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Ali RT, Abdullah TN, Emin AK. The effectiveness of two types of low-level laser therapy in patients with persistent tinnitus. Lasers Med Sci 2023; 38:132. [PMID: 37273123 DOI: 10.1007/s10103-023-03797-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 05/08/2023] [Indexed: 06/06/2023]
Abstract
Tinnitus is a perception disorder of sound with no hearing impulse. It is a very common otology complaint that leads to worsening quality of life. The experience of sound is only the product of neural system activity, with no matching mechanical or vibratory activity in the cochlea, and is unrelated to any external stimuli. Low-level laser therapy (LLLT) is a medical treatment of tinnitus that uses low-energy-level lasers or light-emitting diodes to stimulate or inhibit cellular function. The study included nine patients aged 20-68 years with unilateral or bilateral tinnitus. It was a self-controlled clinical trial study on subjective tinnitus. All patients attended the ENT outpatient Department, Rzgari Teaching Hospital, Erbil, Iraq. Two types of low-level laser therapy (LLLT) devices were used for patients. The first tool, a soft laser called a Tinnitool, has a wavelength of 660 nm and a power of 100 mW. The second tool is a Tinnitus Pen, which has a wavelength of 650 nm and a power of 5 mW. Seven females (77.7%) and two males (22.2%) participated in this study during one month. The mean age of the study sample was 44 years, with a standard deviation of 15.59 years. There was a significant improvement in the comparison of both types of therapy low-level laser before and after treatment, which reduced the tinnitus level among patients from 70% before treatment to 59% and 65.50%, respectively, after one month of treatment. A paired t test was applied to assess this difference before and after treatment. LLLT devices can be an effective device tool for the treatment of tinnitus and can reduce the symptoms of annoyance that affect the life of the sufferer.
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Affiliation(s)
- Ronak Taher Ali
- Department of Pharmacology & Medical Physics, Collage of Medicine, Hawler Medical University, Kurdistan Region Government, Erbil, Iraq.
- Department of Physiotherapy, Faculty of Applied Science, Tishk International University, Erbil, Kurdistan Region Government, Iraq.
| | - Tara Nooruldeen Abdullah
- Department of Pharmacology & Medical Physics, Collage of Medicine, Hawler Medical University, Kurdistan Region Government, Erbil, Iraq
| | - Abdulkhaliq K Emin
- Surgical Department, Collage of Medicine, Hawler Medical University, Kurdistan Region Government, Erbil, Iraq
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Kutyba JJ, Jędrzejczak WW, Gos E, Raj-Koziak D, Skarzynski PH. Chronic Tinnitus and the Positive Effects of Sound Treatment via a Smartphone App: Mixed-Design Study. JMIR Mhealth Uhealth 2022; 10:e33543. [PMID: 35451975 PMCID: PMC9073599 DOI: 10.2196/33543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/25/2021] [Accepted: 02/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background Tinnitus is a phantom auditory sensation in the absence of an external stimulus. It is accompanied by a broad range of negative emotional symptoms and a significantly lower quality of life. So far, there is no cure for tinnitus, although various treatment options have been tried. One of them is mobile technology employing dedicated apps based on sound therapy. The apps can be managed by the patient and tailored according to their needs. Objective The study aims to assess the effect of a mobile app that generates background sounds on the severity of tinnitus. Methods The study involved 68 adults who had chronic tinnitus. Participants were divided into a study group (44 patients) and a control group (24 patients). For 6 months those in the study group used a free mobile app that enriched the sound environment with a background sound. Participants were instructed to use the app for at least 30 minutes a day using their preferred sound. The participants in the control group did not use the app. Subjective changes in the day-to-day functioning of both groups were evaluated using the Tinnitus Handicap Inventory (THI) questionnaire, a visual analog scale, and a user survey. Results After 3 months of using the app, the THI global score significantly decreased (P<.001) in the study group, decreasing again at 6 months (P<.001). The largest improvements were observed in the emotional and catastrophic reactions subscales. A clinically important change in the THI was reported by 39% of the study group (17/44). Almost 90% of the study participants (39/44) chose environmental sounds to listen to, the most popular being rain and ocean waves. In the control group, tinnitus severity did not change over 3 or 6 months. Conclusions Although the participants still experienced limitations caused by tinnitus, the advantage of the app was that it led to lower negative emotions and thus reduced overall tinnitus severity. It is worth considering whether a mobile app might be incorporated into the management of tinnitus in a professional setting.
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Affiliation(s)
| | - W Wiktor Jędrzejczak
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Elżbieta Gos
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Danuta Raj-Koziak
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Piotr Henryk Skarzynski
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- Institute of Sensory Organs, Kajetany, Poland
- Department of Heart Failure and Cardiac Rehabilitation, Second Faculty, Medical University of Warsaw, Warsaw, Poland
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Mahafza N, Zhao F, El Refaie A, Chen F. A comparison of the severity of tinnitus in patients with and without hearing loss using the tinnitus functional index (TFI). Int J Audiol 2020; 60:220-226. [PMID: 32787604 DOI: 10.1080/14992027.2020.1804081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of this study was to compare the severity of tinnitus in tinnitus patients with and without hearing loss. DESIGN AND STUDY SAMPLE 73 tinnitus patients were included in this study at an audiology clinic in Amman, Jordan. Participants were assigned to two groups according to their hearing status. The severity of tinnitus was evaluated using the Tinnitus Functional Index questionnaire. All participants were interviewed, followed by an otoscopic examination, pure tone audiometry, and tests for admittance and tinnitus matching. RESULTS The normal hearing group included 34 participants (46.6%) whose TFI scores were divided as follows: mild annoyance (17), significant annoyance (14), and severe annoyance (3). The sensorineural loss group included 39 participants (53.4%) with mild annoyance (11), significant annoyance (12), and severe annoyance (16). A statistically significant association was found between hearing status and the severity of tinnitus using a Chi-Squared test (x2 = 0.487, p = 0.007). There was no association between tinnitus severity and age or gender. CONCLUSION Tinnitus severity was significantly worse in tinnitus patients with a hearing loss than tinnitus patients with normal hearing thresholds. This should be taken into consideration when clinicians are planning counselling and management protocols for individual patients.
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Affiliation(s)
- Nadeem Mahafza
- Centre for Speech and Language Therapy and Hearing Science, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Fei Zhao
- Centre for Speech and Language Therapy and Hearing Science, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK.,Department of Hearing and Speech Science, Xinhua College, Sun Yat-Sen University, Guangzhou, China
| | - Amr El Refaie
- Speech and Hearing Sciences, University College Cork, Cork, Ireland
| | - Feifan Chen
- Centre for Speech and Language Therapy and Hearing Science, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
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McKenna L, Vogt F, Marks E. Current Validated Medical Treatments for Tinnitus: Cognitive Behavioral Therapy. Otolaryngol Clin North Am 2020; 53:605-615. [PMID: 32334871 DOI: 10.1016/j.otc.2020.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tinnitus distress results from a weave of physical and psychological processes. Reducing the power of the psychological processes will therefore reduce the degree of suffering. The main psychological therapy in this context is cognitive behavioral therapy (CBT). This seeks to understand and change the influence of thinking processes, including information processing biases, and the behaviors that these motivate, on the experience of tinnitus. The results of systematic reviews and meta-analyses indicate that CBT is the tinnitus management approach for which there is the most robust evidence. In spite of this, it remains difficult to access for people with tinnitus.
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Affiliation(s)
- Laurence McKenna
- Department Clinical Psychology, Royal National Ear Nose Throat and Eastman Dental Hospital, University College Hospital London, 6th Floor West, Ground Floor North, 250 Euston Road, London WN1 2PG, UK; UK & Ear Institute, University College London, 332 Grays Inn Rd, London WC1X 8EE, UK.
| | - Florian Vogt
- Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY, UK
| | - Elizabeth Marks
- Department Clinical Psychology, Royal National Ear Nose Throat and Eastman Dental Hospital, University College Hospital London, 6th Floor West, Ground Floor North, 250 Euston Road, London WN1 2PG, UK
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Systematic Review and Network Meta-analysis of Cognitive and/or Behavioral Therapies (CBT) for Tinnitus. Otol Neurotol 2020; 41:153-166. [DOI: 10.1097/mao.0000000000002472] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fuller T, Cima R, Langguth B, Mazurek B, Vlaeyen JWS, Hoare DJ. Cognitive behavioural therapy for tinnitus. Cochrane Database Syst Rev 2020; 1:CD012614. [PMID: 31912887 PMCID: PMC6956618 DOI: 10.1002/14651858.cd012614.pub2] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Tinnitus affects up to 21% of the adult population with an estimated 1% to 3% experiencing severe problems. Cognitive behavioural therapy (CBT) is a collection of psychological treatments based on the cognitive and behavioural traditions in psychology and often used to treat people suffering from tinnitus. OBJECTIVES To assess the effects and safety of CBT for tinnitus in adults. SEARCH METHODS The Cochrane ENT Information Specialist searched the ENT Trials Register; CENTRAL (2019, Issue 11); Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 25 November 2019. SELECTION CRITERIA Randomised controlled trials (RCTs) of CBT versus no intervention, audiological care, tinnitus retraining therapy or any other active treatment in adult participants with tinnitus. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. Our primary outcomes were the impact of tinnitus on disease-specific quality of life and serious adverse effects. Our secondary outcomes were: depression, anxiety, general health-related quality of life, negatively biased interpretations of tinnitus and other adverse effects. We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS We included 28 studies (mostly from Europe) with a total of 2733 participants. All participants had had tinnitus for at least three months and their average age ranged from 43 to 70 years. The duration of the CBT ranged from 3 to 22 weeks and it was mostly conducted in hospitals or online. There were four comparisons and we were interested in outcomes at end of treatment, and 6 and 12 months follow-up. The results below only refer to outcomes at end of treatment due to an absence of evidence at the other follow-up time points. CBT versus no intervention/wait list control Fourteen studies compared CBT with no intervention/wait list control. For the primary outcome, CBT may reduce the impact of tinnitus on quality of life at treatment end (standardised mean difference (SMD) -0.56, 95% confidence interval (CI) -0.83 to -0.30; 10 studies; 537 participants; low certainty). Re-expressed as a score on the Tinnitus Handicap Inventory (THI; range 0 to 100) this is equivalent to a score 10.91 points lower in the CBT group, with an estimated minimal clinically important difference (MCID) for this scale being 7 points. Seven studies, rated as moderate certainty, either reported or informed us via personal communication about serious adverse effects. CBT probably results in little or no difference in adverse effects: six studies reported none and in one study one participant in the CBT condition worsened (risk ratio (RR) 3.00, 95% CI 0.13 to 69.87). For the secondary outcomes, CBT may result in a slight reduction in depression (SMD -0.34, 95% CI-0.60 to -0.08; 8 studies; 502 participants; low certainty). However, we are uncertain whether CBT reduces anxiety, improves health-related quality of life or reduces negatively biased interpretations of tinnitus (all very low certainty). From seven studies, no other adverse effects were reported (moderate certainty). CBT versus audiological care Three studies compared CBT with audiological care. CBT probably reduces the impact of tinnitus on quality of life when compared with audiological care as measured by the THI (range 0 to 100; mean difference (MD) -5.65, 95% CI -9.79 to -1.50; 3 studies; 444 participants) (moderate certainty; MCID = 7 points). No serious adverse effects occurred in the two included studies reporting these, thus risk ratios were not calculated (moderate certainty). The evidence suggests that CBT may slightly reduce depression but may result in little or no difference in anxiety or health-related quality of life (all low certainty) when compared with audiological care. CBT may reduce negatively biased interpretations of tinnitus when compared with audiological care (low certainty). No other adverse effects were reported for either group (moderate certainty). CBT versus tinnitus retraining therapy (TRT) One study compared CBT with TRT (including bilateral sound generators as per TRT protocol). CBT may reduce the impact of tinnitus on quality of life as measured by the THI when compared with TRT (range 0 to 100) (MD -15.79, 95% CI -27.91 to -3.67; 1 study; 42 participants; low certainty). For serious adverse effects three participants deteriorated during the study: one in the CBT (n = 22) and two in the TRT group (n = 20) (RR 0.45, 95% CI 0.04 to 4.64; low certainty). We are uncertain whether CBT reduces depression and anxiety or improves health-related quality of life (low certainty). CBT may reduce negatively biased interpretations of tinnitus. No data were available for other adverse effects. CBT versus other active control Sixteen studies compared CBT with another active control (e.g. relaxation, information, Internet-based discussion forums). CBT may reduce the impact of tinnitus on quality of life when compared with other active treatments (SMD -0.30, 95% CI -0.55 to -0.05; 12 studies; 966 participants; low certainty). Re-expressed as a THI score this is equivalent to 5.84 points lower in the CBT group than the other active control group (MCID = 7 points). One study reported that three participants deteriorated: one in the CBT and two in the information only group (RR 1.70, 95% CI 0.16 to 18.36; low certainty). CBT may reduce depression and anxiety (both low certainty). We are uncertain whether CBT improves health-related quality of life compared with other control. CBT probably reduces negatively biased interpretations of tinnitus compared with other treatments. No data were available for other adverse effects. AUTHORS' CONCLUSIONS CBT may be effective in reducing the negative impact that tinnitus can have on quality of life. There is, however, an absence of evidence at 6 or 12 months follow-up. There is also some evidence that adverse effects may be rare in adults with tinnitus receiving CBT, but this could be further investigated. CBT for tinnitus may have small additional benefit in reducing symptoms of depression although uncertainty remains due to concerns about the quality of the evidence. Overall, there is limited evidence for CBT for tinnitus improving anxiety, health-related quality of life or negatively biased interpretations of tinnitus.
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Affiliation(s)
- Thomas Fuller
- Maastricht UniversityDepartment of Clinical Psychological ScienceUniversiteitssingel 40MaastrichtNetherlands6200 MD
- Adelante, Centre for Expertise in Rehabilitation & AudiologyZandbergsweg 111HoensbroekLimburgNetherlands6432 CC
- MedtronicSpine and BiologicsMaastrichtNetherlands
| | - Rilana Cima
- Maastricht UniversityDepartment of Clinical Psychological ScienceUniversiteitssingel 40MaastrichtNetherlands6200 MD
- Adelante, Centre for Expertise in Rehabilitation & AudiologyZandbergsweg 111HoensbroekLimburgNetherlands6432 CC
| | - Berthold Langguth
- University of RegensburgDepartment of Psychiatry and PsychotherapyUniversitätsstraße 84RegensburgGermany93053
| | - Birgit Mazurek
- Charité ‐ Universitätsmedizin BerlinLuisenstrasse 13BerlinGermany10117
| | - Johan WS Vlaeyen
- KU Leuven UniversityResearch Group Health PsychologyTiensestraat 102 – 3000LeuvenBelgium
| | - Derek J Hoare
- Division of Clinical Neuroscience, School of Medicine, University of NottinghamNIHR Nottingham Biomedical Research CentreRopewalk House, 113 The RopewalkNottinghamUKNG1 5DU
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Aazh H, Landgrebe M, Danesh AA, Moore BC. Cognitive Behavioral Therapy For Alleviating The Distress Caused By Tinnitus, Hyperacusis And Misophonia: Current Perspectives. Psychol Res Behav Manag 2019; 12:991-1002. [PMID: 31749641 PMCID: PMC6817772 DOI: 10.2147/prbm.s179138] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 10/01/2019] [Indexed: 11/23/2022] Open
Abstract
This article reviews the evidence related to the efficacy of Cognitive Behavioral Therapy (CBT) for alleviating the distress caused by tinnitus, hyperacusis and misophonia. Where available, the review was focused on meta-analyses of randomized controlled trials (RCTs) using either passive control groups (typically waiting list or education only) or active control groups (receiving some other form of treatment). Where data from RCTs were not available, case studies and retrospective studies were reviewed. Analyses were conducted separately for studies of patients with tinnitus, hyperacusis and misophonia. RCTs show that CBT is effective in alleviating the distress caused by tinnitus in comparison to passive control groups and sometimes active control groups. CBT for tinnitus can be effective both in individual and in group settings, whether delivered by psychiatrists, clinical psychologists, or specially trained audiologists. CBT for tinnitus can also be effective when delivered via the internet, when combined with help from audiologists. Usually, CBT does not reduce the loudness of tinnitus but it can improve quality of life. Case studies and some limited RCTs suggest that CBT can also be effective in alleviating the distress caused by hyperacusis and misophonia. However, RCTs with active control groups are currently lacking. There is strong evidence supporting the effectiveness of CBT in alleviating the distress caused by tinnitus. However, it is not yet clear whether CBT is more effective than some other forms of treatment. RCTs with active control groups are needed to establish more clearly the extent to which CBT is effective in alleviating the distress caused by hyperacusis and misophonia.
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Affiliation(s)
- Hashir Aazh
- London Tinnitus and Hyperacusis Therapy Specialist Clinic, London, WC2N 5BW, UK.,Guildford Tinnitus and Hyperacusis Therapy Specialist Clinic, Guildford, Surrey, GU2 4RG, UK.,Audiology Department, Royal Surrey County Hospital, Guildford GU2 7XX, UK
| | - Michael Landgrebe
- Department of Psychiatry, Psychosomatics and Psychotherapy, Kbo Lech-Mangfall-Hospital Agatharied, Hausham 83734, Germany
| | - Ali A Danesh
- Department of Communication Sciences and Disorders, Florida Atlantic University, Boca Raton, FL, 33431, USA
| | - Brian Cj Moore
- Department of Psychology, University of Cambridge, Cambridge CB2 3EB, UK
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Cima RFF, Mazurek B, Haider H, Kikidis D, Lapira A, Noreña A, Hoare DJ. A multidisciplinary European guideline for tinnitus: diagnostics, assessment, and treatment. HNO 2019; 67:10-42. [DOI: 10.1007/s00106-019-0633-7] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Ainscough E, Smith SN, Greenwell K, Hoare DJ. Findings and Ethical Considerations From a Thematic Analysis of Threads Within Tinnitus Online Support Groups. Am J Audiol 2018; 27:503-512. [PMID: 30452754 DOI: 10.1044/2018_aja-imia3-18-0013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 08/09/2018] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Tinnitus is the perception of noise without a corresponding external stimulus. Current management typically aims to moderate associated psychosocial stressors and allow sufferers to retain an adequate quality of life. With the increasing recognition of the Internet as a repository for health advice, information, and support, the online support group has become a popular coping strategy for those living with chronic conditions such as tinnitus. Patients find that communicating with each other, providing encouragement, and sharing information in the absence of physical and temporal boundaries are invaluable ways of managing their condition. The purpose of this study was to explore the potential positive and negative consequences of participating in online support groups for tinnitus. METHOD Discussion forum threads were collated from across 4 public online support group websites. All threads were initiated between February and April 2016. Texts from these threads were coded by 3 separate analysts using both inductive and deductive thematic analysis, until data saturation was reached. RESULTS Analysis of 75 threads (641 individual posts) found 9 independent themes pertaining to aspects of participation in tinnitus online support groups. The results revealed that using the forums allowed users to exchange knowledge and experiences, express complex emotions, profit from a network of support, and engage in everyday conversation away from the burden of their tinnitus. However, some experiences appeared to be compromised by negative messages, limited communication, and informational issues such as conflicting advice or information overload. CONCLUSIONS This study represents the 1st research into discussion forums in tinnitus online support groups. A nonintrusive (passive) analysis method was used, whereby messages comprising the dataset were retrieved without direct interaction with the discussion forum. Individuals and the community of tinnitus online support groups are deemed to be at low risk from potential harm in this study. Most tinnitus patients likely benefit from accessing online support groups, for example, they discover they are not alone, and they find new coping strategies. However, for those who are particularly vulnerable or prone to psychological stress, accessing these groups could be detrimental.
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Affiliation(s)
- Eve Ainscough
- School of Medicine, University of Nottingham, United Kingdom
| | - Sandra N. Smith
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom
| | - Kate Greenwell
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, United Kingdom
| | - Derek J. Hoare
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom
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Lambert SD, Beatty L, McElduff P, Levesque JV, Lawsin C, Jacobsen P, Turner J, Girgis A. A systematic review and meta-analysis of written self-administered psychosocial interventions among adults with a physical illness. PATIENT EDUCATION AND COUNSELING 2017; 100:2200-2217. [PMID: 28734559 DOI: 10.1016/j.pec.2017.06.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/19/2017] [Accepted: 06/30/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The cost of implementing professionally-led psychosocial interventions has limited their integration into routine care. To enhance the translation of effective psychosocial interventions in routine care, a self-administered format is sometimes used. The meta-analysis examined the efficacy of written self-administered, psychosocial interventions to improve outcomes among individuals with a physical illness. METHODS Studies comparing a written self-administered intervention to a control group were identified through electronic databases searching. Pooled effect sizes were calculated across follow-up time points using random-effects models. Studies were also categorised according to three levels of guidance (self-administered, minimal contact, or guided) to examine the effect of this variable on outcomes. RESULTS Forty manuscripts were retained for the descriptive review and 28 for the meta-analysis. Findings were significant for anxiety, depression, distress, and self-efficacy. Results were not significant for quality of life and related domains as well as coping. Purely self-administered interventions were efficacious for depression, distress, and self-efficacy; only guided interventions had an impact on anxiety. CONCLUSIONS Findings showed that written self-administered interventions show promise across a number of outcomes. PRACTICE IMPLICATIONS Self-administered interventions are a potentially efficacious and cost-effective approach to address some of the most common needs of patients with a physical illness.
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Affiliation(s)
- Sylvie D Lambert
- Ingram School of Nursing, McGill University, Wilson Hall, 3506 University Street, Montreal, H3A 2A7, Canada; Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, The University of New South Wales, Liverpool, Australia(1); St. Mary's Research Centre.
| | - Lisa Beatty
- School of Psychology, Flinders University, Adelaide, Australia
| | - Patrick McElduff
- School of Medicine and Public Health, The University of Newcastle, HMRI building, John Hunter Hospital Campus, New Lambton Heights, Australia
| | - Janelle V Levesque
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, The University of New South Wales, Liverpool, Australia(1)
| | - Catalina Lawsin
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Paul Jacobsen
- Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, USA
| | - Jane Turner
- Mental Health Centre, The University of Queensland, Herston, Australia
| | - Afaf Girgis
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, The University of New South Wales, Liverpool, Australia(1)
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11
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Phillips JS, McFerran DJ, Hall DA, Hoare DJ. The natural history of subjective tinnitus in adults: A systematic review and meta-analysis of no-intervention periods in controlled trials. Laryngoscope 2017; 128:217-227. [PMID: 28425615 DOI: 10.1002/lary.26607] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Tinnitus is a prevalent condition, but little has been published regarding the natural history of the condition. One technique for evaluating the long-term progression of the disease is to examine what happens to participants in the no-intervention control arm of a clinical trial. The aim of this study was to examine no-intervention or waiting-list data reported in trials, in which participants on the active arm received any form of tinnitus intervention. DATA SOURCES CINAHL, PsychINFO, EMBASE, ASSIA, PubMed, Web of Science, Science Direct, EBSCO Host, and Cochrane. METHODS Inclusion criteria followed the PICOS principles: Participants, adults with tinnitus; Intervention, none; Control, any intervention for alleviating tinnitus; Outcomes, a measure assessing tinnitus symptoms using a multi-item patient-reported tinnitus questionnaire. Secondary outcome measures included multi-item patient-reported questionnaires of mood and health-related quality of life and measures that quantified change in tinnitus loudness; Study design, randomized controlled trials or observational studies utilizing a no-intervention or waiting-list control group. Data were extracted and standardized mean difference was calculated for each study to enable meta-analysis. RESULTS The evidence strongly favored a statistically significant decrease in the impact of tinnitus over time, though there was significant heterogeneity and clinical significance cannot be interpreted. Outcome data regarding secondary measures did not demonstrate any clinically significant change. CONCLUSIONS Participants allocated to the no-intervention or waiting-list control arm of clinical trials for a tinnitus intervention show a small but significant improvement in self-reported measures of tinnitus with time; the clinical significance of this finding is unknown. There is, however, considerable variation across individuals. These findings support previous work and can cautiously be used when counseling patients. Laryngoscope, 128:217-227, 2018.
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Affiliation(s)
- John S Phillips
- Department of Otolaryngology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom
| | - Don J McFerran
- Colchester Hospital University National Health Service Foundation Trust, Colchester, United Kingdom
| | - Deborah A Hall
- Nottingham Hearing Biomedical Research Unit, National Institute for Health Research, Nottingham, United Kingdom.,Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Derek J Hoare
- Nottingham Hearing Biomedical Research Unit, National Institute for Health Research, Nottingham, United Kingdom.,Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Greenwell K, Sereda M, Coulson N, El Refaie A, Hoare DJ. A systematic review of techniques and effects of self-help interventions for tinnitus: Application of taxonomies from health psychology. Int J Audiol 2016; 55 Suppl 3:S79-89. [DOI: 10.3109/14992027.2015.1137363] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Kate Greenwell
- National Institute for Health Research - Nottingham Hearing Biomedical Research Unit, Nottingham, UK,
- Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK,
| | - Magdalena Sereda
- National Institute for Health Research - Nottingham Hearing Biomedical Research Unit, Nottingham, UK,
- Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK,
| | - Neil Coulson
- Division of Rehabilitation and Aging, School of Medicine, University of Nottingham, Nottingham, UK and
| | - Amr El Refaie
- Speech and Hearing Department, School of Clinical Therapies, University College, Cork, Ireland
| | - Derek J. Hoare
- National Institute for Health Research - Nottingham Hearing Biomedical Research Unit, Nottingham, UK,
- Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK,
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Palaniappan M, Mintz L, Heatherly R. Bibliotherapy interventions for female low sexual desire: erotic fiction versus self-help. SEXUAL AND RELATIONSHIP THERAPY 2016. [DOI: 10.1080/14681994.2016.1158805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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Nyenhuis N, Golm D, Kröner-Herwig B. A systematic review and meta-analysis on the efficacy of self-help interventions in tinnitus. Cogn Behav Ther 2014; 42:159-69. [PMID: 23777192 DOI: 10.1080/16506073.2013.803496] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study is a review and meta-analysis on the efficacy of cognitive-behavioural therapy (CBT) self-help interventions for tinnitus. Randomized controlled trials were identified by searching in databases (e.g. ISI Web of Knowledge, PubMed, Cochrane Library, and PSYNDEX) and by manual search. Ten studies with 1188 participants in total were included in the meta-analysis. Participants were 49.2 years old and had tinnitus for 5.2 years. Self-help interventions significantly reduced tinnitus distress (d = 0.48) and depressiveness (d = 0.25) when compared with a passive control (e.g. information only and discussion forums) at post-assessment. There was no difference to the face-to-face controls (group treatment). The presence of therapists and the methodological quality of the studies did not influence the results. Sensitivity analysis revealed that there might be a publication bias regarding the comparison to the face-to-face control. However, the results suggest that CBT self-help interventions are an effective treatment for tinnitus distress. Since few studies were identified, this conclusion must be supported by future meta-analyses.
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Affiliation(s)
- Nele Nyenhuis
- Department of Clinical Psychology and Psychotherapy, University of Göttingen, Germany.
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15
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Guitton MJ. Telemedicine in tinnitus: feasibility, advantages, limitations, and perspectives. ISRN OTOLARYNGOLOGY 2013; 2013:218265. [PMID: 23762623 PMCID: PMC3666222 DOI: 10.1155/2013/218265] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 04/24/2013] [Indexed: 11/17/2022]
Abstract
Given the important patient needs for support and treatment, telemedicine-defined by medical approaches supported by the new technologies of information-could provide interesting alternative in tinnitus treatment. By analyzing the published tools and approaches which could be used in the context of telemedicine for tinnitus by health professionals or self-administrated by patients, this review summarizes, presents, and describes the principal telemedicine approaches available presently or in the near future to help assess or treat tinnitus or to offer support to tinnitus sufferers. Several pieces of evidence strongly support the feasibility of telemedicine approaches for tinnitus. Telemedicine can be used to help tinnitus sufferers at several points in the therapeutic process: for early screening, initial evaluation, and diagnosis; for optimizing therapeutic tools, particularly behavioural therapies and virtual reality-enhanced behavioral therapies; for long-term monitoring of patients and provision of online support. Several limitations are, however, discussed in order to optimize the safe development of such approaches. Cost effective and easy to implement, telemedicine is likely to represent an important part of the future of tinnitus therapies and should be progressively integrated by otolaryngologists.
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Affiliation(s)
- Matthieu J. Guitton
- Department of Otorhinolaryngology and Ophthalmology, Faculty of Medicine, Laval University, Quebec City, QC, Canada G1V 0A6
- Institut Universitaire en Santé Mentale de Québec (IUSMQ), 2601 chemin de la Canardière F-6517, Quebec City, QC, Canada G1J 2G3
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Kaldo V, Haak T, Buhrman M, Alfonsson S, Larsen HC, Andersson G. Internet-based cognitive behaviour therapy for tinnitus patients delivered in a regular clinical setting: outcome and analysis of treatment dropout. Cogn Behav Ther 2013; 42:146-58. [PMID: 23432207 DOI: 10.1080/16506073.2013.769622] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cognitive behaviour therapy (CBT) can reduce tinnitus distress but is not available for most patients. Therapist guided, internet-based CBT (ICBT) increase availability and has been shown to be effective. However, the initial positive results need to be replicated in larger samples, and treatment dropout has not been thoroughly studied. Moreover, it has not been evaluated if a low-intensity version of ICBT without therapist contact could be an alternative for patients who do not need or are able to manage the full ICBT-program. This study evaluated two parallel interventions delivered in regular care: ICBT for tinnitus distress (n = 293) and a low-intensity version of ICBT (n = 81) for patients with lower levels of tinnitus distress. We also explored predictors of dropout from ICBT and if dropout influences outcome. Tinnitus Reaction Questionnaire (Wilson, Henry, Bowen, & Haralambous, 1991) was used as the primary outcome. Secondary outcomes were measures of depression, anxiety, sleep, and sound sensitivity. Significant reductions following ICBT were found on all measures after treatment and also at a three-month follow-up. Patients receiving low-intensity ICBT showed a significant reduction in distress, even when they had low levels of distress initially. Treatment dropout was preceded by an increase in days spent at each treatment step but not by an increased distress. Early dropout was related to worse outcome. ICBT can be used in a regular clinical setting to reduce tinnitus distress. Early dropouts may need additional management. For help-seeking patients with lower distress, a low-intensity version of ICBT can be used.
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Affiliation(s)
- Viktor Kaldo
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
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Effects of frequency discrimination training on tinnitus: results from two randomised controlled trials. J Assoc Res Otolaryngol 2012; 13:543-59. [PMID: 22476724 PMCID: PMC3387303 DOI: 10.1007/s10162-012-0323-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 03/15/2012] [Indexed: 12/30/2022] Open
Abstract
That auditory perceptual training may alleviate tinnitus draws on two observations: (1) tinnitus probably arises from altered activity within the central auditory system following hearing loss and (2) sound-based training can change central auditory activity. Training that provides sound enrichment across hearing loss frequencies has therefore been hypothesised to alleviate tinnitus. We tested this prediction with two randomised trials of frequency discrimination training involving a total of 70 participants with chronic subjective tinnitus. Participants trained on either (1) a pure-tone standard at a frequency within their region of normal hearing, (2) a pure-tone standard within the region of hearing loss or (3) a high-pass harmonic complex tone spanning a region of hearing loss. Analysis of the primary outcome measure revealed an overall reduction in self-reported tinnitus handicap after training that was maintained at a 1-month follow-up assessment, but there were no significant differences between groups. Secondary analyses also report the effects of different domains of tinnitus handicap on the psychoacoustical characteristics of the tinnitus percept (sensation level, bandwidth and pitch) and on duration of training. Our overall findings and conclusions cast doubt on the superiority of a purely acoustic mechanism to underpin tinnitus remediation. Rather, the nonspecific patterns of improvement are more suggestive that auditory perceptual training affects impact on a contributory mechanism such as selective attention or emotional state.
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Development and validation of a brief measure of therapeutically-induced change. Behav Cogn Psychother 2011; 39:627-30. [PMID: 21729342 DOI: 10.1017/s1352465811000257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A premise of cognitive behavioural treatment is that individuals make cognitive, behavioural and situational changes prompted by interventions and that these changes bring about improvements in targeted outcomes. AIMS The present project set out to provide reliability and validity information for a brief measure of therapeutically induced change. METHODS A total of 281 participants, comprising three samples who took part in three different intervention studies, completed items relating to cognitive, behavioural and situational changes and completed measures relating to the intervention in which they participated. RESULTS The internal consistency of the scale assessing therapeutically induced change was high in the three samples. The scale showed evidence of validity through association with (1) more involvement in an intervention (2) reporting that an intervention was meaningful (3) being instructed to incorporate insights gained from an intervention into one's daily life (4) greater decreases in psychological distress and negative affect from pre-intervention to post-intervention, and (5) greater increases in positive affect from pre-intervention to post-intervention. CONCLUSIONS The therapeutically-induced change scale may have utility as a process measure in various interventions.
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Hoare DJ, Kowalkowski VL, Kang S, Hall DA. Systematic review and meta-analyses of randomized controlled trials examining tinnitus management. Laryngoscope 2011; 121:1555-64. [PMID: 21671234 PMCID: PMC3477633 DOI: 10.1002/lary.21825] [Citation(s) in RCA: 173] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 03/14/2011] [Accepted: 03/18/2011] [Indexed: 01/19/2023]
Abstract
Objectives/Hypothesis To evaluate the existing level of evidence for tinnitus management strategies identified in the UK Department of Health's Good Practice Guideline. Study Design Systematic review of peer-reviewed literature and meta-analyses. Methods Searches were conducted in PubMed, Cambridge Scientific Abstracts, Web of Science, and EMBASE (earliest to August 2010), supplemented by hand searches in October 2010. Only randomized controlled trials that used validated questionnaire measures of symptoms (i.e., measures of tinnitus distress, anxiety, depression) were included. Results Twenty-eight randomized controlled trials met our inclusion criteria, most of which provide moderate levels of evidence for the effects they reported. Levels of evidence were generally limited by the lack of blinding, lack of power calculations, and incomplete data reporting in these studies. Only studies examining cognitive behavioral therapy were numerous and similar enough to perform meta-analysis, from which the efficacy of cognitive behavioral therapy (moderate effect size) appears to be reasonably established. Antidepressants were the only drug class to show any evidence of potential benefit. Conclusions The efficacy of most interventions for tinnitus benefit remains to be demonstrated conclusively. In particular, high-level assessment of the benefit derived from those interventions most commonly used in practice, namely hearing aids, maskers, and tinnitus retraining therapy needs to be performed.
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Affiliation(s)
- Derek J Hoare
- National Institute for Health Research National Biomedical Research Unit in Hearing, Nottingham, United Kingdom.
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Abstract
This article reviews recent articles relevant to tinnitus-related distress (TRD). Recent studies provide evidence that 1) chronic tinnitus, which occurs in a significant percentage of adults, has stress-inducing effects similar to those of other chronic health problems; 2) the effects of tinnitus on distress are worse in individuals who have certain personality characteristics, such as type D personality and anxiety sensitivity; 3) neural activity in TRD is similar to that for pain and depression; 4) tinnitus leads to less distress in individuals who accept their condition; and 5) cognitive-behavioral treatments, including relaxation training, attention-control training, and acceptance activities, tend to reduce TRD. The recent findings suggest that it would be good practice for mental health professionals to ask patients, especially older patients, about tinnitus and to offer psychological treatment for TRD in appropriate cases. Future research on TRD might explore the extent to which the problem is genetic and the possibility of preventing TRD in individuals who have recently developed persistent tinnitus.
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Affiliation(s)
- John M Malouff
- Department of Psychology, University of New England, Armidale, NSW, Australia.
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Lumley MA. The two views of emotion in psychosomatic research. J Psychosom Res 2010; 68:219-21. [PMID: 20159206 DOI: 10.1016/j.jpsychores.2010.01.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 01/19/2010] [Accepted: 01/19/2010] [Indexed: 10/19/2022]
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