Grant D. Searchfield

The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus.

Objectives: Chronic subjective tinnitus is a prevalent condition that causes significant distress to millions of Americans. Effective tinnitus treatments are urgently needed, but evaluating them is hampered by the lack of standardized measures that are validated for both intake assessment and evaluation of treatment outcomes. This work was designed to develop a new self-report questionnaire, the Tinnitus Functional Index (TFI), that would have documented validity both for scaling the severity and negative impact of tinnitus for use in intake assessment and for measuring treatment-related changes in tinnitus (responsiveness) and that would provide comprehensive coverage of multiple tinnitus severity domains. Design: To use preexisting knowledge concerning tinnitus-related problems, an Item Selection Panel (17 expert judges) surveyed the content (175 items) of nine widely used tinnitus questionnaires. From those items, the Panel identified 13 separate domains of tinnitus distress and selected 70 items most likely to be responsive to treatment effects. Eliminating redundant items while retaining good content validity and adding new items to achieve the recommended minimum of 3 to 4 items per domain yielded 43 items, which were then used for constructing TFI Prototype 1. Prototype 1 was tested at five clinics. The 326 participants included consecutive patients receiving tinnitus treatment who provided informed consent—constituting a convenience sample. Construct validity of Prototype 1 as an outcome measure was evaluated by measuring responsiveness of the overall scale and its individual items at 3 and 6 mo follow-up with 65 and 42 participants, respectively. Using a predetermined list of criteria, the 30 best-functioning items were selected for constructing TFI Prototype 2. Prototype 2 was tested at four clinics with 347 participants, including 155 and 86 who provided 3 and 6 mo follow-up data, respectively. Analyses were the same as for Prototype 1. Results were used to select the 25 best-functioning items for the final TFI. Results: Both prototypes and the final TFI displayed strong measurement properties, with few missing data, high validity for scaling of tinnitus severity, and good reliability. All TFI versions exhibited the same eight factors characterizing tinnitus severity and negative impact. Responsiveness, evaluated by computing effect sizes for responses at follow-up, was satisfactory in all TFI versions. In the final TFI, Cronbach’s alpha was 0.97 and test–retest reliability 0.78. Convergent validity (r = 0.86 with Tinnitus Handicap Inventory [THI]; r = 0.75 with Visual Analog Scale [VAS]) and discriminant validity (r = 0.56 with Beck Depression Inventory-Primary Care [BDI-PC]) were good. The final TFI was successful at detecting improvement from the initial clinic visit to 3 mo with moderate to large effect sizes and from initial to 6 mo with large effect sizes. Effect sizes for the TFI were generally larger than those obtained for the VAS and THI. After careful evaluation, a 13-point reduction was considered a preliminary criterion for meaningful reduction in TFI outcome scores. Conclusions: The TFI should be useful in both clinical and research settings because of its responsiveness to treatment-related change, validity for scaling the overall severity of tinnitus, and comprehensive coverage of multiple domains of tinnitus severity.

Methodological aspects of clinical trials in tinnitus: A proposal for an international standard

Chronic tinnitus is a common condition with a high burden of disease. While many different treatments are used in clinical practice, the evidence for the efficacy of these treatments is low and the variance of treatment response between individuals is high. This is most likely due to the great heterogeneity of tinnitus with respect to clinical features as well as underlying pathophysiological mechanisms. There is a clear need to find effective treatment options in tinnitus, however, clinical trials differ substantially with respect to methodological quality and design. Consequently, the conclusions that can be derived from these studies are limited and jeopardize comparison between studies. Here, we discuss our view of the most important aspects of trial design in clinical studies in tinnitus and make suggestions for an international methodological standard in tinnitus trials. We hope that the proposed methodological standard will stimulate scientific discussion and will help to improve the quality of trials in tinnitus.

Hearing aids as an adjunct to counseling: Tinnitus patients who choose amplification do better than those that don't

Abstract Hearing aids are commonly used for tinnitus management (16) but there is limited evidence to support their use. The purpose of this study was to quantify the effectiveness of hearing aids and counseling as a tinnitus treatment option. This study is a retrospective analysis of tinnitus handicap questionnaire (THQ, 17) results from 58 tinnitus patients with hearing loss who received counseling, and (1) chose to follow recommendations of hearing aid fitting, or (2) chose not to have hearing aids. The groups (N = 29 each) had similar audiometric configuration, tinnitus duration, and age. It was hypothesized that the use of hearing aids would provide greater reduction in THQ scores than counseling alone. THQ scores were reduced 12 months following counseling but improvement in THQ only reached statistical significance for the group that received hearing aids (p < 0.0001). The hearing aid group had reduced; psychosocial handicap (p < 0.0002); and tinnitus-hearing handicap (p < 0.0005). It is concluded that patients with hearing loss and tinnitus should trial amplification. Sumario Los auxiliares auditivos son usados comúnmente para el manejo del acúfeno (16) pero existe evidencia limitada para apoyar su uso. El propósito de este estudio fue cuantificar la efectividad de los auxiliares auditivos y de la consejería como una opción de tratamiento del acúfeno. Este estudio es un análisis retrospectivo del los resultados del cuestionario de desventaja por acúfeno (TQH, Luky col, 1990) de 58 pacientes con acúfeno y con hipoacusia, que recibieron orientación, y (1) escogieron seguir la recomendación de adaptación de un auxiliar auditivo, o (2) escogieron no utilizar auxiliares auditivos. Los grupos (N = 29 cada uno) tenían configuraciones audiométricas, duración del acúfeno y edades similares. Se estableció la hipótesis de que el uso de auxiliares auditivos proporcionaría una mayor reducción en los puntajes THQ que la orientación sola. Los puntajes THQ se redujeron 12 meses después de recibir consejería, pero la mejoría en THQ sólo alcanzó significancia estadística para el grupo que utilizó auxiliares auditivos (p < 0.0001). El grupo con auxiliares auditivos tuvo un impedimento psico-social reducido (p < 0.0002) y un impedimento acúfeno-audición reducido (p < 0.0005). Se concluye que los pacientes con hipoacusia y acúfeno deberían intentar la amplificación.

Transcranial Direct Current Stimulation Intensity and Duration Effects on Tinnitus Suppression

Background. Perception of sound in the absence of an external auditory source is called tinnitus, which may negatively affect quality of life. Anodal transcranial direct current stimulation (tDCS) of the left temporoparietal area (LTA) was explored for tinnitus relief. Objective. This pilot study examined tDCS dose (current intensity and duration) and response effects for tinnitus suppression. Methods. Twenty-five participants with chronic tinnitus and a mean age of 54 years took part. Anodal tDCS of LTA was carried out. Current intensity (1 mA and 2 mA) and duration (10 minutes, 15 minutes, and 20 minutes) were varied and their impact on tinnitus measured. Results. tDCS was well tolerated. Fifty-six percent of participants (14) experienced transient suppression of tinnitus, and 44% of participants (11) experienced long-term improvement of symptoms (overnight—less annoyance, more relaxed, and better sleep). There was an interaction between duration and intensity of the stimulus on the change in rated loudness of tinnitus, F(2, 48) = 4.355, P = .018, and clinical global improvement score, F(2, 48) = 3.193, P = .050, after stimulation. Conclusions. Current intensity of 2 mA for 20 minutes was the more effective stimulus parameter for anodal tDCS of LTA. tDCS can be a potential clinical tool for reduction of tinnitus, although longer term trials are needed.

Sound therapy for tinnitus management: Practicable options

BACKGROUND The authors reviewed practicable options of sound therapy for tinnitus, the evidence base for each option, and the implications of each option for the patient and for clinical practice. PURPOSE To provide a general guide to selecting sound therapy options in clinical practice. INTERVENTION Practicable sound therapy options. DATA COLLECTION AND ANALYSIS Where available, peer-reviewed empirical studies, conference proceedings, and review studies were examined. Material relevant to the purpose was summarized in a narrative. RESULTS The number of peer-reviewed publications pertaining to each sound therapy option reviewed varied significantly (from none to over 10). Overall there is currently insufficient evidence to support or refute the routine use of individual sound therapy options. It is likely, however, that sound therapy combined with education and counseling is generally helpful to patients. CONCLUSIONS Clinicians need to be guided by the patients point of care, patient motivation and expectations of sound therapy, and the acceptability of the intervention both in terms of the sound stimuli they are to use and whether they are willing to use sound extensively or intermittently. Clinicians should also clarify to patients the role sound therapy is expected to play in the management plan.

Intensity, Duration, and Location of High-Definition Transcranial Direct Current Stimulation for Tinnitus Relief.

Background and Objective. Tinnitus is the perception of a phantom sound. The aim of this study was to compare current intensity (center anode 1 mA and 2 mA), duration (10 minutes and 20 minutes), and location (left temporoparietal area [LTA] and dorsolateral prefrontal cortex [DLPFC]) using 4 × 1 high-definition transcranial direct current stimulation (HD-tDCS) for tinnitus reduction. Methods. Twenty-seven participants with chronic tinnitus (>2 years) and mean age of 53.5 years underwent 2 sessions of HD-tDCS of the LTA and DLPFC in a randomized order with a 1 week gap between site of stimulation. During each session, a combination of 4 different settings were used in increasing dose (1 mA, 10 minutes; 1 mA, 20 minutes; 2 mA, 10 minutes; and 2 mA, 20 minutes). The impact of different settings on tinnitus loudness and annoyance was documented. Results. Twenty-one participants (77.78%) reported a minimum of 1 point reduction on tinnitus loudness or annoyance scales. There were significant changes in loudness and annoyance for duration of stimulation, F(1, 26) = 10.08, P < .005, and current intensity, F(1, 26) = 14.24, P = .001. There was no interaction between the location, intensity, and duration of stimulation. Higher intensity (2 mA) and longer duration (20 minutes) of stimulation were more effective. Conclusions. A current intensity of 2 mA for 20-minute duration was the most effective setting used for tinnitus relief. The stimulation of the LTA and DLPFC were equally effective for suppressing tinnitus loudness and annoyance.

Randomized Trial of Transcranial Direct Current Stimulation and Hearing Aids for Tinnitus Management

Background. The perception of sound in the absence of an external sound is tinnitus. Tinnitus can have a severe negative impact on quality of life. Objective. This trial investigated whether multisession anodal transcranial direct current stimulation (tDCS) of the left temporoparietal area would enhance sound therapy from hearing aids. Methods. Forty participants (mean age = 54 years) experiencing chronic tinnitus (minimum 2 years) completed a 7-month long double-blind randomized clinical trial. Participants were randomized into 2 groups: control receiving sham tDCS and experimental receiving tDCS. Each group underwent multisession (5 consecutive sessions with 24-hour gap) anodal tDCS (2 mA intensity and 20 minutes duration) of the left temporoparietal area, followed by hearing aid use for 6 months. The impact of tDCS and hearing aid use on tinnitus was assessed using questionnaires (primary measure: Tinnitus Functional Index) and minimum masking level measurement. Results. There was a significant reduction in the overall Tinnitus Functional Index score with time, F(2, 37) = 11.9, P = .0001, for both the groups. Similar patterns were seen for secondary measures. tDCS appeared to have a positive effect on minimum masking levels but not questionnaire responses. Conclusions. After 3 months of hearing aid use, there were significant improvements in tinnitus, which were sustained at 6 months of use. The hearing aid effects appeared independent of tDCS. Further investigations of tDCS or other neuromodulators priming the auditory system for sound therapy based tinnitus treatments are warranted.

Tinnitus pitch, masking, and the effectiveness of hearing aids for tinnitus therapy

Abstract Objective: To assess the benefits of hearing aids on tinnitus according to the tinnitus reaction questionnaire (TRQ; 36), to verify whether the degree of masking provided by the hearing aid influenced the TRQ score, to examine whether the matched tinnitus pitch predicted the effectiveness of hearing aids in masking tinnitus, and to determine whether prescription of high-frequency amplification might be desirable in tinnitus management when tinnitus pitch is high. Design and study sample: A retrospective evaluation of the clinical outcomes of 70 tinnitus patients fitted with hearing aids was undertaken. The primary outcome measure was the TRQ, with a secondary subjective measure of tinnitus masking. Results: Participants who achieved masking with their hearing aids had greater reduction in TRQ scores. Masking was more likely to be achieved when participants had good low-frequency hearing and tinnitus pitch fell into the frequency range of the hearing aids. Conclusions: The results support the use of hearing aids for tinnitus management, and suggest that masking may be a significant contributor to hearing aid success, implying that high-frequency amplification may be effective in high-pitch tinnitus.

Occupational stress amongst audiologists: compassion satisfaction, compassion fatigue, and burnout.

Abstract Objective: This study aimed to investigate occupational stress amongst audiologists, along with quantification of their professional quality of life: Burnout, compassion fatigue, and compassion satisfaction. Design: A cross-sectional postal survey research design using an audiology occupational stress questionnaire (AOSQ), and the professional quality of life (ProQOL) instrument. Study sample: The sample consisted of members of the New Zealand Audiological Society. One hundred and forty-five questionnaires were mailed, 82 responses were received. Results: The main findings suggest that six stress factors dominate clinical audiology: (1) time demand, (2) audiological management, (3) patient contact, (4) clinical protocol, (5) patient accountability, and (6) administration or equipment. A significant relationship was found between increasing age of the audiologist and risk of acquiring burnout (chi-square (1) = 6.119, p < 0.05). Pearsons correlations revealed time demand was the strongest predictor of low compassion satisfaction (r = 0.327) and burnout (r = 0.463), while stress associated with patient contact was the strongest predictor of compassion fatigue (r = 0.352). Conclusions: This study identifies sources of stress for clinical audiologists and different factors that contribute to professional quality of life.

An adaptation level theory of tinnitus audibility.

Models of tinnitus suggest roles for auditory, attention, and emotional networks in tinnitus perception. A model of tinnitus audibility based on Helson’s (1964) adaptation level theory (ALT) is hypothesized to explain the relationship between tinnitus audibility, personality, memory, and attention. This theory attempts to describe how tinnitus audibility or detectability might change with experience and context. The basis of ALT and potential role of auditory scene analysis in tinnitus perception are discussed. The proposed psychoacoustic model lends itself to incorporation into existing neurophysiological models of tinnitus perception. It is hoped that the ALT hypothesis will allow for greater empirical investigation of factors influencing tinnitus perception, such as attention and tinnitus sound therapies.