Clinical characteristics of patients with tinnitus evaluated with the Tinnitus Sample Case History Questionnaire in Japan: A case series

Help-seeker satisfaction with diagnosis and treatment of tinnitus

OBJECTIVE

To examine help-seeker satisfaction with the first communication of a tinnitus diagnosis by a healthcare provider, whether help-seekers undertook treatment and how they rated this treatment.

DESIGN

A survey design assessed tinnitus characteristics and distress, health status, help-seeking, diagnosis communication, treatment and patient satisfaction.

STUDY SAMPLE

A self-selected cohort and a population-based cohort.

RESULTS

Satisfaction scores were examined against demographic, clinical factors, and type of healthcare provider. A total of 281 adults participated (median age 61.6, IQR = 10.8 years), 52.3% sought help for tinnitus and 22.4% received treatment. The most frequently seen healthcare providers were general practitioners (34.0%), audiologists (29.3%) and ear, nose and throat specialists (25.9%). About two-thirds (64.1%) of help-seekers were unsatisfied with the first communication of a tinnitus diagnosis they received, and 56.5% rated their first tinnitus treatment as poor. Help-seekers were significantly more satisfied with audiologists than other providers regarding the communication of the first tinnitus diagnosis. Higher tinnitus distress scores were significantly associated with lower patient satisfaction with communication of first tinnitus diagnosis. No other factors were associated with patient satisfaction.

CONCLUSION

There are significant communication barriers along the tinnitus clinical pathway. Identifying and addressing these barriers could improve patient satisfaction.

Prediction meets time series with gaps: User clusters with specific usage behavior patterns

With mHealth apps, data can be recorded in real life, which makes them useful, for example, as an accompanying tool in treatments. However, such datasets, especially those based on apps with usage on a voluntary basis, are often affected by fluctuating engagement and by high user dropout rates. This makes it difficult to exploit the data using machine learning techniques and raises the question of whether users have stopped using the app. In this extended paper, we present a method to identify phases with varying dropout rates in a dataset and predict for each. We also present an approach to predict what period of inactivity can be expected for a user in the current state. We use change point detection to identify the phases, show how to deal with uneven misaligned time series and predict the user's phase using time series classification. In addition, we examine how the evolution of adherence develops in individual clusters of individuals. We evaluated our method on the data of an mHealth app for tinnitus, and show that our approach is appropriate for the study of adherence in datasets with uneven, unaligned time series of different lengths and with missing values.

Comparison of otoacoustic emissions in tinnitus and hyperacusis in adults with normal hearing sensitivity

Objective: To investigate the effect of tinnitus and/or hyperacusis on distortion product otoacoustic emission (DPOAE) measures in adults with normal hearing thresholds from 0.25 to 8 kHz, while accounting for extended high-frequency (EHF) thresholds.Design: A behavioural study consisted of comprehensive audiological assessment, validated tinnitus and hyperacusis questionnaires, DPOAE amplitudes and input/output (I/O) functions.Study sample: Data of 56 participants with normal hearing were included for the analysis. Participants were categorised into four groups: (1) without tinnitus or hyperacusis, (2) with tinnitus only, (3) with hyperacusis only, and (4) with both tinnitus and hyperacusis.Results: The groups with tinnitus showed elevated EHF thresholds compared with those without tinnitus. DPOAE amplitudes were not significantly affected by tinnitus and/or hyperacusis status; however, they were significantly affected by EHF thresholds. Further, no appreciable differences in DPOAE I/O functions were found across groups.Conclusions: The reported non-significant differences in DPOAEs in individuals with tinnitus and/or hyperacusis do not support a peripheral mechanism or an interaction between peripheral and central mechanisms underlying tinnitus or hyperacusis. Our findings, however, suggest the need to assess basal cochlear function (e.g. EHF thresholds) for a better understanding of differences in DPOAE measures in tinnitus and/or hyperacusis.

An online survey study of the association between tinnitus and hyperacusis using validated questionnaires

OBJECTIVE

To investigate the association between the highly comorbid tinnitus and hyperacusis conditions using standard questionnaires.

DESIGN

A cross-sectional internet-based survey consisted of general demographic questions, questions about hearing and emotional status, Tinnitus Primary Function Questionnaire (TPFQ), and Hyperacusis Questionnaire (HQ).

STUDY SAMPLE

Six hundred sixteen completed surveys were obtained primarily from students and staff in a large university.

RESULTS

About 6% of the respondents could be classified as having hyperacusis based on the criterion of HQ scores ≥ 28 and had significantly increased odds of reporting having tinnitus (OR 10.11; 95% CI 3.76-35.3). Tinnitus severity (TPFQ) and HQ scores were correlated regardless of the hearing loss status. When predicting TPFQ scores, after controlling for demographic factors and affective states, hyperacusis status became an insignificant predictor. In contrast, both affirmative answers to having anxiety and depression, together with hearing loss status and tinnitus were significant predictors of HQ scores.

CONCLUSIONS

Having hyperacusis did not appear to contribute significantly to tinnitus severity, but having tinnitus contributed to the likelihood of having hyperacusis. Our findings provide a nuanced view of how tinnitus and hyperacusis conditions co-occur and influence each other, which may be valuable to clinicians and researchers.

Using a visual analog scale (VAS) to measure tinnitus-related distress and loudness: Investigating correlations using the Mini-TQ results of participants from the TrackYourTinnitus platform

INTRODUCTION

Tinnitus, a perception of ringing and buzzing sound in the ear, has not been completely understood yet. It is well known that tinnitus-related distress and loudness can change over time. However, proper comparability for the data collection approaches requires further focused studies. In this context, technology such as the use of mobile devices may be a promising approach. Repeated assessments of tinnitus-related distress and loudness in Ecological Momentary Assessment (EMA) studies require a short assessment, and a Visual Analogic Scale (VAS) is often used in this context. Yet, their comparability with psychometric questionnaires remains unclear and thus was the focus of this study. Research goals: The evaluation of the appropriateness of VAS in measuring tinnitus-related distress and loudness is pursued in this paper.

METHODS

The Mini Tinnitus Questionnaire (Mini-TQ) measured tinnitus-related distress once. Tinnitus-related distress and tinnitus loudness were measured repeatedly using VAS on a daily basis during 7 days in the TrackYourTinnitus (TYT) smartphone app and were summarized per day using mean and median results. Then, correlations between summarized VAS tinnitus-related distress and summarized VAS tinnitus loudness, on the one side, and Mini-TQ, on the other side, were calculated.

RESULTS

Correlations between Mini-TQ and VAS tinnitus-related distress ranged between r = 0.36 and r = 0.52, while correlations between Mini-TQ and VAS tinnitus loudness ranged between r = 0.25 and r = 0.36. The more time difference between the Mini-TQ and the VAS assessments is, the lower the correlations between them. Mean and median VAS values per day resulted in similar correlations.

CONCLUSIONS

Mobile-based VAS seems to be an appropriate approach to utilize daily measurements of tinnitus-related distress.

A Review and a Framework of Variables for Defining and Characterizing Tinnitus Subphenotypes

Tinnitus patients can present with various characteristics, such as those related to the tinnitus perception, symptom severity, and pattern of comorbidities. It is speculated that this phenotypic heterogeneity is associated with differences in the underlying pathophysiology and personal reaction to the condition. However, there is as yet no established protocol for tinnitus profiling or subtyping, hindering progress in treatment development. This review summarizes data on variables that have been used in studies investigating phenotypic differences in subgroups of tinnitus, including variables used to both define and compare subgroups. A PubMed search led to the identification of 64 eligible articles. In most studies, variables for subgrouping were chosen by the researchers (hypothesis-driven approach). Other approaches included application of unsupervised machine-learning techniques for the definition of subgroups (data-driven), and subgroup definition based on the response to a tinnitus treatment (treatment response). A framework of 94 variable concepts was created to summarize variables used across all studies. Frequency statistics for the use of each variable concept are presented, demonstrating those most and least commonly assessed. This review highlights the high dimensionality of tinnitus heterogeneity. The framework of variables can contribute to the design of future studies, helping to decide on tinnitus assessment and subgrouping.

Retrospective evaluation of secondary effects of hearing aids for tinnitus therapy in patients with hearing loss

OBJECTIVE

Acoustic therapies including hearing aids and tinnitus control instruments are widely used in Japan but without high levels of evidence. The outpatient hearing aid clinic at our institution fits patients with hearing aids and instructs patients on how to use them to control tinnitus if present. In this study, we examined the effects of this approach on tinnitus.

METHODS

One hundred and eleven of 138 patients who visited our hearing aid clinic from April 2016 to September 2018 purchased hearing aids after fitting. Sixty-six of these patients (31 men, 35 women; mean age 78.0 ± 8.0 years) had both hearing loss and tinnitus and were enrolled. The tinnitus was bilateral in 41 patients and unilateral in 25 (poor hearing ear, n = 16, good hearing ear, n = 9). Hearing aids were worn bilaterally by 23 patients and unilaterally by 43 (89 devices). Seventeen of the 23 patients wearing bilateral hearing aids had bilateral tinnitus and 6 had unilateral tinnitus, i.e., in 40 ears, the tinnitus side matched the hearing aid side (40 devices) and in 6 ears did not (6 devices). Twenty-four of 43 patients wearing unilateral hearing aids had bilateral tinnitus, meaning that in 24 ears the tinnitus side matched the hearing aid side (24 devices). In six of the remaining 19 cases with unilateral tinnitus, the hearing aid and tinnitus were on the same side (6 devices) and in 13 were on opposite sides (13 devices). Changes in the Tinnitus Handicap Inventory (THI), visual analog scale (VAS, for tinnitus discomfort, severity, and persistence), and Hospital Anxiety and Depression Scale scores were measured immediately before using a hearing aid and 12 months later.

RESULTS

Significant effects of hearing aids on tinnitus were observed in all subjects (THI, p = 0.0000030), VAS (severity, p = 0.000000066; discomfort, p = 0.0000013). Significant effects were observed with bilateral hearing aids (THI, p = 0.0012; VAS for severity, p = 0.00069; VAS for discomfort, p = 0.00052) and with unilateral hearing aids (THI, p = 0.00055; VAS for severity, p = 0.000034; VAS for discomfort, p = 0.00007). Spearman's rank correlation coefficient showed a significant positive correlation between the THI and VAS scores (p = 0.0033). In cases of bilateral tinnitus, significant differences were observed with bilateral hearing aids (THI, p = 0.011; VAS for severity, p = 0.0019; VAS for discomfort; p = 0.020) and with unilateral hearing aids (THI, p = 0.00069; VAS for severity, p = 0.00071; VAS for discomfort, p = 0.000093).

CONCLUSION

Acoustic therapy using hearing aids was effective for tinnitus. Even when bilateral, a unilateral hearing aid is able to improve tinnitus. When unilateral, the ipsilateral hearing aid is able to improve tinnitus.

A preliminary validation of a Norwegian version of the Tinnitus Sample Case History Questionnaire

At present there is no validated tinnitus questionnaire available in Norway. The aim of the present study was to psychometrically evaluate and report on a Norwegian translation of the Tinnitus Sample Case History Questionnaire (TSCHQ). Furthermore, the results were compared to those of a recent Swedish validation of TSCHQ. More than two hundred (N = 218) participants with tinnitus participated in the study, of which 78% completed the Norwegian TSCHQ on two occasions so that test-retest reliability could be evaluated. Results show that the Norwegian TSCHQ has acceptable test-retest reliability with the exception of 10 items, which is slightly better than the recent Swedish validation of TSCHQ. At the item level, there were both similarities and differences between the Norwegian and Swedish validation studies. It is concluded that the Norwegian TSCHQ is an appropriate measure of patients' history and experience of tinnitus, and while we recommend further validation of the Norwegian TSCHQ, we encourage Norwegian researchers and clinicians to use the Norwegian translation of TSCHQ.

Validation of the Chronic Tinnitus Acceptance Questionnaire (CTAQ-I): the Italian version

Tinnitus is a widespread symptom that is chronically experienced by approximately 10% of the adult population. While the vast majority of individuals do not feel impaired by their ear noise, about 0.5-3% of the adult population develops severe distress and feels impaired in everyday life. The severity of the distress experienced can only partially be explained by the characteristics of the ear noise itself (e.g. objective tinnitus loudness or duration). Psychological variables such as tinnitus acceptance are being increasingly investigated by tinnitus research. The aim of this study was to analyse the psychometric quality of the Italian version of the “Chronic Tinnitus Acceptance Questionnaire” (CTAQ-I). The CTAQ-I is an adaption of the Italian “Chronic Pain Acceptance Questionnaire (CPAQ)” and altered for the study of tinnitus acceptance. This cross-sectional multicentre questionnaire study included 141 outpatients with chronic tinnitus. Sociodemographic and clinical data were assessed with the Tinnitus Sample Case History (TSCH), tinnitus acceptance with the Italian “Chronic Tinnitus Acceptance Questionnaire” (CTAQ-I), tinnitus distress with the Tinnitus Handicap Inventory (THI) and the Tinnitus Questionnaire Short Form (TQ 12-I). Furthermore, we assessed the patient’s general psychological distress (Brief Symptom Inventory - BSI) and Health Related Quality of Life (SF-36). Psychometric and factorial evaluation of the CTAQ-I were carried out. To investigate the influence of sociodemographic and numerous clinical variables on tinnitus acceptance we calculated correlation coefficients, analysis of variance and independent sample-t-tests. The factor analysis revealed a two-factor solution (“activity engagement” and “tinnitus willingness”), accounting for 41.1% of the variance. Good internal consistency for the total score (α = 0.84) and both factors (α = 0.80-0.88) was found. Moderate negative correlations with tinnitus distress indicated good validity. Tinnitus acceptance was further correlated with lower psychological distress and subjective tinnitus loudness, as well as increased emotional well-being. Tinnitus acceptance is considered to be an important source of therapeutic change in behavioural-based treatments as well as in professional counselling for tinnitus. Our study shows that the CTAQ-I is a reliable and valid instrument to measure the acceptance of patients suffering from chronic tinnitus.