Patient Acceptance of Invasive Treatments for Tinnitus

The out-of-pocket expenses of people with tinnitus in Europe

BACKGROUND

Despite the high frequency of tinnitus and its impact on wellbeing, little is known about its economic burden and no data to our knowledge are available on out-of-pocket (OOP) expenses.

METHODS

In 2022 a survey was conducted on OOP costs of tinnitus. We enrolled 679 participants with slight, moderate and severe tinnitus in Italy, United Kingdom, Netherlands, Germany and Spain. We estimated annual OOP expenses for tinnitus-related healthcare visits, treatments, medications and alternative medicine practices. Prevalence of tinnitus in the general population, obtained from a representative survey we conducted in Europe in 2017-2018, was used to generalise costs for people with any tinnitus at the national level.

RESULTS

OOP expenses were 368€ (95% confidence intervals (CI), 78€-690€), 728€ (95% CI, 316€-1,288€), and 1,492€ (95% CI, 760€-2,688€) for slight, moderate, and severe tinnitus, respectively, with annual expenditure of 565€ for people with any tinnitus: 209€ for healthcare visits, 93€ for treatments, 16€ for drugs, 64€ for hearing supporting systems and 183€ for acupuncture, homeopathy and osteopathy. Individuals with slight, moderate, and severe tinnitus expressed a willingness to invest 1.6, 4.3, and 7.0 times their monthly income, respectively, to achieve complete relief from tinnitus.

CONCLUSIONS

This study offers for the first time insights into the OOP expenses incurred by individuals with tinnitus. OOP expenses exhibited substantial variations based on severity status, accounting for more than 17 thousand million€ in the countries considered. In terms of financial burden, these findings align tinnitus to the recognised leading disabilities, including back pain and migraine.

A Protocol to Investigate Deep Brain Stimulation for Refractory Tinnitus: From Rat Model to the Set-Up of a Human Pilot Study

BACKGROUND

Chronic tinnitus can have an immense impact on quality of life. Despite recent treatment advances, many tinnitus patients remain refractory to them. Preclinical and clinical evidence suggests that deep brain stimulation (DBS) is a promising treatment to suppress tinnitus. In rats, it has been shown in multiple regions of the auditory pathway that DBS can have an alleviating effect on tinnitus. The thalamic medial geniculate body (MGB) takes a key position in the tinnitus network, shows pathophysiological hallmarks of tinnitus, and is readily accessible using stereotaxy. Here, a protocol is described to evaluate the safety and test the therapeutic effects of DBS in the MGB in severe tinnitus sufferers.

METHODS

Bilateral DBS of the MGB will be applied in a future study in six patients with severe and refractory tinnitus. A double-blinded, randomized 2 × 2 crossover design (stimulation ON and OFF) will be applied, followed by a period of six months of open-label follow-up. The primary focus is to assess safety and feasibility (acceptability). Secondary outcomes assess a potential treatment effect and include tinnitus severity measured by the Tinnitus Functional Index (TFI), tinnitus loudness and distress, hearing, cognitive and psychological functions, quality of life, and neurophysiological characteristics.

DISCUSSION

This protocol carefully balances risks and benefits and takes ethical considerations into account. This study will explore the safety and feasibility of DBS in severe refractory tinnitus, through extensive assessment of clinical and neurophysiological outcome measures. Additionally, important insights into the underlying mechanism of tinnitus and hearing function might be revealed.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03976908 (6 June 2019).

The Utility of Economic Measures to Quantify the Burden of Tinnitus in Affected Individuals: A Scoping Review

BACKGROUND AND OBJECTIVES

Tinnitus is a chronic subjective condition that impacts patients' health-related quality of life (HRQoL) and requires multidisciplinary interventions. In health economics, quality-adjusted life years (QALYs) and willingness to pay (WTP) are essential for evaluating treatment effectiveness in cost-effectiveness, cost-utility, or cost-benefit analysis. The extent to which these economic measures have been used in tinnitus research has not been investigated. The objectives of this scoping review were to explore findings and limitations of existing studies and provide an insight into how these economic measures could be used to quantify the burden of tinnitus in affected individuals.

METHODS

A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodological framework. The search strategy involved four electronic databases. Records were included when QALYs or WTP were measured in individuals whose primary or secondary complaint was tinnitus.

RESULTS

A total of 15 studies were identified: three WTP assessment studies and 12 QALY assessment studies using direct preference-based measures (PBMs) (n = 4), indirect PBMs (n = 7), and a disease-specific psychometric instrument (n = 1). The limited use to date of PBMs to assess HRQoL in tinnitus patients is an important finding.

CONCLUSIONS

Further studies using reliable economic methods and focusing on patients' WTP for treatment or their preference for their current health state are needed. Applying PBMs in tinnitus research is crucial not only for the healthcare decision-making process but also to improve patient-centred care.

Survey of tinnitus patients' acceptance of high-definition transcranial direct current stimulation as a management option

OBJECTIVES

To investigate acceptance of high-definition transcranial direct current stimulation (HD-tDCS) as a management option for tinnitus.

DESIGN

Participants completed an online version of the Tinnitus Functional Index (TFI), after which they recorded their satisfaction ratings with different hypothetical intervention outcomes on a 10-point rating scale using Opinio survey software.

STUDY SAMPLE

Data from 272 tinnitus sufferers from English-speaking regions worldwide were collected, of which the majority had moderate to severe tinnitus as per TFI.

RESULTS

The survey showed that HD-tDCS was considered an acceptable form of tinnitus management, and that the satisfaction rating depended significantly on a number of factors: (1) the strength of the tinnitus reduction following the intervention (p < 0.001); 2) the duration of the intervention (p < 0.001); and (3) the effects of the intervention on either tinnitus loudness or tinnitus-related distress (p < 0.001). Respondents rated their satisfaction with the intervention 10/10 only if it completely eliminated tinnitus loudness, although reductions of 50-80% were also rated highly acceptable. No association was found between tinnitus severity and acceptability ratings.

CONCLUSIONS

These findings are important for future HD-tDCS trials for tinnitus, as they demonstrate the need to optimise stimulation protocols to increase effect sizes and decrease time spent on the treatment.

Avenue for Future Tinnitus Treatments

Tinnitus is a common symptom. Standard therapies aim at improving the quality of life and reducing the psychological stress associated with tinnitus. Most interventions have little or no effect on the main symptom. Those affected subjects, however, want such a change and prefer a specific solution, such as pharmacologic therapy to other modalities. Scientific efforts have not yet led to significant improvement in the range of therapies. This article outlines existing efforts and develops ideas on how research for improved tinnitus therapy might look in the future.