Further validation of the Iowa tinnitus handicap questionnaire

Towards a psychological framework on time perception in patients with chronic tinnitus

Although disabling tinnitus is a chronic auditory phantom sensation, current knowledge on time perception (i.e., subjective time) in sufferers is limited and unsystematic. This theoretical analysis provides a first approach to this topic, highlighting the heterogeneity of time perception in humans as shown in various research areas. This heterogeneity is inherently related to goal attainment. Our immediate perception of time is restricted to present moment and recent past, whereas our sense of time is mostly future-oriented and represented as our past in a mental time line. The heterogeneity of time translates into a tension between anticipated changes one wants to see happen and full commitment that is required to goal attainment. Tinnitus sufferers are intensely aware of this tension in their self-perception. Their most compelling desire is that they no longer perceive tinnitus, but they get closer to this goal only by avoiding to put all their thoughts into it. Our analysis provides new perspectives on acceptance of tinnitus in relation to this time paradox. Building on the Tolerance model and the role of self-awareness in time perception, we contend that the main way for patients to gain long-term self-confidence is to engage in the present moment. Attention to this attitude is obscured in chronic sufferers by worries and ruminations associated with the ongoing presence of tinnitus. We provide arguments that time perception is a social perception, emphasizing the role of rewarding interactions in helping sufferers to overcome the feeling of being prevented from living in the moment. In the course of improvement towards acceptance, different changes in time perception are hypothesized that promote individuals' disengagement from unattainable goal (i.e., tinnitus suppression). A framework for future research is proposed, which distinguishes individuals' behaviors and associated emotions in relation to the time paradox.

Translation and validation of the Tinnitus Primary Function Questionnaire into Brazilian Portuguese

OBJECTIVE

In this study, the Tinnitus Primary Function Questionnaire was translated, culturally adapted and validated for Brazilian Portuguese.

METHODS

This study was carried out in two stages. First, a prospective study of translation and cultural adaptation was carried out with a group of 20 patients. The questionnaire was translated, revised and back-translated from Portuguese into English. Subsequently, a retrospective study was carried out with 1,095 patients, 18 months after the first stage. The validation and reliability of the Tinnitus Primary Function Questionnaire was verified by comparing its results with the results of the Tinnitus Handicap Inventory.

RESULTS

The interclass correlation coefficient of the behavioral aspects ranged from 0.82 to 0.90 and the total score was 0.93, while Cronbach's alpha was >0.94 for the total score during the test-retest application. To validate the questionnaire, a database was used, which consisted of 1,095 patients submitted to tinnitus assessment using the Tinnitus Primary Function Questionnaire and Tinnitus Handicap Inventory simultaneously. Patients were enrolled from 14 Brazilian states (46% female), with a mean age of 58 years. The reliability of the Tinnitus Primary Function Questionnaire was tested during validation for the four different evaluated behavioral aspects, and the results were significantly high for all aspects and the total score. To validate the Tinnitus Primary Function Questionnaire, the results of the total Tinnitus Primary Function Questionnaire and Tinnitus Handicap Inventory scores were compared using Pearson's product-moment correlation test. The results indicate a high correlation between the two questionnaires (r=0.84; p<0.001; 95% CI 0.82-0.85).

CONCLUSION

The data from the Tinnitus Primary Function Questionnaire showed a high correlation with those of the Tinnitus Handicap Inventory. This indicates that the Portuguese version of the Tinnitus Primary Function Questionnaire can be adopted as a valuable tool in the clinical evaluation of patients with tinnitus.

LEVEL OF EVIDENCE

2C.

Validation of the mandarin tinnitus evaluation questionnaire: A clinician-administered tool for tinnitus management

This study sought to validate the applicability of the mandarin Tinnitus Evaluation Questionnaire (TEQ), a brief score method administered by clinicians to quantify the tinnitus severity.A descriptive observational questionnaire study in regard to psychometric properties and practicability was conducted with a total of 414 primary tinnitus outpatients, in which 173 of 414 patients completed the follow-up after receiving an intervention based on the tinnitus educational counseling and the life-style adjustment guidance. For quantifying the tinnitus severity, the TEQ and other 2 self-report questionnaires, Tinnitus Handicap Inventory and visual analog scale, were administered on patients' first-visit and follow-up. With the psychometric analysis, we evaluated the performance of TEQ in tinnitus management, including distinguishing patients with varying severity and detecting the treatment-related outcome.At the first visit, the TEQ showed an excellent inter-rater reliability (Pearson correlation, 0.97, P < .01), a good internal consistency reliability (Cronbach's α, 0.79), and an acceptable convergent validity (Pearson correlation, 0.78 with the Tinnitus Handicap Inventory; 0.62 with a single-question visual analog scale, P < .01). In detecting the treatment-related change, a large effect size of TEQ verified a sensitive responsiveness. After estimating the test-error, a 2-point reduction (2/21) of the TEQ was recommend to be considered a reference outcome indicator for the effective intervention.Even though the TEQ is scored by clinician, it can reflect the clinical features of tinnitus patient. Flexible and simple assessing process makes it a practical tool for patient intake, intervention selection, and outcome measurement.

An Empowerment Model for Individuals with Chronic Tinnitus

OBJECTIVE

This qualitative study sought to construct a model of empowerment for clinical implementation, based on the first-hand experience of a sample of individuals with chronic tinnitus.

DESIGN

The study was conducted in accordance with the inductive approach to data in classic grounded theory (GT). GT aims to build a model of behavior that accounts for the main concern of individuals and how they strive to resolve it. Twenty-one participants with chronic tinnitus (10 females, 11 males, age 31-85, mean: 57.6 years, mean duration of tinnitus: 12 years) were recruited through the patient association France Acouphènes and ENT consultations. Open-ended, tape-recorded interviews addressed the variation in the intrusiveness of tinnitus in daily life. A constant comparison analysis was undertaken to identify a core category and to distinguish stages in behavioral changes toward the tolerance of tinnitus.

RESULTS

Participants' main concern was to limit the intrusiveness of tinnitus day in, day out. They continuously had to handle tinnitus-induced frustration, which was found to be the core category of the analysis accounting for how all the participants tried to deal with the condition. The more they managed to handle their frustration, the better they coped with the condition. Three behavior patterns were identified as facilitating the ongoing management of tinnitus-induced frustration: (1) searching for perspective upon tinnitus; (2) maintaining order in perception despite its interference; and (3) alleviating conflict arising from social interactions. A model of empowerment is presented that is based on four stages toward tolerance of tinnitus. They are dominated by lack of perspective upon tinnitus (circuit 1), preservation of energy through attempts to control its intrusiveness (circuit 2), attempts to detach oneself from the interference of tinnitus through constant activities (circuit 3), and self-induced relief through the fulfillment of meaningful goals (circuit 4).

CONCLUSION

Tolerance of tinnitus requires finding balance between limiting one's social participation and spontaneity in carrying out meaningful activities. Tolerance can be enhanced by the preservation of one's energy and the mediating role of enjoyment through the fulfillment of gratifying goals. In patient counseling, it is essential to address the individual's desire for direct relief from tinnitus through its elimination. Individuals should be made aware that such a desire will likely be thwarted, resulting in the worsening of intrusiveness. Improvement in tolerance is accompanied by the attenuation of niggling self-awareness, a change that is typical of full commitment with valued goals and that helps in alleviating the interference of tinnitus. By understanding the role of frustration, individuals may develop a sense of responsibility in dealing with disabling tinnitus.

Exploring Tinnitus-Induced Disablement by Persistent Frustration in Aging Individuals: A Grounded Theory Study

Background: Qualitative research can help to improve the management of patients, meet their expectations and assist physicians in alleviating their suffering. The perception of moment-to-moment variability in tinnitus annoyance is an emerging field of exploration. This study sought to enlighten variability in tinnitus-induced disablement using a qualitative approach. Methods: Twelve participants (six females, six males, aged 51-79) were recruited via the French Tinnitus Association Journal for participation in recorded semi-structured interviews. Each participant had three interviews lasting 1 h, the sessions being separated one from the other by 2 weeks. Following recommendations of Charmaz (2014), the second and third interviews were aimed at gathering rich data, by enhancing the participants' reflexivity in the circumstances of distress caused by tinnitus. After transcription, the data (n = 36 interviews) were analyzed using the approach to Grounded Theory proposed by Strauss and Corbin (1998). Results: Tinnitus as persistent frustration emerged as being the core category uniting all the other categories of the study. Hence, the core category accounted for the broader scope in participants' experience of chronic tinnitus. It is suggested that tinnitus-induced disablement varied according to the degree of frustration felt by the participants in not being able to achieve their goals. The implications of this were analyzed using the following categories: "Losing body ownership," "Lacking perspectives," and "Persevering through difficulties." Based on these findings, we draw a substantive theory of tinnitus tolerance that promotes an active, disciplined and individualized approach to tinnitus-induced disablement. The model distinguishes pathways from sustained suffering to reduced annoyance (i.e., emerging tolerance). It accounts for difficulties that the participants experienced with a perceived unchanged annoyance over time. Furthermore, this model identifies a set of new attitudes toward oneself and others that tinnitus tolerance would entail. Conclusion: The subjective experience of frustration enlightens tinnitus-induced disablement, offering new perspectives for long-term self-management. Modulation of frustration, rather than moderation of tinnitus interference, is suggested as a new approach to the clinical management of tinnitus-related distress.

Symptom severity, social supports, coping styles, and quality of life among individuals' diagnosed with Ménierè's disease

OBJECTIVES

To (1) examine the quality of life of individuals with Ménierè's disease in relation to symptom severity, social supports, and coping styles and (2) develop a prediction model to identify factors most strongly associated with quality of life.

METHODS

Data were collected using a web-based survey that included previously developed and validated measures (i.e. SF-12, Dizziness Handicap Inventory, Hearing Handicap Inventory for Elderly Screening Version, Iowa Tinnitus Handicap Questionnaire, Interpersonal Support Evaluation List, Brief COPES, Lehman's Quality of Life). Ninety-five individuals with Ménierè's disease who were members of one of five online Ménierè's disease support groups responded to the survey.

RESULTS

The findings indicated that symptom severity was negatively associated with patients' quality of life, social supports were positively associated with quality of life, and the use of negative coping styles (e.g. substance use, blaming) was negatively associated with quality of life. Four predictors (i.e. SF-12 mental health, dizziness severity, self-esteem support, and negative coping styles) accounted for 62% of the variance in quality of life.

DISCUSSION

The findings suggest that the factors associated with the quality of life of patients with Ménierè's disease are similar to those reported in the literature among patients with other chronic illnesses. The results also suggested that emphasis on psychosocial factors may be an important aspect of a comprehensive treatment intervention for individuals with Ménierè's disease.

A confirmatory factor analytic validation of the Tinnitus Handicap Inventory

OBJECTIVE

Because the postulated three-factor structure of the internationally widely used Tinnitus Handicap Inventory (THI) has not been confirmed yet by a confirmatory factor analytic approach this was the central aim of the current study.

METHODS

From a clinical setting, N=373 patients with chronic tinnitus completed the THI and further questionnaires assessing tinnitus-related and psychological variables. In order to analyze the psychometric properties of the THI, confirmatory factor analysis (CFA) and correlational analyses were conducted.

RESULTS

CFA provided a statistically significant support for a better fit of the data to the hypothesized three-factor structure (RMSEA=.049, WRMR=1.062, CFI=.965, TLI=.961) than to a general factor model (RMSEA=.062, WRMR=1.258, CFI=.942, TLI=.937). The calculation of Cronbach's alpha as indicator of internal consistency revealed satisfactory values (.80-.91) with the exception of the catastrophic subscale (.65). High positive correlations of the THI and its subscales with other measures of tinnitus distress, anxiety, and depression, high negative correlations with tinnitus acceptance, moderate positive correlations with anxiety sensitivity, sleeping difficulties, tinnitus loudness, and small correlations with the Big Five personality dimensions confirmed construct validity.

CONCLUSION

Results show that the THI is a highly reliable and valid measure of tinnitus-related handicap. In contrast to results of previous exploratory analyses the current findings speak for a three-factor in contrast to a unifactorial structure. Future research is needed to replicate this result in different tinnitus populations.

Acouphènes et thérapie comportementale et cognitive

INTRODUCTION

Tinnitus is a common auditory symptom that interferes with activities of daily living and is often associated with anxiety and depression.

METHOD

This study included consecutive patients with chronic intense tinnitus for more than six months who were treated with Tinnitus Retraining Therapy (TRT), a cognitive-behavioral therapy, after previous treatment failed and after a clinical evaluation based on standardized questionnaires, including the Tinnitus Handicap Questionnaire (THQ). One year after the end of the TRT, the treatment was evaluated by the same standardized questionnaires.

RESULTS

This prospective study included 96 consecutive patients (49 women, 47 men, mean age: 48 years). Tinnitus improved significantly in 75%, where significant improvement was defined as a final THQ score of less than 500 after CBT. This improvement varied according to initial THQ scores and was seen in: all patients with moderate (THQ<500), 70.3% of the patients with intermediate (500<THQ>1001), and 34.8% of patients with severe (THQ>1000) tinnitus.

CONCLUSION

CBT shows promise as a treatment of tinnitus-related distress.

Tinnitus handicap inventory: adaptação cultural para o Português brasileiro

TEMA: o zumbido pode provocar muitos prejuízos na qualidade de vida dos pacientes. A avaliação de quanto a qualidade de vida é prejudicada pelo zumbido pode ser útil para o melhor conhecimento do paciente em relação às limitações impostas por este sintoma, a programação terapêutica e a verificação da eficácia terapêutica, quando aplicado antes e após o tratamento. OBJETIVO: adaptar culturalmente o Tinnitus Handicap Inventory (THI) para aplicação na população brasileira e avaliar a sua reprodutibilidade. MÉTODO: a adaptação cultural do THI (Newman et al., 1996) seguiu as etapas indicadas por Guillemin et al. (1993), que incluem a tradução do idioma Inglês para o Português, adaptação lingüística e revisão das equivalências gramatical e idiomática. Realizou-se, também, a avaliação das reprodutibilidades inter e intra-pesquisadores deste questionário. Participaram 30 pacientes com zumbido, dos sexos feminino 19 (63,3%) ou masculino 11 (36,7%), com idade entre 39 e 79 anos (média 56,8 anos), encaminhados a partir de ambulatório específico em otoneurologia. RESULTADOS: o THI foi adaptado para ser aplicado na população brasileira, denominado THI Brasileiro. Não houve diferença estatisticamente significante quanto à reprodutibilidade inter-pesquisadores nos resultados obtidos à aplicação da versão brasileira deste questionário, bem como da reprodutibilidade intra-pesquisadores. Verificou-se prejuízo da qualidade de vida em relação aos aspectos emocionais, funcionais e/ou catastróficos em todos os pacientes avaliados. CONCLUSÃO: o THI foi traduzido e adaptado culturalmente para ser aplicado na população brasileira, mostrando-se um instrumento confiável para verificação do prejuízo causado pelo zumbido na qualidade de vida.

Apport des thérapies cognitives et comportementales dans la prise en charge des acouphènes

OBJECTIVES

Tinnitus is a common otologic symptom but, despite important advances in the evaluation and management of such symptom, ENTs often fail to address tinnitus properly. Some tinnitus patients report that tinnitus interferes with activities of daily living, such as reading, social interactions, sleep, concentrating on complex tasks. Anxiety and depression are current major disorders associated with tinnitus. Many theories exist regarding mechanisms of tinnitus origin. A number of publications favors the theory of discordant dysfunction of inner or outer hair cells of the organ of Corti. Nevertheless, some authors insist on the possible role of the central auditory pathways. Multiple functional connections between auditory system, limbic system, autonomic nervous system seem crucial in the development of tinnitus. The aim of this paper is to present a new approach in France of tinnitus treatment by cognitive-behavioral therapy (CBT).

MATERIAL AND METHODS

96 patients with chronic and intense tinnitus were included in the study (38 females, 36 males, mean age 48 years). A CBT was developed after a clinical evaluation based on standardized questionnaires.

RESULTS

The two main results are: (i) the importance of anxiety and depression in this population, (ii) the amelioration of tinnitus perception in 750f the included patients.

CONCLUSION

CBT shows promise as a treatment of tinnitus-related distress.