Polish Translation and Validation of the Tinnitus Handicap Inventory and the Tinnitus Functional Index

Translation and validation of the Tinnitus Functional Index (TFI) into Kannada: a tool for clinical and research use in the Indian population

PURPOSE

The Tinnitus Functional Index (TFI) is a widely recognized measure for evaluating tinnitus and is frequently used in both therapeutic and research contexts. Unfortunately, TFI is currently not available in any Indian languages. In a multilingual country like India, cross-cultural adaptation, translation, and validation of such scales in regional languages are critical to improving their use for clinical and research purposes. Therefore, this study focused on translating and validating the TFI in Kannada for use among the Indian population.

MATERIALS AND METHODS

The original version of TFI was translated with the help of audiologists and linguistic experts who were proficient in Kannada. The translated version was content validation by five audiologists and a cognitive debriefing by native speakers to check the familiarity of words. The final version (TFI-K) was then administered to 181 participants with tinnitus. Along with the TFI, other scales like Tinnitus Handicap Inventory (THI) were also obtained to check the convergent validity. The obtained data was then subjected to various statistical analyses like internal consistency, convergent and discriminant validity, and factor analysis.

RESULTS

The TFI-K was found to have an excellent internal consistency (Cronbach's α = 0.974) and good convergent validity (p < 0.001; r = 0.778) with THI-K. A principal component analysis with varimax rotation showed communalities ranging from 0.64 to 0.91. Scree plots with the TFI-K component showed a sharp decline after the first factor and approximately four factors above the eigenvalue of 1. The factor analysis results suggest that the TFI-K has a structurally intact 8-factor loading, with a few exceptions that are discussed in detail.

CONCLUSION

The TFI-K has demonstrated remarkable dependability and satisfactory integrity, making it a valuable tool for assessment and treatment planning in clinical and research settings.

A global bibliometric analysis on the relationship between tinnitus and temporomandibular disorders

BACKGROUND AND OBJECTIVES

This global bibliometric review aimed to investigate trends in publications relating to tinnitus and TMD.

METHODS

A search was performed in eight databases (June/2022), by independent researchers with relevant keywords about tinnitus and TMD, without restriction of date or language. Original research or case report/series evaluating prevalence, association and risk related to tinnitus and TMD were included. Independent examiners selected studies by title and abstract and performed data extraction. Data about publication and researchers, study population, objective, study design and diagnostic criteria for tinnitus and TMD were exported to VintagePoint® for bibliometric analyses. Data about the direct association between tinnitus and TMD were extracted.

RESULTS

One hundred and seventeen articles from 25 countries were included, most observational (68.4%) and evaluating association (N = 60; 44.8%). Among the 60 studies of association, 22 (36.6%) presented results of a direct association between the presence/absence of tinnitus and the presence/absence of TMD. Brazil (19.5%) and the United States (12.7%) were the countries with the most publications, and Dentistry (48.6%) was the main publication area. A growth in publications in Dentistry was observed in the past 30 years and in the past 10 years in Medicine. Half of the studies included the elderly population (50.2%). The main diagnostic criterion for both tinnitus (37.8%) and TMD (28%) was general questionnaires and/or self-report.

CONCLUSION

There is a growing trend in publications relating to tinnitus and TMD, especially in Dentistry, with a predominance of observational and association studies in the elderly population using questionnaires and/or self-report. More research with robust diagnostic methods and other study designs should be encouraged in the future.

Migraine associated with tinnitus and hearing loss in adults: a systematic review

OBJECTIVE

To describe evidence of migraine-associated tinnitus and hearing loss.

DESIGN

This study was registered in PROSPERO and followed the PRISMA guidelines. The inclusion criteria were observational studies with subjects aged ≥18 years, in which the association between migraine and tinnitus and/or hearing loss was evaluated. Reviews, case reports, commentaries, letters to the editor, and studies that included individuals with some diseases were excluded.

STUDY SAMPLE

The search yielded 698 articles from electronic databases. Six studies were eligible for this review with 26,166 participants.

RESULTS

Most studies have shown an association between migraine and tinnitus, and between migraine and hearing loss. Studies have concluded that migraine presented high odds ratio, and hazard ratio for tinnitus. Another study found a strong association between these conditions (p < 0.001), and two investigations detected the presence of migraine in 10.1 and 22.5% of tinnitus patients. Migraine presented high odds ratio and hazard ratio for hearing loss. Additionally, the studies included were of good quality, adhering to most of the requirements on the JBI Critical Appraisal Checklist. However, a limitation of this review is the small number of studies included.

CONCLUSIONS

Associations between migraine, tinnitus, and hearing loss were observed in the included studies.

An MR spectroscopy study of temporal areas excluding primary auditory cortex and frontal regions in subjective bilateral and unilateral tinnitus

Previous studies indicate changes in neurotransmission along the auditory pathway in subjective tinnitus. Most authors, however, investigated brain regions including the primary auditory cortex, whose physiology can be affected by concurrent hearing deficits. In the present MR spectroscopy study we assumed increased levels of glutamate and glutamine (Glx), and other Central Nervous System metabolites in the temporal lobe outside the primary auditory cortex, in a region involved in conscious auditory perception and memory. We studied 52 participants with unilateral (n = 24) and bilateral (n = 28) tinnitus, and a control group without tinnitus (n = 25), all with no severe hearing losses and a similar hearing profile. None of the metabolite levels in the temporal regions of interest were found related to tinnitus status or laterality. Unexpectedly, we found a tendency of increased concentration of Glx in the control left medial frontal region in bilateral vs unilateral tinnitus. Slightly elevated depressive and anxiety symptoms were also shown in participants with tinnitus, as compared to healthy individuals, with the bilateral tinnitus group marginally more affected. We discuss no apparent effect in the temporal lobes, as well as the role of frontal brain areas, with respect to hearing loss, attention and psychological well-being in chronic tinnitus. We furthermore elaborate on the design-related and technical obstacles of MR spectroscopy.

The Role of Religiosity and Spirituality in Helping Polish Subjects Adapt to Their Tinnitus

This study aims to assess whether religiosity and spirituality might be significant internal resources that help people with tinnitus to adapt to their condition. The study group comprised 256 Polish patients with tinnitus (123 women and 133 men) who answered the Tinnitus Handicap Inventory and Tinnitus Functional Index (both of which measure tinnitus annoyance) and the Self-Description Questionnaire (which measures: religious attitudes, ethical sensitivity, and harmony). Significant positive correlations between religious attitudes and tinnitus annoyance were found in subjects with tinnitus. The higher the religiosity, the higher tinnitus the annoyance, at least in the two TFI questionnaire dimensions: sense of control and quality of life (although these correlations were statistically significant only for men). Religiosity was found to be a positive predictor of tinnitus annoyance. Also, ethical sensitivity positively predicted tinnitus annoyance, whereas harmony was a negative predictor. We suggest that psychologists and audiologists should, in their diagnostic and therapeutic work with patients with tinnitus, pay attention to the religious and spiritual aspects of their patients' lives.

A Study to Grade the Severity of Tinnitus and its Psychological Impact Using Tinnitus Functional Index (tfi)

Background

Chronic tinnitus has a lot impact on the quality of life of person by affecting his/ her physical health, occupational health and social relations. It can lead to sleep interference, cognitive difficulties, lack of concentration, anxiety, frustration, anger and depression. The present study showed the severity and impact of tinnitus on quality of life of subjects with or without hearing loss using tinnitus functional index (TFI).

Methods

Subjects with history of tinnitus with or without hearing loss including informed consent, otoscopy, pure tone audiometry (PTA) were done. Grading of tinnitus was done by using tinnitus functional index score.

Results

The mean age of participants were 50.20 ± 4.2 years and male to female ratio were found to be 1.05:1. On PTA, 122 participants had hearing loss and 28 had no hearing loss. 49 patients had mild TFI score, 85 had moderate TFI score and 16 had severe hearing loss. The difference in the severity of tinnitus using TFI between normal hearing and sensorineural hearing loss individual was statistically significant. On the other hand, the severity of tinnitus and degree of hearing loss were also found to be statistically significant with p value < 0.0001 chi. Sq = 77.39. This shows that with increase in increase in hearing loss there is increase in TFI sore.

Conclusion

Tinnitus has a negative impact on the quality of life like pshycological, emotional and physical effects. The effects of tinnitus is more in those with co-existing hearing loss.

Ego-resiliency and Tinnitus Annoyance

BACKGROUND

Tinnitus is a common and, in many cases, chronic condition. Coping with a chronic ailment is a long-term process, which also depends on the personality of the individual. One important personality resource is ego-resiliency, that is, how flexible the person is in adapting to the impulse to control their environment.

PURPOSE

The aim of the study was to determine whether ego-resiliency affects the perceived level of tinnitus annoyance.

RESEARCH DESIGN

This was a questionnaire study combined with a retrospective analysis of medical data.

STUDY SAMPLE

The study involved 176 people with diagnosed chronic tinnitus who volunteered to participate (53 men and 123 women aged 31-80 years).

DATA COLLECTION AND ANALYSIS

The following tools were used: Ego-Resiliency Scale to measure ego-resiliency, Tinnitus Functional Index to assess the impact of tinnitus on daily life, and a survey of sociodemographics and tinnitus history.

RESULTS

The conducted research showed that men had higher ego-resiliency than women. Older subjects (older than 60 years) had higher ego-resiliency than younger ones. There was a negative correlation between ego-resiliency and the perceived annoyance of tinnitus. Regression analysis showed that a person's ability to cope and to tolerate negative emotions were the only factors of ego-resiliency that were a significant predictor of tinnitus annoyance.

CONCLUSION

People with a high level of personal ability to cope and to tolerate negative emotions are likely to experience decreased tinnitus annoyance. Ego-resiliency levels should be considered when diagnosing and planning interventions for people with tinnitus. In psychological intervention programs for people with tinnitus, it is worthwhile developing ego-resiliency, paying particular attention to positive emotions which are crucial in building it. Research should be continued on other personal resources affecting perceived tinnitus annoyance.

The role of vitamin D in subjective tinnitus-A case-control study

Regarding the high prevalence of vitamin D (25(OH)D) deficiency in the population and its possible association with ear diseases, we aimed to investigate the 25(OH)Dserum level in patients with subjective, nonpulsating tinnitus and its effect on tinnitus severity. The study included 201 tinnitus patients and 99 controls. Patient clinical information, including tinnitus characteristics and severity according to Tinnitus Handicap Inventory (THI), loudness assessed by Visual Analogue Scale (VAS), audiometry, and the blood level of vitamin D, was recorded. The level of 25(OH)D in tinnitus patients was significantly decreased compared with the controls (19.86 ± 7.53 and 27.43 ± 8.85 ng/ml, respectively; P value < 0.0001). More patients in the tinnitus group were deficient in vitamin D, compared with the controls (50.7% vs. 22.2% respectively, p < 0.0001). Tinnitus patients with a lower serum level of 25(OH)D (≤15 ng/dl) were significantly younger, had a higher degree of tinnitus severity measured with THI and VAS scales, had higher triglyceride and TSH levels, and a lower HDL level compared with individuals who had higher 25(OH)D level (>15 ng/dl). There was a strong correlation between the 25(OH)D level and THI. Our findings suggest that a large proportion of tinnitus patients suffers from vitamin D deficiency and that the vitamin D level correlates with tinnitus impact. We recommend a vitamin D assessment for all tinnitus patients.

Translation, Cultural Adaptation and Validation to Brazilian Portuguese of the Tinnitus Functional Index Questionnaire

Introduction  Tinnitus affects a large portion of the world's population. There are several questionnaires being used for the evaluation of the severity of tinnitus and its impact in quality of life; however, they do not measure treatment-related changes. So, a new self-reported questionnaire was developed, the Tinnitus Functional Index (TFI), which has been translated into several languages.

Objective  To perform the translation, cultural adaptation and validation of the TFI questionnaire for Brazilian Portuguese.

Method  This is a multicenter project divided into two stages: translation and cultural adaptation; and validation and reliability. For the validation, the Brazilian Portuguese version of the TFI was correlated with the Tinnitus Handicap Inventory (THI) domains for tinnitus and quality of life and was evaluated by the Spearman ρ test. The reliability and internal consistency were evaluated by the Cronbach α test.

Result  The Brazilian version of the TFI was obtained through an initial translation process, synthesis of translations, backtranslation and evaluation by a committee of experts. This version was then applied in 88 patients complaining of tinnitus from speech therapy and otorhinolaryngology outpatient clinics of the three school clinics. The Brazilian version presented high reliability, as evidenced by the Cronbach α value (α = 0.870), and strong correlation (rho = 0.760 and p  = 0.000).

Conclusion  The high reliability found in the results demonstrates that the Brazilian Portuguese version of the TFI is a valid and reliable instrument to evaluate the severity and impact of tinnitus on quality of life and changes related to its treatment.

Validation of a Dutch version of the Tinnitus Functional Index in a tertiary referral tinnitus clinic

INTRODUCTION

Tinnitus is a condition with a subjective nature that requires self-report questionnaires for its assessment. Aspects such as quality of life, sleep or intrusiveness have been addressed by multiple tinnitus questionnaires, but the high responsiveness to treatment effects of the Tinnitus Functional Index (TFI) makes this questionnaire part of the standard practice in tinnitus screening. To date, the TFI has been translated to more than 20 languages and used in more than 22 countries. In this study, the TFI was translated to Dutch and validated through a clinical population in the Netherlands.

METHODS

After a back-translation procedure, the Dutch TFI was filled-out by 377 patients in the tinnitus outpatient clinic at the Ear, Nose and Throat (ENT) department of the University Medical Center Groningen, in the Netherlands. Reliability and construct validity of the questionnaire were assessed by correlations with one other tinnitus questionnaire (Tinnitus Handicap Inventory, THI) and with three psychological functioning questionnaires (Rand-36, Cantril's ladder and the Hospital Anxiety and Depression Scale (HADS)). The eight-factor structure of the Dutch TFI was tested by means of exploratory factor analysis using three different models (ICM-CFA, ESEM and ESEM-CFA).

RESULTS

The Dutch TFI showed a high internal consistency (α = 0.95), and construct validity was proven by moderate-to high-convergent correlations with the THI (r = 0.47-0.79) and by moderate convergent (r = 0.55-0.67) and good-to moderate-divergent (r = 0.12-0.47) correlations with the psychological functioning questionnaires. The eight-factor structure of the TFI was confirmed for the Dutch version by the three models.

CONCLUSION

The Dutch version of the TFI is a reliable instrument for screening tinnitus impact in a clinical population, and its psychometric properties are comparable to the original TFI and other validated tinnitus questionnaires.

Improving the assessment of functional impairment in tinnitus sufferers: validation of the German version of the Tinnitus Functional Index using a confirmatory factor analysis

OBJECTIVES

Chronic tinnitus negatively impacts daily functioning. To specifically assess this impairment, the Tinnitus Functional Index (TFI) was developed. The current study investigated the hierarchical, eight-factorial structure for the German TFI and examined its psychometric properties.

DESIGN

In an online assessment, the TFI and other validated health-related measurements were completed. Confirmatory factor analysis (CFA) was conducted to investigate the factorial structure by testing two competing models: (1) a general factor model, and (2) a hierarchical second-order factor model.

STUDY SAMPLE

316 research volunteers (59.8% female) with low to moderate tinnitus distress were included.

RESULTS

CFA revealed an insufficient fit of the data to the general factor model. For the hierarchical second-order factor model, an acceptable model fit was shown (χ²/df ratio = 2.74, RMSEA = 0.07, SRMR = 0.05, CFI = 0.95, TLI = 0.95). Correlational analyses between the TFI and measures assessing tinnitus distress, depression, sleeping difficulties, subjective well-being, and personality dimensions indicated high convergent and moderate discriminant validity. Internal consistency reliability was excellent.

CONCLUSIONS

The results confirm the hierarchical, eight-factorial structure of the German TFI. The TFI is a promising inventory that should be used on a regular basis.HighlightsThe results of our study confirm the hierarchical eight-factorial structure of the German TFI.Confirmatory factor analysis revealed an acceptable model fit of the data.Convergent validity of the German TFI was high.Discriminant validity of the German TFI was moderate.The German TFI is a reliable questionnaire to assess tinnitus functional impairment.

Effectiveness of tinnitus therapy using a mobile application

Background

The World Health Organization reports that the number of tinnitus sufferers is increasing year on year. Given the common use of mobile devices and the availability of applications designed to support patients in tinnitus therapy and reduce tinnitus severity, patients seeking help are likely to try this form of support. The aim of this study was to evaluate the effectiveness of a mobile application in tinnitus sound therapy, in this case ReSound Tinnitus Relief™.

Methods

The study involved 52 patients hospitalized for tinnitus. All participants used the free ReSound Tinnitus Relief application for 6 months. The application is based on sound therapy. Patients were advised to use the application for at least 30 min per day, the sounds should not completely mask the tinnitus, and they should be listened to via a loudspeaker. The effects of the therapy were evaluated by means of standardized questionnaires for tinnitus severity: the Tinnitus Handicap Inventory and the Tinnitus Functional Index.

Results

The study showed a reduction in tinnitus severity as measured by both questionnaires. The general severity decreased after the first 3 months and again in the following 3 months of using the application. In both questionnaires the biggest changes were observed in the subscales of emotions.

Conclusions

Results obtained here from standardized questionnaires indicate that the tested application may contribute to tinnitus reduction. However, it is advisable to conduct further research on the applicability of such technology in medical practice.

All for One and One for All? - Examining Convergent Validity and Responsiveness of the German Versions of the Tinnitus Questionnaire (TQ), Tinnitus Handicap Inventory (THI), and Tinnitus Functional Index (TFI)

BACKGROUND

Measurement of tinnitus-related distress and treatment responsiveness is key in understanding, conceptualizing and addressing this often-disabling symptom. Whilst several self-report measures exist, the heterogeneity of patient populations, available translations, and treatment contexts requires ongoing psychometric replication and validation efforts.

OBJECTIVE

To investigate the convergent validity and responsiveness of the German versions of the Tinnitus Questionnaire [TQ], Tinnitus Handicap Inventory [THI], and Tinnitus Functional Index [TFI] in a large German-speaking sample of patients with chronic tinnitus who completed a psychologically anchored 7-day Intensive Multimodal Treatment Programme.

METHODS

Two-hundred-and-ten patients with chronic tinnitus completed all three questionnaires at baseline and post-treatment. Intraclass correlation coefficients determined the convergent validity of each questionnaire's total and subscale scores. Treatment responsiveness was investigated by [a] comparing treatment-related change in responders vs. non-responders as classified by each questionnaire's minimal clinically important difference-threshold, and [b] comparing agreement between the questionnaires' responder classifications.

RESULTS

The total scores of all three questionnaires showed high agreement before and after therapy (TQ | THI: 0.80 [Pre], 0.83 [Post], TQ | TFI: 0.72 [Pre], 0.78 [Post], THI | TFI: 0.76 [Pre] 0.80 [Post]). All total scores changed significantly with treatment yielding small effect sizes. The TQ and TFI yielded comparable (19.65 and 18.64%) and the THI higher responder rates (38.15%). The TQ | THI and TQ | TFI showed fair, and the THI | TFI moderate agreement of responder classifications. Independent of classification, responders showed significantly higher change rates than non-responders across most scores. Each questionnaire's total change score distinguished between responders and non-responders as classified by the remaining two questionnaires.

CONCLUSION

The total scores of all three questionnaires show high convergent validity and thus, comparability across clinical and research contexts. By contrast, subscale scores show high inconsistency. Whilst the TFI appears well suited for research purposes, the THI may be better suited to measure psychological aspects of tinnitus-related distress and their changes with accordingly focused treatment approaches.

How to Interpret Tinnitus Functional Index Scores: A Proposal for a Grading System Based on a Large Sample of Tinnitus Patients

OBJECTIVES

The Tinnitus Functional Index (TFI) is considered the gold standard in measuring tinnitus severity. The aim of the study was to establish reference values to improve the interpretability of TFI scores.

DESIGN

Results from 1114 patients with tinnitus were retrospectively analyzed. The participants were consecutive patients who attended our tertiary referral Ear, Nose, and Throat Center. The eligibility criteria were: at least 18 years old, persistent tinnitus, completed pure-tone audiometry, and answered all 25 items on the TFI. Hearing status (normal hearing vs. hearing impairment) was established according to the recommendation of the Bureau International d'Audiophonologie. Means (M) and SD on the TFI were the basis for grading tinnitus severity on four levels: low, lower moderate, upper moderate, and high. To gauge individual scores in clinical practice, percentiles are also proposed.

RESULTS

All 1114 patients (586 women and 528 men) were Caucasian and aged from 19 to 87 years (M = 50.96; SD = 13.10 years). Tinnitus duration ranged from 0.5 to 50 years (M = 7.17; SD = 7.71 years). There were 258 patients with normal hearing and 856 patients with hearing loss. A score of above 65 points on TFI was established as the cutoff point for diagnosing high tinnitus severity. A regression model associating tinnitus severity with gender, age, tinnitus duration, and hearing loss was statistically significant: F(4,1109) = 8.99; p < 0.001, but the effect was very small (R2adj = 0.028) and only gender and age were associated with TFI global score, while tinnitus severity was not related to tinnitus duration or hearing loss.

CONCLUSIONS

The reference values proposed here support those reported previously by Meikle et al. They are empirically based and can be used as benchmarks in clinical practice and scientific research. They make it possible to assess tinnitus severity, evaluate individual scores, and categorize individuals with tinnitus. This allows researchers to set inclusion or exclusion criteria when assigning patients to specific groups during clinical trials involving tinnitus intervention strategies.

The Prevalence of Different Types of Headache in Patients with Subjective Tinnitus and Its Influence on Tinnitus Parameters: A Prospective Clinical Study

Both tinnitus and headache are very prevalent conditions in the general population, with bidirectional co-occurrence of them. A number of studies revealed a high prevalence of headache in tinnitus patients; however, most of them used self-reported symptoms, questionnaires, or health databases and were retrospective. The aim of this study was to evaluate the prevalence of different types of headache in a cohort of tinnitus patients and to assess the influence of headache on tinnitus parameters, focusing on appropriate headache and tinnitus diagnosis verified by clinical examination. This prospective study involved 286 patients diagnosed with subjective non-pulsating tinnitus. Patients’ clinical information was thoroughly assessed by the multidisciplinary team, including tinnitus characteristics and severity according to the Tinnitus Handicap Inventory (THI), loudness assessed by the Visual Analogue Scale (VAS), audiometry, type of headache diagnosed according to the third edition of the International Classification of Headache Disorders, severity of headache assessed by the Numeric Rating Scale (NRS), and impact of headache using the Headache Impact Test (HIT). In total, 141 (49.3%) tinnitus patients were diagnosed with headache, most of them with tension-type headache or migraine. They were significantly younger; mostly women; had bilateral tinnitus, vertigo, and depression more frequently; and had hearing loss less frequently as compared with the non-headache group. In total, 82 (58.16%) patients had the same localization of tinnitus and headache. Younger age, female gender, higher tinnitus burden measured by THI, and coexistence of hearing loss were independent variables connected with the occurrence of headache in the tinnitus group. According to our study, headaches impact tinnitus on many different levels and may be an important co-factor for tinnitus subtyping. We recommend screening for headache coexistence in all tinnitus patients.

Slovenian Cross-Cultural Adaptation and Validation of Health-Related Quality of Life Measures for Chronic Otitis Media (COMQ-12), Vertigo (DHI, NVI) and TINNITUS (THI)

PURPOSE

To provide physicians and patients with the tools needed to evaluate patients' problems and health-related quality of life by cross-culturally adapting and validating the Chronic Otitis Media Questionnaire 12 (COMQ-12), the Dizziness Handicap Inventory (DHI), the Neuropsychological Vertigo Inventory (NVI) and the Tinnitus Handicap Inventory (THI).

MATERIALS AND METHODS

COMQ-12, DHI, NVI and THI were translated into the Slovenian language and completed by patients treated at our department for chronic otitis media, vertigo or tinnitus. The control group for each questionnaire consisted of healthy volunteers. Internal consistency, test-retest reliability, discriminant validity, diagnostic accuracy and cut-off value were determined for each questionnaire.

RESULTS

Test-retest reliability was excellent for DHI (ICC A=0.946) and NVI (p=0.315, ICC A=0.975), good to excellent for COMQ-12 (p=0.680, ICC A=0.858) and satisfactory for THI (p=0.120). Discriminant validity was confirmed for each questionnaire (p>0.05) using the Mann-Whitney U test (COMQ-12, DHI, THI) or the Welch t-test (NVI). COMQ-12 had acceptable (α=0.796) and DHI (α=0.910), NVI (α=0.950) and THI (α=0.924) perfect internal consistency. COMQ-12 and DHI had excellent, NVI acceptable and THI perfect diagnostic accuracy (AUC=0.987, AUC=0.999, AUC=0.781 and AUC=1.000 respectively). Cut-off values determined by Youden's index were 7, 7, 9 and 56 for COMQ-12, THI, DHI and NVI, respectively.

CONCLUSION

Slovenian COMQ-12, DHI, NVI and THI are a valid and accurate tool for the diagnosis and measurement of health-related quality of life in patients with chronic otitis media, vertigo and tinnitus. They could aid general practitioners, occupational health specialists, neurologists and otorhinolaryngologists.

Association between Anatomical Features of Petrotympanic Fissure and Tinnitus in Patients with Temporomandibular Joint Disorder Using CBCT Imaging: An Exploratory Study

Mandible displacement is known to correlate with otological conditions such as pain in the ear canal, hearing loss, or tinnitus. The present work aimed to determine the association between the displacement of the condyle in a temporomandibular joint, the structure and position of the petrotympanic fissure (PTF), and comorbid tinnitus in patients affected by temporomandibular joint and muscle disorder (TMD). We enrolled 331 subjects with TMD (268 women and 63 men). The average age of women was 40.8 ± 16.8 years (range 13–88), whereas the average age of the examined men was 38 ± 14 years (range 13–74). We performed imaging studies of the facial part of the skull in the sagittal plane using a volumetric imaging method and a large imaging field (FOV) of 17 cm × 23 cm. The habitual position of the mandible was determined and used as a reference. Based on the imaging results, we developed a classification for the topography and the structure of the petrotympanic fissure. Thirty-three TMD patients (about 10% of the sample) reported having tinnitus. These patients had PTF configurations characterized by a rear (36.59%) or intracranial-cranial (63.41%) condylar displacement of the temporomandibular joint. Our findings imply that the TMJ- and tinnitus-positive group of patients possibly represents a distinct phenotype of tinnitus. We concluded that for such patients, the therapeutic approach for tinnitus should include TMD treatment.

Chinese validation and clinical application of the tinnitus functional index

OBJECTIVE

The Tinnitus Functional Index (TFI) is a new diagnostic measure of the functional impact of tinnitus that is also a sensitive measure of treatment-related changes. However, the TFI has not been translated into Chinese and fully validated in China. The aim of the present study was to evaluate the validity of a Chinese version of the TFI as a diagnostic measure of tinnitus severity in a sample of Chinese patients and to verify the value of its clinical application in China.

DESIGN

A sample of 206 patients whose primary complaint was tinnitus was used to analyze the reliability and validity of the TFI. In addition, patients were asked to fill out the Tinnitus Handicap Inventory (THI) and the Center for Epidemiologic Studies-Depression Scale (CES-D), the Beck Anxiety Inventory (BAI), and the Satisfaction With Life Scale (SWLS) to compare TFI with their association. The internal consistency of the TFI was assessed with Cronbach's alpha coefficient. The factor structure of the TFI was assessed by Exploratory Factor Analysis (EFA). The extracted factors were compared to those of the original TFI scale.

RESULTS

The reliability of the Chinese version of the TFI (Cronbach' s α = .969) showed high internal consistency. The exploratory factor analysis (EFA) of the TFI showed that six factors with one main factor could be extracted instead of eight factors as described in the original version. Nevertheless, relations to the original eight subscales could be demonstrated. A high correlation between the TFI and the THI (r = .865, p < 0.01) and lower correlations between the TFI and the CES-D (r = .334, p < 0.01), BAI (r = .559, p < 0.01), and SWLS (r = - 0.324, p < 0.01) confirmed the satisfactory convergent and discriminant validity of the TFI.

CONCLUSION

After translated and validated a Chinese version of the TFI and found that the TFI had high reliability and validity, which means both instruments are reliable instruments to assess the severity of tinnitus in clinical applications in China.

[Validation of the Chinese version of the auditory subscale of the tinnitus functional index]

Objective:To explore whether the Chinese version of the tinnitus functional index（TFI-CH） auditory subscale score can accurately reflect the impact of tinnitus on hearing. Method:TFI-CH were used to evaluate the severity of tinnitus in 72 adult patients with primary tinnitus. The hearing thershold were recorded by audiological examination. Result:There was significant difference in pure-tone average and the score of the TFI-CH and auditory subscale between patients with normal hearing and patients with hearing loss（P<0.01）. There was no significant correlation between TFI-CH auditory subscale score and age, gender, educational level and course of tinnitus（P>0.05）. A positive correlation was found between the pure-tone average and TFI-CH auditory subscale score（r=0.44, P<0.01）. There was linear correlation between the pure-tone average and the scores of TFI-CH and auditory subscale（P<0.01）. Conclusion:The score of the TFI-CH and its hearing subscale are affected by the hearing threshold of tinnitus patients, especially in tinnitus patients with hearing loss. Whether TFI-CH hearing subscale score can accurately reflect the influence of tinnitus on the hearing threshold of patients remains unclear, which needs to be considered in clinical application.

Prevalence and Severity of Tinnitus in Otosclerosis: Preliminary Findings from Validated Questionnaires

OBJECTIVES

In addition to progressive hearing loss, subjective tinnitus is one of the primary symptoms of the otosclerosis development. The aim of this study was to evaluate the prevalence and severity of preoperative tinnitus among a group of consecutive adult patients with otosclerosis, using standardized research tools.

MATERIALS AND METHODS

The study included 157 cases of clinical otosclerosis (106 women, 51 men). All patients were tested using pure-tone audiometry. The preoperative prevalence and severity of tinnitus were tested using three validated questionnaires: The Tinnitus and Hearing Survey (THS-POL), Tinnitus Handicap Inventory (THI-POL), and Tinnitus Functional Index (TFI-Pl).

RESULTS

Preliminary results showed that 107 of 157 patients with otosclerosis (68.2%) had preoperative tinnitus. Of them, 51 (47.7%) had unilateral tinnitus (in the ear that qualified for stapes surgery), and 56 (52.3%) had bilateral tinnitus. The THS results showed that for 23.4% patients, tinnitus was a problem equal to or greater than hearing loss. The average result of the TFI-Pl questionnaire was 31.6 points, and for THI-POL, it was 38.6 points, indicating that preoperative tinnitus was moderately severe. The statistical analysis did not reveal a correlation between the tinnitus severity and audiometric results (p>0.05). The severity of tinnitus did not differ significantly between men and women (p>0.05), although the TFI-Pl and THI-POL questionnaires indicated that the tinnitus severity generally increased with age in women, while it decreased in men.

CONCLUSION

This is a scientific study conducted to evaluate the prevalence and severity of preoperative tinnitus in Polish patients with otosclerosis, using three validated questionnaires.

The Influence of Cochlear Implantation on Tinnitus in Patients with Single-Sided Deafness: A Systematic Review

Objectives

This systematic review provides an overview of the available studies (published by January 29, 2018) with descriptive data analysis about the influence of cochlear implantation on tinnitus in patients with single-sided deafness (SSD).

Data Sources

PubMed, EMBASE, Web of Science, Cochrane Library, and Google Scholar.

Review Methods

Original studies about the influence of cochlear implantation on tinnitus, measured with different tinnitus questionnaires or visual analog scale, in patients with SSD were included. The pre- and postimplantation tinnitus scores of the included studies were extracted for the further systematic review.

Results

The systematic search yielded 1028 studies. After evaluating titles, abstracts, and full texts, 1011 of these were dismissed. From the remaining 17 studies, 4 showed a low directness of evidence or high risk of bias and were therefore excluded. Due to the nature of cochlear implantation in SSD, only cohort studies and no randomized trials exist, which limits the evaluation in a systematic review. Generally, the mean tinnitus questionnaire scores decreased after cochlear implantation in these 13 studies with a total of 153 patients. The most widely used tinnitus questionnaire was the Tinnitus Handicap Inventory. In these studies, 34.2% of patients demonstrated complete suppression, 53.7% an improvement, 7.3% a stable value, and 4.9% an increase of tinnitus, and none of the patients reported an induction of tinnitus.

Conclusion

This review shows a clear improvement of tinnitus complaints after cochlear implantation in patients with SSD. Therefore, tinnitus might be considered as an additional indication for cochlear implantation in SSD.

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.

Clinically important change in tinnitus sensation after stapedotomy

Background

When measuring the treatment effect in tinnitus with multi-item outcome instruments, it is crucial for both clinical and research purposes to take into consideration clinical importance of the outcome scores. The aim of the present study is to determine minimal important change (MIC) in tinnitus which is clinically meaningful to patients with otosclerosis.

Methods

The study population was 95 patients with otosclerosis, suffering from tinnitus. They completed the Tinnitus Functional Index before stapedotomy and 3 months after the surgery. The minimal important change was estimated with the Clinical Global Impression Scale as the external criterion (anchor). The mean change method and the receiver operating characteristic (ROC) method were used to determine minimal important change in tinnitus sensation.

Results

The improvement in tinnitus after stapedotomy was reported by 69.4% of the patients with otosclerosis. Minimal important change in tinnitus was estimated as reduction of 8.8 points in the Tinnitus Functional Index.

Conclusions

The anchor-based approach using an external criterion (anchor) allows to determine change in tinnitus sensation which is meaningful to patients after stapedotomy. The value of 8.8 points in Tinnitus Functional Index could be used as benchmark of stapedotomy effectiveness in otosclerosis patients suffering from tinnitus. Hearing difficulties comorbid with tinnitus could affect the perception of tinnitus change.

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.

A good practice guide for translating and adapting hearing-related questionnaires for different languages and cultures

OBJECTIVES

To raise awareness and propose a good practice guide for translating and adapting any hearing-related questionnaire to be used for comparisons across populations divided by language or culture, and to encourage investigators to publish detailed steps.

DESIGN

From a synthesis of existing guidelines, we propose important considerations for getting started, followed by six early steps: (1) Preparation, (2, 3) Translation steps, (4) Committee Review, (5) Field testing and (6) Reviewing and finalising the translation.

STUDY SAMPLE

Not applicable.

RESULTS

Across these six steps, 22 different items are specified for creating a questionnaire that promotes equivalence to the original by accounting for any cultural differences. Published examples illustrate how these steps have been implemented and reported, with shared experiences from the authors, members of the International Collegium of Rehabilitative Audiology and TINnitus research NETwork.

CONCLUSIONS

A checklist of the preferred reporting items is included to help researchers and clinicians make informed choices about conducting or omitting any items. We also recommend using the checklist to document these decisions in any resulting report or publication. Following this step-by-step guide would promote quality assurance in multinational trials and outcome evaluations but, to confirm functional equivalence, large-scale evaluation of psychometric properties should follow.

Tinnitus functional index: validation of the German version for Switzerland

Background

Different standardized questionnaires are used to assess tinnitus severity, making comparisons across studies difficult. These questionnaires are also used to measure treatment-related changes in tinnitus although they were not designed for this purpose. To solve these problems, a new questionnaire - the Tinnitus Functional Index (TFI) - has been established. The TFI is highly responsive to treatment-related change and promises to be the new gold standard in tinnitus evaluation. The aim of the current study was to validate a German version of the TFI for a German-speaking population in Switzerland.

Methods

At the ENT department of the University Hospital Zurich, 264 subjects completed an online survey including the German version for Switzerland of TFI, Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and sociodemographic variables. Internal consistency of the TFI was calculated with Cronbach’s alpha coefficient. Pearson correlation coefficients were used for the test-retest reliability of the TFI and to investigate convergent and discriminant validity between the THI and the BDI and BAI, respectively. Factor analysis was assessed using a principal component analysis with oblique rotation. The different factors extracted were then compared with the original questionnaire.

Results

The German version of the TFI for Switzerland showed an excellent internal consistency (Cronbach’s alpha of 0.97) and an excellent test-retest reliability of 0.91. The convergent validity with THI was high (r = 0.86). The discriminant validity with BAI and BDI showed moderate results (BAI: r = 0.60 and BDI: r = 0.65). In the factor analysis only five factors with one main factor could be extracted instead of eight factors as described in the original version. Nevertheless, relations to the original eight subscales could be demonstrated.

Conclusion

The German version of the TFI for Switzerland is a suitable instrument for measuring the impact of tinnitus. The reliability and validity of this version are comparable with the original version of the TFI. Although this study showed only five factors in the factor analysis, relations to the original eight subscales were identified. Therefore, the German version of the TFI for Switzerland can deliver relevant information regarding the different tinnitus domains.

Trial registration

Clinical trial registration number on clinicaltrial.gov: NCT01837368.

Alexithymia Is Associated with Tinnitus Severity

OBJECTIVE

Alexithymia is considered to be a personality trait with a tendency to express psychological distress in somatic rather than emotional form and, therefore, may play a vital role in somatization. Although, such a propensity can be found in patients suffering from tinnitus, the relationship between alexithymic characteristics and the subjective experience of tinnitus severity remains yet unclear. Our aim was to evaluate which alexithymic characteristics are linked to the subjective experience of tinnitus symptomatology.

METHODS

We evaluated tinnitus severity (Tinnitus Handicap Inventory, THI), alexithymia (20-item Toronto Alexithymia Scale, TAS-20), and depression (Beck Depression Inventory, BDI) in 207 outpatients with tinnitus. Correlation analyses and multiple regression analyses were calculated in order to investigate the relationship between alexithymic characteristics, tinnitus severity, and depression.

RESULTS

Highly significant positive correlations were found between THI total score and TAS-20 total score as well as BDI score. Regarding the TAS-20 subscales, multiple regression analyses showed that only the TAS-20 subscale "difficulty in identifying feelings" (DIF) and the BDI significantly predicted the subjective experience of tinnitus severity. Regarding the THI subscales, only higher scores of the THI subscale "functional" demonstrated an independent moderate association with higher scores for DIF.

CONCLUSION

We found an independent association between the subjective experience of tinnitus severity and alexithymic characteristics, particularly with regard to limitations in the fields of mental, social, and physical functioning because of tinnitus and the difficulty of identifying feelings facet of alexithymia. These findings are conducive to a better understanding of affect regulation that may be important for the psychological adaptation of patients suffering from tinnitus.