Coping with tinnitus

History of Tinnitus Research at the VA National Center for Rehabilitative Auditory Research (NCRAR), 1997-2021: Studies and Key Findings

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.

Self-help interventions chosen by subjects with chronic tinnitus - a retrospective study of clinical patients

OBJECTIVE

Self-help (without specialist support) can play an important role in tinnitus therapy. The purpose of this study was to investigate what fraction of subjects with tinnitus use self-help, what techniques are most commonly used to reduce tinnitus severity, and what distinguishes patients that use self-help from others.

DESIGN

retrospective, observational study.

STUDY SAMPLE

Adult patients admitted to our hospital clinic (460 participants) aged 19-83 years and reporting chronic tinnitus. The survey concerned therapy attempts prior to the clinic visit as well as self-help techniques chosen freely by the patient to reduce tinnitus severity.

RESULTS

Data showed that 40.9% of the respondents chose some action themselves to reduce their tinnitus severity. Among the reported self-help techniques, acoustic stimulation was the most popular. In addition, patients chose distraction attention, relaxation, meditation, yoga, and physical activity. The likelihood of undertaking self-help increases with better education and higher tinnitus severity.

CONCLUSIONS

Knowledge about patients' preferences of forms of self-help may help the health practitioner suggest a more suitable form of therapy. Due to the great interest in using sound therapy in tinnitus, it would be worthwhile looking at new forms of this therapy, for example increasingly popular mobile applications.

Coping in Chronic Tinnitus Patients

Background: Tinnitus is the perception of sound without an external stimulus. A large part of the adult population experiences this symptom but never seeks professional help, where others have devastating complaints in daily life. This suggests that the impact of tinnitus varies among patients and may be influenced by coping strategies and multiple psychological factors.

Method: Cross- sectional study of patients visiting the tertiary tinnitus referral center of the University Medical Center Utrecht, the Netherlands. Three hundred and twenty-one consecutive chronic tinnitus patients were evaluated by the tinnitus care group Utrecht from 6–2007 till 11–2012 of which 308 patients were included. Patients completed two tinnitus distress questionnaires (THI, TQ), a coping questionnaire (CISS) as well as a psychopathological questionnaire (SCL-90-R).

Results: Emotional-orientated coping and distraction-orientated coping strategies were significantly correlated with the experienced tinnitus burden. Also a significant negative correlation with task orientated coping was found. The effect size was small. Tinnitus distress also had a significant positive correlation with anxiety, agoraphobia, depression, insufficiency of handling, distrust & personal sensitivity, hostility and sleeping problems.

Conclusion: Patients with higher tinnitus handicap scores demonstrated the use different coping strategies than the patients with lower distress scores. This insight in coping strategies in a group of patients with high tinnitus burden is useful for counseling patients. As tinnitus coping strategy might be related to the extent and success of habituation, this outcome could be of interest to optimize tinnitus treatments in the near future.

Features, Functionality, and Acceptability of Internet-Based Cognitive Behavioral Therapy for Tinnitus in the United States

Objective Although tinnitus is one of the most commonly reported symptoms in the general population, patients with bothersome tinnitus are challenged by issues related to accessibility of care and intervention options that lack strong evidence to support their use. Therefore, creative ways of delivering evidence-based interventions are necessary. Internet-based cognitive behavioral therapy (ICBT) demonstrates potential as a means of delivering this support but is not currently available in the United States. This article discusses the adaptation of an ICBT intervention, originally used in Sweden, Germany, and the United Kingdom, for delivery in the United States. The aim of this study was to (a) modify the web platform's features to suit a U.S. population, (b) adapt its functionality to comply with regulatory aspects, and (c) evaluate the credibility and acceptability of the ICBT intervention from the perspective of health care professionals and patients with bothersome tinnitus. Materials/Method Initially, the iTerapi ePlatform developed in Sweden was adopted for use in the United States. Functional adaptations followed to ensure that the platform's functional and security features complied with both institutional and governmental regulations and that it was suitable for a U.S. population. Following these adaptations, credibility and acceptance of the materials were evaluated by both health care professionals (n = 11) and patients with bothersome tinnitus (n = 8). Results Software safety and compliance regulatory assessments were met. Health care professionals and patients reported favorable acceptance and satisfaction ratings regarding the content, suitability, presentation, usability, and exercises provided in the ICBT platform. Modifications to the features and functionality of the platform were made according to user feedback. Conclusions Ensuring that the ePlatform employed the appropriate features and functionalities for the intended population was essential to developing the Internet-based interventions. The favorable user evaluations indicated that the intervention materials were appropriate for the tinnitus population in the United States.

Two brief group interventions for individuals with tinnitus in Israel

Background/Aims

Subjective tinnitus is a common impairment throughout the world and typically cannot be cured. Coping strategies are cognitive, affective, and behavioural approaches for managing stressors like tinnitus. The aim of this study was to investigate the effects of two brief interventions on coping and tinnitus-related distress.

Methods

A total of 45 individuals with tinnitus in Israel were allocated into one of three groups: acceptance and commitment therapy, coping effectiveness training, or a waitlist control group. Outcomes were assessed at three time points by the Brief Coping Orientation to Problems Experienced scale and the Tinnitus Handicap Inventory, a measure of tinnitus-related distress.

Results

There was a significant difference among the groups on post-intervention Tinnitus Handicap Inventory assessment, but not on coping, when controlling for baseline scores. Pairwise comparisons indicated that the coping effectiveness training group scored significantly lower on the Tinnitus Handicap Inventory than the waitlist control group.

Conclusions

While the results are promising, a larger study is needed to further explore the efficacy of the brief coping effectiveness training intervention.

Tinnitus, Depression, Anxiety, and Suicide in Recent Veterans: A Retrospective Analysis

OBJECTIVES

The purpose of this project was to investigate whether there is an association between tinnitus diagnosis and suicide and whether depression and anxiety strengthen that association. Given that tinnitus is the top service-connected disability among U.S. Veterans () and that suicide among Veterans has been occurring at a higher frequency as compared with community suicide rates (), the possible associations between tinnitus and suicide will be explored. Co-occurring physical conditions also will be examined to determine if they increase the risk of suicide in the context of tinnitus.

DESIGN

Administrative health care data related to Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) were used to identify Veterans who accessed the Veterans Administration (VA) health care system from January 1, 2002, to December 31, 2011. Veterans who were deceased as of December 2011 were identified using the National Death Index (NDI) files. Tinnitus cases were followed until either they were deceased or to the end of the study period. The International Classification of Diseases 9th Revision Clinical Modification (ICD-9-CM) codes were used to identify all conditions and diseases. As per mortality research standards, International Classification of Diseases 10th Revision (ICD-10) codes were used to identify cause of death.

RESULTS

Of 769,934 OEF/OIF/OND Veterans receiving VA care January 2002 to December 2011, 15% (n =116,358) were diagnosed with tinnitus. Of these Veterans diagnosed with tinnitus, 21% were also diagnosed with depression, another 8% with anxiety, and another 17% with both depression and anxiety. Fifty-four percentage were identified as having tinnitus without depression or anxiety. Among individuals with tinnitus, 41.9% had co-occurring hearing loss. Suicide rates were lower among Veterans with tinnitus than Veterans without tinnitus. Co-occurring diagnoses of mental-health conditions did not significantly increase the risk of suicide.

CONCLUSIONS

The study results do not confirm clinical and anecdotal reports that tinnitus could be related to suicide among Veterans. However, tenets from rehabilitation psychology suggest that the onset of chronic impairment or disability does not predict an individual's subsequent psychological states; other personal attributes may be more influential. Health care professionals, such as audiologists and psychologists, should be cognizant of the associations between tinnitus and mental health issues and be prepared to address the psychological needs of individuals who have tinnitus.

Over-the-Counter Tinnitus "Cures": Marketers' Promises Do Not Ring True

OBJECTIVES

The Clinical Practice Guideline of the American Academy of Otolaryngology-Head & Neck Surgery (2014) stated that clinicians should not recommend dietary supplements for the treatment of tinnitus. The aim of this study is to characterize over-the-counter tinnitus remedies (OTCTR) on the U.S. market, describe the ingredients and prices, and characterize the methods of promoting these products.

METHODS

OTCTR were identified via Web search and visits to retail establishments. Information was collected regarding OTCTR chemical composition, product labeling, advertisements and marketing, price, and customers reviews.

RESULTS

A wide array of unproven OTCTR exist on today's market. All make unfounded claims of relief from ear ringing. Most of the products considered in this study consist of mixtures of inexpensive and common vitamins, minerals, and/or herbs sold at a premium compared to similar preparations not expressly advertised for tinnitus. Certain brands, most notably Arches Tinnitus Formula (Arches Natural Products Inc., Salt Lake City, UT) and Lipo-Flavonoid (Clarion Brands Inc., Solon, OH), target otolaryngologists by advertising in specialty journals and prominently featuring supposed endorsement by "Ear-Nose-and-Throat Doctors" in their marketing.

CONCLUSION

It is important for otolaryngologists who are caring for tinnitus sufferers to be aware that a robust and diverse market exists for unproven OTC tinnitus remedies. It is troubling that heavily advertised brands profess support by otolaryngologists. Responsible specialty organizations in the field should consider opposing such commercially motivated representations. Otolaryngology journals may wish to adopt a policy along the lines of The Journal of the American Medical Association publications to decline advertisements of dietary supplements that make unproven therapeutic claims.

LEVEL OF EVIDENCE

5 Laryngoscope, 129:1898-1906, 2019.

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.

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.