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.

Use of a Smartphone App for Cochlear Implant Patients With Tinnitus

Purpose Smartphone apps for tinnitus relief are now emerging; however, research supporting their use and effectiveness is lacking. Research has shown that Tinnitus Therapy sounds intended for individuals with acoustic hearing provide relief to some patients using cochlear implants (CIs) with tinnitus. Here, we evaluated the use and acceptability of a smartphone app to help CI patients with tinnitus. Method Participants completed a laboratory trial ( n = 19) and an at-home trial ( n = 14) using the ReSound Tinnitus Relief app to evaluate its acceptability and effectiveness in reducing their tinnitus. During the laboratory trial, participants selected a sound that was most acceptable in managing their tinnitus (termed chosen sound ). Word recognition scores in quiet were obtained before and after sound therapy. Participants were randomly assigned to one of two groups for the at-home trial, that is, AB or BA, using (A) the chosen sound for 2 weeks and (B) the study sound (i.e., broadband noise at hearing threshold) for another 2 weeks. Ratings were collected weekly to determine acceptability and effectiveness of the app in reducing tinnitus loudness and annoyance. Results Results indicated that some, but not all, participants found their chosen sound to be acceptable and/or effective in reducing their tinnitus. A majority of the participants rated the chosen sound or the study sound to be acceptable in reducing their tinnitus. Word recognition scores for most participants were not adversely affected using the chosen sound; however, a significant decrease was observed for three participants. All 14 participants had a positive experience with the app during the at-home trial on tests of sound therapy acceptability, effectiveness, and word recognition. Conclusions Sound therapy using a smartphone app can be effective for many tinnitus patients using CIs. Audiologists should recommend a sound and a level for tinnitus masking that do not interfere with speech perception.

What Tinnitus Therapy Outcome Measures Are Important for Patients?– A Discrete Choice Experiment

Introduction: The therapeutic rationale varies among tinnitus therapies. A recent study identified which outcome measures should be used for different types of interventions. What patients consider the most important outcome measure in tinnitus therapy is unclear.Objectives: To study the preference of the tinnitus patient for different outcome measures in tinnitus therapy.Methods: A discrete choice experiment was conducted. Participants were provided with two alternatives per choice set (nine choice sets total). Each choice-set consisted of four attributes (tinnitus loudness, tinnitus acceptance, quality of sleep and concentration). With a difference in one of three levels (increased, similar or decreased after treatment) between the alternatives. Results were analyzed with a mixed logit model. Preference heterogeneity was explored with covariates, correlating attributes and a latent class analysis.Results: One hundred and twenty-seven participants took part. In the mixed logit models we found that the choice for a tinnitus therapy was significantly affected by all levels of the outcomes, except for a similar level in concentration and tinnitus acceptance. Tinnitus loudness was considered the most important outcome measure relative to the other attributes. Preference heterogeneity was not explained by correlating attributes. The latent class analysis identified two classes. The first class was similar to the mixed logit analysis, except for a non-significance of similar quality of sleep and tinnitus acceptance. The second class showed a statistical significant preference only for increased tinnitus acceptance and similar quality of sleep.Conclusion: Based on this study, tinnitus patients consider loudness the most important outcome measure. However, there is a variance in preference as indicated by the latent class analysis. This study underlines the importance of research into tinnitus heterogeneity. Next, this study highlights the need for research into tinnitus therapies that focus on diminishing tinnitus loudness.

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.

Impact of anxiety associated with COVID-19 on tinnitus

BackgroundWe investigated how the anxiety associated with COVID-19 impacts the severity of tinnitus and the outcomes of tinnitus therapyMethods and FindingsA retrospective research design was used to compare the clinical characteristics of tinnitus between patients from March to April 2020 under pandemic pressure and those from the matching period in 2019. Tinnitus severity was evaluated using the Tinnitus Handicap Inventory (THI) questionnaire and the minimum masking level (MML) measure while anxiety was quantified using the Zung’s Self-rating Anxiety Scale (SAS). The assessments were repeated after a 2-month interval, in which sound therapy was applied to a subgroup of patients. In all, 94 and 70 cases were reported in the 2020 and 2019 groups, respectively. The effects of the pandemic on emotional status were evident from a higher incidence of anxiety and much higher SAS scores in the 2020 group. There was also an increase in the THI scores in the 2020 group, but the between-year difference was smaller than that of the SAS score. Moreover, there was no between-year difference in MML or the treatment effect, as measured via both THI and MML. Furthermore, the reduction in SAS score in the second assessment was significantly smaller in the 2020 group. However, a positive correlation between the initial SAS score and the improvement was seen within the 2020 group.ConclusionsAnxiety increased greatly in tinnitus subjects due to the COVID-19 pandemic. However this was not associated with an increase in tinnitus severity in 2020. Instead, there was no between-year difference in the THI score or MML or in the improvement of either measure after treatment. The smaller improvement in SAS score and the positive correlation with the initial SAS score in the 2020 group suggests that the SAS score change in this group might largely be due to the natural relief of pressure as the pandemic decelerated in China. Therefore, the anxiety change induced by the COVID-19 pandemic is not likely to have a strong impact on tinnitus.