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Henry JA, Thielman EJ, Zaugg T, Griest S, Stewart BJ. Assessing Meaningful Improvement: Focus on the Tinnitus Functional Index. Ear Hear 2024; 45:537-549. [PMID: 38351518 DOI: 10.1097/aud.0000000000001456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Many studies have attempted to determine methodology for interpreting change on outcome instruments that result from an intervention. The objective of these studies has been to devise methods to identify the minimal level of change that would be consistent with actual benefit perceived by the patient, and not just statistically significant change. With respect to intervention for bothersome tinnitus, the authors of the original study to develop and validate the Tinnitus Functional Index (TFI) suggested that a minimum 13-point reduction in the TFI score was likely to reflect a change perceived as meaningful to an individual. The 13-point estimation of meaningful change for an individual is appropriate for use with any adult seeking care for tinnitus. However, it cannot be relied upon in isolation to determine if an individual believes that there has been a noticeable, or meaningful improvement in their quality of life. It is important to use subjective impressions elicited from the patient to assist in interpreting the meaning of TFI data for an individual. For clinicians engaging in care for tinnitus, we recommend using the TFI and pairing it with the patient's belief/impression as to whether they are doing better than they were before care for tinnitus was provided. Ideally, the outcome assessment would be conducted by someone other than the clinician who provided the intervention.
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Affiliation(s)
- J A Henry
- Veterans Affairs Rehabilitation Research and Development, National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - E J Thielman
- Veterans Affairs Rehabilitation Research and Development, National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | - T Zaugg
- Veterans Affairs Rehabilitation Research and Development, National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | - S Griest
- Veterans Affairs Rehabilitation Research and Development, National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
| | - B J Stewart
- School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
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Langguth B, De Ridder D. Minimal Clinically Important Difference of Tinnitus Outcome Measurement Instruments-A Scoping Review. J Clin Med 2023; 12:7117. [PMID: 38002730 PMCID: PMC10671865 DOI: 10.3390/jcm12227117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE Tinnitus assessment and outcome measurement are complex, as tinnitus is a purely subjective phenomenon. Instruments used for the outcome measurement of tinnitus in the context of clinical trials include self-report questionnaires, visual analogue or numeric rating scales and psychoacoustic measurements of tinnitus loudness. For the evaluation of therapeutic interventions, it is critical to know which changes in outcome measurement instruments can be considered as clinically relevant. For this purpose, the concept of the minimal clinically important difference (MCID) has been introduced. STUDY DESIGN Here we performed a literature research in PubMed in order to identify for which tinnitus outcome measurements MCID criteria have been estimated and which of these estimates fulfil the current methodological standards and can thus be considered as established. RESULTS For most, but not all tinnitus outcome instruments, MCID calculations have been performed. The MCIDs for the Tinnitus Handicap Inventory (THI), the Tinnitus Questionnaire (TQ), the Tinnitus Functional Index (TFI) and visual analogue scales (VAS) vary considerably across studies. Psychoacoustic assessments of tinnitus such as loudness matching have not shown sufficient reliability and validity for the use as an outcome measurement. CONCLUSION Future research should aim at the confirmation of the available estimates in large samples involving various therapeutic interventions and under the consideration of time intervals and baseline values. As a rule of thumb, an improvement of about 15% can be considered clinically meaningful, analogous to what has been seen in other entirely subjective pathologies like chronic pain.
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Affiliation(s)
- Berthold Langguth
- Department of Psychiatry and Psychotherapy, Bezirksklinikum, University of Regensburg, 93053 Regensburg, Germany
| | - Dirk De Ridder
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand;
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De Meulemeester K, Meeus M, De Pauw R, Cagnie B, Keppler H, Lenoir D. Suffering from chronic tinnitus, chronic neck pain, or both: Does it impact the presence of signs and symptoms of central sensitization? PLoS One 2023; 18:e0290116. [PMID: 37616265 PMCID: PMC10449148 DOI: 10.1371/journal.pone.0290116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Chronic subjective tinnitus is a prevalent symptom, which has many similarities with chronic pain. Central sensitization is considered as a possible underlying mechanism of both symptoms. Central sensitization has already been investigated in chronic pain populations but not in patients with chronic subjective tinnitus. Therefore, the main objective of this cross-sectional study was to compare signs and symptoms, indicative for central sensitization, in tinnitus patients with and without chronic idiopathic neck pain, patients with chronic idiopathic neck pain only, and healthy controls. Also, differences in psychological and lifestyle factors, possibly influencing the association between central sensitization and tinnitus, were examined as well as correlations between signs and symptoms of central sensitization, and tinnitus, pain, psychological and lifestyle factors. Differences in signs and symptoms of central sensitization were examined using the self-report Central Sensitization Inventory and QST protocol (local and distant mechanical and heat hyperalgesia, conditioned pain modulation). Tinnitus, pain, psychological and lifestyle factors were evaluated using self-report questionnaires. Symptoms of central sensitization and local mechanical hyperalgesia were significantly more present in both tinnitus groups, compared to healthy controls, but were most extensive in the group with chronic tinnitus+chronic idiopathic neck pain. Distant mechanical hyperalgesia, indicative for central sensitization, was only observed in the group with both chronic tinnitus+chronic idiopathic neck pain. This group also displayed a significantly higher psychological burden and poorer sleep than patients with chronic tinnitus only and healthy controls. Signs and symptoms of central sensitization were also shown to be associated with tinnitus impact, pain-related disability, psychological burden and sleep disturbances. This study shows preliminary evidence for the presence of central sensitization in patients with chronic tinnitus+chronic idiopathic neck pain. This could be explained by the higher perceived tinnitus impact, psychological burden and sleep problems in this group. Trial registration: This study is registered as NCT05186259 (www.clinicaltrials.gov).
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Affiliation(s)
- Kayleigh De Meulemeester
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, The Netherlands
| | - Mira Meeus
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, The Netherlands
- MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Robby De Pauw
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Lifestyle and Chronic Diseases, Department of Epidemiology and Public Health, Sciensano, Belgium
| | - Barbara Cagnie
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Hannah Keppler
- Audiology Research Group, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Oto-Rhino-Laryngology, Ghent University Hospital, Ghent, Belgium
| | - Dorine Lenoir
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, The Netherlands
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Fernández M, Cuesta M, Sanz R, Cobo P. Comparison of Tinnitus Handicap Inventory and Tinnitus Functional Index as Treatment Outcomes. Audiol Res 2022; 13:23-31. [PMID: 36648924 PMCID: PMC9844388 DOI: 10.3390/audiolres13010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Tinnitus is an audiological disorder for which there are no objective measuring tools. Thus, many self-report questionnaires have been proposed to assess its severity. These questionnaires have been judged for their capacity to assess the tinnitus severity at baseline, their sensitivity to treatment-related changes (responsiveness), and their resolution. METHODS The most widely used questionnaires for clinical and research studies are the Tinnitus Handicap Inventory (THI) and the Tinnitus Functional Index (TFI). While both questionnaires have been recognized as good evaluators of the baseline tinnitus severity, the latter is considered to be more responsive to changes following treatments. OBJECTIVES The aim of this work is to provide a preliminary comparison of the performance of both questionnaires in the initial and final tinnitus severity assessment of a cohort of patients undergoing a four-month Enriched Acoustic Environment (EAE) therapy. RESULTS The EAE therapy provided a 30 and 26 point reduction in THI and TFI, respectively. A good correlation is obtained between the THI and TFI questionnaires at baseline and after the treatment. CONCLUSION At baseline, the THI provided a higher score than the TFI for a higher degree of tinnitus but a lower score for lower tinnitus severity. Both THI and TFI were good questionnaires for baseline assessment and for treatment-related changes. The THI provided a slightly higher score drop than the TFI following the treatment, although the TFI had better resolution.
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Affiliation(s)
- Marta Fernández
- Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - María Cuesta
- Institute of Physical and Information Technologies (ITEFI), CSIC, Serrano 144, 28006 Madrid, Spain
| | - Ricardo Sanz
- Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Pedro Cobo
- Institute of Physical and Information Technologies (ITEFI), CSIC, Serrano 144, 28006 Madrid, Spain
- Correspondence: ; Tel.: +34-915618806
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Special Issue "New Insights into Pathophysiology, Diagnosis and Treatment of Tinnitus". Brain Sci 2022; 12:brainsci12101330. [PMID: 36291264 PMCID: PMC9599459 DOI: 10.3390/brainsci12101330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 11/29/2022] Open
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