Studying tinnitus in the ICF framework

Examining the consequences of tinnitus using the multidimensional perspective

BACKGROUND

Tinnitus is one of the most frequent chronic conditions in adults with wide range of consequences.

AIMS/OBJECTIVES

The aim of the current study was to determine the problems and life effects reported by individuals with tinnitus using the International Classification of Functioning, Disability and Health (ICF) framework.

MATERIAL AND METHODS

The study used a cross-sectional survey design. A total of 344 individuals with tinnitus completed a series of questionnaires. The responses to open-ended questions were linked to ICF categories.

RESULTS

Activity limitations and participation restrictions were most dominant consequence of tinnitus followed by effect on the body function with limited emphasis on the contextual factors. Frequently reported responses to body function involved emotional functions (b152), attention function (b140), and sleep functions (b134). Commonly reported responses to activity limitations and participation restrictions were recreation and leisure (d920), conversation (d350), communicating with-receiving-spoken messages (d310), listening (d115), and remunerative employment (d850). Sound intensity (e2500) and sound quality (e2501) were the frequently reported responses to environmental factors. Coping styles, past and present experiences, and lifestyle were the most frequently occurring personal factors.

CONCLUSIONS AND SIGNIFICANCE

The study highlighted some key influencing factors of tinnitus in different ICF domains which can be helpful in rehabilitation planning.

Cost Effectiveness of Cognitive Behavioral Therapy for the Treatment of Subjective Tinnitus in Australia

OBJECTIVES

The aim of this study was to conduct an economic evaluation for the treatment of subjective tinnitus using different modalities of cognitive behavioral therapy (CBT) in Australia.

DESIGN

A decision tree model was used to conduct a cost-utility analysis for CBT to determine the cost effectiveness for tinnitus treatments, in terms of cost per responder and cost per quality-adjusted life-year (QALY), from a health system perspective using a 2-year time horizon. Meta-analysis was used to differentiate the levels of effectiveness between three delivery methods for CBT: individual face-to-face care (fCBT), group sessions (gCBT), and a supported internet program (iCBT). One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) explored the uncertainty surrounding model inputs and outcomes. Results were presented as incremental cost-effectiveness ratios compared with no treatment, and as net monetary benefit at a $50,000 willingness-to-pay threshold.

RESULTS

Compared with no treatment, the incremental cost per responder was $700 for gCBT, $871 for iCBT, and $1380 for fCBT. The base case incremental cost-effectiveness ratio was $35,363 per QALY for fCBT, $17,935 per QALY for gCBT, and $22,321 per QALY for iCBT compared with no treatment, although there was substantial uncertainty around the QALY gain for responders. Net monetary benefit was $356 (fCBT), $555 (gCBT), and $487 (iCBT), indicating the treatments were cost effective compared with no treatment. One-way sensitivity analysis revealed the results were most sensitive to the probability of a positive response to treatment and treatment length. The PSA found the probability of being cost effective compared with no treatment for gCBT was 99.8%, iCBT 98.4%, and fCBT 71.5% at a willingness-to-pay of $50,000 per QALY, although QALY gain remained at a fixed value in the PSA.

CONCLUSIONS

CBT for tinnitus was likely to be cost effective compared with no treatment regardless of treatment modality, assuming they are not mutually exclusive. Of the interventions, gCBT was the lowest cost per responder and lowest cost per QALY. Internet CBT obtained comparable economic outcomes due to similar treatment effectiveness and cost. Group CBT and iCBT warrant greater adoption in clinical practice for the treatment of subjective tinnitus. Further research on preference-based utility measures for varying levels of tinnitus severity and the durability of treatment effect is required to enhance the quality of economic evaluation in this field.

International Classification of Functioning, Disability, and Health in adult and older users of audiology services

ABSTRACT Purpose: to describe aspects of functioning and disability related to hearing and sociodemographic factors of audiology service users. Methods: an exploratory study with a probabilistic sample comprising 152 participants who answered a socioeconomic and assistance questionnaire. The functioning and disability were analyzed by means of the International Classification of Functioning, Disability, and Health. Descriptive data analyses were conducted. Results: most users of the Hearing Health Care Service considered they had mild (41.2%) or moderate (34.2%) disability in b1560 Auditory perception, and mild (36%) and moderate (35.1%) disability in b230 Hearing Functions. In Activities and Participation, the users of the Hearing Health Care Service obtained better results in d330 Speaking (83.3%), d315 Communicating with and receiving nonverbal messages (65.8%), and d760 Family relationships (65.1%). The hearing aid was a facilitator in these subjects’ social interaction with the environment. Most of those attending the Audiology Outpatient Center did not have disabilities or difficulties in the activities and participation, and the environment was a facilitator. Conclusion: most of the participants attending the Hearing Health Care Service had a disability in auditory perception and hearing functions. However, such a disability was not a limiting factor in the performance of most of the activities and participations assessed.

Current-reported outcome domains in studies of adults with a focus on the treatment of tinnitus: protocol for a systematic review

INTRODUCTION

In Europe alone, over 70 million people experience tinnitus. Despite its considerable socioeconomic relevance, progress in developing successful treatments has been limited. Clinical effectiveness is judged according to change in primary outcome measures, but because tinnitus is a subjective condition, the definition of outcomes is challenging and it remains unclear which distinct aspects of tinnitus (ie, 'domains') are most relevant for assessment. The development of a minimum outcome reporting standard would go a long way towards addressing these problems. In 2006, a consensus meeting recommended using 1 of 4 questionnaires for tinnitus severity as an outcome in clinical trials, in part because of availability in different language translations. Our initiative takes an approach motivated by clinimetrics, first by determining what to measure before seeking to determine how to measure it. Agreeing on the domains that contribute to tinnitus severity (ie, 'what') is the first step towards achieving a minimum outcome reporting standard for tinnitus that has been reached via a methodologically rigorous and transparent process.

METHODS AND ANALYSIS

Deciding what should be the core set of outcomes requires a great deal of discussion and so lends itself well to international effort. This protocol lays out the first-step methodology in defining a Core Domain Set for clinical trials of tinnitus by establishing existing knowledge and practice with respect to which outcome domains have been measured and which instruments used in recent registered and published clinical trials.

ETHICS AND DISSEMINATION

No ethical issues are foreseen. Findings will be reported at national and international ear, nose and throat (ENT) and audiology conferences and in a peer-reviewed journal, using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analysis) guidelines.

TRIAL REGISTRATION NUMBER

The systematic review protocol is registered on PROSPERO (International Prospective Register of Systematic Reviews): CRD42015017525.

Acupuncture as a Treatment Option in Treating Posttraumatic Stress Disorder-Related Tinnitus in War Veterans: A Case Presentation

Although close associations between tinnitus and posttraumatic stress disorder (PTSD) among war veterans has been documented, there is limited research that explores evidence-based, efficacious interventions to treat the condition in this particular population. This article presents a case of three war veterans with PTSD symptoms who received a series of acupuncture treatments for tinnitus with positive outcomes. Even though the article presents cases of only three veterans and was based on self-reports, there were very clear trends on how veterans with tinnitus symptoms responded to acupuncture treatments. Information generated from this case presentation is a good starting place in exploring evidence-based approaches in treating tinnitus symptoms in war veterans with PTSD.

A review of tinnitus symptoms beyond 'ringing in the ears': a call to action

BACKGROUND

Tinnitus, often referred to as 'ringing in the ears', is highly prevalent. However, patients may also present with a number of other symptoms.

SCOPE

To review the broad range of symptoms of tinnitus, to evaluate their impact on patient quality of life and to explore methods of diagnosis and assessment. An electronic literature search was performed in PubMed between September and December 2010.

FINDINGS

Accumulating evidence suggests that the symptoms of tinnitus are not confined to the characteristic 'ringing in the ears', but instead encompass wide-ranging symptoms that include emotional components such as sleep disturbance, anxiety, depression, irritation, and concentration difficulties.

CONCLUSION

Patients with tinnitus experience a spectrum of distressing symptoms that impact their quality of life and there is a clear need for action. Clinicians need to recognize and diagnose tinnitus that occurs with other wide-ranging symptoms to ensure that these symptoms are identified and patients receive effective treatment.