.e., functional, emotional, and catastrophic), each showed a significant correlation, with the strongest correlation with functional and emotional scores. The correlation with anxiety was slightly weaker (rho= 0.480, P < .0001*) but also significant. According to the Kaplan-Meier curves and logistic regression, the appearance of depressive symptoms did not significantly influence the appearance of a worsening handicap [P = .428; OR: 1.124 (95% CI: 0.842-1.501)]. However, a worsening handicap significantly influenced the appearance of depressive symptoms [P < .0001*; OR: 1.35 (95% CI: 1.34-4.86)], indicating that tinnitus has a more expressed effect on the appearance of depressive symptoms than reversed. CONCLUSIONS The correlation between tinnitus handicap and psychiatric comorbidities indicates the importance of psychological factors in tinnitus management. Tinnitus handicap has a more profound effect on depression scores. To avoid the occurrence of comorbidities, tinnitus handicaps must be reduced.
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Affiliation(s)
- András Molnár
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | | | - László Tamás
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Voice, Speech and Swallowing Therapy, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| | - Stefani Maihoub
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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Searchfield GD, Sanders PJ. A randomized single-blind controlled trial of a prototype digital polytherapeutic for tinnitus. Front Neurol 2022; 13:958730. [PMID: 35989940 PMCID: PMC9389120 DOI: 10.3389/fneur.2022.958730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This randomized single-blind controlled trial tested the hypothesis that a prototype digital therapeutic developed to provide goal-based counseling with personalized passive and active game-based sound therapy would provide superior tinnitus outcomes, and similar usability, to a popular passive sound therapy app over a 12 week trial period. Methods The digital therapeutic consisted of an app for iPhone or Android smartphone, Bluetooth bone conduction headphones, neck pillow speaker, and a cloud-based clinician dashboard to enable messaging and app personalization. The control app was a popular self-help passive sound therapy app called White Noise Lite (WN). The primary outcome measure was clinically meaningful change in Tinnitus Functional Index (TFI) between baseline and 12 weeks of therapy. Secondary tinnitus measures were the TFI total score and subscales across sessions, rating scales and the Client Oriented Scale of Improvement in Tinnitus (COSIT). Usability of the US and WN interventions were assessed using the System Usability Scale (SUS) and the mHealth App Usability Questionnaire (MAUQ). Ninety-eight participants who were smartphone app users and had chronic moderate-severe tinnitus (>6 months, TFI score > 40) were enrolled and were randomly allocated to one of the intervention groups. Thirty-one participants in the USL group and 30 in the WN group completed 12 weeks of trial. Results Mean changes in TFI for the USL group at 6 (16.36, SD 17.96) and 12 weeks (17.83 points, SD 19.87) were clinically meaningful (>13 points reduction), the mean change in WN scores were not clinically meaningful (6 weeks 10.77, SD 18.53; 12 weeks 10.12 points, SD 21.36). A statistically higher proportion of USL participants achieved meaningful TFI change at 6 weeks (55%) and 12 weeks (65%) than the WN group at 6 weeks (33%) and 12 weeks (43%). Mean TFI, rating and COSIT scores favored the US group but were not statistically different from WN. Usability measures were similar for both groups. Conclusions The USL group demonstrated a higher proportion of responders than the WN group. The usability of the USL therapeutic was similar to the established WN app. The digital polytherapeutic demonstrated significant benefit for tinnitus reduction supporting further development.
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Affiliation(s)
- Grant D. Searchfield
- Section of Audiology, The University of Auckland, Auckland, New Zealand
- Eisdell Moore Centre, The University of Auckland, Auckland, New Zealand
- *Correspondence: Grant D. Searchfield
| | - Philip J. Sanders
- Section of Audiology, The University of Auckland, Auckland, New Zealand
- Eisdell Moore Centre, The University of Auckland, Auckland, New Zealand
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20
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Henry JA, Carlson KF, Theodoroff S, Folmer RL. Reevaluating the Use of Sound Therapy for Tinnitus Management: Perspectives on Relevant Systematic Reviews. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2327-2342. [PMID: 35619049 DOI: 10.1044/2022_jslhr-21-00668] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Tinnitus is a highly prevalent condition that can severely reduce health functioning. In spite of extant clinical practice guidelines (CPGs), implementation of these CPGs is relatively uncommon. As a result, patients seeking professional services for tinnitus often have no assurance of receiving evidence-based care. The purpose of this tutorial was to clarify the evidence for sound therapy so that it may be included in future CPGs for tinnitus. METHOD "Best clinical evidence" is obtained from high-quality systematic reviews, which are generally considered the highest level of evidence. Our review of recent, comprehensive, high-quality systematic reviews of interventions for tinnitus concludes that cognitive behavioral therapy is the only effective intervention, though the strength of evidence was generally rated as low in these reviews. Although trials of sound therapy for tinnitus have been included in these reviews, they have been rated as having high risk of bias (RoB) and not included in syntheses or rated as insufficient strength of evidence. RESULTS Conclusions from these and other reviews have influenced recommendations made in CPGs for tinnitus. These conclusions, however, can make it appear that an intervention for tinnitus is not effective, even if the opposite is true. We contend that the strict inclusion criteria for these reviews are counterproductive and have the effect of obscuring decades of evidence demonstrating the clinical effectiveness of sound therapies for tinnitus. Ultimately, this process has resulted in many patients not receiving sound therapy, despite what should be sufficient evidence that this is an effective form of intervention. CONCLUSION If we rely on systematic reviews using contemporary RoB assessment criteria for studies published prior to these reporting guidelines, then we risk excluding important conclusions regarding interventions that could help patients in need.
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Affiliation(s)
- James A Henry
- VA RR&D National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, OR
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Kathleen F Carlson
- VA RR&D National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, OR
- School of Public Health, Oregon Health & Science University, Portland
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, OR
| | - Sarah Theodoroff
- VA RR&D National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, OR
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Robert L Folmer
- VA RR&D National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, OR
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, OR
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Pros and cons in tinnitus brain: Enhancement of global connectivity for alpha and delta waves. Prog Neuropsychopharmacol Biol Psychiatry 2022; 115:110497. [PMID: 34922998 DOI: 10.1016/j.pnpbp.2021.110497] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/04/2021] [Accepted: 12/12/2021] [Indexed: 12/17/2022]
Abstract
Interactions among cortical areas of tinnitus brain remained unclear. Weaker alpha and stronger delta activities in tinnitus have been noted over auditory cortices. However, the interplay between a single substrate with whole brain within alpha/delta band remained unknown. Thirty-one patients with chronic tinnitus were recruited. Thirty-four healthy volunteers served as controls. Magnetoencephalographic measurements of spontaneous activities were performed. The strength of alpha/delta activities was analyzed. By dividing cortices into 38 regions of interest (ROIs), measurements of connectivity were performed using amplitude envelope correlation (AEC). Global connectivity was calculated by adding and averaging connectivity of single ROI with every other region. There were no significant differences in mean power of alpha and delta band between groups, despite the trend of stronger alpha and weaker delta band in controls. The global connectivity of alpha wave was significantly stronger in tinnitus for left frontal pole, and of delta wave for bilateral pars orbitalis, bilateral superior temporal, bilateral middle temporal, right pars triangularis, right transverse temporal, right inferior temporal, and right supra-marginal. The global connectivity of alpha/delta waves was enhanced for tinnitus in designated ROIs of frontal/temporal/parietal lobes. The underlying mechanism(s) might be associated with augmentation/modulation of tinnitus perception. Our results corroborated the evolving consensus about neural correlates inside frontal/temporal/parietal lobes as essential elements of hubs for central processing of tinnitus. Further study to explore the resolution of effective connectivity between those ROIs and respective substrates by using AEC will be necessary for the evaluation of pathogenetic scenario for tinnitus.
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22
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Mazurek B, Hesse G, Dobel C, Kratzsch V, Lahmann C, Sattel H. Clinical practice guideline: Chronic tinnitus—diagnosis and treatment. DEUTSCHES ÄRZTEBLATT INTERNATIONAL 2022; 119:219-225. [PMID: 35197187 PMCID: PMC9342131 DOI: 10.3238/arztebl.m2022.0135] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/13/2022] [Accepted: 02/04/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Chronic tinnitus is a commonly occurring symptom of the auditory system. Epidemiological studies assume a lifetime prevalence in men and women of 3.5% for chronic tinnitus requiring treatment. Almost 25% of all Germans have experienced at least one episode of tinnitus. No causal therapy is yet available, but numerous treatment strategies are being pursued. Rigorous scientific assessment of these procedures is essential. METHODS For this exhaustive revision of the German clinical practice guideline, the literature in the medical databases PubMed and Cochrane Library, including existing guidelines from various countries, was systematically searched using keywords on the topic of chronic tinnitus. On the basis of the revised guideline, a separate guideline was written in language accessible to patients. RESULTS Chronic tinnitus is often associated with hearing loss, but the mental distress caused by the ear noise is another crucial element. Apart from expert counseling, the recommended treatment comprises psychotherapeutic interventions, particularly cognitive behavioral therapy (with effect sizes of 0.54 to 0.91 for reduction of the tinnitus-related distress), and measures to improve the hearing. There is insufficient evidence regarding the effects of drug treatment, sound and music therapy, and neuromodulation (magnetic stimulation or electrostimulation). CONCLUSION Alongside thorough and sound diagnosis and counseling, the principal treatment options for chronic tinnitus are specific cognitive behavioral therapy and expert psychotherapeutic interventions on an individual or group basis. Future-preferably interdisciplinary-research should evaluate the long-term effects of the treatment options, with particular attention to psychosomatic comorbidity.
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Slater PW, Duhon BH, Feldman DJ. Transtemporal Sigmoid Sinus Decompression: A Novel Surgical Procedure for the Treatment of Idiopathic Pulsatile Tinnitus. Otol Neurotol 2022; 43:328-336. [PMID: 35085110 DOI: 10.1097/mao.0000000000003469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Idiopathic pulsatile tinnitus (IPT) is associated with high patient morbidity although treatment methods remain unsatisfactory. In the present study, the transtemporal sigmoid sinus decompression is used in the treatment of idiopathic pulsatile tinnitus. STUDY DESIGN Retrospective case study. SETTING Tertiary referral center. PATIENTS From 2005 to 2020, 287 patients presented with a complaint of pulsatile tinnitus. After exclusion criteria, 25 patients were diagnosed with IPT. Those patients underwent treatment and were included in a retrospective study. INTERVENTIONS Following failed conservative therapies, the primary author performed a transtemporal sigmoid sinus decompression surgery on the patients under general anesthesia. MAIN OUTCOME MEASURES Long-term resolution of IPT was measured using the Tinnitus Handicap Inventory (THI). Outcome measurements were taken preoperatively, immediately postoperatively, three months postoperatively, and the status of all 25 patients is known at the time of this study. RESULTS Transtemporal sigmoid sinus decompression was performed on 25 patients (mean age: 51.7 years, 80.0% female). Out of the 25 patients, 23 (92.0%) patients experienced complete resolution of their IPT. Statistically significant differences based on preoperative THI (mean THI: 4.19) were evident immediately after surgery (mean THI: 1.31; p < 0.001), at 3 months postoperatively (mean THI: 1.19; p < 0.001), and over a mean follow-up time of 68.7 months (range, 3-168 months) (mean THI: 1.38; p < 0.001). Out of the two patients considered unsuccessful, Case 21 experienced a partial resolution. No major postoperative complications occurred. CONCLUSIONS Transtemporal sigmoid sinus decompression is a safe and effective surgical procedure demonstrated to give near total resolution in properly selected patients and provides long-term relief for patients with IPT.
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Affiliation(s)
- Patrick W Slater
- Department of Otology, Neurotology, and Skull Base Surgery, Austin Ear Clinic
| | - Bailey H Duhon
- Department of Otology, Neurotology, and Skull Base Surgery, Austin Ear Clinic
| | - David J Feldman
- Department of Neuroradiology, ARA Diagnostic Imaging, Austin, Texas
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Formby C, Yang X, Scherer RW. Contributions of Counseling and Sound Generator Use in Tinnitus Retraining Therapy: Treatment Response Dynamics Assessed in a Secondary Analysis of a Randomized Trial. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:816-828. [PMID: 35073492 PMCID: PMC9132149 DOI: 10.1044/2021_jslhr-21-00210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/20/2021] [Accepted: 10/19/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE Tinnitus retraining therapy (TRT) has been widely used for 30 years, but its efficacy and the component contributions from counseling and sound therapy remain controversial. The purpose of this secondary analysis from the Tinnitus Retraining Therapy Trial (TRTT) was to compare treatment response dynamics for TRT (counseling and conventional sound generators) with partial TRT (pTRT; counseling and placebo sound generators) and standard of care (SOC; a patient-centered counseling control). METHOD The TRTT randomized 151 participants with primary tinnitus (no significant hearing or sound tolerance problems) to TRT, pTRT, or SOC, each of which encouraged use of enriched environmental sound. The primary outcome, mean change in Tinnitus Questionnaire score assessed at baseline and follow-up across 18 months, was normalized for a common baseline and fitted with an exponential model. Time constants were estimated to quantify and compare the treatment response dynamics, which were evaluated for statistical significance using bootstrap analyses. RESULTS The change in response to TRT took less time to achieve than that for either pTRT or SOC, as demonstrated by time for normalized Tinnitus Questionnaire scores to decline to 63% and 99% of baseline TRT values: 1.2 months (95% CI [0.2, 1.9]) and 5.7 months (95% CI [0.9, 9.0]), respectively. Corresponding SOC values were 2.7 months (95% CI [1.5, 4.1]) and 12.4 months (95% CI [6.9, 19.0]), while those for pTRT were 2.2 months (95% CI [1.2, 3.4]) and 10.1 months (95% CI [5.7, 15.9]). The differences were significant for TRT versus SOC (p = .020), borderline significant for TRT versus pTRT (p = .057), but nonsignificant for pTRT versus SOC (p = .285). The magnitude of the asymptotic treatment response did not differ significantly among groups. CONCLUSION Sound generator use in TRT increases treatment efficiency (beyond any advantage from enriched environmental sound) without affecting treatment efficacy (determined by counseling).
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Affiliation(s)
- Craig Formby
- Emeritus, Department of Communicative Disorders, University of Alabama, Tuscaloosa
| | - Xin Yang
- The Culverhouse College of Business, University of Alabama, Tuscaloosa
| | - Roberta W. Scherer
- Retired from Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Liu H, Zhang J, Yang S, Wang X, Zhang W, Li J, Yang T. Efficacy of sound therapy interventions for tinnitus management: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2021; 100:e27509. [PMID: 34731137 PMCID: PMC8519222 DOI: 10.1097/md.0000000000027509] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/08/2021] [Accepted: 09/24/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Tinnitus is a common otological symptom and can be debilitating. Sound therapy has increased in popularity due to its potential for increased efficacy and fewer and milder side effects, but the available evidence is limited by the lack of randomized controlled trials comparing different sound therapies for tinnitus. Network meta-analysis (NMA) is a useful tool to compare multiple treatments when there is limited or no direct evidence available. The aim of this paper is to evaluate the efficacy and acceptability of different sound therapies for tinnitus. METHODS AND ANALYSIS A literature search was conducted to identify articles in EMBASE, PubMed/MEDLINE, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Literature, and Wanfang and Weipu from inception to April 1, 2021. The Tinnitus Handicap Inventory, Tinnitus Questionnaire, and effective rate were used to assess perceived tinnitus suppression after treatment. We used Review Manager 5.4 for the standard meta-analysis; R 4.0.4 and Stata 15.1 were used for the NMA and the publication bias and sensitivity analyses. RESULTS The effect estimates of the direct comparisons (when available) were very similar to those of the NMA. Overall, sound stimulation alone performed better than medication alone, educational consultation alone, and no treatment. Combination therapy, such as sound stimulation plus educational consultation and sound stimulation plus drug therapy, yielded significantly better outcomes with regard to the alleviation of tinnitus than individual treatments. CONCLUSION This is the first NMA to evaluate and compare the effectiveness of different sound therapies for the management of tinnitus. It may help inform the selection of sound therapy and the development of guidelines in clinical practice. Future studies of sound therapy with larger sample sizes involving multiple medical centers are needed to improve the current evidence.
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Affiliation(s)
- Hui Liu
- Department of Otolaryngology, Shaanxi Provincial People's Hospital, China
| | - Jin Zhang
- Department of Otolaryngology, Shaanxi Provincial People's Hospital, China
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Schubert NMA, Rosmalen JGM, van Dijk P, Pyott SJ. A retrospective cross-sectional study on tinnitus prevalence and disease associations in the Dutch population-based cohort Lifelines. Hear Res 2021; 411:108355. [PMID: 34607212 DOI: 10.1016/j.heares.2021.108355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/14/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
Tinnitus is a highly prevalent disorder with heterogenous presentation and limited treatment options. Better understanding of its prevalence and disease and lifestyle risk factor associations in the general population is necessary to identify the underlying mechanisms. To this end, we quantified the prevalence of tinnitus and identified disease and lifestyle risk factors associated with tinnitus within a general population cohort. For this study, we used the Lifelines population-based cohort study to perform a retrospective cross-sectional study. Lifelines is a large, multi-generational, prospective cohort study that includes over 167,000 participants (or 10% of the population) from the northern Netherlands. For this study, conducted between 2018 and 2021, data from the Lifelines population-based cohort study was used to perform a cross-sectional study. Adult participants (age ≥ 18 years) with data on tinnitus perception (collected once between 2011 and 2015) were included in this study. An elastic-net regression analysis was performed with tinnitus as the dependent variable and parameters of diseases and lifestyle risk factors (collected once between 2006 and 2014)-including hearing problems, cardiovascular disease, metabolic disorders, psychiatric disorders, thyroid disease, inflammatory disease, and functional somatic syndromes-as the independent variables. Among 124,609 participants, N = 8,011 (6.4%) reported perceiving tinnitus constantly (CT: constant tinnitus) and N = 39,625 (31.8%) reported perceiving tinnitus constantly or occasionally (AT: any tinnitus). Our analysis identified 38 parameters that were associated with AT and 48 parameters that were associated with CT. Our study identified established disease associates with tinnitus, including problems with hearing (OR 8.570 with CT), arrythmia (OR 1.742 with CT), transient ischemic attack (OR 1.284 with AT), diabetes mellitus (OR 1.014 with AT) and psychiatric disorders, including major depressive disorder (OR 1.506 with CT). Factors related to lifestyle associated with tinnitus included waist-hip ratio (OR 1.061 with CT) and smoking (OR 1.028 with AT). Novel disease associates with CT were identified for inflammatory diseases, including rheumatoid arthritis (OR 1.297) and ulcerative colitis (OR 1.588), thyroid disease (as evidenced by the use of thyroid medication) (OR 1.298), and functional somatic syndromes, including chronic fatigue syndrome (OR 1.568). In addition to validating established disease associates in a general population cohort, this study identified novel associations with tinnitus and several disease categories, including functional somatic syndromes, inflammatory diseases, and thyroid disease. Future work will be necessary to identify whether (common) mechanisms underly tinnitus and these associated disorders. Lifelines is an important new resource available for future studies investigating tinnitus in the general population.
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Affiliation(s)
- Nick M A Schubert
- University of Groningen, University Medical Center Groningen, Dept. of Otorhinolaryngology / Head and Neck Surgery, the Netherlands; Graduate School of Medical Sciences Research School of Behavioral and Cognitive Neurosciences, University of Groningen, the Netherlands
| | - Judith G M Rosmalen
- University of Groningen, University Medical Center Groningen, Dept. of Internal Medicine, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Dept. of Psychiatry, Groningen, the Netherlands
| | - Pim van Dijk
- University of Groningen, University Medical Center Groningen, Dept. of Otorhinolaryngology / Head and Neck Surgery, the Netherlands; Graduate School of Medical Sciences Research School of Behavioral and Cognitive Neurosciences, University of Groningen, the Netherlands
| | - Sonja J Pyott
- University of Groningen, University Medical Center Groningen, Dept. of Otorhinolaryngology / Head and Neck Surgery, the Netherlands; Graduate School of Medical Sciences Research School of Behavioral and Cognitive Neurosciences, University of Groningen, the Netherlands.
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Gilles A, Jacquemin L, Cardon E, Vanderveken OM, Joossen I, Vermeersch H, Vanhecke S, Van den Brande K, Michiels S, Van de Heyning P, Van Rompaey V. Long-term effects of a single psycho-educational session in chronic tinnitus patients. Eur Arch Otorhinolaryngol 2021; 279:3301-3307. [PMID: 34596715 DOI: 10.1007/s00405-021-07026-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/28/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the effects of a single psycho-educational session on tinnitus burden in chronic tinnitus patients. The session is organized at a tertiary referral center for otologic disorders at the University Hospital Antwerp as a group session (maximum of 10-15 patients a time) lasting for approximately 3-4 h. The session focusses on different aspects of tinnitus. METHODS The current manuscript reports on 96 patients who completed the Tinnitus Functional Index (TFI), Visual Analogue Scale for mean loudness (VAS), Hyperacusis Questionnaire (HQ), and the Hospital Anxiety and Depression Scale (HADS) prior to treatment and at 6-month follow-up. The TFI was chosen as the primary outcome. Paired-samples T tests were performed to evaluate therapy effect at 6-month follow-up. In addition, a logistic regression model revealed baseline TFI/VAS scores and duration of tinnitus as contributing factors to a significant decrease of the TFI. RESULTS The TFI total score showed a significant decrease (p < 0.001) at the 6-month follow-up time point. At follow-up, 75% of patients reported their tinnitus to be under control not requiring any additional treatment. The logistic regression model showed that patients with higher baseline TFI scores, lower baseline mean VAS loudness ratings, and shorter tinnitus duration were more likely to show clinically significant improvement on the TFI scale. CONCLUSIONS Tinnitus Retraining Therapy or Cognitive Behavioural Therapy are effective, though very time-consuming and expensive treatments. A single psycho-educational group session was shown to be highly effective in decreasing the tinnitus burden, which increases feasibility and cost-effectiveness. TRIAL REGISTRATION Not applicable as this is a retrospective reporting of tinnitus outcome in the daily clinical practice, not a clinical trial.
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Affiliation(s)
- Annick Gilles
- Department Translational Neuroscience, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium. .,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium. .,Department of Education, Health and Social Work, University College Ghent, Ghent, Belgium.
| | - Laure Jacquemin
- Department Translational Neuroscience, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Emilie Cardon
- Department Translational Neuroscience, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Olivier M Vanderveken
- Department Translational Neuroscience, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Iris Joossen
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Hanne Vermeersch
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Stefanie Vanhecke
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Kaat Van den Brande
- University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Sarah Michiels
- Department Translational Neuroscience, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Paul Van de Heyning
- Department Translational Neuroscience, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Vincent Van Rompaey
- Department Translational Neuroscience, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium
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Choi JH, Park SS, Kim SY. Associations of Earphone Use with Tinnitus and Anxiety/Depression. Noise Health 2021; 23:108-116. [PMID: 34975126 PMCID: PMC8772443 DOI: 10.4103/nah.nah_48_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objective: This study aimed to investigate the association of earphone use with audiologic and psychologic factors. Materials and methods: Korea National Health and Nutrition Examination Survey 2010–2012 data were collected for participants aged ≥12 years old with earphone use ≥1 hour/day. They were matched to a control group for age, sex, income, and education level. The relationship between earphone use and the hearing thresholds of pure-tone audiometry, tinnitus, and psychologic factors such as depression and anxiety, and other quality of life variables was analyzed using multiple logistic regression tests with complex sampling. Results: Among the participants, 22.9% (449/1955) of earphone users and 18.1% (355/1600) of control participants had tinnitus (P < 0.001). Earphone users showed 1.27-times higher odds for tinnitus (95% confidence interval [CI] = 1.09–1.50, P = 0.003). Moreover, 6.5% (128/1955) of earphone users and 5.0% (97/1600) of control participants had anxiety and depressive symptoms (P = 0.033). Earphone users showed 1.32-times higher odds for anxiety and depressive symptoms (95% CI = 1.14–1.52, P = 0.040). Nevertheless, the hearing thresholds were comparable between earphone users and control participants. Conclusion: Earphone use was associated with tinnitus and anxiety or depressive symptoms.
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Affiliation(s)
- Jay Hyug Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA University College of Medicine, Korea
| | - Sung Su Park
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA University College of Medicine, Korea
| | - So Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA University College of Medicine, Korea
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Nishimura T, Okayasu T, Yamashita A, Hosoi H, Kitahara T. Perception Mechanism of Bone-Conducted Ultrasound and Its Clinical Use. Audiol Res 2021; 11:244-253. [PMID: 34070877 PMCID: PMC8261637 DOI: 10.3390/audiolres11020022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/15/2021] [Accepted: 05/28/2021] [Indexed: 12/13/2022] Open
Abstract
It is generally believed that ultrasound cannot be heard. However, ultrasound is audible when it is presented through bone conduction. Bone-conducted ultrasound (BCU) has unique characteristics; the most interesting is its perception in patients with profound deafness. Some patients can perceive it and discriminate speech-modulated BCU. Previous reports have suggested that BCU can be used for a hearing aid or tinnitus sound therapy. In this review, the perception of BCU at both the peripheral and central levels was investigated based on previous studies, although some of them remain controversial. We also investigated the clinical use of BCU. To develop hearing aids utilizing BCU, the encoding of speech signals into BCU has to be established. The outcomes of the reported speech modulations were evaluated. Furthermore, the suppression of tinnitus by BCU was reviewed, and the feasibility of the application of BCU to tinnitus treatment was investigated.
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Affiliation(s)
- Tadashi Nishimura
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (T.O.); (A.Y.); (T.K.)
- Correspondence: ; Tel.: +81-744-22-3051
| | - Tadao Okayasu
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (T.O.); (A.Y.); (T.K.)
| | - Akinori Yamashita
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (T.O.); (A.Y.); (T.K.)
| | - Hiroshi Hosoi
- MBT (Medicine-Based Town) Institute, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan;
| | - Tadashi Kitahara
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan; (T.O.); (A.Y.); (T.K.)
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Kikidis D, Vassou E, Schlee W, Iliadou E, Markatos N, Triantafyllou A, Langguth B. Methodological Aspects of Randomized Controlled Trials for Tinnitus: A Systematic Review and How a Decision Support System Could Overcome Barriers. J Clin Med 2021; 10:1737. [PMID: 33923778 PMCID: PMC8074073 DOI: 10.3390/jcm10081737] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 12/05/2022] Open
Abstract
Although a wide range of tinnitus management interventions is currently under research and a variety of therapeutic interventions have already been applied in clinical practice, no optimal and universal tinnitus treatment has been reached yet. This fact is to some extent a consequence of the high heterogeneity of the methodologies used in tinnitus related clinical studies. In this manuscript, we have identified, summarized, and critically appraised tinnitus-related randomized clinical trials since 2010, aiming at systematically mapping the research conducted in this area. The results of our analysis of the 73 included randomized clinical trials provide important insight on the identification of limitations of previous works, methodological pitfalls or gaps in current knowledge, a prerequisite for the adequate interpretation of current literature and execution of future studies.
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Affiliation(s)
- Dimitrios Kikidis
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippokration General Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (E.V.); (E.I.); (N.M.); (A.T.)
| | - Evgenia Vassou
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippokration General Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (E.V.); (E.I.); (N.M.); (A.T.)
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, Universität Regensburg, 93053 Regensburg, Germany; (W.S.); (B.L.)
| | - Eleftheria Iliadou
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippokration General Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (E.V.); (E.I.); (N.M.); (A.T.)
| | - Nikolaos Markatos
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippokration General Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (E.V.); (E.I.); (N.M.); (A.T.)
| | - Aikaterini Triantafyllou
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippokration General Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (E.V.); (E.I.); (N.M.); (A.T.)
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, Universität Regensburg, 93053 Regensburg, Germany; (W.S.); (B.L.)
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Gold SL, Formby C, Scherer RW. The Tinnitus Retraining Therapy Counseling Protocol as Implemented in the Tinnitus Retraining Therapy Trial. Am J Audiol 2021; 30:1-15. [PMID: 33259725 DOI: 10.1044/2020_aja-20-00024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose This clinical focus article is a companion to the work of Erdman et al. (2019), in which we described the rationale, development, and implementation of the standard-of-care protocol used in the Tinnitus Retraining Therapy Trial (TRTT), a multicenter, placebo-controlled, randomized, definitive efficacy trial of tinnitus retraining therapy (TRT). We now describe the historical background, development, and standardized implementation and delivery of the TRT counseling protocol (tinnitus counseling [TC]) used in the TRTT. TC is conjectured to be the key component in the TRT protocol for initiating the habituation process that reduces the response to the tinnitus signal and, ultimately, reduces its impact. In the TRTT, participants assigned to receive TC achieved > 30% reduction in the impact of tinnitus. Method and Results The design and implementation of standardized treatments in multisite randomized controlled trials presents many challenges for investigators. Here, subsequent to presenting the background, rationale, and the TRT protocol model, we describe the development, refinement, and training/certification for standardized delivery of TC in the TRTT. The primary challenges encountered while distilling and streamlining TC for standardized delivery across multiple clinicians and their replacements at six participating military treatment centers in the TRTT are considered, and the resulting counseling protocol is detailed. Conclusions The standardized and streamlined TC used in the TRTT was successful for treating debilitating tinnitus among persons with functionally adequate unaided hearing sensitivity. The structured TC protocol described here appears to be the main determinant of the significant and sizable TRT treatment effects measured in the TRTT, thus bolstering the merits of this standardized counseling approach as one model for the clinical implementation of TRT for the treatment of primary tinnitus.
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Affiliation(s)
- Susan L. Gold
- Tinnitus & Hyperacusis Center, Department of Otolaryngology, University of Maryland Medical Center, Baltimore
| | - Craig Formby
- Department of Communicative Disorders, The University of Alabama, Tuscaloosa
| | - Roberta W. Scherer
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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孙 慧, 冯 国, 高 志. [Clinical application of sound therapy in chronic subjective tinnitus]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:282-285. [PMID: 33794620 PMCID: PMC10128241 DOI: 10.13201/j.issn.2096-7993.2021.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Indexed: 06/12/2023]
Abstract
Chronic subjective tinnitus is an auditory phantom phenomenon perceived by patients only, with no external sound source. It's a common disease and it lacks effective treatments. Sound therapy is an optional treatment which proved to reduce the tinnitus loudness and the negative effects on life. After decades of development, a wide variety of acoustic therapies have been produced, but seldom are likely to thoroughly cure tinnitus. In recent years, some new acoustic treatments based on the hypothesis of mechanisms of tinnitus, are expected to alleviate or even eliminate tinnitus.
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Affiliation(s)
- 慧颖 孙
- 中国医学科学院北京协和医学院 北京协和医院耳鼻咽喉头颈外科(北京,100730)
| | - 国栋 冯
- 中国医学科学院北京协和医学院 北京协和医院耳鼻咽喉头颈外科(北京,100730)
| | - 志强 高
- 中国医学科学院北京协和医学院 北京协和医院耳鼻咽喉头颈外科(北京,100730)
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Gourishetti SC, Carter C, Nguyen NK, Sherlock L, Eisenman DJ. Presence of hearing loss is predictive of return for further stages of tinnitus therapy following initial education and counseling. Int J Audiol 2020; 60:421-426. [PMID: 33243031 DOI: 10.1080/14992027.2020.1849830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Identify clinical factors that predict the likelihood of patients returning for further evaluation and treatment following stage 1 education and counselling in a staged tinnitus habituation program. DESIGN Retrospective cross-sectional study. Demographics, audiometric findings and Tinnitus Handicap Inventory (THI) scores were used for predictive modelling to determine the likelihood of patients returning for subsequent therapy. STUDY SAMPLES One hundred and ninety consecutive patients treated in an outpatient, staged tinnitus habituation program. RESULTS Improvements in THI scores were observed in all subjects (n = 119, d = 0.49, p < 0.001), both for those without hearing loss (n = 13, d = 0.54, p = 0.03) and those with hearing loss (n = 106, d = 0.48, p < 0.001) following Stage 1 education and counselling. Subjects with hearing loss were 14 times more likely to return for Stage 2 evaluation (p < 0.001) following completion of Stage 1 education and counselling. CONCLUSION Subjects with idiopathic subjective non-pulsatile tinnitus across all degrees of tinnitus severity benefit from group education and counselling alone. Subjects with hearing loss, irrespective of most hearing loss configurations, are more likely to return for subsequent stages of the program.
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Affiliation(s)
- Saikrishna C Gourishetti
- Department of Otorhinolaryngology Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Chelsea Carter
- Department of Otorhinolaryngology Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nicole K Nguyen
- Department of Hearing and Speech Sciences, University of Maryland College Park, College Park, MD, USA
| | - LaGuinn Sherlock
- US Army Public Health Center, Army Hearing Program and Walter Reed National Military Medical Center, Audiology and Speech Pathology Center, Bethesda, MD, USA
| | - David J Eisenman
- Department of Otorhinolaryngology Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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Meijers SM, Lieftink AF, Stegeman I, Smit AL. Coping in Chronic Tinnitus Patients. Front Neurol 2020; 11:570989. [PMID: 33329312 PMCID: PMC7717935 DOI: 10.3389/fneur.2020.570989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022] Open
Abstract
Background: Tinnitus is the perception of sound without an external stimulus. A large part of the adult population experiences this symptom but never seeks professional help, where others have devastating complaints in daily life. This suggests that the impact of tinnitus varies among patients and may be influenced by coping strategies and multiple psychological factors. Method: Cross- sectional study of patients visiting the tertiary tinnitus referral center of the University Medical Center Utrecht, the Netherlands. Three hundred and twenty-one consecutive chronic tinnitus patients were evaluated by the tinnitus care group Utrecht from 6–2007 till 11–2012 of which 308 patients were included. Patients completed two tinnitus distress questionnaires (THI, TQ), a coping questionnaire (CISS) as well as a psychopathological questionnaire (SCL-90-R). Results: Emotional-orientated coping and distraction-orientated coping strategies were significantly correlated with the experienced tinnitus burden. Also a significant negative correlation with task orientated coping was found. The effect size was small. Tinnitus distress also had a significant positive correlation with anxiety, agoraphobia, depression, insufficiency of handling, distrust & personal sensitivity, hostility and sleeping problems. Conclusion: Patients with higher tinnitus handicap scores demonstrated the use different coping strategies than the patients with lower distress scores. This insight in coping strategies in a group of patients with high tinnitus burden is useful for counseling patients. As tinnitus coping strategy might be related to the extent and success of habituation, this outcome could be of interest to optimize tinnitus treatments in the near future.
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Affiliation(s)
- Sebastiaan M Meijers
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Arno F Lieftink
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Adriana L Smit
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
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Low-Frequency Noise and Its Main Effects on Human Health—A Review of the Literature between 2016 and 2019. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10155205] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This paper summarizes the presently available knowledge about the association between low-frequency noise and its effects on health. A database was constructed with a total of 142 articles published between 2016 and 2019 regarding low-frequency noise exposure and its effects on health. A total of 39 articles were analysed in depth. The articles were divided into categories according to the effects on human health addressed. Regarding the emitting source, there was a greater number of articles addressing issues related to sources of environmental noise and noise from wind turbines. As for the effects generated on human health, there was a greater number of articles referring to the effects on sleep disorders, discomfort, sensitivity to and irritability from noise, annoyance, hearing loss, and cardiovascular diseases, and these effects are analysed in more detail in the present article.
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Scherer RW, Erdman SA, Gold S, Formby C. Treatment fidelity in the Tinnitus Retraining Therapy Trial. Trials 2020; 21:670. [PMID: 32703244 PMCID: PMC7376906 DOI: 10.1186/s13063-020-04530-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/18/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Treatment fidelity, defined as ensuring that the recipient receives the intended intervention, is a critical component for accurate estimation of treatment efficacy. Ensuring fidelity and protocol adherence in behavioral trials requires careful planning during the design phase and implementation during the trial. The Tinnitus Retraining Therapy Trial (TRTT) randomized individuals with severe tinnitus to tinnitus retraining therapy (TRT, comprised of tinnitus-specific educational counseling (TC) and sound therapy (ST) using conventional sound generators (SGs)); Partial TRT (TC and placebo SGs); or standard of care (SOC), using a patient-centered care approach. Study audiologists administered both types of counseling in the TRTT, creating a challenge for managing protocol adherence. METHODS We developed methods to enhance treatment fidelity including training, competency assessment, scripts, visual aids, and fidelity monitoring. Protocol monitors identified critical topics and content to be addressed for each type of counseling session, prepared corresponding scripts, and developed training aids and treatment-specific checklists covering those topics. Study audiologists' competency assessment required submission and review by the protocol monitors of an audiotape of one TC and one SOC counseling session. Treatment-specific aids included scripts, a 3-D model of the ear, handouts, and for TC, an illustrated flip-chart with talking points that followed the scripted content. During the trial, audiologists completed treatment-specific checklists during each counseling session, indicating topics covered/discussed and submitted audiotapes of counseling sessions. Protocol monitors reviewed audiotapes using corresponding treatment-specific checklists. Results for individual checklist items were tabulated and proportions calculated. RESULTS Twenty-five audiologists were certified for TC and/or SOC counseling and 24 completed at least one counseling session. Adherence to each of 33 critical items on the TC checklist as assessed by the protocol monitor ranged from 70 to 100% across 37 counseling sessions (median 97%), with no difference between adherence for TRT (median, 97%) and partial TRT (median, 100%). Adherence to each of 44 critical items on the SOC checklist across 30 SOC counseling sessions ranged from 42 to 100% (median, 87.5%). CONCLUSION The TRTT used multiple methods to address treatment fidelity. The close adherence to each treatment type was critical for evaluating the efficacy of the study interventions in this randomized trial. TRIAL REGISTRATION clinicaltrials.gov NCT01177137 . Registered on 5 August 2010.
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Affiliation(s)
- Roberta W Scherer
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Sue Ann Erdman
- Audiologic Rehabilitation Consulting Services, Jensen Beach, FL, USA
| | - Susan Gold
- Tinnitus and Hyperacusis Center of Maryland, Department of Otolaryngology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Craig Formby
- Department of Communicative Disorders, University of Alabama, Tuscaloosa, AL, USA
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Wang K, Tang D, Ma J, Sun S. Auditory Neural Plasticity in Tinnitus Mechanisms and Management. Neural Plast 2020; 2020:7438461. [PMID: 32684922 PMCID: PMC7349625 DOI: 10.1155/2020/7438461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/15/2020] [Accepted: 06/20/2020] [Indexed: 11/24/2022] Open
Abstract
Tinnitus, which is the perception of sound in the absence of a corresponding external acoustic stimulus, including change of hearing and neural plasticity, has become an increasingly important ailment affecting the daily life of a considerable proportion of the population and causing significant burdens for both the affected individuals and society as a whole. Here, we briefly review the epidemiology and classification of tinnitus, and the currently available treatments are discussed in terms of the available evidence for their mechanisms and efficacy. The conclusion drawn from the available evidence is that there is no specific medication for tinnitus treatment at present, and tinnitus management might provide better solutions. Therapeutic interventions for tinnitus should be based on a comprehensive understanding of the etiology and features of individual cases of tinnitus, and more high quality and large-scale research studies are urgently needed to develop more efficacious medications.
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Affiliation(s)
- Kunkun Wang
- ENT institute and Otorhinolaryngology Department of Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai 200031, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai 200031, China
| | - Dongmei Tang
- ENT institute and Otorhinolaryngology Department of Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai 200031, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai 200031, China
| | - Jiaoyao Ma
- ENT institute and Otorhinolaryngology Department of Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai 200031, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai 200031, China
| | - Shan Sun
- ENT institute and Otorhinolaryngology Department of Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai 200031, China
- NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai 200031, China
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Abstract
Device-based clinical treatments for tinnitus are predominantly sound based and include ear-level sound generators, hearing aids, cochlear implants, and tinnitus treatment devices. They are intended for patients with bothersome tinnitus. Bothersome tinnitus is characterized by problems with sleep, concentration, and mood. Most people with bothersome tinnitus have hearing loss and would benefit from amplification; however, not all patients are willing to use hearing aids. Tinnitus treatment devices are available to assist those who are not good candidates for amplification, and include devices used while sleeping and devices used for specified periods during the day.
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39
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Affiliation(s)
- Jay F Piccirillo
- Washington University School of Medicine, Department of Otolaryngology-Head & Neck Surgery, St Louis, Missouri
- Editor
| | | | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine in St Louis, Missouri
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40
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Khariwala SS, Davies L, Weinreich H, Baldassari C, McCoul E, Piccirillo JF. JAMA Otolaryngology-Head & Neck Surgery-Best of 2019. JAMA Otolaryngol Head Neck Surg 2020; 146:225-227. [PMID: 31895423 DOI: 10.1001/jamaoto.2019.4043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Louise Davies
- Geisel School of Medicine at Dartmouth, Veterans Affairs Outcomes Group, White River Junction, Vermont
| | - Heather Weinreich
- Department of Otolaryngology, University of Illinois-Chicago, Chicago
| | | | - Edward McCoul
- Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
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Sense and Sensibility: A Review of the Behavioral Neuroscience of Tinnitus Sound Therapy and a New Typology. Curr Top Behav Neurosci 2020; 51:213-247. [PMID: 33547596 DOI: 10.1007/7854_2020_183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Tinnitus Sound Therapy is not a single strategy. It consists of many different sound types, targeting many different mechanisms. Therapies that use sound to cover, reduce attention to, or facilitate habituation of tinnitus are among the most common tinnitus treatment paradigms. Recent history has seen a proliferation of sound therapies, but they have each been criticized for having limited empirical support. In this review, Sound Therapy's modern history will be described, and a typology will be introduced and discussed in light of current behavioral neuroscience research. It will be argued that contributing factors to the limited evidence for the efficacy of Sound Therapy are its diversity, plural modes of action, and absence of a clear typology. Despite gaps in understanding the efficacy of sound's effects on tinnitus, there is compelling evidence for its multiple, but related, neurophysiological mechanisms. Evidence suggests that sound may reduce tinnitus through its presence, context, reaction, and potentially adaptation. This review provides insights into the neurocognitive basis of these tinnitus Sound Therapy modes. It concludes that a unifying classification is needed to secure and advance arguments in favor of Sound Therapy.
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Delaney H, Devane D, Hunter A, Treweek S, Mills N, Gamble C, Smith V. A concept analysis of 'trial recruitment' using the hybrid model. HRB Open Res 2020; 3:92. [PMID: 35510227 PMCID: PMC9021666 DOI: 10.12688/hrbopenres.13173.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 01/18/2023] Open
Abstract
Background: The International Committee of Medical Journal Editors (ICMJE) requires trials submitted for publication to be registered before recruitment of the first participant; however, there is ambiguity around the definition of recruitment and in anchoring the trial start date, end date, and recruitment, or as often interchangeably referred to, enrolment, temporally to trial processes. There is potential for variation in how recruitment is reported and understood in trial protocols and trial reports. We report on a concept analysis of 'trial recruitment' and develop an operational definition of 'trial recruitment'. Methods: A concept analysis using the hybrid model. In Phase 1 we examined randomised and non-randomised trial reports (n=150) published between January 2018 and June 2019 to conceptually explore how recruitment was temporally aligned to the four time-points of screening/eligibility, consent, randomisation and allocation. A preliminary operational definition of 'trial recruitment' was determined. This definition was further explored, refined and finalised in Phase 2 (field work), through an interactive, discussion-focused workshop with trial recruiters and trial participants. Results: Of the 150 trial reports analysed, over half did not identify a clear time point of when recruitment took place and varying terminology is used when reporting on trial recruitment. In Phase 2, the workshop attendees agreed that the proposed definition of 'trial recruitment' offers an acceptable definition that provides a standardised approach of how trial recruitment may be temporally understood as part of overall trial processes. Conclusion: There is ambiguity around temporal descriptions of 'trial recruitment' in health care journals. Informed by the findings of this concept analysis we propose a temporal operational definition of trial recruitment based on i) trial recruitment of an individual or cluster and ii) the trial recruitment period.
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Affiliation(s)
- Hannah Delaney
- Health Research Board - Trials Methodology Research Network, National University of Ireland, Galway, Galway, Ireland
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Declan Devane
- Health Research Board - Trials Methodology Research Network, National University of Ireland, Galway, Galway, Ireland
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Andrew Hunter
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
- Qualitative Research in Trials Centre (QUESTS), National University of Ireland, Galway, Galway, Ireland
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Nicola Mills
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Carrol Gamble
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Valerie Smith
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Delaney H, Devane D, Hunter A, Treweek S, Mills N, Gamble C, Smith V. A concept analysis of 'trial recruitment' using the hybrid model - Phase 1 findings. HRB Open Res 2020; 3:92. [PMID: 35510227 PMCID: PMC9021666 DOI: 10.12688/hrbopenres.13173.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 11/20/2022] Open
Abstract
Background: The International Committee of Medical Journal Editors (ICMJE) requires trials submitted for publication to be registered before enrolment of the first participant; however, there is ambiguity around the definition of recruitment and in anchoring the trial start date, end date, recruitment and enrolment, temporally to trial processes. There is potential for variation in how recruitment is reported and understood in trial protocols and trial reports. We report on Phase 1 of a concept analysis of 'trial recruitment' and develop a preliminary operational definition of 'trial recruitment'. Methods: A concept analysis using the hybrid model. We searched randomised and non-randomised trial reports published between January 2018 and June 2019. Included studies were sourced from the five top journals in the category of medicine with the highest impact factor. We examined how recruitment was defined temporally to four time points; screening, consent, randomisation, and allocation. Results: Of the 150 trial reports analysed, over half did not identify a clear time point of when recruitment took place in relation to any of screening/consent/randomisation/allocation. The majority of the assessed trials provided a time frame in relation to the trial (i.e. start/end date), the process that this time frame referred to differed between studies. There was variation across studies in the terminology used to describe entry to the trial and often multiple terms were used interchangeably. Conclusion: There is ambiguity around temporal descriptions of 'trial recruitment' in health care journals. Informed by the findings of Phase 1, we developed a preliminary temporal operational definition of trial recruitment based on i) trial recruitment of an individual or cluster and ii) the trial recruitment period. In Phase 2 this definition will be discussed in focus groups with healthcare workers involved in designing/implementing/reporting on trials; to contribute to the final phase (analytical phase) of this concept analysis.
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Affiliation(s)
- Hannah Delaney
- Health Research Board - Trials Methodology Research Network, National University of Ireland, Galway, Galway, Ireland
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Declan Devane
- Health Research Board - Trials Methodology Research Network, National University of Ireland, Galway, Galway, Ireland
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Andrew Hunter
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
- Qualitative Research in Trials Centre (QUESTS), National University of Ireland, Galway, Galway, Ireland
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Nicola Mills
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Carrol Gamble
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Valerie Smith
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Lee SY, Rhee J, Shim YJ, Kim Y, Koo JW, De Ridder D, Vanneste S, Song JJ. Changes in the Resting-State Cortical Oscillatory Activity 6 Months After Modified Tinnitus Retraining Therapy. Front Neurosci 2019; 13:1123. [PMID: 31680845 PMCID: PMC6813998 DOI: 10.3389/fnins.2019.01123] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 10/04/2019] [Indexed: 12/21/2022] Open
Abstract
Although tinnitus retraining therapy (TRT) based on Jastreboff’s classical neurophysiological model is efficacious in most patients, its effects on the cortical activity changes responsible for the improvement of tinnitus are still unclear. In this study, we compared pre- and post-TRT resting-state quantitative electroencephalography (rs-qEEG) findings to identify power changes that could explain TRT-induced improvements. Thirty-seven patients with severe tinnitus were enrolled in the study, and rs-qEEG data recorded before the initial TRT sessions and 6 months after TRT were compared. In addition, associations between the changes in qEEG and percentage improvements in Tinnitus Handicap Inventory (THI) scores and numeric rating scale (NRS) scores of tinnitus loudness and tinnitus perception were examined. The mean THI score decreased significantly 6 months after the initial TRT session. Also, significant improvements were observed 6 months after the initial TRT session compared with the pre-treatment scores in NRS loudness, distress, and perception. As compared with the pre-TRT status, post-TRT 6 months status showed significantly decreased powers in the left primary and secondary auditory cortices for the gamma frequency band. Changes in the alpha 1 frequency band power in the right insula and orbitofrontal cortex (OFC) appeared to be positively correlated with the percentage changes in NRS distress. These results suggested that TRT improved tinnitus-related distress by reducing the power of the top-down autonomic response modulator or peripheral physiological responses to emotional experiences. That is, TRT induced habituation via modulation of functional connections between the auditory system and the limbic and autonomic nervous systems. Our results confer additional basis for understanding the neurophysiological model and the newly suggested integrative model of tinnitus by De Ridder et al. (2014) in the context of the long-term efficacy of TRT.
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Affiliation(s)
- Sang-Yeon Lee
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jihye Rhee
- Department of Otolaryngology-Head and Neck Surgery, Seoul Veterans Hospital, Seoul, South Korea
| | - Ye Ji Shim
- Department of Otolaryngology-Head & Neck Surgery, Seoul National University Hospital, Healthcare System Gangnam Center, Seoul, South Korea
| | - Yoonjoong Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ja-Won Koo
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dirk De Ridder
- Unit of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sven Vanneste
- Laboratory for Clinical and Integrative Neuroscience, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, United States
| | - Jae-Jin Song
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
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Erdman SA, Scherer RW, Sierra-Irizarry B, Formby C. The Tinnitus Retraining Therapy Trial's Standard of Care Control Condition: Rationale and Description of a Patient-Centered Protocol. Am J Audiol 2019; 28:534-547. [PMID: 31425658 PMCID: PMC6808311 DOI: 10.1044/2019_aja-18-0068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 01/24/2019] [Accepted: 05/01/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose The selection and design of control conditions are critical factors in minimizing the influence of unwanted variables in randomized controlled trials (RCTs). This article describes the rationale, design, and content of a standard of care control condition in a Phase III RCT of tinnitus retraining therapy. Method Existing tinnitus practices at military hospitals were identified and aligned with the American Speech-Language-Hearing Association's (2006) preferred practice patterns for tinnitus management and counseling and embedded in a patient-centered protocol to ensure uniformity and treatment fidelity. Results For those involved in the design of behavioral RCTs, the article identifies options and methods to consider in the selection and design of control conditions. Conclusion For those who provide tinnitus services, the standard of care protocol developed for the tinnitus retraining therapy trial constitutes a patient-centered approach to intervention that can be implemented clinically. Supplemental Material https://doi.org/10.23641/asha.9342503.
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Affiliation(s)
- Sue Ann Erdman
- Audiologic Rehabilitation Consulting Services, Jensen Beach, FL
| | | | | | - Craig Formby
- Department of Communicative Disorders, University of Alabama, Tuscaloosa
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