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Kleinjung T, Peter N, Schecklmann M, Langguth B. The Current State of Tinnitus Diagnosis and Treatment: a Multidisciplinary Expert Perspective. J Assoc Res Otolaryngol 2024:10.1007/s10162-024-00960-3. [PMID: 39138756 DOI: 10.1007/s10162-024-00960-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 07/31/2024] [Indexed: 08/15/2024] Open
Abstract
Tinnitus, the perception of sound without an external source, affects 15% of the population, with 2.4% experiencing significant distress. In this review, we summarize the current state of knowledge about tinnitus management with a particular focus on the translation into clinical practice. In the first section, we analyze shortcomings, knowledge gaps, and challenges in the field of tinnitus research. Then, we highlight the relevance of the diagnostic process to account for tinnitus heterogeneity and to identify all relevant aspects of the tinnitus in an individual patient, such as etiological aspects, pathophysiological mechanisms, factors that contribute most to suffering, and comorbidities. In the next section, we review available treatment options, including counselling, cognitive-behavioral therapy (CBT), hearing aids and cochlear implants for patients with a relevant hearing loss, sound generators, novel auditory stimulation approaches, tinnitus retraining therapy (TRT), pharmacological treatment, neurofeedback, brain stimulation, bimodal stimulation, Internet- and app-based digital approaches, and alternative treatment approaches. The evidence for the effectiveness of the various treatment interventions varies considerably. We also discuss differences in current respective guideline recommendations and close with a discussion of how current pathophysiological knowledge, latest scientific evidence, and patient perspectives can be translated in patient-centered care.
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Affiliation(s)
- Tobias Kleinjung
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Nicole Peter
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Bezirksklinikum, Universitätsstr. 84, 93049, Regensburg, Germany
- Multidisciplinary Tinnitus Clinic, University of Regensburg, Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Bezirksklinikum, Universitätsstr. 84, 93049, Regensburg, Germany.
- Multidisciplinary Tinnitus Clinic, University of Regensburg, Regensburg, Germany.
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Jarach CM, Karydou K, Trochidis I, Bernal-Robledano A, van den Brandt PA, Cima R, Cederroth CR, Lopez-Escamez JA, Ghislandi S, Hall DA, Kikidis D, Langguth B, Lugo A, Mazurek B, Odone A, Schecklmann M, Schoisswohl S, Simoes J, Schlee W, Gallus S. The out-of-pocket expenses of people with tinnitus in Europe. J Epidemiol 2024:JE20230358. [PMID: 38797674 PMCID: PMC11464849 DOI: 10.2188/jea.je20230358] [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: 05/29/2024] Open
Abstract
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.
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Affiliation(s)
- Carlotta M Jarach
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Department of Medical Epidemiology
| | | | | | | | - Piet A van den Brandt
- Maastricht University Medical Centre, CAPHRI- School for Public Health and Primary Care, Department of Epidemiology
- Maastricht University Medical Centre, GROW- School for Oncology and Developmental Biology, Department of Epidemiology
| | - Rilana Cima
- Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven University
- Tinnitus Center of Expertise, Centre of Expertise in Rehabilitation and Audiology, Adelante
- Experimental Health Psychology, Faculty of Psychology and Neurosciences, Maastricht University
| | - Christopher R Cederroth
- Laboratory of Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institutet
- Translational Hearing Research, Tübingen Hearing Research Center, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen
| | - Jose Antonio Lopez-Escamez
- Instituto de Investigación Biosanitaria ibs.GRANADA
- Sensorineural Pathology Programme, Centro de Investigación Biomédica en Red en Enfermedades Raras, CIBERER
- Meniere's Disease Neuroscience Research Program, Faculty of Medicine & Health, School of Medical Sciences, The Kolling Institute, University of Sydney
| | | | | | - Dimitris Kikidis
- Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Medical School
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg
- Interdisciplinary Tinnitus Clinic, University of Regensburg
| | - Alessandra Lugo
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Department of Medical Epidemiology
| | | | - Anna Odone
- School of Medicine, University Vita-Salute San Raffaele
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia
| | | | - Stefan Schoisswohl
- Department of Psychiatry and Psychotherapy, University of Regensburg
- Department of Psychology, Universität der Bundeswehr München
| | - Jorge Simoes
- Department of Psychology, Health and Technology, University of Twente
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg
- Institute for Information and Process Management, Eastern Switzerland University of Applied Sciences
| | - Silvano Gallus
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Department of Medical Epidemiology
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Bernal-Robledano A, Perez-Carpena P, Kikidis D, Mazurek B, Schoisswohl S, Staudinger S, Langguth B, Schlee W, Lopez-Escamez JA. Cognitive Screening and Hearing Assessment in Patients With Chronic Tinnitus. Clin Exp Otorhinolaryngol 2024; 17:15-25. [PMID: 37974057 PMCID: PMC10933812 DOI: 10.21053/ceo.2023.00808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/27/2023] [Accepted: 11/12/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES The study aimed to assess the relationship of tinnitus with hyperacusis with cognitive impairment as indicated by the Montreal Cognitive Assessment (MoCA) tool. METHODS This multicenter cross-sectional study included individuals with chronic tinnitus from the "Unification of Treatments and Interventions for Tinnitus Patients" (UNITI) database. Participants were recruited from four different tertiary clinical centers located in Athens and Granada (Mediterranean group), as well as Berlin and Regensburg (German group). In total, 380 individuals with a diagnosis of non-pulsatile chronic tinnitus (permanent and constant tinnitus lasting more than 6 months) and no evidence of severe cognitive impairment (MoCA score >22) were enrolled. The evaluation utilized the following tools: MoCA, Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (GÜF), Patient Health Questionnaire (PHQ-9), and the European School for Interdisciplinary Tinnitus Research Screening Questionnaire. RESULTS MoCA scores differed between German and Mediterranean individuals (P<0.01), necessitating separate analyses for each group. In both cohorts, MoCA scores were significantly associated with education level, age, hearing threshold at 8 kHz, and THI. Furthermore, a significant correlation was observed between PHQ-9 scores and both THI and GÜF (P<0.01 for both Germans and those from the Mediterranean). CONCLUSION Our data suggest an association between tinnitus handicap, high-frequency hearing loss, and mild cognitive impairment. Additionally, PHQ-9 scores were associated with tinnitus and hyperacusis scores, independent of hearing loss thresholds.
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Affiliation(s)
- Alberto Bernal-Robledano
- Otology and Neurotology Group CTS495, Instituto de Investigación Biosanitaria, ibs. Granada, Universidad de Granada, Granada, Spain
- Division of Otolaryngology, Department of Surgery, University of Granada, Granada, Spain
- Sensorineural Pathology Programme, Centro de Investigación Biomédica en Red en Enfermedades Raras, CIBERER, Madrid, Spain
| | - Patricia Perez-Carpena
- Otology and Neurotology Group CTS495, Instituto de Investigación Biosanitaria, ibs. Granada, Universidad de Granada, Granada, Spain
- Division of Otolaryngology, Department of Surgery, University of Granada, Granada, Spain
- Sensorineural Pathology Programme, Centro de Investigación Biomédica en Red en Enfermedades Raras, CIBERER, Madrid, Spain
- Department of Otolaryngology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Dimitris Kikidis
- Department of Otolaryngology-Head and Neck Surgery, Hippocrateion General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Birgit Mazurek
- Charité‒Universitätsmedizin Berlin, Tinnitus Center, Berlin, Germany
| | - Stefan Schoisswohl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Department of Human Sciences, Institute of Psychology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Susanne Staudinger
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Institute for Information and Process Management, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
| | - Jose Antonio Lopez-Escamez
- Otology and Neurotology Group CTS495, Instituto de Investigación Biosanitaria, ibs. Granada, Universidad de Granada, Granada, Spain
- Division of Otolaryngology, Department of Surgery, University of Granada, Granada, Spain
- Sensorineural Pathology Programme, Centro de Investigación Biomédica en Red en Enfermedades Raras, CIBERER, Madrid, Spain
- Meniere’s Disease Neuroscience Research Program, Faculty of Medicine and Health, School of Medical Sciences, The Kolling Institute, University of Sydney, Sydney, Australia
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Simoes JP, Schoisswohl S, Schlee W, Basso L, Bernal-Robledano A, Boecking B, Cima R, Denys S, Engelke M, Escalera-Balsera A, Gallego-Martinez A, Gallus S, Kikidis D, López-Escámez JA, Marcrum SC, Markatos N, Martin-Lagos J, Martinez-Martinez M, Mazurek B, Vassou E, Jarach CM, Mueller-Locatelli N, Neff P, Niemann U, Omar HK, Puga C, Schleicher M, Unnikrishnan V, Perez-Carpena P, Pryss R, Robles-Bolivar P, Rose M, Schecklmann M, Schiele T, Schobel J, Spiliopoulou M, Stark S, Vogel C, Wunder N, Zachou Z, Langguth B. The statistical analysis plan for the unification of treatments and interventions for tinnitus patients randomized clinical trial (UNITI-RCT). Trials 2023; 24:472. [PMID: 37488627 PMCID: PMC10367236 DOI: 10.1186/s13063-023-07303-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/06/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Tinnitus is a leading cause of disease burden globally. Several therapeutic strategies are recommended in guidelines for the reduction of tinnitus distress; however, little is known about the potentially increased effectiveness of a combination of treatments and personalized treatments for each tinnitus patient. METHODS Within the Unification of Treatments and Interventions for Tinnitus Patients project, a multicenter, randomized clinical trial is conducted with the aim to compare the effectiveness of single treatments and combined treatments on tinnitus distress (UNITI-RCT). Five different tinnitus centers across Europe aim to treat chronic tinnitus patients with either cognitive behavioral therapy, sound therapy, structured counseling, or hearing aids alone, or with a combination of two of these treatments, resulting in four treatment arms with single treatment and six treatment arms with combinational treatment. This statistical analysis plan describes the statistical methods to be deployed in the UNITI-RCT. DISCUSSION The UNITI-RCT trial will provide important evidence about whether a combination of treatments is superior to a single treatment alone in the management of chronic tinnitus patients. This pre-specified statistical analysis plan details the methodology for the analysis of the UNITI trial results. TRIAL REGISTRATION ClinicalTrials.gov NCT04663828 . The trial is ongoing. Date of registration: December 11, 2020. All patients that finished their treatment before 19 December 2022 are included in the main RCT analysis.
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Affiliation(s)
- Jorge Piano Simoes
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.
| | - Stefan Schoisswohl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Department of Psychology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Institute for Information and Process Management, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
| | - Laura Basso
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Alberto Bernal-Robledano
- Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs.Granada, Hospital Universitario Virgen de Las Nieves, Universidad de Granada, 18014, Granada, Spain
| | - Benjamin Boecking
- Tinnitus Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Rilana Cima
- Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven University, Leuven, Belgium
- Tinnitus Center of Expertise, Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, The Netherlands
- Experimental Health Psychology, Faculty of Psychology and Neurosciences, Maastricht University, Maastricht, The Netherlands
| | - Sam Denys
- Research group Experimental Otorhinolaryngology (ExpORL), Department of Neurosciences, KU Leuven University, Leuven, Belgium
- Department of Otorhinolaryngology, Head and Neck surgery, University Hospitals of Leuven, Leuven, Belgium
| | - Milena Engelke
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Alba Escalera-Balsera
- Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs.Granada, Hospital Universitario Virgen de Las Nieves, Universidad de Granada, 18014, Granada, Spain
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, Granada, Spain
| | - Alvaro Gallego-Martinez
- Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs.Granada, Hospital Universitario Virgen de Las Nieves, Universidad de Granada, 18014, Granada, Spain
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, Granada, Spain
| | - Silvano Gallus
- Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Dimitris Kikidis
- Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Jose A López-Escámez
- Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs.Granada, Hospital Universitario Virgen de Las Nieves, Universidad de Granada, 18014, Granada, Spain
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, Granada, Spain
- Department of Surgery, Division of Otolaryngology, Faculty of Medicine, University of Granada, Granada, Spain
- Meniere's Disease Neuroscience Research Program, Faculty of Medicine & Health, School of Medical Sciences, The Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Steven C Marcrum
- Department of Otolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Nikolaos Markatos
- Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Juan Martin-Lagos
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Granada, ibs.GRANADA, Hospital Universitario San Cecilio, Granada, Spain
| | - Marta Martinez-Martinez
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Granada, ibs.GRANADA, Hospital Universitario San Cecilio, Granada, Spain
| | - Birgit Mazurek
- Tinnitus Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Evgenia Vassou
- Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Nicolas Mueller-Locatelli
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Granada, ibs.GRANADA, Hospital Universitario San Cecilio, Granada, Spain
| | - Patrick Neff
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Neuro-X Institute, École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Uli Niemann
- Knowledge Management and Discovery Lab (KMD), Faculty of Computer Science, Otto Von Guericke University Magdeburg, Magdeburg, Germany
| | - Hafez Kader Omar
- Knowledge Management and Discovery Lab (KMD), Faculty of Computer Science, Otto Von Guericke University Magdeburg, Magdeburg, Germany
| | - Clara Puga
- Knowledge Management and Discovery Lab (KMD), Faculty of Computer Science, Otto Von Guericke University Magdeburg, Magdeburg, Germany
| | - Miro Schleicher
- Knowledge Management and Discovery Lab (KMD), Faculty of Computer Science, Otto Von Guericke University Magdeburg, Magdeburg, Germany
| | - Vishnu Unnikrishnan
- Knowledge Management and Discovery Lab (KMD), Faculty of Computer Science, Otto Von Guericke University Magdeburg, Magdeburg, Germany
| | - Patricia Perez-Carpena
- Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs.Granada, Hospital Universitario Virgen de Las Nieves, Universidad de Granada, 18014, Granada, Spain
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, Granada, Spain
| | - Rüdiger Pryss
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Paula Robles-Bolivar
- Department of Otolaryngology, Instituto de Investigación Biosanitaria ibs.Granada, Hospital Universitario Virgen de Las Nieves, Universidad de Granada, 18014, Granada, Spain
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, Granada, Spain
| | - Matthias Rose
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Tabea Schiele
- Tinnitus Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Johannes Schobel
- Institute DigiHealth, University of Applied Sciences, Neu-Ulm, Germany
| | - Myra Spiliopoulou
- Knowledge Management and Discovery Lab (KMD), Faculty of Computer Science, Otto Von Guericke University Magdeburg, Magdeburg, Germany
| | - Sabine Stark
- Tinnitus Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Carsten Vogel
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Nina Wunder
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Zoi Zachou
- Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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Manta O, Sarafidis M, Schlee W, Mazurek B, Matsopoulos GK, Koutsouris DD. Development of Machine-Learning Models for Tinnitus-Related Distress Classification Using Wavelet-Transformed Auditory Evoked Potential Signals and Clinical Data. J Clin Med 2023; 12:jcm12113843. [PMID: 37298037 DOI: 10.3390/jcm12113843] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
Tinnitus is a highly prevalent condition, affecting more than 1 in 7 adults in the EU and causing negative effects on sufferers' quality of life. In this study, we utilised data collected within the "UNITI" project, the largest EU tinnitus-related research programme. Initially, we extracted characteristics from both auditory brainstem response (ABR) and auditory middle latency response (AMLR) signals, which were derived from tinnitus patients. We then combined these features with the patients' clinical data, and integrated them to build machine learning models for the classification of individuals and their ears according to their level of tinnitus-related distress. Several models were developed and tested on different datasets to determine the most relevant features and achieve high performances. Specifically, seven widely used classifiers were utilised on all generated datasets: random forest (RF), linear, radial, and polynomial support vector machines (SVM), naive bayes (NB), neural networks (NN), and linear discriminant analysis (LDA). Results showed that features extracted from the wavelet-scattering transformed AMLR signals were the most informative data. In combination with the 15 LASSO-selected clinical features, the SVM classifier achieved optimal performance with an AUC value, sensitivity, and specificity of 92.53%, 84.84%, and 83.04%, respectively, indicating high discrimination performance between the two groups.
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Affiliation(s)
- Ourania Manta
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece
| | - Michail Sarafidis
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
- Institute for Information and Process Management, Eastern Switzerland University of Applied Sciences, 9001 St. Gallen, Switzerland
| | - Birgit Mazurek
- Tinnitus Center, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - George K Matsopoulos
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece
| | - Dimitrios D Koutsouris
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece
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6
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Langguth B, Kleinjung T, Schlee W, Vanneste S, De Ridder D. Tinnitus Guidelines and Their Evidence Base. J Clin Med 2023; 12:jcm12093087. [PMID: 37176527 PMCID: PMC10178961 DOI: 10.3390/jcm12093087] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/17/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Evidence-based medicine (EBM) is generally accepted as the gold standard for high-quality medicine and, thus, for managing patients with tinnitus. EBM integrates the best available scientific information with clinical experience and patient values to guide decision-making about clinical management. To help health care providers and clinicians, the available evidence is commonly translated into medical or clinical guidelines based on a consensus. These involve a systematic review of the literature and meta-analytic aggregation of research findings followed by the formulation of clinical recommendations. However, this approach also has limitations, which include a lack of consideration of individual patient characteristics, the susceptibility of guideline recommendations to material and immaterial conflicts of interest of guideline authors and long latencies till new knowledge is implemented in guidelines. A further important aspect in interpreting the existing literature is that the absence of evidence is not evidence of absence. These circumstances could result in the decoupling of recommendations and their supporting evidence, which becomes evident when guidelines from different countries differ in their recommendations. This opinion paper will discuss how these weaknesses can be addressed in tinnitus.
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Affiliation(s)
- Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
- Interdisciplinary Tinnitus Clinic, University of Regensburg, 93053 Regensburg, Germany
| | - Tobias Kleinjung
- Department of Otorhinolaryngology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
- Interdisciplinary Tinnitus Clinic, University of Regensburg, 93053 Regensburg, Germany
- Institute for Information and Process Management, Eastern Switzerland University of Applied Sciences, 9001 St. Gallen, Switzerland
| | - Sven Vanneste
- Trinity Institute for Neuroscience, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, D02 PN40 Dublin, Ireland
- School of Psychology, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Dirk De Ridder
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin 9016, New Zealand
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7
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Grundfast KM, Jamil TL. Evaluation and Management of Tinnitus: Are There Opportunities for Improvement? Otolaryngol Head Neck Surg 2023; 168:45-58. [PMID: 35349391 DOI: 10.1177/01945998221088286] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/02/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review current information about diagnosis and management of tinnitus aiming to identify opportunities for achieving a cost-effective, efficient, evidence-based approach that meets the needs of tinnitus sufferers. DATA SOURCES PubMed/MEDLINE. REVIEW METHODS In total, 249 relevant published reports were reviewed. Pertinent keywords and MeSH terms identified reports via PubMed and EMBASE. Acknowledged experts were consulted on ways to improve tinnitus management. CONCLUSIONS There may be opportunities to improve evaluation and management of patients with tinnitus using modern modes of communication and a multidisciplinary therapeutic approach. IMPLICATIONS FOR PRACTICE Tinnitus can adversely affect quality of life while being time-consuming and costly to evaluate and manage. Based on both personal experience and the reports of others, patients with tinnitus who choose to see a physician primarily want to know two things: (1) that the tinnitus that is so distressing will not remain at the same level of severity forever and (2) that something can be done to help cope with the tinnitus that is so annoying. Recent advancements in internet communications, social media, information technology, artificial intelligence, machine learning, holistic medical care, mind-body integrative health care, and multidisciplinary approaches in medical therapeutics may be possibly making new ways of meeting the needs of patients with tinnitus.
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Affiliation(s)
- Kenneth M Grundfast
- Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Otology Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Taylor L Jamil
- Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, Massachusetts, USA
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Manta O, Sarafidis M, Vasileiou N, Schlee W, Consoulas C, Kikidis D, Vassou E, Matsopoulos GK, Koutsouris DD. Development and Evaluation of Automated Tools for Auditory-Brainstem and Middle-Auditory Evoked Potentials Waves Detection and Annotation. Brain Sci 2022; 12:brainsci12121675. [PMID: 36552135 PMCID: PMC9775187 DOI: 10.3390/brainsci12121675] [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] [Received: 11/06/2022] [Revised: 11/28/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Auditory evoked potentials (AEPs) are brain-derived electrical signals, following an auditory stimulus, utilised to examine any obstructions along the brain neural-pathways and to diagnose hearing impairment. The clinical evaluation of AEPs is based on the measurements of the latencies and amplitudes of waves of interest; hence, their identification is a prerequisite for AEP analysis. This process has proven to be complex, as it requires relevant clinical experience, and the existing software for this purpose has little practical use. The aim of this study was the development of two automated annotation tools for ABR (auditory brainstem response)- and AMLR (auditory middle latency response)-tests. After the acquisition of 1046 raw waveforms, appropriate pre-processing and implementation of a four-stage development process were performed, to define the appropriate logical conditions and steps for each algorithm. The tools' detection and annotation results, regarding the waves of interest, were then compared to the clinicians' manual annotation, achieving match rates of at least 93.86%, 98.51%, and 91.51% respectively, for the three ABR-waves of interest, and 93.21%, 92.25%, 83.35%, and 79.27%, respectively, for the four AMLR-waves. The application of such tools in AEP analysis is expected to assist towards an easier interpretation of these signals.
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Affiliation(s)
- Ourania Manta
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece
- Correspondence:
| | - Michail Sarafidis
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece
| | - Nikolaos Vasileiou
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany
| | - Christos Consoulas
- Laboratory of Experimental Physiology, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Dimitris Kikidis
- 1st Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General Hospital, 15772 Athens, Greece
| | - Evgenia Vassou
- 1st Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General Hospital, 15772 Athens, Greece
| | - George K. Matsopoulos
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece
| | - Dimitrios D. Koutsouris
- Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece
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Alzahrani L, Sereda M, Chamouton CS, Haider H, Dewey RS, Hoare DJ. Experience of tinnitus in adults who have severe-to-profound hearing loss: A scoping review. Front Neurol 2022; 13:1004059. [DOI: 10.3389/fneur.2022.1004059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTinnitus is defined as the subjective perception of sound in the absence of an external stimulus, and tinnitus disorder becomes relevant when it is associated with emotional distress, cognitive dysfunction, and/or autonomic arousal. Hearing loss is recognized as the main risk factor for the pathogenesis of tinnitus. However, clinical guidelines for tinnitus disorder provide little direction for those who have severe-to-profound hearing loss including those who are pre-lingually Deaf. The aim of this scoping review was to catalogue what is known from the existing literature regarding the experience and management of tinnitus in adults who have a severe-to-profound hearing loss.SummaryA scoping review was conducted following the Preferred Reporting Item for Systematic Reviews and Meta-analysis extension for Scoping Reviews. Records were included if they reported an evaluation of tinnitus in adults who had severe-to-profound hearing loss. The online databases Ovid (MEDLINE, EMBASE and PsycINFO), CINAHL, ProQuest, Scopus, and Google Scholar were searched using the search terms ‘tinnitus’ (as a MESH term) and ‘deaf’ OR ‘profound hearing loss. Thirty-five records met the inclusion criteria for this review and were cataloged according to three major themes: Impact of tinnitus in deaf adults; Primary treatment of tinnitus in deaf adults; and Cochlear implant studies where tinnitus was a secondary outcome. Tinnitus symptom severity was assessed before and after intervention using tinnitus validated questionnaires in 29 records, with six further records using other assessment tools to measure tinnitus severity. Participants using cochlear implants were included in 30 studies. Medication, repetitive transcranial magnetic stimulation (rTMS), electrical promontory stimulation, and behavioral self-control therapy were each reported in single records.Key messagesThis scoping review cataloged the experience, assessment, and treatment of tinnitus in adults who have severe-to-profound hearing loss. It is shown that there is very limited research reported in this field. Although this review included many records, most focused on the provision of cochlear implants for severe-to-profound hearing loss, with assessment and measurement of tinnitus as a baseline or secondary outcome. Largely missing in the literature are empirical studies that seek firstly to understand the nature of the experience of tinnitus by people with no or little residual access to external sound.
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Bromis K, Sarafidis M, Manta O, Kouris I, Vellidou E, Schlee W, Koutsouris D. Predicting the optimal therapeutic intervention for tinnitus patients using random forest regression: A preliminary study of UNITI's decision support system model. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:2655-2658. [PMID: 36085810 DOI: 10.1109/embc48229.2022.9871331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Tinnitus is the conscious perception of a phantom sound in absence of an external or internal stimulus. More than 1 in 7 adults in the EU experience tinnitus and for a large proportion of them tinnitus is an intrusive, persistent, and disabling condition, which impairs their life quality. Therefore, tinnitus is posed as a major global burden, which requires a precision-medicine approach in terms of treatments that are tailored to individual patients, due to its high heterogeneity. UNITI is a research and innovation project which aims towards this goal, unifying treatments and interventions for tinnitus. In the context UNITI, a randomized controlled trial (RCT) is being conducted and all the participants' data will be utilized for the development of a clinical decision support system (CDSS). This CDSS will predict the optimal therapeutic intervention for a tinnitus patient based on their profile. In this paper, we present a preliminary study of the CDSS model development process. We describe the available input data, the pre-processing steps conducted, the algorithms tested to model the CDSS' prediction, the models' results, and the future work in the context of this project. The R2 score of the selected model is currently 0.65, indicating that its development process is in the right direction but further tuning and hyperparameter optimization is needed. Clinical Relevance- The proposed model will be integrated in a CDSS aiming at indicating the optimal treatment strategy for a tinnitus patient based their personal profile.
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Smartphone-Guided Educational Counseling and Self-Help for Chronic Tinnitus. J Clin Med 2022; 11:jcm11071825. [PMID: 35407432 PMCID: PMC8999555 DOI: 10.3390/jcm11071825] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/10/2022] [Accepted: 03/23/2022] [Indexed: 12/10/2022] Open
Abstract
Tinnitus is an auditory phantom perception in the ears or head in the absence of a corresponding external stimulus. There is currently no effective treatment available that reliably reduces tinnitus. Educational counseling is a treatment approach that aims to educate patients and inform them about possible coping strategies. For this feasibility study, we implemented educational material and self-help advice in a smartphone app. Participants used the educational smartphone app unsupervised during their daily routine over a period of four months. Comparing the tinnitus outcome measures before and after smartphone-guided treatment, we measured changes in tinnitus-related distress, but not in tinnitus loudness. Improvements on the Tinnitus Severity numeric rating scale reached an effect size of 0.408, while the improvements on the Tinnitus Handicap Inventory (THI) were much smaller with an effect size of 0.168. An analysis of user behavior showed that frequent and intensive use of the app is a crucial factor for treatment success: participants that used the app more often and interacted with the app intensively reported a stronger improvement in the tinnitus. Between study allocation and final assessment, 26 of 52 participants dropped out of the study. Reasons for the dropouts and lessons for future studies are discussed in this paper.
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