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Coco L, Hooker ER, Gilbert TA, Prewitt AL, Reavis KM, O'Neil ME, Clark KD, Henry JA, Zaugg T, Carlson KF. Associations Between Traumatic Brain Injury and Severity of Tinnitus-Related Functional Impairment Among US Military Veterans: A National, Population-Based Study. J Head Trauma Rehabil 2024; 39:218-230. [PMID: 38709830 DOI: 10.1097/htr.0000000000000896] [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: 05/08/2024]
Abstract
OBJECTIVE To describe associations between a history of traumatic brain injury (TBI) and the severity of tinnitus-related functional impairment among a national, stratified random sample of veterans diagnosed with tinnitus by the Department of Veterans Affairs (VA) healthcare system. SETTING A multimodal (mailed and internet) survey administered in 2018. Participants: VA healthcare-using veterans diagnosed with tinnitus; veterans with comorbid TBI diagnosis were oversampled. DESIGN A population-based survey. MAIN MEASURES TBI history was assessed using International Classification of Diseases (ICD) diagnosis codes in veterans' VA electronic health records. The severity of participants' overall tinnitus-related functional impairment was measured using the Tinnitus Functional Index. Population prevalence and 95% confidence intervals (CIs) were estimated using inverse probability weights accounting for sample stratification and survey nonresponse. Veterans' relative risk ratios of very severe or moderate/severe tinnitus-related functional impairment, versus none/mild impairment, were estimated by TBI history using bivariable and multivariable multinomial logistic regression. RESULTS The population prevalence of TBI was 5.6% (95% CI: 4.8-6.4) among veterans diagnosed with tinnitus. Veterans with a TBI diagnosis, compared with those without a TBI diagnosis, had 3.6 times greater likelihood of rating their tinnitus-related impairment as very severe (95% CI: 2.1-6.3), and 1.5 times greater likelihood of rating their impairment as moderate/severe (95% CI: 1.0-2.4), versus none/mild. CONCLUSIONS These findings suggest an important role of TBI in the severity of tinnitus-related functional impairment among veterans. This knowledge can help inform the integration of tinnitus management services into the care received by veterans with TBI.
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Affiliation(s)
- Laura Coco
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, California (Dr Coco); VA Health Services Research & Development Service Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon (Drs Coco, O'Neil, and Carlson, Ms Hooker and Gilbert, and Mr Prewitt); Oregon Health & Science University-Portland State University School of Public Health, Portland (Ms Hooker, Mr Prewitt, and Drs Reavis, Clark, Zaugg, and Carlson); VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, Oregon (Drs Reavis, Henry, and Carlson); and Departments of Medical Informatics and Clinical Epidemiology (Drs O'Neil and Clark); and Otolaryngology-Head and Neck Surgery (Dr Henry), Oregon Health & Science University, Portland
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Henry JA, Folmer RL, Zaugg TL, Theodoroff SM, Quinn CM, Reavis KM, Thielman EJ, Carlson KF. History of Tinnitus Research at the VA National Center for Rehabilitative Auditory Research (NCRAR), 1997-2021: Studies and Key Findings. Semin Hear 2024; 45:4-28. [PMID: 38370521 PMCID: PMC10872658 DOI: 10.1055/s-0043-1770140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
The Veterans Affairs (VA) Rehabilitation Research & Development (RR&D) National Center for Rehabilitative Auditory Research (NCRAR) was first funded by the RR&D Service in 1997 and has been funded continuously since that time. The overall purpose of the NCRAR is to "improve the quality of life of Veterans and others with hearing and balance problems through clinical research, technology development, and education that leads to better patient care" ( www.ncrar.research.va.gov ). An important component of the research conducted at the NCRAR has been a focus on clinical and rehabilitative aspects of tinnitus. Multiple investigators have received grants to conduct tinnitus research and the present article provides an overview of this research from the NCRAR's inception through 2021.
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Affiliation(s)
- James A. Henry
- VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, Oregon
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Robert L. Folmer
- VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, Oregon
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Tara L. Zaugg
- VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Sarah M. Theodoroff
- VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, Oregon
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Candice M. Quinn
- VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, Oregon
- Durham VA Health Care System, Durham, North Carolina
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Kelly M. Reavis
- VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, Oregon
- School of Public Health, Oregon Health and Science University, Portland, Oregon
| | - Emily J. Thielman
- VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Kathleen F. Carlson
- VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, Oregon
- School of Public Health, Oregon Health and Science University, Portland, Oregon
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon
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Clark KD, Zaugg T, DeFrancesco S, Kaelin C, Henry JA, Carlson KF. Rehabilitation Service Needs and Preferences among Veterans with Tinnitus: A Qualitative Study. Semin Hear 2024; 45:29-39. [PMID: 38370519 PMCID: PMC10872667 DOI: 10.1055/s-0043-1770138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Tinnitus is prevalent among military Veterans, yet there is a gap between the demand and the provision of services for tinnitus rehabilitation services within the Veterans Health Administration (VHA). We sought to understand tinnitus rehabilitation service needs and preferences among Veterans with bothersome tinnitus who use Veterans Affairs (VA) services. We conducted semistructured telephone interviews in 2019 with Veterans diagnosed with tinnitus, who reported it as bothersome. Veterans were purposively sampled to represent national VA users, with and without comorbid traumatic brain injury (TBI), and who were or were not interested in tinnitus rehabilitation services. Qualitative data were analyzed using a modified grounded theory approach. Among 40 Veterans interviewed (32 men, 8 women; 50% with TBI), 72.5% endorsed being somewhat/very likely to be interested in tinnitus rehabilitation services while 27.5% were very/somewhat unlikely. Themes related to Veterans' interest in tinnitus rehabilitation services included barriers and facilitators to participation and preferences for receiving tinnitus services (e.g., individual vs. group-based; in-person vs. remote access). Our findings highlight factors that influence Veterans' reported need and preferences for, and readiness to engage in, rehabilitation services for tinnitus. Personalized or otherwise adaptable approaches to program delivery may help ensure maximal uptake among Veterans.
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Affiliation(s)
- Khaya D. Clark
- VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System (P5-NCRAR), Portland, Oregon
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Oregon Health and Science University, Portland, Oregon
- Department of Defense, Hearing Center of Excellence, San Antonio, Texas
| | - Tara Zaugg
- VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System (P5-NCRAR), Portland, Oregon
| | - Susan DeFrancesco
- VA Health Services Research & Development Service Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66), Portland, Oregon
- Oregon Health and Science University – Portland State University School of Public Health, Oregon Health and Science University, Portland, Oregon
| | - Christine Kaelin
- VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System (P5-NCRAR), Portland, Oregon
| | - James A. Henry
- VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System (P5-NCRAR), Portland, Oregon
- Department of Otolaryngology – Head and Neck Surgery, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Kathleen F. Carlson
- VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System (P5-NCRAR), Portland, Oregon
- VA Health Services Research & Development Service Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66), Portland, Oregon
- Oregon Health and Science University – Portland State University School of Public Health, Oregon Health and Science University, Portland, Oregon
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Coco L, Hooker ER, Gilbert TA, Harker GR, Clark KD, Reavis KM, Henry JA, Zaugg TL, Carlson KF. The Impact of Tinnitus Severity on Work Functioning among U.S. Military Veterans with Tinnitus. Semin Hear 2024; 45:40-54. [PMID: 38370516 PMCID: PMC10872655 DOI: 10.1055/s-0043-1770152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Tinnitus is highly prevalent among military Veterans. Severe tinnitus can be associated with negative impacts on daily life. Veterans with severe tinnitus may also have greater difficulties in functional roles, including work. However, few studies have explicitly explored this relationship. Traumatic brain injury (TBI), also prevalent among Veterans, is associated with tinnitus and can additionally impair work functioning. This quantitative investigation used a population-based survey to assess the relationship between tinnitus severity, measured using the Tinnitus Functional Index (TFI), and the impact of tinnitus on work, measured using a composite score from the Tinnitus History Questionnaire, among a stratified random sample of VA healthcare-using Veterans diagnosed with tinnitus, with and without comorbid TBI. Analyses were weighted to account for sampling design and Veteran non-response; multiple imputation was used to account for missing data. Results indicated that for every 1-point increase in TFI score, there was an average 8% increase in the odds of reporting a high level of impact on work functioning (OR: 1.08; 95% CI: 1.06, 1.11). Veterans with a comorbid TBI diagnosis, compared with those without, were more likely to have high tinnitus-related impact on work functioning (OR: 2.69, 95% CI: 1.85, 3.91), but the relationship between tinnitus severity and the impact of tinnitus on work functioning did not differ by TBI status. These data can help researchers and clinicians understand complex symptoms experienced by Veterans with tinnitus, with and without TBI, supporting the improved provision of clinical services to these patients.
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Affiliation(s)
- Laura Coco
- VA Health Services Research & Development Center of Innovation, Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon
- VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, Oregon
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, California
| | - Elizabeth R. Hooker
- VA Health Services Research & Development Center of Innovation, Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon
| | - Tess A. Gilbert
- VA Health Services Research & Development Center of Innovation, Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon
| | - Graham R. Harker
- VA Health Services Research & Development Center of Innovation, Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon
- School of Public Health, Oregon Health & Science University, Portland, Oregon
| | - Khaya D. Clark
- VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Kelly M. Reavis
- VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, Oregon
- School of Public Health, Oregon Health & Science University, Portland, Oregon
| | - James A. Henry
- VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, Oregon
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon
| | - Tara L. Zaugg
- VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Kathleen F. Carlson
- VA Health Services Research & Development Center of Innovation, Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon
- VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, Oregon
- School of Public Health, Oregon Health & Science University, Portland, Oregon
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Myers EE, Joseph AR, Dougherty AL, Clouser MC, MacGregor AJ. Relationship Between Tinnitus and Hearing Outcomes Among US Military Personnel After Blast Injury. Ear Hear 2023; 44:300-305. [PMID: 36253906 DOI: 10.1097/aud.0000000000001285] [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: 11/05/2022]
Abstract
OBJECTIVES To examine the association between tinnitus and hearing outcomes among US military personnel after blast injury, including any hearing loss, low-frequency hearing loss, high-frequency hearing loss, early warning shift, and significant threshold shift. DESIGN In this retrospective study, the Blast-Related Auditory Injury Database was queried for male military service members who had audiometric data 2 years before and after blast injury between 2004 and 2012 with no history of hearing loss or tinnitus before injury (n = 1693). Tinnitus was defined by diagnostic codes in electronic health records. Multivariable logistic regression examined the association between tinnitus and hearing outcomes, while adjusting for covariates. RESULTS Overall, 14.2% (n = 241) of the study sample was diagnosed with tinnitus within 2 years after blast injury. The proportions of all examined hearing outcomes were higher among service members with tinnitus than those without ( p < 0.001). In multivariable analysis, service members with tinnitus had higher adjusted odds of any hearing loss (odds ratio [OR] = 1.72, 95% confidence interval [CI] = 1.20-2.47), low-frequency hearing loss (OR = 2.77, 95% CI = 1.80-4.26), high-frequency hearing loss (OR = 2.15, 95% CI = 1.47-3.16), early warning shift (OR = 1.83, 95% CI = 1.36-2.45), and significant threshold shift (OR = 2.15, 95% CI = 1.60-2.89) compared with service members without tinnitus. CONCLUSIONS The findings of this study demonstrate that tinnitus diagnosed within 2 years after blast injury is associated with the examined hearing outcomes in US military personnel. Service members with blast injury who subsequently experience tinnitus should receive routine audiometric hearing conservation testing and be carefully examined for poor hearing outcomes by an audiologist.
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Affiliation(s)
- Emily E Myers
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
| | - Antony R Joseph
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
- Hearing Loss Prevention Laboratory, Communication Sciences and Disorders Department, Illinois State University, Normal, Illinois, USA
| | - Amber L Dougherty
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
| | - Mary C Clouser
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
- Leidos, Inc., San Diego, California, USA
| | - Andrew J MacGregor
- Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California, USA
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Halverson TF, Mann AJD, Zelkowitz RL, Patel TA, Evans MK, Aho N, Beckham JC, Calhoun PS, Pugh MJ, Kimbrel NA. Nonsuicidal self-injury in veterans: Prevalence, clinical characteristics, and gender differences from a national cohort. Psychiatry Res 2022; 315:114708. [PMID: 35868073 PMCID: PMC9378466 DOI: 10.1016/j.psychres.2022.114708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/28/2022]
Abstract
Nonsuicidal self-injury (NSSI) is a robust predictor of suicidal thoughts and behaviors; however, while there are typically only small differences observed in the prevalence of NSSI between men and women, this condition has been largely overlooked and underestimated among men. Assessing NSSI methods more common in men may address misidentification as well as allow for more precise NSSI prevalence estimates. Survey data from a national sample of Gulf War I-Era veterans (N = 1063) was used to estimate the prevalence of NSSI and compare prevalence of NSSI methods between men and women veterans. Demographic and clinical correlates of NSSI engagement were also examined. The national lifetime prevalence rate of NSSI among Gulf War I-Era veterans was 22.40%, whereas the past year prevalence rate was 8.10%. In both men and women, wall/object punching was the most common NSSI method endorsed across the lifetime. Men had slightly higher overall NSSI prevalence rates compared with women. This study highlights the need to systematically assess NSSI, particularly among veterans, to better identify, and consequently treat, NSSI in men. This is the first available prevalence estimate of NSSI to include the assessment of wall/object punching in a national sample of adult veterans.
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Affiliation(s)
- Tate F Halverson
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA.
| | - Adam J D Mann
- Department of Psychology, University of Toledo, Toledo, OH, USA
| | - Rachel L Zelkowitz
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston School of Medicine, Boston, MA, USA
| | - Tapan A Patel
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Mariah K Evans
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Natalie Aho
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jean C Beckham
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Patrick S Calhoun
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Mary Jo Pugh
- VA Salt Lake City Healthcare System, Salt Lake City, UT, USA; School of Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs Health Care System, 3022 Croasdaile Drive, Durham, NC 27705, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
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Henry JA, Carlson KF, Theodoroff S, Folmer RL. Reevaluating the Use of Sound Therapy for Tinnitus Management: Perspectives on Relevant Systematic Reviews. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2327-2342. [PMID: 35619049 DOI: 10.1044/2022_jslhr-21-00668] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Tinnitus is a highly prevalent condition that can severely reduce health functioning. In spite of extant clinical practice guidelines (CPGs), implementation of these CPGs is relatively uncommon. As a result, patients seeking professional services for tinnitus often have no assurance of receiving evidence-based care. The purpose of this tutorial was to clarify the evidence for sound therapy so that it may be included in future CPGs for tinnitus. METHOD "Best clinical evidence" is obtained from high-quality systematic reviews, which are generally considered the highest level of evidence. Our review of recent, comprehensive, high-quality systematic reviews of interventions for tinnitus concludes that cognitive behavioral therapy is the only effective intervention, though the strength of evidence was generally rated as low in these reviews. Although trials of sound therapy for tinnitus have been included in these reviews, they have been rated as having high risk of bias (RoB) and not included in syntheses or rated as insufficient strength of evidence. RESULTS Conclusions from these and other reviews have influenced recommendations made in CPGs for tinnitus. These conclusions, however, can make it appear that an intervention for tinnitus is not effective, even if the opposite is true. We contend that the strict inclusion criteria for these reviews are counterproductive and have the effect of obscuring decades of evidence demonstrating the clinical effectiveness of sound therapies for tinnitus. Ultimately, this process has resulted in many patients not receiving sound therapy, despite what should be sufficient evidence that this is an effective form of intervention. CONCLUSION If we rely on systematic reviews using contemporary RoB assessment criteria for studies published prior to these reporting guidelines, then we risk excluding important conclusions regarding interventions that could help patients in need.
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Affiliation(s)
- James A Henry
- VA RR&D National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, OR
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Kathleen F Carlson
- VA RR&D National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, OR
- School of Public Health, Oregon Health & Science University, Portland
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, OR
| | - Sarah Theodoroff
- VA RR&D National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, OR
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Robert L Folmer
- VA RR&D National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, OR
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, OR
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Boussaty EC, Friedman RA, Clifford RE. Hearing loss and tinnitus: association studies for complex-hearing disorders in mouse and man. Hum Genet 2022; 141:981-990. [PMID: 34318347 PMCID: PMC8792513 DOI: 10.1007/s00439-021-02317-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/13/2021] [Indexed: 12/29/2022]
Abstract
Genome-wide association studies (GWAS) provide an unbiased first look at genetic loci involved in aging and noise-induced sensorineural hearing loss and tinnitus. The hearing phenotype, whether audiogram-based or self-report, is regressed against genotyped information at representative single nucleotide polymorphisms (SNPs) across the genome. Findings include the fact that both hearing loss and tinnitus are polygenic disorders, with up to thousands of genes, each of effect size of < 0.02. Smaller human GWAS' were able to use objective measures and identified a few loci; however, hundreds of thousands of participants have been required for the statistical power to identify significant variants, and GWAS is unable to assess rare variants with mean allele frequency < 1%. Animal studies are required as well because of inability to access the human cochlea. Mouse GWAS builds on linkage techniques and the known phenotypic differences in auditory function between inbred strains. With the advantage that the laboratory environment can be controlled for noise and aging, the Hybrid Mouse Diversity Panel (HDMP) combines 100 strains sequenced at high resolution. Lift-over regions between mice and humans have identified over 17,000 homologous genes. Since most significant SNPs are either intergenic or in introns, and binding sites between species are poorly preserved between species, expression quantitative trait locus information is required to bring humans and mice into agreement. Transcriptome-wide analysis studies (TWAS) can prioritize putative causal genes and tissues. Diverse species, each making a distinct contribution, carry a synergistic advantage in the quest for treatment and ultimate cure of sensorineural hearing difficulties.
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Affiliation(s)
- Ely Cheikh Boussaty
- School of Health Sciences, Division of Otolaryngology, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Rick Adam Friedman
- School of Health Sciences, Division of Otolaryngology, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Royce E Clifford
- School of Health Sciences, Division of Otolaryngology, University of California San Diego, La Jolla, San Diego, CA, USA.
- Research Department, VA Hospitals San Diego, San Diego, CA, USA.
- Visiting Scientist, Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA.
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