MinT-trial: Mindfulness versus cognitive behavioural therapy in Tinnitus patients: protocol for a randomised controlled, non-inferiority trial

Digital thErapy For Improved tiNnitus carE Study (DEFINE): Protocol for a randomised controlled trial

Tinnitus is a common health condition, affecting approximately 15% of the UK population. The tinnitus treatment with the strongest evidence base is Cognitive Behavioural Therapy (CBT), with standard tinnitus therapy typically augmented with education, relaxation and other techniques. Availability of CBT and conventional tinnitus therapy more broadly is limited for tinnitus sufferers. The DEFINE trial aims to assess whether smartphone-delivered tinnitus therapy, the Oto app, is as effective as current standard care, one-to-one therapist-delivered tinnitus treatment for the treatment of tinnitus in adults. The trial is registered in the ISRCTN Registry: ISRCTN99577932. DEFINE is an open-label, non-inferiority, prospective, parallel design, randomised-controlled trial. Recruitment, interventions and assessments will be remote, enabling UK-wide participant involvement. 198 participants aged 18 years or more will be recruited via social media advertisement or via primary care physicians. A screening process will identify those with tinnitus that impacts health-related quality of life, and following consent smartphone-based audiometry will be performed. Randomisation 1:1 to the Oto app or one-to-one therapist-led tinnitus therapy will be performed centrally by computer, matching groups for age, sex and hearing level. Following participant allocation, the Oto app will be provided for immediate use, or a one-to-one remote therapy appointment booked to occur within approximately 1 week, with up to 6 sessions delivered. Participant outcomes will be collected at 4,12, 26 and 52 weeks via questionnaire and phone call. The primary outcome is the change in Tinnitus Functional Index (TFI) total score measured at 26 weeks following allocation. Adverse events will be recorded. A health economic evaluation in the form of a cost-utility analysis will be performed using data from participant submitted EuroQol 5D-5L and Health Utilities Index Mark 3 scores and resource use data. Trial results will be made publicly available, including a plain English summary.

Problem-Oriented Personality Type in Patients with Tinnitus: Specificity and Practical Relevance in Diagnostics

The article presents the results of an empirical study of personality characteristics of the presence or absence of a problem-oriented personality type in 55 patients with (average age 49.6±11.2 years, 60% of men and 40% of women) and without (average age 48.5±12.2 years; 55% of men and 45% of women) subjective idiopathic tinnitus. The use of the Tinnitus Severity Index (TSI), the type-D Scale (DS-14), the Eysenck Personality Questionnaire (EPQ) and the Emotional stability assessment subscale from the Five-Factor Personality Inventory (FFPI) made it possible for the first time to describe the affective style of patients with tinnitus. Compared to people without tinnitus, patients with tinnitus have statistically and clinically significant higher levels of neuroticism, negative affectivity and social inhibition (isolation), on the one hand, and lower levels of extraversion and emotional stability, on the other hand. Patients with tinnitus and severe tinnitus distress are more likely to have a problem-oriented personality type, a problem-oriented personality type is associated with the presence of tinnitus and contributes to its perceived severity. Negative affectivity, as one of the dimensions of a problem-oriented personality type, has an adverse effect on the severity of tinnitus, and is a risk factor for tinnitus distress. In this regard, the article provides practical recommendations for the psychological examination of patients with tinnitus and the tactics of cognitive behavioral therapy.