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Demoen S, Cardon E, Jacquemin L, Timmermans A, Van Rompaey V, Gilles A, Michiels S. Health-Related Quality of Life in Subjective, Chronic Tinnitus Patients: A Scoping Review. J Assoc Res Otolaryngol 2024; 25:103-129. [PMID: 38253898 PMCID: PMC11018725 DOI: 10.1007/s10162-024-00926-5] [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: 08/07/2023] [Accepted: 12/31/2023] [Indexed: 01/24/2024] Open
Abstract
PURPOSE This scoping review aims to assess whether the severity or distress of subjective tinnitus is negatively associated or correlated with the level of health-related quality of life (HRQoL). A second objective is to examine whether tinnitus patients score differently on HRQoL questionnaires in comparison to subjects without tinnitus and whether HRQoL differs between specific subgroups of tinnitus. METHODS This scoping review adheres to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA guidelines): the statement and extension for scoping reviews (PRISMA-ScR). The following databases were consulted (on the 20th of October 2023): PubMed, Cochrane Library, Web of Science, and Scopus. The search string was composed of the terms tinnitus, HRQoL, and synonyms. A double-blinded screening for eligibility was performed, first on the title and abstract and subsequently on the full-text articles. Studies were considered eligible if they looked at HRQoL questionnaire results for adult patients (> 18 years) reporting chronic (> 3 months), subjective tinnitus as a primary complaint. RESULTS In total, 37 studies with a total sample size of 33,900 participants were included in this scoping review, with some studies answering multiple study objectives. Seventeen studies demonstrated the presence of a significant negative correlation between tinnitus-related distress and HRQoL. Two studies indicated that HRQoL is mediated by tinnitus-related distress. Eighteen studies found that, in general, patients with tinnitus scored significantly lower on HRQoL questionnaires in comparison to subjects without tinnitus. Nineteen studies demonstrated that subgroups of patients with more severe tinnitus complaints or specific additional complaints scored worse on HRQoL questionnaires. CONCLUSION Based on the current literature, chronic subjective tinnitus-related distress has a significant impact on health-related quality of life. In addition, subjects without tinnitus generally score significantly higher on HRQoL questionnaires than patients with tinnitus. The heterogeneity in outcome measures between studies precludes meta-analysis. Increased homogeneity in the choice of HRQoL questionnaires would make a comparison between studies possible, which would give valuable information on both a clinical and an economic level, guiding future tinnitus treatment. REGISTRATION The protocol for the scoping review is registered at Open Science Framework: https://doi.org/10.17605/OSF.IO/F5S9C .
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Affiliation(s)
- Sara Demoen
- Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium.
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium.
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Emilie Cardon
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Laure Jacquemin
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Annick Timmermans
- Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Annick Gilles
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
- Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Education, Health and Social Work, University College Ghent, Ghent, Belgium
| | - Sarah Michiels
- Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, 2650, Edegem, Belgium
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MacDonald C, Caimino C, Burns-O’Connell G, Hartley D, Lockwood J, Sereda M, Whitmer W, Cima R, Turton L, Hoare DJ. Tinnitus, Suicide, and Suicidal Ideation: A Scoping Review of Primary Research. Brain Sci 2023; 13:1496. [PMID: 37891863 PMCID: PMC10605905 DOI: 10.3390/brainsci13101496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Tinnitus (the perception of sound in the absence of any corresponding external source) is highly prevalent and can be distressing. There are unanswered questions about how tinnitus, suicidal thoughts, and suicidal behaviours co-occur and interact. To establish the extent of scientific literature, this scoping review catalogued primary reports addressing the associations between tinnitus, suicidal ideation, attempted suicide, and death by suicide. We searched OvidSP, Medline, EMBASE, PsycINFO, CINAHL, Google Scholar, EThoS, and ProQuest for all studies and case reports on ideation and/or attempted and/or completed suicide in the context of tinnitus. Twenty-three studies were included, and data were charted according to study type. Several epidemiological and other observational studies gave evidence of risk factors and an association between suicidal ideation, suicidal behaviour, and tinnitus. However, there was no evidence of the direction of causality. Qualitative studies are indicated to explore the patient's experience and understand the dynamics of any interaction between tinnitus and suicidal thoughts and behaviours. A theory-informed model of tinnitus and suicide needs to be developed to inform the development of interventions and how tinnitus patients are supported clinically.
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Affiliation(s)
- Carol MacDonald
- NIHR Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK (D.J.H.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- Department of Psychology, University of Stirling, Stirling FK9 4LA, UK
| | | | | | - Douglas Hartley
- NIHR Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK (D.J.H.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
| | - Joanna Lockwood
- NIHR MindTech MedTech Co-Operative, Institute of Mental Health, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK;
| | - Magdalena Sereda
- NIHR Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK (D.J.H.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - William Whitmer
- Hearing Sciences: Scottish Section, Glasgow, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK;
| | - Rilana Cima
- Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven University, 3000 Leuven, Belgium;
- Tinnitus Center of Expertise, Centre of Expertise in Rehabilitation and Audiology, Adelante, 6432 CC Hoensbroek, The Netherlands
- Experimental Health Psychology, Faculty of Psychology and Neurosciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | | | - Derek J. Hoare
- NIHR Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK (D.J.H.)
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
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Mazurek B, Böcking B, Dobel C, Rose M, Brüggemann P. Tinnitus and Influencing Comorbidities. Laryngorhinootologie 2023; 102:S50-S58. [PMID: 37130530 PMCID: PMC10184670 DOI: 10.1055/a-1950-6149] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Numerous studies show that impairments in chronic tinnitus are closely connected with psychosomatic and other concomitant symptoms. This overview summarizes some of these studies. Beyond hearing loss, individual interactions of medical and psychosocial stress factors as well as resources are of central importance. Tinnitus related distress reflects a large number of intercorrelated, psychosomatic influences - such as personality traits, stress reactivity and depression or anxiety - which can be accompanied by cognitive difficulties and should be conceptualized and assessed within a vulnerability-stress-reaction model. Superordinate factors such as age, gender or education level can increase vulnerability to stress. Therefore, diagnosis and therapy of chronic tinnitus be individualised, multidimensional and interdisciplinary. Multimodal psychosomatic therapy approaches aim to address individually constellated medical, audiological and psychological influences in order to sustainably increase the quality of life of those affected. Counselling in the first contact is also indispensable for diagnosis and therapy.
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Affiliation(s)
- Birgit Mazurek
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Berlin
| | | | - Christian Dobel
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Jena, Jena
| | - Matthias Rose
- Medizinische Klinik m. S. Psychosomatik, Charité - Universitätsmedizin Berlin, Berlin
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Better Together. Group versus individual Cognitive-Behavioral Therapy for tinnitus: A Multiple-Baseline Single-Case Experimental Design. Ear Hear 2023; 44:167-178. [PMID: 36117259 DOI: 10.1097/aud.0000000000001261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Chronic tinnitus is effectively treated through cognitive-behavioral therapy (CBT). Both group and individual CBT for tinnitus are effective, but no study has directly compared the two. The current study explores group versus individual CBT for tinnitus. DESIGN A multiple-baseline single-case experimental design was employed to observe changes within/between individual and group treatments. Six participants started a 10-week CBT protocol and were equally divided into individual or group treatment. Participants were exchanged between treatments at random time points. Diary data included 14 variables on tinnitus experience (e.g. annoyance and distraction) and wellbeing (e.g. happiness and stress). Five male participants (59- to 67-year-old) completed treatment. RESULTS Randomization tests comparing means between individual and group treatments did not reveal significant differences. Analysis of data overlap and trend (Tau-U) revealed minor significant improvements for seven variables (50%) in group treatment as compared to individual treatment. Diminished happiness and activity levels were observed in participants who went from group to individual treatment. CONCLUSIONS Low effect sizes and homogeneity of sample restrict the generalizability of data. Group CBT indicated potential benefits when compared to individual CBT. Social learning may be an underlying process in group delivery boosting tinnitus recovery. Findings are limited to male patients with chronic disabling tinnitus.
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What Should Be Considered When Assessing Hyperacusis? A Qualitative Analysis of Problems Reported by Hyperacusis Patients. Brain Sci 2022; 12:brainsci12121615. [PMID: 36552075 PMCID: PMC9775019 DOI: 10.3390/brainsci12121615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/27/2022] Open
Abstract
Hyperacusis (decreased sound tolerance) is a prevalent complaint. Yet, to date, no research has qualitatively evaluated the types of problems experienced by adults with hyperacusis. Our service evaluation aims to determine the hyperacusis-related problem domains reported by patients and the degree to which these domains were reported together. Retrospective analysis was conducted on an anonymised clinical dataset from 306 patients who attended a UK tinnitus and hyperacusis treatment centre between 1994 and 2017. Conventional content analysis was used to categorise responses to the question 'Why is hyperacusis a problem?' into domains which were then subjected to a cluster analysis. Twenty-five problem domains were identified, of which 12 were further classified into three overarching categories. 'Fear', 'Reduced quality of life' and 'Physical reaction to sound' were most frequently reported problems. Cluster analysis revealed that 'Sleep difficulties' and 'Despondency', were commonly reported together. Adults with hyperacusis face many challenges in their everyday lives. The nature of these problems indicates the need to develop complex interventions and assessments to aid management of hyperacusis. Current hyperacusis questionnaires may be useful in identifying some problem domains, but further assessment thorough patient interviews is required to fully explore all potential problems and make informed decisions about treatment.
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Pragmatic Uncontrolled Study of Specialized Cognitive Behavioral Therapy for Adults With Chronic Tinnitus. Ear Hear 2022; 43:1893-1903. [PMID: 35470813 DOI: 10.1097/aud.0000000000001226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Tinnitus is the perception of sound without an external source, affecting quality of life that can cause severe distress in approximately 1 to 3% of the population of people with tinnitus. Randomized controlled trials of cognitive behavioral therapy for tinnitus have demonstrated its effectiveness in improving quality of life, but the effects of their implementation on a large scale in routine practice remains unknown. Therefore, the main purpose of this study was to examine the effects of stepped-care cognitive behavioral therapy for tinnitus delivered in a tertiary audiological center of a regional hospital. Second, we wished to examine predictors of favorable outcome. DESIGN Four hundred three adults with chronic tinnitus were enrolled in this prospective observational study (at 3 months, N=334, 8 months, N=261; 12 months, N=214). The primary outcome was health-related quality of life as measured by the Health Utilities Index III (HUI-III) at 12 months. Secondary outcomes were self-reported levels of tinnitus-related distress, disability, affective distress and tinnitus-related negative beliefs and fear. Measures were completed pre-intervention at 3 months, 8 months, and 12 months. Multilevel modeling was used to examine effects and their predictors. RESULTS Younger participants with lower levels of tinnitus distress were more likely to dropout while those with higher tinnitus distress at baseline and quality of life were more likely to receive step 2 of treatment. MLM analyses revealed, with one exception, no relation between any baseline variable and outcome change over time. Most participants' improvement exceeded minimally clinical important difference criteria for quality of life, tinnitus-related handicap, and tinnitus distress. CONCLUSIONS Results from this large pragmatic study complements those from randomized controlled trials of cognitive behavioral therapy for chronic tinnitus distress and supports its implementation under "real-world" conditions.
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Mazurek B, Hesse G, Sattel H, Kratzsch V, Lahmann C, Dobel C. S3 Guideline: Chronic Tinnitus : German Society for Otorhinolaryngology, Head and Neck Surgery e. V. (DGHNO-KHC). HNO 2022; 70:795-827. [PMID: 36227338 PMCID: PMC9581878 DOI: 10.1007/s00106-022-01207-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Birgit Mazurek
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Gerhard Hesse
- Tinnitus-Klinik, KH Bad Arolsen, Große Allee 50, 34454, Bad Arolsen, Germany.
- Universität Witten/Herdecke, Witten, Germany.
| | - Heribert Sattel
- Klinikum rechts der Isar, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Technical University of Munich, Langerstr. 3, 81675, Munich, Germany
| | - Volker Kratzsch
- Abt. Hörbehinderung, Tinnitus und Schwindelerkrankungen, VAMED Rehaklinik Bad Grönenbach, Sebastian-Kneipp-Allee 3-5, 87730, Bad Grönenbach, Germany
| | - Claas Lahmann
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Hauptstr. 8, 79104, Freiburg, Germany
| | - Christian Dobel
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
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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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van der Wal A, Michiels S, Van de Heyning P, Gilles A, Jacquemin L, Van Rompaey V, Braem M, Visscher CM, Topsakal V, Truijen S, De Hertogh W. Reduction of Somatic Tinnitus Severity is Mediated by Improvement of Temporomandibular Disorders. Otol Neurotol 2022; 43:e309-e315. [PMID: 35020685 DOI: 10.1097/mao.0000000000003446] [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: 11/27/2022]
Abstract
BACKGROUND Successful orofacial treatment can reduce tinnitus severity in patients with somatic tinnitus (ST). However, it is still unclear to what extent the degree of reduction in temporomandibular disorders (TMD) actually contributes to the decrease in tinnitus severity after orofacial treatment. Therefore, the aim of this study was to analyze the mediating effect of reduction in TMD pain on the improvement of tinnitus severity after multidisciplinary orofacial treatment. METHODS A total of 80 patients with moderate to severe ST attributed to the temporomandibular region, were recruited from a tertiary tinnitus clinic. At baseline, patients were randomly assigned to the orofacial treatment group or to the control group. Both groups received a minimum of information and advice regarding their tinnitus complaints. The orofacial treatment group received orofacial physical therapy complemented with occlusal splints when needed, while the control group received no other treatment. A mediation analysis was performed according to the steps described by Baron and Kenny and the proportion of the mediating effect was calculated for the potential mediator: "change in TMD pain," measured by a one-point decrease in TMD pain screener score. RESULTS Our analysis showed that 35% of the observed decrease in tinnitus severity can be attributed to a reduction in TMD pain. A significant total effect of orofacial treatment compared with control on the change in tinnitus functional index (TFI) score was found (B = 0.253 p = 0.025 Cl for B = 1.265-18.576). Orofacial treatment was also significantly related to the change in TMD pain (Exp (B) = 2.800, p = 0.034 Cl for Exp B 1.081-7.251). Additionally, the change in TMD pain screener score was significantly related to the change in TFI score (B = -0.273 p = 0.016 Cl for B = -19.875 to -2.119). CONCLUSION Reduction of TMD pain is a mediating factor in the decrease of tinnitus severity after multidisciplinary orofacial treatment. PRACTICAL IMPLICATIONS Orofacial treatment can be used to decrease tinnitus severity in patients with TMD related somatic tinnitus.
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Affiliation(s)
- Annemarie van der Wal
- Department of Rehabilitation Sciences and Physiotherapy
- Department of Otorhinolaryngology, Antwerp University Hospital
| | - Sarah Michiels
- Department of Rehabilitation Sciences and Physiotherapy
- Department of Otorhinolaryngology, Antwerp University Hospital
- Faculty of Rehabilitation Sciences, REVAL, University of Hasselt, Hasselt
- Department of Translational Neurosciences
| | - Paul Van de Heyning
- Department of Otorhinolaryngology, Antwerp University Hospital
- Department of Translational Neurosciences
| | - Annick Gilles
- Department of Otorhinolaryngology, Antwerp University Hospital
- Department of Translational Neurosciences
| | - Laure Jacquemin
- Department of Otorhinolaryngology, Antwerp University Hospital
- Department of Translational Neurosciences
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology, Antwerp University Hospital
- Department of Translational Neurosciences
| | - Marc Braem
- Lab Dental Materials
- Special Care Dentistry, University Hospital Antwerp, Edegem
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp
| | - Corine Mirjam Visscher
- Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Research Institute MOVE Amsterdam, Amsterdam, The Netherlands
| | - Vedat Topsakal
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Brussels, Free University Brussels, Brussels Health Campus Belgium, Jette, Belgium
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Schoisswohl S, Langguth B, Schecklmann M, Bernal-Robledano A, Boecking B, Cederroth CR, Chalanouli D, Cima R, Denys S, Dettling-Papargyris J, Escalera-Balsera A, Espinosa-Sanchez JM, Gallego-Martinez A, Giannopoulou E, Hidalgo-Lopez L, Hummel M, Kikidis D, Koller M, Lopez-Escamez JA, Marcrum SC, Markatos N, Martin-Lagos J, Martinez-Martinez M, Martinez-Martinez M, Ferron MM, Mazurek B, Mueller-Locatelli N, Neff P, Oppel K, Perez-Carpena P, Robles-Bolivar P, Rose M, Schiele T, Schiller A, Simoes J, Stark S, Staudinger S, Stege A, Verhaert N, Schlee W. Unification of Treatments and Interventions for Tinnitus Patients (UNITI): a study protocol for a multi-center randomized clinical trial. Trials 2021; 22:875. [PMID: 34863270 PMCID: PMC8642746 DOI: 10.1186/s13063-021-05835-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/15/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Tinnitus represents a relatively common condition in the global population accompanied by various comorbidities and severe burden in many cases. Nevertheless, there is currently no general treatment or cure, presumable due to the heterogeneity of tinnitus with its wide variety of etiologies and tinnitus phenotypes. Hence, most treatment studies merely demonstrated improvement in a subgroup of tinnitus patients. The majority of studies are characterized by small sample sizes, unstandardized treatments and assessments, or applications of interventions targeting only a single organ level. Combinatory treatment approaches, potentially targeting multiple systems as well as treatment personalization, might provide remedy and enhance treatment responses. The aim of the present study is to systematically examine established tinnitus therapies both alone and in combination in a large sample of tinnitus patients. Further, it wants to provide the basis for personalized treatment approaches by evaluating a specific decision support system developed as part of an EU-funded collaborative project (Unification of treatments and interventions for tinnitus patients; UNITI project). METHODS/STUDY DESIGN This is a multi-center parallel-arm randomized clinical trial conducted at five different clinical sites over the EU. The effect of four different tinnitus therapy approaches (sound therapy, structured counseling, hearing aids, cognitive behavioral therapy) applied over a time period of 12 weeks as a single or rather a combinatory treatment in a total number of 500 chronic tinnitus patients will be investigated. Assessments and interventions are harmonized over the involved clinical sites. The primary outcome measure focuses on the domain tinnitus distress assessed via the Tinnitus Handicap Inventory. DISCUSSION Results and conclusions from the current study might not only provide an essential contribution to combinatory and personalized treatment approaches in tinnitus but could also provide more profound insights in the heterogeneity of tinnitus, representing an important step towards a cure for tinnitus. TRIAL REGISTRATION ClinicalTrials.gov NCT04663828 . Registered on 11 December 2020.
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Affiliation(s)
- Stefan Schoisswohl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany.
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany
| | - Alberto Bernal-Robledano
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Benjamin Boecking
- Tinnitus Center, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt Universität Berlin, Berlin, Germany
| | | | | | - Rilana Cima
- Department of Health Psychology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sam Denys
- Department of Neurosciences, Research group Experimental Oto-Rhino-Laryngology, University of Leuven, Leuven, Belgium.,Department of Otorhinolaryngology - Head and Neck surgery, University Hospitals Leuven, Leuven, Belgium.,Multidisciplinary University Center for Speech-Language Pathology and Audiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Alba Escalera-Balsera
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | - Juan Manuel Espinosa-Sanchez
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | - Alvaro Gallego-Martinez
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | | | - Leyre Hidalgo-Lopez
- Department of Mental Health, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Michael Hummel
- Central Biobank Charité, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt Universität Berlin, Berlin, Germany
| | - Dimitris Kikidis
- Department of Otolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General Hospital, Athens, Greece
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Jose A Lopez-Escamez
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain.,Department of Surgery, Division of Otolaryngology, Universidad de Granada, Granada, Spain
| | - Steven C Marcrum
- Department of Otolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Nikolaos Markatos
- Department of Otolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General Hospital, Athens, Greece
| | - Juan Martin-Lagos
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria ibs. GRANADA, Hospital Universitario Clinico San Cecilio, Granada, Spain
| | - Maria Martinez-Martinez
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | - Marta Martinez-Martinez
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Department of Otolaryngology, Instituto de Investigacion Biosanitaria ibs. GRANADA, Hospital Universitario Clinico San Cecilio, Granada, Spain
| | - Maria Mata Ferron
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | - Birgit Mazurek
- Tinnitus Center, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt Universität Berlin, Berlin, Germany
| | - Nicolas Mueller-Locatelli
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria ibs. GRANADA, Hospital Universitario Clinico San Cecilio, Granada, Spain
| | - Patrick Neff
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany.,Center for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Kevin Oppel
- Terzo-Institute for Applied Hearing Research, ISMA, Sonneberg, Germany
| | - Patricia Perez-Carpena
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | - Paula Robles-Bolivar
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | - Matthias Rose
- Department of Psychosomatic and Psychotherapy, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt Universität Berlin, Berlin, Germany
| | - Tabea Schiele
- Tinnitus Center, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt Universität Berlin, Berlin, Germany
| | - Axel Schiller
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany
| | - Jorge Simoes
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany
| | - Sabine Stark
- Tinnitus Center, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt Universität Berlin, Berlin, Germany
| | - Susanne Staudinger
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany
| | - Alexandra Stege
- Central Biobank Charité, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt Universität Berlin, Berlin, Germany
| | - Nicolas Verhaert
- Department of Neurosciences, Research group Experimental Oto-Rhino-Laryngology, University of Leuven, Leuven, Belgium.,Department of Otorhinolaryngology - Head and Neck surgery, University Hospitals Leuven, Leuven, Belgium.,Multidisciplinary University Center for Speech-Language Pathology and Audiology, University Hospitals Leuven, Leuven, Belgium
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany
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11
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Greenwell K, Sereda M, Bradbury K, Geraghty AWA, Coulson NS, Hoare DJ. Intervention Planning for the Tinnitus E-Programme 2.0, an Internet-Based Cognitive Behavioral Intervention for Tinnitus. Am J Audiol 2021; 30:241-254. [PMID: 34038162 DOI: 10.1044/2021_aja-20-00131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Purpose The purpose of this study is to comprehensively describe the intervention planning process for the Tinnitus E-Programme 2.0, an Internet-based cognitive behavioral intervention for tinnitus. Method Theory-, evidence-, and person-based approaches to intervention development were used. In Phase 1, quantitative systematic reviews were used to identify potentially effective intervention techniques and design features. Primary mixed-methods research involving adults with tinnitus explored the acceptability of the first version of the intervention. In Phase 2, person-based guiding principles highlighted key intervention design objectives and features to address needs of the intervention's target group (identified in Phase 1) to maximize its acceptability, feasibility of delivery, and effectiveness. Theory-based "behavioral analysis" and "logic modeling" comprehensively described intervention content and potential mechanisms of action. From this planning work, a prototype intervention was developed. Results The intervention design objectives outlined in the guiding principles were to (a) normalize tinnitus, (b) support users to maintain a regular relaxation practice, (c) minimize the worsening of users' tinnitus sensation, and (d) ensure the intervention is accessible to those with hearing loss. Behavioral analysis and logic modeling identified intervention processes (e.g., illness perceptions, beliefs about consequences, skills, goals) and purported mediators (acceptance of tinnitus, negative thinking, use of the cognitive skills tools for managing negative thoughts, and practicing regular relaxation) hypothesized to facilitate reductions in tinnitus symptom severity. Conclusions The guiding principles highlight key design objectives and features to consider when developing interventions for tinnitus. The logic model offers hypothesized mechanisms of action that can be tested in future process analyses.
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Affiliation(s)
- Kate Greenwell
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, United Kingdom
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Hearing Sciences group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom
| | - Magdalena Sereda
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Hearing Sciences group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom
| | - Katherine Bradbury
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, United Kingdom
| | - Adam W. A. Geraghty
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, United Kingdom
| | - Neil S. Coulson
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, United Kingdom
| | - Derek J. Hoare
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Hearing Sciences group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom
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12
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Stegeman I, Eikelboom RH, Smit AL, Baguley DM, Bucks RS, Stokroos RJ, Bennett RJ, Tegg-Quinn S, Hunter M, Atlas MD. Tinnitus and its associations with general health, mental health and hearing loss. PROGRESS IN BRAIN RESEARCH 2021; 262:431-450. [PMID: 33931190 DOI: 10.1016/bs.pbr.2021.01.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND A deeper knowledge of tinnitus is essential in order to better manage and treat tinnitus and its effects. Most studies to date are based on small samples and/or conducted in clinical settings. In this study we assessed the associations between tinnitus, general and mental health, hearing status and demographics in a large population cohort study. MATERIALS AND METHODS The Busselton Healthy Aging Study recruited people born between 1946 and 1964. Data were collected between 2010 and 2015. Logistic regression was used to examine the associations between tinnitus and its effect on daily life, age, gender, hearing, self-reported mental and general health, and doctor diagnosed health conditions. RESULTS Of 5107 participants, 1154 (22.6%) reported experiencing tinnitus. Of those, 32.4% reported that their tinnitus had an occasional effect on their daily lives, while for a further 8.9% the effect on their daily life was frequent or constant. The odds ratio for having a SF12-PCS was (OR 1.02 (95%CI 1.01-1.03). Furthermore, individuals who experience their tinnitus as having an effect on their daily life, have an increased risk of having a lower general health (OR 1.04 (95%CI 1.02-1.03)) than those without tinnitus. Higher levels of depression, anxiety and stress, as well as doctor diagnosed depression, were all significant risk factors for tinnitus. There were statistically significant worse hearing thresholds related to the presence of tinnitus. CONCLUSION The outcomes raise the question for clinicians and researchers whether addressing the mental and general health of individuals will influence the presence or burden of tinnitus.
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Affiliation(s)
- Inge Stegeman
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Robert H Eikelboom
- Ear Science Institute Australia, Subiaco, WA, Australia; Ear Sciences Centre, The University of Western Australia, Nedlands, WA, Australia; Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Adriana L Smit
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David M Baguley
- Hearing Sciences, Division of Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom; NIHR Bottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Romola S Bucks
- School of Psychological Science, The University of Western Australia, Nedlands, WA, Australia
| | - Robert J Stokroos
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rebecca J Bennett
- Ear Science Institute Australia, Subiaco, WA, Australia; Ear Sciences Centre, The University of Western Australia, Nedlands, WA, Australia
| | - Susan Tegg-Quinn
- Ear Science Institute Australia, Subiaco, WA, Australia; Ear Sciences Centre, The University of Western Australia, Nedlands, WA, Australia
| | - Michael Hunter
- Busselton Health Study Centre, Busselton Population Medical Research Institute, Busselton, WA, Australia; School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
| | - Marcus D Atlas
- Ear Science Institute Australia, Subiaco, WA, Australia; Ear Sciences Centre, The University of Western Australia, Nedlands, WA, Australia
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13
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Abstract
Tinnitus is not traceable to a single disease or pathology, but merely a symptom, which is distressing to some but not all individuals able to perceive it. The experience of tinnitus does not equate to tinnitus distress. Tinnitus suffering might be understood as a function of tinnitus-related distress in that bothersome tinnitus is an illness rather than a disease. In bothersome (distressing) tinnitus, the perception of the characteristic sound is a very disturbing and bothersome experience because of maladaptive psychological responses. Several cognitive and behavioral theoretical frameworks attempting to explain the nature and cause of tinnitus suffering have been introduced in and will be summarized here. Current treatment approaches are generally based on models that aim to: alleviate the perceptional experience by focusing on the tinnitus perception for habituation or even soothing purposes; decrease awareness of the sound by attentional training and cognitive interventions; decrease the maladaptive responses and the resulting distress by behavioral methods (i. e., exposure). The cognitive behavioral fear-avoidance model may offer an integrative cognitive behavioral approach that can lead to a new set of paradigms for studying the underlying mechanisms explaining chronic tinnitus suffering as well for developing innovative strategies to treat bothersome tinnitus.
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Affiliation(s)
- R F F Cima
- Section Behavioural Medicine, Faculty of Psychology and Neuroscience, Maastricht University, 616, 6200 MD, Maastricht, The Netherlands.
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14
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Kommentar zur Europäischen Tinnitus-Leitlinie. HNO 2019; 67:272-273. [DOI: 10.1007/s00106-019-0620-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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