Efficacy of Sound Therapy for Tinnitus Using an Enriched Acoustic Environment with Hearing-Loss Matched Broadband Noise

Background: Tinnitus is a rather heterogeneous chronic condition/disorder which is difficult to treat. Some tinnitus treatments combine sound therapy with counselling. The main goal of this study is to report the efficacy of a customized sound therapy combined with counselling on a cohort of 83 tinnitus patients. Methods: 119 tinnitus subjects, recruited between January 2018 and June 2021, were subjected to a treatment consisting of a combination of an initial counselling session and four-month sound therapy. The sound stimulus was a personalized broadband noise colored by the audiometry of the subjects. These stimuli were given to the patients in mp3 format to be heard 1 h per day over 4 months. The tinnitus severity of the patients was evaluated monthly through the validated Spanish version of the Tinnitus Handicap Inventory. Results: Of the patients, 30% (36 of 119) withdrew from the treatment before finishing, and 96% (80 of 83) of the subjects completing the therapy attained some relief after 4 months. The overall average THI decrease of these 80 participants was 23. However, when the THI was analyzed by severity scales, it was found that patients with initial mild, moderate, severe and catastrophic handicap had an average THI decrease of 14, 20, 31 and 42 points, respectively. Thus, the average THI decrease depended on the baseline severity scale of patients. Conclusions: Consequently, the proposed treatment was demonstrated to be effective in providing clinically relevant relief in tinnitus distress patients in just 4 months.

The DizzyQuest: relation between self-reported hearing loss, tinnitus and objective hearing thresholds in patients with Meniere’s disease

Background Combining a mobile application-based vestibular diary called the DizzyQuest and an iPad-based hearing test enables evaluation of the relationship between experienced neuro-otological symptoms and hearing thresholds in daily life setting. The aim was to investigate the relationship between self-reported hearing symptoms and hearing thresholds in patients with Meniere’s disease (MD), using the DizzyQuest and the iPad-based hearing test simultaneously. Methods The DizzyQuest was administered for 3 weeks in 21 patients. Using the experience-sampling-method (ESM), it assessed hearing loss and tinnitus severity for both ears separately. Each day after the DizzyQuest, an iPad-based hearing test was used to measure hearing thresholds. A mixed model regression analysis was performed to investigate relationships between hearing thresholds and self-reported hearing loss and tinnitus severity. Results Fifteen patients were included. Overall, pure-tone averages (PTAs) were not correlated with self-reported hearing loss severity and tinnitus. Individual differences in PTA results between both ears did not significantly influence the difference in self-reported hearing loss severity between both ears. Self-reported hearing loss and tinnitus scores were significantly higher in ears that corresponded with audiometric criteria of MD (p < 0.001). Self-reported tinnitus severity significantly increased with self-reported hearing loss severity in affected (p = 0.011) and unaffected ears (p < 0.001). Conclusion Combining the DizzyQuest and iPad-based hearing test, facilitated assessment of self-reported hearing loss and tinnitus severity and their relationship with hearing thresholds, in a daily life setting. This study illustrated the importance of investigating neuro-otological symptoms at an individual level, using multiple measurements. ESM strategies like the DizzyQuest should therefore be considered in neuro-otological research.

Perception of tinnitus: direct and indirect effects of resilience, personality traits and psychiatric symptoms

Background: Psychiatric conditions are common in individuals with tinnitus, so the ways individuals cope with such conditions and personality can influence the characteristics of tinnitus. Purpose: The study aims to investigate the direct and indirect effects of resilience, personality traits and psychiatric symptoms on the tinnitus perception. Research Design: Descriptive, cross-sectional, and observational field study involving quantitative results. Study Sample: Thirty-seven individuals who sought the tinnitus care service (mean age = 44.6 years; SD = 11.7 years), with chronic tinnitus for more than six months. Data Collection and Analysis: The specific anamnesis of tinnitus, adult self-report, resilience scale, big five inventory, tinnitus handicap inventory (M=45.0; SD= 24.1) and visual analog scale (M=6.4; SD= 2.7) were used. Psychoacoustic measurements (loudness: M=25.4; SD= 12.8) of tinnitus were performed to characterize the condition in terms of pitch and loudness. The study analyzed the relationship between tinnitus (annoyance, severity, and loudness), psychiatric symptoms, personality, and resilience. Results: Resilience did not influence tinnitus severity (BCa: -1.12 to 0.51), annoyance (BCa: -0.10 to 0.11), or loudness (BCa: -0.44 to 0.28) when mediated by anxiety and depression. Additionally, there was only a direct effect of resilience for annoyance (t=-2.14, p=0.03; BCa: -0.10 to 0.11). There was no direct influence of anxiety and depression on the tinnitus severity (b = 0.53, p> 0.05), annoyance (b = -0.01, p> 0.05) or loudness (b = 0.11, p> 0.05). However, there was an association of personality traits (neuroticism) with the tinnitus severity (b = 1.16, 95% CI: 0.15-2.17; t = 2.53, p = 0.02) and annoyance (b = 0.12, 95% CI: 0.003-0.24; t = 2.09, p = 0.04). Conclusions: Resilience and psychiatric symptoms did not have a direct or indirect influence on the tinnitus annoyance, severity, or loudness, with only a direct association of resilience and annoyance, and neuroticism trait with the tinnitus annoyance and severity. Our results suggest that it is essential patients with high neuroticism be conducted to develop personalized treatment.

Chronic tinnitus and the positive effects of sound enrichment from a smartphone app of: case–control study (Preprint)

BACKGROUND Tinnitus is a phantom auditory sensation in the absence of any external stimuli. It is accompanied by a broad range of negative emotional symptoms and significantly lower quality of life. So far, there is no cure for tinnitus although various treatment options have been tried. One of them is mobile technology employing dedicated applications based on sound therapy. The applications can be managed by the patient and tailored according to their needs. OBJECTIVE The aim of the study was to assess the effect on the severity of tinnitus of using a mobile application that generates background sounds. METHODS The study involved 68 adults who experienced chronic tinnitus. Participants were divided into a study group and a control group. For 6 months those in the study group used a free mobile application that enriched the sound environment with a background sound. Participants were instructed to use the application for at least 30 min a day and they could listen to any sort of sound according to their preference. The participants in the control group did not use the application. Subjective changes in the daily functioning of both groups were evaluated using the Tinnitus Handicap Inventory (THI) questionnaire, a visual analog scale, and a user survey. RESULTS After 3 months of using the application the THI global score significantly decreased in the study group, and decreased again at 6 months. The highest improvement was observed in the emotional and catastrophic reactions subscales. Based on the THI questionnaire, a clinically significant change was reported by 39% (17 of 44). Almost 90% of the study participants chose environmental sounds to listen to, the most popular being rain and ocean waves. In the control group, tinnitus severity did not change over 3 or 6 months. CONCLUSIONS Although the participants still experienced limitations caused by tinnitus, the advantage of the app was that it led to lower negative emotions and thus reduced overall tinnitus severity. It is worth considering whether a mobile app might be incorporated into the management of tinnitus in a professional setting. CLINICALTRIAL N/A

Third party disability for significant others of individuals with tinnitus: A cross-sectional survey design

Background: The impact of tinnitus on significant others (SOs) is largely unknown. Objectives: The study aims included investigating third-party disability in a sample of SOs of individuals with tinnitus and to investigate factors associated with third-party disability. Design: The study used a cross-sectional survey design. Setting: The study was undertaken online Participants: Individuals with tinnitus together with their SOs completed questionnaires online. Outcome measures: The SO sample completed the newly developed Consequences of Tinnitus on Significant Others Questionnaire (CTSOQ). Individuals with tinnitus completed standardized self-reported outcome measures for tinnitus severity, anxiety, depression, insomnia, hearing related quality of life, tinnitus cognitions, hearing disability and hyperacusis to identify any associations between these scores and those of the significant others. Results: A total of 194 pairs of individuals with tinnitus and their SOs that participated, with a mean age of 57 and 56 years, respectively. The CTSOQ showed that 37 (19%) of SOs had mild impact, 58 (29%) had significant impact, and 101 (52%) had severe impact. The clinical variables of tinnitus severity, anxiety and hyperacusis in individuals with tinnitus were the best predictors of the impact of tinnitus on SOs. Conclusions: This study indicates that SOs of individuals with tinnitus may experience third-party disability. The effect of the individual’s tinnitus on SOs may be greater when the individual with tinnitus has greater tinnitus severity, anxiety and hyperacusis. Ways of mitigating these effects should be prioritized such as involving them in the tinnitus management process.

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.

Internet-based cognitive–behavioural therapy for tinnitus: secondary analysis to examine predictors of outcomes

ObjectivesThe current study examined predictors of outcomes of internet-based cognitive–behavioural therapy (ICBT) for individuals with tinnitus.DesignSecondary analysis of intervention studies.SettingInternet-based guided tinnitus intervention provided in the UK.Participants228 individuals who underwent ICBT.InterventionsICBT.Primary and secondary outcome measuresThe key predictor variables included demographic, tinnitus, hearing-related and treatment-related variables as well as clinical factors (eg, anxiety, depression, insomnia), which can have an impact on the treatment outcome. A 13-point reduction in Tinnitus Functional Index (TFI) scores has been defined as a successful outcome.ResultsOf the 228 subjects who were included in the study, 65% had a successful ICBT outcome. As per the univariate analysis, participants with a master’s degree or above had the highest odds of having a larger reduction in tinnitus severity (OR 3.47; 95% CI 1.32 to 12.51), compared with the participants who had education only up to high school or less. Additionally, the baseline tinnitus severity was found to be a significant variable (OR 2.65; 95% CI 1.50 to 4.67) contributing to a successful outcome with the intervention. Both linear and logistic regression models have identified education level and baseline tinnitus severity to be significant predictor variables contributing to a reduction in tinnitus severity post-ICBT. As per the linear regression model, participants who had received disability allowance had shown a 25.3-point lower TFI reduction compared with those who did not experience a decrease in their workload due to tinnitus after adjusting for baseline tinnitus severity and their education level.ConclusionsPredictors of intervention outcome can be used as a means of triaging patients to the most suited form of treatment to achieve optimal outcomes and to make healthcare savings. Future studies should consider including a heterogeneous group of participants as well as other predictor variables not included in the current study.ClinicalTrial.gov Registration:NCT02370810 (completed); NCT02665975 (completed)

Quality of Life and Psychological Distress in Portuguese Older Individuals with Tinnitus

Tinnitus is the perception of a sound without an external source, often associated with adverse psychological and emotional effects leading to impaired quality of life (QoL). The present study investigated QoL and psychological distress in tinnitus patients and analysed the effects of associated comorbidities. Tonal and speech audiometry, tinnitus assessment, and clinical interviews were obtained from 122 Portuguese individuals (aged from 55 to 75). Portuguese versions of the Brief Symptoms Inventory (BSI), the Medical Outcomes Study Short Form Health Survey (MOS SF-36) and Tinnitus Handicap Inventory (THI) were used to evaluate psychological distress, health-related QoL, social difficulties and tinnitus severity. The presence of tinnitus was significantly associated with hearing loss. The increases in tinnitus severity were associated with decreases in QoL, particularly regarding MOS SF-36 subscales “perception of health”, “social functioning”, and “mental health”. Regarding BSI, patients with greater tinnitus severity had more severe psychopathology symptoms, measured with scales “Obsessive–compulsive”, “Depression”, “Anxiety”, “Hostility” and “Phobic Anxiety”. Our study supports the notion of the negative impact of increased tinnitus severity on QoL and psychological distress in older adults. Presented data strengthen the importance of a multidisciplinary approach to tinnitus assessment and treatment.