Review of Smart Services for Tinnitus Self-Help, Diagnostics and Treatments

[Apps for tinnitus? A systematic review on quality, intervention components, and behavior change techniques]

BACKGROUND

Various smartphone applications (apps) for people with tinnitus are available and promise tinnitus relief. Yet, it is difficult for people suffering from tinnitus and healthcare professionals to estimate their quality, potential, or risks. The current study aims to generate an overview of available tinnitus apps in the German language and to offer orientation for research and healthcare providers.

METHOD

The most prominent stores were searched systematically (November 2020-April 2021; Google Play Store and Apple App Store). Apps specifically developed for tinnitus were evaluated by two independent raters using multiple approaches: a) a quality screening was performed using the German version of the Mobile App Rating Scale (MARS-G), b) intervention components were assessed using a newly developed list of categories, and c) implemented strategies for active tinnitus management were analyzed using behavior change techniques (BCTs).

RESULTS

The search yielded 1073 apps, of which 21 apps were analyzed. The apps' overall quality as assessed by MARS‑G was average (M = 3.37, SD = 039). A lot of apps offered sounds (n = 18) and information (n = 9) or assessed tinnitus characteristics (n = 13). Out of 93 BCTs, 24 were identified at least once. Only one app was evaluated in non-randomized trials.

CONCLUSION

Although a variety of apps are available, most of them focus on a few intervention components (e.g., sounds or information). Therefore, apps do not exploit their potential to impart important evidence-based content for tinnitus management. The app evaluation using multiple approaches points out potential for improvement.

Internet-based cognitive behavioural therapy for tinnitus in Spanish: a global feasibility trial

OBJECTIVE

Internet-based cognitive behavioural therapy (ICBT) for tinnitus is an evidence-based intervention, but only available in a few languages. To increase accessibility, ICBT was translated into Spanish. This study's objective was to determine the feasibility of ICBT for Spanish speakers.

DESIGN

A single-group pre-test post-test design was used. Compliance, engagement, acceptance and outcome feasibility were measured.

STUDY SAMPLE

Forty-six Spanish speakers with tinnitus were screened. There were 32 participants meeting the eligibility criteria, with a mean age of 47 (±11) years. Of these 91% were Hispanic or Latino with 66% living in Spain and 34% living in South America.

RESULTS

Outcome feasibility was established, as a large pre- and post-test within-group effect size of d = 0.90 was found for tinnitus severity. Large pre- and post-test effect sizes were also present for the secondary outcomes of anxiety and depression with a medium effect for insomnia, health-related quality of life, and tinnitus cognitions. Intervention engagement and compliance were not optimal although no participants withdrew. Intervention acceptance rates indicated scope for improvement.

CONCLUSIONS

ICBT for Spanish communities appears to be feasible. A randomised controlled trial is required to further investigate the effects and identify ways of improving engagement and attracting Spanish speakers from different countries.

Auricular Acupressure Combined with Self-Help Intervention for Treating Chronic Tinnitus: A Longitudinal Observational Study

Tinnitus is a phantom sound perception in the ears or head and can arise from many different medical disorders. Currently, there is no standard treatment for tinnitus that reliably reduces tinnitus. Individual patients reported that acupressure at various points around the ear can help to reduce tinnitus, which was investigated here. With this longitudinal observational study, we report a systematic evaluation of auricular acupressure on 39 tinnitus sufferers, combined with a self-help smartphone app. The participants were asked to report on tinnitus, stress, mood, neck, and jaw muscle tensions twice a day using an ecological momentary assessment study design for six weeks. On average, 123.6 questionnaires per person were provided and used for statistical analysis. The treatment responses of the participants were heterogeneous. On average, we observed significant negative trends for tinnitus loudness (Cohen’s d effect size: −0.861), tinnitus distress (d = −0.478), stress (d = −0.675), and tensions in the neck muscles (d = −0.356). Comparison with a matched control group revealed significant improvements for tinnitus loudness (p = 0.027) and self-reported stress level (p = 0.003). The positive results of the observational study motivate further research including a randomized clinical trial and long-term assessment of the clinical improvement.

A State-of-Art Review of Digital Technologies for the Next Generation of Tinnitus Therapeutics

Background: Digital processing has enabled the development of several generations of technology for tinnitus therapy. The first digital generation was comprised of digital Hearing Aids (HAs) and personal digital music players implementing already established sound-based therapies, as well as text based information on the internet. In the second generation Smart-phone applications (apps) alone or in conjunction with HAs resulted in more therapy options for users to select from. The 3rd generation of digital tinnitus technologies began with the emergence of many novel, largely neurophysiologically-inspired, treatment theories that drove development of processing; enabled through HAs, apps, the internet and stand-alone devices. We are now of the cusp of a 4th generation that will incorporate physiological sensors, multiple transducers and AI to personalize therapies. Aim: To review technologies that will enable the next generations of digital therapies for tinnitus. Methods: A "state-of-the-art" review was undertaken to answer the question: what digital technology could be applied to tinnitus therapy in the next 10 years? Google Scholar and PubMed were searched for the 10-year period 2011-2021. The search strategy used the following key words: "tinnitus" and ["HA," "personalized therapy," "AI" (and "methods" or "applications"), "Virtual reality," "Games," "Sensors" and "Transducers"], and "Hearables." Snowballing was used to expand the search from the identified papers. The results of the review were cataloged and organized into themes. Results: This paper identified digital technologies and research on the development of smart therapies for tinnitus. AI methods that could have tinnitus applications are identified and discussed. The potential of personalized treatments and the benefits of being able to gather data in ecologically valid settings are outlined. Conclusions: There is a huge scope for the application of digital technology to tinnitus therapy, but the uncertain mechanisms underpinning tinnitus present a challenge and many posited therapeutic approaches may not be successful. Personalized AI modeling based on biometric measures obtained through various sensor types, and assessments of individual psychology and lifestyles should result in the development of smart therapy platforms for tinnitus.

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.

Contemporary Review of Smartphone Apps for Tinnitus Management and Treatment

Tinnitus is a complex and heterogeneous psycho-physiological disorder responsible for causing a phantom ringing or buzzing sound albeit the absence of an external sound source. It has a direct influence on affecting the quality of life of its sufferers. Despite being around for a while, there has not been a cure for tinnitus, and the usual course of action for its treatment involves use of tinnitus retaining and sound therapy, or Cognitive Behavioral Therapy (CBT). One positive aspect about these therapies is that they can be administered face-to-face as well as delivered via internet or smartphone. Smartphones are especially helpful as they are highly personalized devices, and offer a well-established ecosystem of apps, accessible via respective marketplaces of differing mobile platforms. Note that current therapeutic treatments such as CBT have shown to be effective in suppressing the tinnitus symptoms when administered face-to-face, their effectiveness when being delivered using smartphones is not known so far. A quick search on the prominent market places of popular mobile platforms (Android and iOS) yielded roughly 250 smartphone apps offering tinnitus-related therapies and tinnitus management. As this number is expected to steadily increase due to high interest in smartphone app development, a contemporary review of such apps is crucial. In this paper, we aim to review scientific studies validating the smartphone apps, particularly to test their effectiveness in tinnitus management and treatment. We use the PRISMA guidelines for identification of studies on major scientific literature sources and delineate the outcomes of identified studies.

Adapting Personal Therapies Using a Mobile Application for Tinnitus Rehabilitation: A Preliminary Study

OBJECTIVES

To develop a smartphone application providing sound therapy and cognitive behavioral therapy (CBT) for treating tinnitus and performing a proof-of-concept pilot study evaluating its potential efficacy.

METHODS

An interactive smartphone application available on iOS and Android platforms was developed, which provided an 8-week tinnitus-specific CBT and personalized and frequency-matched sound therapy. Included patients presented to our tertiary clinic between 2017 and 2018, while those waitlisted were regarded as controls. Three surveys were administrated: Tinnitus Handicap Inventory (THI), Generalized Anxiety Disorder 7-item (GAD-7), and Perceived Stress Scale (PSS).

RESULTS

A total of 30 patients enrolled in this study consisting of 20 treatment and 10 control patients and mean age was 55.4 ± 11.6 years. Treatment and control patients had similar age, sex, and pre-enrolment GAD and PSS (all P > .05). Baseline THI scores were also similar between treatment and control cohorts (50.1 ± 21.9 vs 62.0 ± 20.7; P = .15). After 8 weeks, though changes in GAD and PSS scores were similar (P > .05), the treatment group reported a significantly greater improvement in THI scores (17.7 ± 15.8 vs 5.3 ± 10.5, P = .04).

CONCLUSIONS

This pilot study demonstrated potentially promising efficacy of a smartphone-based CBT and sound therapy platform for treating tinnitus and encourages future randomized controlled trials on this treatment modality.

Smartphone and Mobile Health Apps for Tinnitus: Systematic Identification, Analysis, and Assessment

Background

Modern smartphones contain sophisticated high-end hardware features, offering high computational capabilities at extremely manageable costs and have undoubtedly become an integral part in users' daily life. Additionally, smartphones offer a well-established ecosystem that is easily discoverable and accessible via the marketplaces of differing mobile platforms, thus encouraging the development of many smartphone apps. Such apps are not exclusively used for entertainment purposes but are also commonplace in health care and medical use. A variety of those health and medical apps exist within the context of tinnitus, a phantom sound perception in the absence of any physical external source.

Objective

In this paper, we shed light on existing smartphone apps addressing tinnitus by providing an up-to-date overview.

Methods

Based on PRISMA guidelines, we systematically searched and identified existing smartphone apps on the most prominent app markets, namely Google Play Store and Apple App Store. In addition, we applied the Mobile App Rating Scale (MARS) to evaluate and assess the apps in terms of their general quality and in-depth user experience.

Results

Our systematic search and screening of smartphone apps yielded a total of 34 apps (34 Android apps, 26 iOS apps). The mean MARS scores (out of 5) ranged between 2.65-4.60. The Tinnitus Peace smartphone app had the lowest score (mean 2.65, SD 0.20), and Sanvello—Stress and Anxiety Help had the highest MARS score (mean 4.60, SD 0.10). The interrater agreement was substantial (Fleiss κ=0.74), the internal consistency was excellent (Cronbach α=.95), and the interrater reliability was found to be both high and excellent—Guttman λ6=0.94 and intraclass correlation, ICC(2,k) 0.94 (95% CI 0.91-0.97), respectively.

Conclusions

This work demonstrated that there exists a plethora of smartphone apps for tinnitus. All of the apps received MARS scores higher than 2, suggesting that they all have some technical functional value. However, nearly all identified apps were lacking in terms of scientific evidence, suggesting the need for stringent clinical validation of smartphone apps in future. To the best of our knowledge, this work is the first to systematically identify and evaluate smartphone apps within the context of tinnitus.

Smartphone Apps in the Context of Tinnitus: Systematic Review

Smartphones containing sophisticated high-end hardware and offering high computational capabilities at extremely manageable costs have become mainstream and an integral part of users' lives. Widespread adoption of smartphone devices has encouraged the development of many smartphone applications, resulting in a well-established ecosystem, which is easily discoverable and accessible via respective marketplaces of differing mobile platforms. These smartphone applications are no longer exclusively limited to entertainment purposes but are increasingly established in the scientific and medical field. In the context of tinnitus, the ringing in the ear, these smartphone apps range from relief, management, self-help, all the way to interfacing external sensors to better understand the phenomenon. In this paper, we aim to bring forth the smartphone applications in and around tinnitus. Based on the PRISMA guidelines, we systematically analyze and investigate the current state of smartphone apps, that are directly applied in the context of tinnitus. In particular, we explore Google Scholar, CiteSeerX, Microsoft Academics, Semantic Scholar for the identification of scientific contributions. Additionally, we search and explore Google's Play and Apple's App Stores to identify relevant smartphone apps and their respective properties. This review work gives (1) an up-to-date overview of existing apps, and (2) lists and discusses scientific literature pertaining to the smartphone apps used within the context of tinnitus.

Internet/smartphone-based applications for the treatment of tinnitus: a systematic review

INTRODUCTION

Most of the individuals suffering from tinnitus report of negative effects on their lives to the extent that clinical intervention is necessary. Although traditional tinnitus management has proven to be effective in treating tinnitus, there are a few drawbacks. The major drawback is the lack of professionals for the treatment of tinnitus, especially in remote areas. Considering the growing usage of the internet as a platform for availing treatment, there is a requirement for the development of applications in the health care sector. Recent search related to tinnitus treatment revealed that more than 200 applications are available online in the most popular platforms like Android and iOS. However, most of the applications for the treatment of tinnitus lack validation, and thus, there is a need for research on this ground.

METHOD

Five studies evaluating the efficacy of Internet/app delivered tinnitus treatments were identified. The treatment forms included were Tinnitus E-program, Mobile serious game, Tinnitus web-based sound therapy, and Tailor-made notch music therapy delivered through a smart phone.

RESULTS

Each study used a variety of standardized and validated questionnaires to measure the outcome of the treatment. The outcome measures were diverse, but both Internet/app-based and traditional methods like Tinnitus Retraining Therapy, Cognitive Behavioral Therapy, and Acceptance and Commitment Therapy had similar improvements in terms of tinnitus distress and quality of life.

CONCLUSION

It can be construed that the development of tinnitus treatment applications and web-based platforms will have a significant impact on the normal life of individuals with tinnitus.

A Comprehensive Evaluation of Tinnitus Apps

Purpose The use of mobile phones is on the rise worldwide. Many people who experience tinnitus often turn to the Internet and applications (apps) on their smartphones to acquire information on tinnitus and solutions to "cure" tinnitus. The aim of this study was to evaluate and summarize features offered by tinnitus-related apps on different mobile platforms. Method This study was conducted on 3 mobile platforms-Apple iOS, Google Android, and Windows. The key word tinnitus was searched, and all free and paid apps were downloaded. Relevant apps were reviewed in-depth and then classified into 4 categories based on their functionality-"tinnitus education, awareness, and prevention," "tinnitus assessment and measurement," "tinnitus management," and "misinformation." Results All mobile platforms yielded both free and paid tinnitus apps, allowing individuals to learn more about tinnitus, assess and measure their own tinnitus, gain access to different sounds to help manage their tinnitus, and find strategies to better cope with their tinnitus. The Google Android platform revealed the most number of tinnitus apps. The "tinnitus management" category consistently outperformed the other categories-containing the most number of apps and the most number of features. A small proportion of misinformation apps were detected across platforms. There were no significant differences in the total number of features between free and paid apps (except on the Windows platform). A cost-feature analysis revealed that more expensive apps did not necessarily offer more number of features. Conclusions This study reveals that a variety of tinnitus-related apps-both free and paid-are available on different mobile platforms. Clinicians should be aware that patients with tinnitus often rely on apps for additional help and should be prepared to direct them to valid apps. Implications for end users are discussed as well. Supplemental Material https://doi.org/10.23641/asha.8956775.