Rapid Assessment of Tinnitus Complaints with a Modified Version of the Tinnitus and Hearing Survey

The objective of this project was to establish cutoff scores on the tinnitus subscale of the Tinnitus and Hearing Survey (THS) using a large sample of United States service members (SM) with the end goal of guiding clinical referrals for tinnitus evaluation. A total of 4,589 SM undergoing annual audiometric surveillance were prospectively recruited to complete the THS tinnitus subscale (THS-T). A subset of 1,304 participants also completed the Tinnitus Functional Index (TFI). The original 5-point response scale of the THS (THS-T16) was modified to an 11-point scale (THS-T40) for some participants, to align with the response scale of the TFI. Age, sex, hearing loss, and self-reported tinnitus bother were also recorded. The THS-T was relatively insensitive to hearing, but self-reported bothersome tinnitus was significantly associated with the THS-T40 score. Receiver operating characteristic analysis was used to determine cutoff scores on the THS-T that aligned with recommended cutoff values for clinical intervention on the TFI. A cutoff of 9 on the THS-T40 aligns with a TFI cutoff of 25, indicating a patient may need intervention for tinnitus. A cutoff of 15 aligns with a TFI cutoff of 50, indicating that more aggressive intervention for tinnitus is warranted. The THS-T is a viable tool to identify patients with tinnitus complaints warranting clinical evaluation for use by hearing conservation programs and primary care clinics. The THS-T40 cutoff scores of 9 and 15 provide clinical reference points to guide referrals to audiology.

Rapid Assessment of Subjective Hearing Complaints With a Modified Version of the Tinnitus and Hearing Survey

Hearing difficulties are frequently reported by patients in audiology clinics, including patients with normal audiometric thresholds. However, because all individuals experience some difficulty understanding speech in noisy environments, it can be difficult to assess hearing complaints objectively across patients. Normative values help address this issue by providing an objective cutoff score for determining what is or is not clinically significant. The goal of this study was to establish normative values for the four-item hearing subscale of the Tinnitus and Hearing Survey (THS-H). Respondents completing the THS-H rate the level of difficulty understanding speech in the situations most commonly reported as being difficult: in the presence of noise, on TV or in movies, soft voices and group conversations. In this study, 22,583 US Service Members (SMs) completed the THS-H using an 11-point scale ranging from 0 (not a problem) to 10 (a very big problem). Responses to the four items were summed to produce values between 0 and 40. The distribution of the final scores was analyzed based on severity of hearing loss, age, and sex. Only 5% of SMs with clinically normal hearing scored above 27, so this score was selected as a cutoff for "clinically significant hearing problems." Due to its ease of administration and interpretation, the THS-H could be a useful tool for identifying patients with subjective hearing difficulty warranting audiological evaluation and management.

Assessment of Subjective Tinnitus Treatment Results Using a Prototype Device for Electrical and Magnetic Stimulation of the Ear-Preliminary Study

Background: The aim of the study was to evaluate the effectiveness of subjective tinnitus treatment in patients with cochlear sensorineural hearing loss with magnetic ear stimulation using a prototype device. Since the 1970s, studies have been conducted on the use of electrical stimulation of the ear in the treatment of tinnitus. The available literature contains various hypotheses about the influence of electrical stimulation of the ear on tinnitus. Material and Methods: Preclinical studies were performed for 100 patients, 40 women and 60 men (124 ears in total), aged 38-72 years, treated for tinnitus. A subjective assessment of the loudness of tinnitus was performed, and the frequency and intensity as well as hearing threshold were determined using a prototype device for electro-magnetic stimulation of the ear. The treatment cycle consisted of 10 five-minute stimulations performed daily 5 times a week. Results: Before treatment, persistent tinnitus was found in 100 ears (80.6%) and periodic tinnitus in 24 ears (19.4%). Immediately after treatment, persistent tinnitus was present only in 50 ears (40.3%) and periodic tinnitus in 40 ears (32.3%). Complete resolution of tinnitus was noted in 34 ears (27.4%). On the other hand, the examination performed 3 months after the treatment showed persistent tinnitus in 40 ears (32.3%) and periodic tinnitus in 50 ears (40.3%), and complete resolution of tinnitus was recorded in 34 ears (27.4%). Based on the VAS analog scale, there was an improvement in tinnitus in 98 ears (79.0%) immediately after treatment and no improvement in 26 ears (20.0%). The mean VAS scale before treatment was 4.9 points, after treatment it was 2.1 points and 3 months after treatment it was 1.9 points. Conclusions: The preliminary research results show the high effectiveness of magnetic stimulation in the treatment of tinnitus with the use of a prototype device for electromagnetic stimulation of the ear. There was no negative effect of the stimulation on hearing or tinnitus.

Job satisfaction in a group of patients with tinnitus

BACKGROUND

Tinnitus is an auditory impression without any external auditory stimulus. It may cause negative symptoms (anxiety, insomnia, depression) significantly affecting work performance and job satisfaction.

OBJECTIVE

To evaluate the job satisfaction in tinnitus sufferers.

METHODS

Cross-sectional study were conducted and 51 individuals (23-70 years) were recruited. Participants completed two questionnaires: Tinnitus Handicap Inventory and Job Satisfaction Scale.

RESULTS

People affected by tinnitus report higher job satisfaction than healthy people. Job satisfaction was significantly related to age: r = 0.31; p < 0.05 in all tinnitus patients. There was a correlation between job satisfaction and tinnitus severity but only in people with normal hearing (-0.69; p < 0.05).

CONCLUSIONS

The results show that job satisfaction is affected by the level of tinnitus annoyance (from both its emotional and functional aspects), but only in people with normal hearing. In future research it is recommended that additional factors be investigated, both work and non-work related, to thoroughly explore the impact of tinnitus on job satisfaction.

The applicability of the Tinnitus and Hearing Survey (THS) in the differentiation of tinnitus and hearing complaints

PURPOSE

To verify the applicability of the Tinnitus and Hearing Survey (THS) to measure the different complaints of tinnitus, hearing loss and sound tolerance.

METHODS

THS was performed, composed of 4 questions about tinnitus, 4 about hearing loss and one about sound tolerance. Previously, all participants performed a battery of audiological diagnostic tests and were then divided into 4 groups: Bilateral normal audiometry with mean up to 25dB, with and without tinnitus complaint (Groups 1 and 3); diagnosis of mild to moderate neural sensory hearing loss (26dB to 60dB), no previous use of individual hearing aids, complaining of chronic tinnitus (≥6 months) and individuals without tinnitus complaints (Groups 2 and 4); and age ≥18 years old.

RESULTS

Seventy subjects were included in the present study. Regarding the analysis of the total between the groups by the Kruskal-Wallis test, significant differences were found in the sections about tinnitus and hearing loss, but there was no significance in the section regarding sound tolerance. Regarding the questions in Section A of the THS, only Groups 3 and 4 scored the highest. Regarding the questions related to Section B about hearing loss, the groups without hearing loss (Groups 1 and 3) scored the lowest. In relation to the question of the THS in Section C, Group 3 scored the highest.

CONCLUSIONS

The THS questionnaire proved to be a useful, quick and simple tool to assist the audiologist in the understanding and differentiation of the audiologic complaints.

How to Interpret Tinnitus Functional Index Scores: A Proposal for a Grading System Based on a Large Sample of Tinnitus Patients

OBJECTIVES

The Tinnitus Functional Index (TFI) is considered the gold standard in measuring tinnitus severity. The aim of the study was to establish reference values to improve the interpretability of TFI scores.

DESIGN

Results from 1114 patients with tinnitus were retrospectively analyzed. The participants were consecutive patients who attended our tertiary referral Ear, Nose, and Throat Center. The eligibility criteria were: at least 18 years old, persistent tinnitus, completed pure-tone audiometry, and answered all 25 items on the TFI. Hearing status (normal hearing vs. hearing impairment) was established according to the recommendation of the Bureau International d'Audiophonologie. Means (M) and SD on the TFI were the basis for grading tinnitus severity on four levels: low, lower moderate, upper moderate, and high. To gauge individual scores in clinical practice, percentiles are also proposed.

RESULTS

All 1114 patients (586 women and 528 men) were Caucasian and aged from 19 to 87 years (M = 50.96; SD = 13.10 years). Tinnitus duration ranged from 0.5 to 50 years (M = 7.17; SD = 7.71 years). There were 258 patients with normal hearing and 856 patients with hearing loss. A score of above 65 points on TFI was established as the cutoff point for diagnosing high tinnitus severity. A regression model associating tinnitus severity with gender, age, tinnitus duration, and hearing loss was statistically significant: F(4,1109) = 8.99; p < 0.001, but the effect was very small (R2adj = 0.028) and only gender and age were associated with TFI global score, while tinnitus severity was not related to tinnitus duration or hearing loss.

CONCLUSIONS

The reference values proposed here support those reported previously by Meikle et al. They are empirically based and can be used as benchmarks in clinical practice and scientific research. They make it possible to assess tinnitus severity, evaluate individual scores, and categorize individuals with tinnitus. This allows researchers to set inclusion or exclusion criteria when assigning patients to specific groups during clinical trials involving tinnitus intervention strategies.

Tinnitus: An Epidemiologic Perspective

Tinnitus is commonly referred to as "ringing in the ears." Epidemiologic studies highlight challenges associated with clinical determination of tinnitus and ascertainment of its etiology, functional effects, temporal characteristics, psychoacoustic parameters, and risk factors. Because no standards exist for capturing these factors as measures, direct comparison of data between studies is not possible. This report suggests terminology and definitions to promote standardization, with a brief overview of findings from selected population-based epidemiologic studies. Tinnitus-specific data are presented from the Noise Outcomes in Servicemembers Epidemiology study. Further epidemiologic studies are needed to develop tinnitus treatment and a cure for this chronic condition.

Prevalence and Severity of Tinnitus in Otosclerosis: Preliminary Findings from Validated Questionnaires

OBJECTIVES

In addition to progressive hearing loss, subjective tinnitus is one of the primary symptoms of the otosclerosis development. The aim of this study was to evaluate the prevalence and severity of preoperative tinnitus among a group of consecutive adult patients with otosclerosis, using standardized research tools.

MATERIALS AND METHODS

The study included 157 cases of clinical otosclerosis (106 women, 51 men). All patients were tested using pure-tone audiometry. The preoperative prevalence and severity of tinnitus were tested using three validated questionnaires: The Tinnitus and Hearing Survey (THS-POL), Tinnitus Handicap Inventory (THI-POL), and Tinnitus Functional Index (TFI-Pl).

RESULTS

Preliminary results showed that 107 of 157 patients with otosclerosis (68.2%) had preoperative tinnitus. Of them, 51 (47.7%) had unilateral tinnitus (in the ear that qualified for stapes surgery), and 56 (52.3%) had bilateral tinnitus. The THS results showed that for 23.4% patients, tinnitus was a problem equal to or greater than hearing loss. The average result of the TFI-Pl questionnaire was 31.6 points, and for THI-POL, it was 38.6 points, indicating that preoperative tinnitus was moderately severe. The statistical analysis did not reveal a correlation between the tinnitus severity and audiometric results (p>0.05). The severity of tinnitus did not differ significantly between men and women (p>0.05), although the TFI-Pl and THI-POL questionnaires indicated that the tinnitus severity generally increased with age in women, while it decreased in men.

CONCLUSION

This is a scientific study conducted to evaluate the prevalence and severity of preoperative tinnitus in Polish patients with otosclerosis, using three validated questionnaires.

Tinnitus and hearing survey: cultural adaptation to Brazilian Portuguese

Introduction

Hearing loss is associated with several comorbidities and may be frequently associated with tinnitus. When patients complain of both tinnitus and hearing difficulties in audiology and otolaryngology clinics, there, is often great difficulty separating the two complaints. The tinnitus and hearing survey was specially developed for this purpose to identify the main complaint and help direct the choice of appropriate intervention.

Objective

To translate and culturally adapt the tinnitus and hearing survey for the Brazilian-Portuguese.

Methods

Seventy patients who had previously completed a battery of audiological diagnostic exams were invited to complete the tinnitus and hearing survey and were categorized into four groups: normal hearing without tinnitus, normal hearing with tinnitus, hearing loss without tinnitus, and hearing loss with tinnitus. Cultural adaptation of tinnitus and hearing survey followed the steps indicated by Guillemin et al. (1993), including assessment of inter-researchers’ reproducibility, internal consistency, and reliability of the instrument.

Results

There were no substantial changes to the content of the tinnitus and hearing survey questions, although a few adaptations were made to two-item sound tolerance section to facilitate participants’ understanding. Internal consistency and reliability tested by Cronbach’s α was considered good for all domains. The reproducibility of the tinnitus and hearing survey was measured by the Kappa coefficient at two different moments and agreement between evaluators 1 and 2 was considered almost perfect, indicating good reproducibility.

Conclusion

The tinnitus and hearing survey was culturally adapted to Brazilian Portuguese and analyzed for internal consistency, reliability, and reproducibility. Results support this questionnaire as a useful tool to help professionals differentiate the main complaint of the individual, allowing the choice of a more appropriate intervention.

Changes in Hearing Threshold and Tinnitus Severity after Stapes Surgery: Which Is More Important to the Patient's Quality of Life?

BACKGROUND

Stapes surgery is a common method of treatment of otosclerosis, and its effectiveness is reported based on audiometric hearing thresholds. Audiometric tests do not gauge the impact of tinnitus severity and auditory function on quality of life (QOL) after stapes surgery.

OBJECTIVE

To measure self-assessed QOL in otosclerosis patients after stapedotomy in terms of three major factors: change in audiometric hearing threshold, subjective hearing benefit, and tinnitus severity.

METHOD

This prospective clinical study included 191 patients who underwent stapedotomy between April and October 2017 due to otosclerosis. All patients were tested by pure tone audiometry and filled in a questionnaire before surgery and 6 months afterwards. Subjective hearing was assessed with the Abbreviated Profile for Hearing Aid Benefit (APHAB); tinnitus severity was established using the Tinnitus Functional Index (TFI), and the QOL was measured by the Glasgow Benefit Inventory (GBI).

RESULTS

Statistical analysis showed that the average GBI total score (mean = 33.7; SD = 23.7) was statistically significantly higher than zero (t = 19.7; p < 0.001). Based on a regression model, all the three variables studied - audiometric hearing thresholds change, APHAB change, and TFI change - had a significant effect on QOL after stapedotomy. Interestingly, the highest beta value (b = 0.040; p < 0.001) was for TFI change, implying that TFI change had the greatest effect on QOL.

CONCLUSION

Although the improvement of QOL after stapes surgery undoubtedly depended on improvement in both audiometric and self-reported hearing, the reduction of tinnitus severity had the greatest impact on increase in QOL.

Tinnitus Severity Change Following Stapedotomy in Patients With Otosclerosis

OBJECTIVE

To determine whether stapedotomy was effective in reducing tinnitus severity. In addition, the relationship between reduction in tinnitus and improvement in hearing after stapedotomy was analyzed.

STUDY DESIGN

Prospective clinical study.

SETTING

Tertiary referral center.

PATIENTS

A group of 168 otosclerosis patients diagnosed with chronic tinnitus.

INTERVENTION

Stapedotomy.

MAIN OUTCOME MEASURES

The Tinnitus Functional Index questionnaire (TFI) was used to assess tinnitus severity before surgery, and at 3 and 6 months postoperatively. Pure-tone audiometry was conducted before surgery and 6 months postoperatively.

RESULTS

The TFI Total score before the operation was M = 34.5 (standard deviation [SD] = 1.6) points, and decreased 3 months after stapedotomy to M = 17.5 (SD = 1.7), a statistically significant change (T = -8.200; p < 0.001). A weak correlation was found between the pre- and postoperative difference of TFI Total score and air-conduction thresholds (r = 0.21; p = 0.013) as well as between the TFI Total score and the size of the air-bone gap (r = 0.21; p = 0.013). Preoperatively, 86 patients tinnitus was a not or small problem, and for 82 it was moderate to very big. After stapedotomy, 93 (55%) of patients experienced a significant reduction in tinnitus severity. Of the whole group, 62 patients (37%) reported complete disappearance of their tinnitus. No change in tinnitus severity was reported by 63 patients (38%), and an increase was observed by 12 patients (7%).

CONCLUSION

Stapedotomy not only improves hearing but also reduces tinnitus severity. The current results extend knowledge of postoperative results in terms of tinnitus severity, and might benefit patients undergoing tinnitus counseling. It might also be useful to otolaryngologists when making decisions regarding qualification criteria.

Prevalence and severity of tinnitus in Polish otosclerosis patients qualified for stapes surgery

Purpose

To assess the prevalence and severity of tinnitus among a group of Polish patients with otosclerosis who qualified for stapes surgery. A secondary objective was to gauge the relationship between tinnitus severity and hearing thresholds.

Methods

Based on the eligibility criteria, 460 adults with otosclerosis (236 women, 134 men) were included in the study. The Tinnitus Functional Index (TFI) was used to assess tinnitus severity. Hearing thresholds for air and bone conduction were established using clinical pure-tone audiometry in a soundproof cabin.

Results

Based on the medical interview, tinnitus was the first symptom of otosclerosis in 35% of the participants and 65% of all patients with otosclerosis experienced clinically significant, chronic tinnitus before stapes surgery. For 59% of patients, tinnitus was a significant or severe problem. The degree of hearing loss seemed to be marginally related to the severity of tinnitus reported by the patient.

Conclusions

Tinnitus is a common complaint among patients with otosclerosis, being a significant or severe problem for more than half of them. For this reason, it is worth considering in the future the implementation of standardized questionnaires for the assessment of tinnitus severity as a routine procedure in the diagnostic process of patients with otosclerosis, as well as in the postoperative period, which will be the next stage of our study.

Visual Analogue Scales as a Tool for Initial Assessment of Tinnitus Severity: Psychometric Evaluation in a Clinical Population

The aim of this study was to evaluate the psychometric properties of patient-reported visual analogue scale (VAS) ratings. All of the participants (100 Polish-speaking adults) completed a Tinnitus Functional Index (TFI) once and a 4-component VAS twice over a period of 3 days. Spearman's correlation coefficients between the VAS score and global TFI ranged from ρ = 0.52 for VAS-coping (VAS-C) to ρ = 0.81 for VAS-annoyance (VAS-A). Using the Bland-Altman method, the agreement ranged from 93% for VAS-A to 96% for VAS-distress (VAS-D). Interclass correlation coefficients ranged from 0.67 for VAS-C to 0.90 for VAS-A. The VAS cutoff points representing significant tinnitus severity ranged from 45 points for VAS-C to 66 points for VAS-D. VAS scales are a valid and reliable brief screening tool for obtaining quick information about tinnitus.

Clinically important change in tinnitus sensation after stapedotomy

Background

When measuring the treatment effect in tinnitus with multi-item outcome instruments, it is crucial for both clinical and research purposes to take into consideration clinical importance of the outcome scores. The aim of the present study is to determine minimal important change (MIC) in tinnitus which is clinically meaningful to patients with otosclerosis.

Methods

The study population was 95 patients with otosclerosis, suffering from tinnitus. They completed the Tinnitus Functional Index before stapedotomy and 3 months after the surgery. The minimal important change was estimated with the Clinical Global Impression Scale as the external criterion (anchor). The mean change method and the receiver operating characteristic (ROC) method were used to determine minimal important change in tinnitus sensation.

Results

The improvement in tinnitus after stapedotomy was reported by 69.4% of the patients with otosclerosis. Minimal important change in tinnitus was estimated as reduction of 8.8 points in the Tinnitus Functional Index.

Conclusions

The anchor-based approach using an external criterion (anchor) allows to determine change in tinnitus sensation which is meaningful to patients after stapedotomy. The value of 8.8 points in Tinnitus Functional Index could be used as benchmark of stapedotomy effectiveness in otosclerosis patients suffering from tinnitus. Hearing difficulties comorbid with tinnitus could affect the perception of tinnitus change.

Skarzynski Tinnitus Scale: validation of a brief and robust tool for assessing tinnitus in a clinical population

BACKGROUND

Many tinnitus scales are available, but all of them have certain limitations. The aim of the current study was to present a psychometric data of a new brief and reliable questionnaire that could be conveniently used for evaluating tinnitus complaint in adults (either with normal or impaired hearing)-Skarzynski Tinnitus Scale (STS).

METHODS

The study included 125 participants with at least 1 month of tinnitus duration. All participants were asked to complete the STS, Tinnitus and Hearing Survey (THS), Tinnitus Functional Index (TFI), Tinnitus Handicap Inventory (THI), and Beck Depression Inventory. Psychometric properties of the new tool were tested using exploratory factor analysis (EFA), Pearson bivariate correlation with other tinnitus questionnaires, Pearson bivariate correlation with pure-tone audiometry, Cronbach's alpha coefficient, limits of agreement, smallest detectable change, and floor and ceiling effects. Norms for tinnitus severity as measured by the STS are proposed.

RESULTS

As a whole, the STS has excellent reliability (ICC = 0.94) and good internal consistency (α = 0.91). The results of EFA and content analysis of wording of the items justified the three-factorial structure. The convergent validity was proven by a significant positive correlation with THI, TFI and THS Subscale A scores. Additionally, the authors proposed norms dividing the results into four tinnitus severity grades.

CONCLUSIONS

Statistical analysis shows that STS is a brief but robust tool well-suited to clinical practice. A feature of STS is that it takes into account the impact of tinnitus on the patient's psychological (emotional, cognitive) and functional domains as well as their ability to cope with tinnitus-related distress.

Tinnitus in patients with hearing loss due to mitochondrial DNA pathogenic variants

Purpose

Tinnitus described as individual perception of phantom sound constitutes a significant medical problem and has become an essential subject of many studies conducted worldwide. In the study, we aimed to examine the prevalence of tinnitus among Polish hearing loss (HL) patients with identified mitochondrial DNA (mtDNA) variants.

Methods

Among the selected group of unrelated HL patients with known mtDNA pathogenic variants, two questionnaires were conducted, i.e. Tinnitus Handicap Inventory translated into Polish (THI-POL) and Visual Analogue Scale (VAS) for measuring subjectively perceived tinnitus loudness, distress, annoyance and possibility of coping with this condition (VASs). Pathogenic mtDNA variants were detected with real-time PCR and sequencing of the whole mtDNA.

Results

This is the first extensive tinnitus characterization using THI-POL and VASs questionnaires in HL patients due to mtDNA variants. We have established the prevalence of tinnitus among the studied group at 23.5%. We found that there are no statistically significant differences in the prevalence of tinnitus and its characteristic features between HL patients with known HL mtDNA variants and the general Polish population. In Polish HL patients with tinnitus, m.7511T>C was significantly more frequent than in patients without tinnitus. We observed that the prevalence of tinnitus is lower in Polish patients with m.1555A>G as compared to other available data.

Conclusions

Our data suggest that the mtDNA variants causative of HL may affect tinnitus development but this effect seems to be ethnic-specific.