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Purpose: Cognitive behavioral therapy (CBT) is a key intervention for management of misophonia, hyperacusis, and tinnitus. The aim of this study was to perform a preliminary analysis comparing the scores for self-report questionnaires before and after audiologist-delivered CBT via video calls for adults with misophonia, hyperacusis, or tinnitus or a combination of these. Method: This was a retrospective cross-sectional study. The data for 37 consecutive patients who received CBT for misophonia, hyperacusis, or tinnitus from a private institute in the United Kingdom were analyzed. Self-report questionnaires taken as part of routine care were as follows: 4C Questionnaires for tinnitus, hyperacusis, and misophonia (4C-T, 4C-H, and 4C-M, respectively), Tinnitus Impact Questionnaire (TIQ), Hyperacusis Impact Questionnaire (HIQ), Misophonia Impact Questionnaire (MIQ), Sound Sensitivity Symptoms Questionnaire (SSSQ), and Screening for Anxiety and Depression in Tinnitus (SAD-T). Responses were also obtained to other questionnaires related to tinnitus, hyperacusis, insomnia, and anxiety and mood disorders. A linear mixed-model method was used to assess the changes in response to the questionnaires pretreatment and posttreatment. Results: Pretreatment--posttreatment comparisons showed that scores for the 4C-T, 4C-H, 4C-M, TIQ, HIQ, MIQ, SSSQ, and SAD-T improved, with effect sizes of 1.4, 1.2, 1.3, 2.6, 0.9, 0.7, 0.9, and 1.4, respectively (all p < .05). Conclusions: This preliminary analysis suggests that CBT via video calls may be effective in reducing the impact of misophonia, hyperacusis, and tinnitus. However, this study did not have a control group, so its results need to be interpreted with caution. [ABSTRACT FROM AUTHOR]

A confirmatory factor analysis (CFA) of the Tinnitus Impact Questionnaire (TIQ) was performed. In contrast to commonly used tinnitus questionnaires, the TIQ is intended solely to assess the impact of tinnitus by not including items related to hearing loss or tinnitus loudness. This was a psychometric study based on a retrospective cross-sectional analysis of clinical data. Data were available for 155 new patients who had attended a tinnitus and hyperacusis clinic in the UK within a five-month period and had completed the TIQ. The mean age was 54 years (standard deviation = 14 years). The TIQ demonstrated good internal consistency, with Cronbach's α = 0.84 and McDonald's ω = 0.89. CFA showed that two items of the TIQ had low factor loadings for both one-factor and two-factor models and their scores showed low correlations with scores for other items. Bi-factor analysis gave a better fit, indicated by a relative chi-square (χ2) of 18.5, a Root-Mean Square Error of Approximation (RMSEA) of 0.103, a Comparative Fit Index (CFI) of 0.97, a Tucker Lewis Index (TLI) of 0.92, and a Standardized Root-Mean Residual (SPMR) of 0.038. Total TIQ scores were moderately correlated with scores for the Visual Analogue Scale of effect of tinnitus on life and the Screening for Anxiety and Depression-Tinnitus questionnaire, supporting the convergent validity of the TIQ. The TIQ score was not correlated with the pure-tone average hearing threshold, indicating discriminant validity. A multiple-causes multiple-indicator (MIMIC) model showed no influences of age, gender or hearing status on TIQ item scores. The TIQ is an internally consistent tool. CFA suggests a bi-factor model with sufficient unidimensionality to support the use of the overall TIQ score for assessing the impact of tinnitus. TIQ scores are distinct from the impact of hearing impairment among patients who have tinnitus combined with hearing loss. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the association between residential greenness and tinnitus and the potential interaction between greenness and genetic predisposition to tinnitus. The normalized difference vegetation index (NDVI) is used to measure residential greenness. The tinnitus is defined based on self‐reported. In the cross‐sectional analyses, logistic regression models are used for the baseline sample of the United Kingdom Biobank cohort. In the secondary analysis, a Cox proportional hazard model is used for a subsample of participants who completed the tinnitus questionnaire at follow‐up. In the cross‐sectional analysis including 106471 participants, higher residential greenness is associated with lower odds of tinnitus for each interquartile range increase in continuous NDVI, with an adjusted odds ratio of 0.97 (95% confidence interval: 0.95 to 0.99) for tinnitus. A similar association is observed in the longitudinal analysis, with an adjusted hazard ratio of 0.92 (95% confidence interval: 0.86 to 0.98) for the association of NDVI increased per interquartile range with incident tinnitus. Moreover, there is a significant interaction between greenness and genetic predisposition to tinnitus (P < 0.05). This study suggested that residential greenness is negatively associated with tinnitus. Greenness and genetic predisposition to tinnitus are found to have a significant interaction. [ABSTRACT FROM AUTHOR]

The potential influence of tinnitus on cardiovascular disease (CVD) and all-cause mortality has yet to be explored. We aim to examine the correlations between tinnitus and the risk of cardiovascular events and all-cause mortality. We conducted a prospective cohort study utilising data from the UK Biobank. The presence of tinnitus was evaluated through a questionnaire. The primary outcome was defined as a composition of cardiovascular events, including myocardial infarction (MI), stroke, and mortality from CVD, as well as all-cause mortality. Cox proportional hazard models were employed to examine the associations between tinnitus and both the primary outcome and its individual components. Sensitivity analyses were conducted to evaluate the robustness of the primary analysis. A total of 140,146 participants were included in the study. The presence of tinnitus was found to be associated with a higher incident rate of the primary outcome (HR = 1.057, 95%CI: 1.017–1.099, p = 0.005), MI (HR = 1.139, 95%CI: 1.061–1.222, p < 0.001) and all-cause mortality (HR = 1.053, 95%CI: 1.003–1.105, p = 0.038) after adjusting for confounders. However, there was no significant association between tinnitus and stroke or mortality from CVD. Subgroup analysis revealed that the association between tinnitus and the primary outcome was significant in females, participants with abnormal BMI, and those without hearing difficulty, depression or anxiety. Sensitivity analyses yielded consistent results. The findings from this study contribute to the existing body of evidence suggesting an association between tinnitus and an increased risk of cardiovascular events and all-cause mortality. [ABSTRACT FROM AUTHOR]

Background: The link between anxiety and tinnitus severity has garnered significant scholarly interest, with numerous studies identifying a positive correlation. Despite this, the genetic basis of this relationship remains underexplored. Leveraging publicly accessible GWAS data, this study employs Mendelian randomization to elucidate the genetic causality between anxiety and tinnitus severity. Methods: This research analyzed single nucleotide polymorphisms (SNPs) related to anxiety and tinnitus severity from the UK Biobank, utilizing aggregated data from genome-wide association studies (GWAS). Instrumental variables linked to anxiety were meticulously selected. The study implemented several Mendelian randomization techniques, including "mr_ivw," "mr_egger_regression," "mr_weighted_median," "mr_simple_mode," and "mr_weighted_mode," to assess the causal impact of anxiety on tinnitus risk through odds ratios (ORs). Sensitivity analyses, including MR-Egger and the leave-one-out method, were conducted to ensure result stability. The F-value was also calculated to ascertain the strength of the instrumental variables. Results: Analysis identified five SNPs as instrumental variables. The calculated ORs and 95% confidence intervals from MR-Egger regression, weighted median, and inverse variance weighting showed no statistically significant causal relationship between anxiety and severe tinnitus, with all P-values exceeding 0.05. This lack of statistical significance, consistent across various methods, indicates no genetic causality between anxiety and tinnitus severity. Furthermore, no evidence of heterogeneity (P = 0.80) or horizontal pleiotropy (P = 0.31) was found, reinforcing the robustness of the instrumental variables (F > 10). Conclusion: Our Mendelian randomization analysis reveals no genetic causality between anxiety and tinnitus severity, suggesting the need for further research into the multifaceted etiology of tinnitus. Highlights: Investigating Genetic Causality: This study delves into the genetic basis of the relationship between anxiety and tinnitus severity, aiming to establish a theoretical foundation for clinical practices. Findings from Mendelian Randomization: Our Mendelian randomization analysis reveals the absence of a genetic causal link between anxiety and tinnitus severity, challenging previous assumptions within the field. Call for Further Research: Despite the high clinical prevalence of tinnitus, its etiology remains elusive. This underscores the need for more comprehensive research to unravel its complex causes and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: Consistent symptom reporting for conditions like tinnitus that do not have an associated sign is critical for evaluating severity and intervention effectiveness, and for interpreting research findings. There is little research examining reporting of tinnitus and hearing difficulty over time. We address this here by comparing reported hearing difficulty and tinnitus at two time-points. Design: A cross-sectional study comparing symptom reporting in March 2019 and August/September 2021 using data from two online surveys of the same cohort. Although each survey was designed to address a different question, both asked about symptoms of tinnitus and hearing difficulties and enabled this exploratory analysis. Study sample: 6881 members of the UK general public aged 18+ years. Results: Inconsistent reporting was evident - many participants who reported experiencing tinnitus and/or hearing difficulties in 2019, said in 2021 that they had never had such symptoms before. Additionally, reports of new tinnitus/hearing difficulties in 2021 were unexpectedly high, equating to 18-month incidence rates of 13.6% and 11.7%, respectively. Conclusions: Psychosocial factors, expectations and context impact symptom reporting. This should be considered when treating patients and interpreting research findings. Using real-time data collection methods could thus provide a better understanding of experiences of tinnitus and hearing. [ABSTRACT FROM AUTHOR]

Objective: Although insomnia often compounds tinnitus, sleeping problems in people experiencing tinnitus are rarely treated. This study investigates the experiences of participants receiving Cognitive Behavioural Therapy for insomnia (CBTi) as part of a randomised controlled trial for managing tinnitus-related insomnia. The aim of this study is to gain detailed insight into participants' perceptions and experiences of this treatment. Design: Semi-structured interviews were conducted via phone or in-person by one of the two clinical psychologists who facilitated the CBTi sessions. Reflexive thematic analysis with semantic inductive approach was used for analysis to keep the research question theoretically flexible. Study samples: Eight participants (three females, age range 32–69 years) were interviewed six months after CBTi completion. Results: Three superordinate themes were identified: "Common humanity and transcending individual distress," "Changing the things I can" and "Accepting the things I cannot change." The group environment helped participants to normalise their experiences. Reliable tinnitus/sleep information and robust behavioural change techniques helped participants to respond and relate to their condition differently. Conclusion: Generally, participants reported long-term benefits from CBTi to treat tinnitus-related insomnia, particularly increased confidence, and getting on with life. CBTi is multi-component, so clinicians need to respond to individual preferences and lifestyles. [ABSTRACT FROM AUTHOR]

Tinnitus is a common health condition, affecting approximately 15% of the UK population. The tinnitus treatment with the strongest evidence base is Cognitive Behavioural Therapy (CBT), with standard tinnitus therapy typically augmented with education, relaxation and other techniques. Availability of CBT and conventional tinnitus therapy more broadly is limited for tinnitus sufferers. The DEFINE trial aims to assess whether smartphone-delivered tinnitus therapy, the Oto app, is as effective as current standard care, one-to-one therapist-delivered tinnitus treatment for the treatment of tinnitus in adults. The trial is registered in the ISRCTN Registry: ISRCTN99577932. DEFINE is an open-label, non-inferiority, prospective, parallel design, randomised-controlled trial. Recruitment, interventions and assessments will be remote, enabling UK-wide participant involvement. 198 participants aged 18 years or more will be recruited via social media advertisement or via primary care physicians. A screening process will identify those with tinnitus that impacts health-related quality of life, and following consent smartphone-based audiometry will be performed. Randomisation 1:1 to the Oto app or one-to-one therapist-led tinnitus therapy will be performed centrally by computer, matching groups for age, sex and hearing level. Following participant allocation, the Oto app will be provided for immediate use, or a one-to-one remote therapy appointment booked to occur within approximately 1 week, with up to 6 sessions delivered. Participant outcomes will be collected at 4,12, 26 and 52 weeks via questionnaire and phone call. The primary outcome is the change in Tinnitus Functional Index (TFI) total score measured at 26 weeks following allocation. Adverse events will be recorded. A health economic evaluation in the form of a cost-utility analysis will be performed using data from participant submitted EuroQol 5D-5L and Health Utilities Index Mark 3 scores and resource use data. Trial results will be made publicly available, including a plain English summary. [ABSTRACT FROM AUTHOR]

To assess the psychometric properties of a new questionnaire evaluating patients' confidence in managing their tinnitus, the 4C tinnitus management questionnaire (4C), which was designed to be used in the process of cognitive behavioural therapy. Retrospective cross-sectional based on patient records. 99 consecutive patients who sought help for tinnitus (with or without hyperacusis) from an audiology clinic in the UK. Pure tone average (PTA) hearing thresholds, Uncomfortable Loudness Levels (ULLs), and responses to the 4C questionnaire, Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire (HQ), and Screening for Anxiety and Depression in Tinnitus (SAD-T) questionnaire were gathered from the records of patients held at the audiology department. Cronbach's alpha for the 4C was 0.91, indicating high internal consistency. Exploratory factor analysis suggested a one-factor solution. Discriminant validity was supported by weak correlations between 4C scores and PTA across ears and ULLmin (the across-frequency average ULL for the ear with lower average ULL). Convergent validity was supported by moderate correlations between 4C scores and scores for the THI, HQ, and SAD-T. The 4C is an internally consistent questionnaire with high convergent and discriminant validity, which can be used to assess patients' confidence in managing their tinnitus. [ABSTRACT FROM AUTHOR]

To evaluate the psychometric properties of the Tinnitus Impact Questionnaire (TIQ), whose questions focus on assessing the impact of tinnitus on the patient's day to day activities, mood, and sleep, and not on hearing difficulties. This was a retrospective cross-sectional study. Data were included for 172 adult patients who attended a tinnitus and hyperacusis clinic in the UK within a six-month period and who had completed the TIQ. Two items whose scores were very highly correlated with those for other items were removed, leaving seven items. Exploratory factor analysis suggested a single factor for the TIQ. A multiple causes multiple indicator model showed significant but very small direct effects of age on TIQ scores for two items, after adjustment for gender. The TIQ had excellent internal consistency, with Cronbach's alpha = 0.89. The total TIQ score was moderately to strongly correlated with scores for the Tinnitus Handicap Inventory, Screening for Anxiety and Depression-Tinnitus questionnaire, Hyperacusis Questionnaire, and Hyperacusis Impact Questionnaire, indicating convergent validity. The TIQ score was weakly correlated with the pure-tone average hearing threshold, indicating discriminant validity. The TIQ is a brief, valid and internally consistent questionnaire for assessing the impact of tinnitus. [ABSTRACT FROM AUTHOR]

Hearing conditions such as hearing loss, tinnitus and hyperacusis are highly prevalent in the population and can severely impact communication and quality of life. Hearing is affected by multiple factors, including heredity, noise exposure, age, sex, ear disorders and lifestyle factors. Globally, hearing loss affects over 80% of adults aged 80 years and older, is often experienced in combination with other long-term health conditions and is a mid-life risk factor for dementia. To form a themed collection , we searched Age and Ageing for articles on hearing conditions published from 2000 onwards. This resulted in 22 articles included within the collection. They examined a range of important topics related to hearing healthcare and research, including noise-induced hearing loss, health service quality and safety, psychological and psychosocial consequences of hearing loss and co-morbidities of hearing loss. All articles reported on hearing loss; there were no published articles with a primary focus on other hearing conditions such as tinnitus or hyperacusis, on the health of older people from the Deaf community or on users of Cochlear implants, suggesting key gaps in knowledge and targets for future research. This New Horizons article highlights novel directions in research and practice and takes a forward look at how research into hearing conditions may develop in years to come. It highlights opportunities for the growth of patient-centred research and hearing healthcare supported by the better integration of health and care services as well as cross-speciality working to include common co-morbid health conditions. [ABSTRACT FROM AUTHOR]

Introduction: Tinnitus is a complex experience that often occurs alongside other health conditions, including hearing loss. In the UK, as in other western countries, patterns of health are changing with a rise in multi-morbidity and complexity of health conditions. As we age, we can expect to live with multiple health conditions. Burden of illness has long been recognised. Less well recognised is the burden that accumulates from the treatment of health conditions. Methods: This qualitative thematic analysis of patient accounts described the cumulative burdens of tinnitus, both the experience of hearing the tinnitus and from the treatments undertaken. Between 2017-8 we conducted interviews with 38 participants who were help-seekers in a range of contrasting UK clinical services (Physician led, Audiology led and Hearing Therapy led). We examined these interview data using reflexive thematic analysis methods to identify and explore the cumulative burdens for those who live with and seek help for their tinnitus. Specifically, we used six phased approach to determine and group themes. Results: The themes provide a coherent description of the nature of the burden that people with tinnitus experience. Discussion: In tinnitus, as with most chronic health conditions, the largest treatment workload is devolved to the patient. Patients are required to implement treatments, learn about tinnitus and find new ways of coping. Yet this work happens invisibly, without recognition from clinicians who measure outcomes but not the efforts made to achieve outcomes. Patient-centred care depends upon the recognition of the cumulative burdens that patients experience. [ABSTRACT FROM AUTHOR]

Tinnitus, a phantom perception of sound in the absence of any external sound source, is a prevalent health condition often accompanied by psychiatric comorbidities. Recent genome-wide association studies (GWAS) highlighted a polygenic nature of tinnitus susceptibility. A shared genetic component between tinnitus and psychiatric conditions remains elusive. Here we present a GWAS using the UK Biobank to investigate the genetic processes linked to tinnitus and tinnitus-related distress, followed by gene-set enrichment analyses. The UK Biobank sample comprised 132,438 individuals with tinnitus and genotype data. Among the study sample, 38,525 individuals reported tinnitus, and 26,889 participants mentioned they experienced tinnitus-related distress in daily living. The genome-wide association analyses were conducted on tinnitus and tinnitus-related distress. We conducted enrichment analyses using FUMA to further understand the genetic processes linked to tinnitus and tinnitus-related distress. A genome-wide significant locus (lead SNP: rs71595470) for tinnitus was obtained in the vicinity of GPM6A. Nineteen independent loci reached suggestive association with tinnitus. Fifteen independent loci reached suggestive association with tinnitus-related distress. The enrichment analysis revealed a shared genetic component between tinnitus and psychiatric traits, such as bipolar disorder, feeling worried, cognitive ability, fast beta electroencephalogram, and sensation seeking. Metabolic, cardiovascular, hematological, and pharmacological gene sets revealed a significant association with tinnitus. Anxiety and stress-related gene sets revealed a significant association with tinnitus-related distress. The GWAS signals for tinnitus were enriched in the hippocampus and cortex, and for tinnitus-related distress were enriched in the brain and spinal cord. This study provides novel insights into genetic processes associated with tinnitus and tinnitus-related distress and demonstrates a shared genetic component underlying tinnitus and psychiatric conditions. Further collaborative attempts are necessary to identify genetic components underlying the phenotypic heterogeneity in tinnitus and provide biological insight into the etiology. [ABSTRACT FROM AUTHOR]

Background: Education and advice is provided for tinnitus management in all UK audiology clinics. Sound therapy, including provision of hearing aids may be offered, but this is often dependent on a clinician's decision rather than UK policy. This inconsistent management reflects a lack of evidence around the effectiveness of hearing aids for tinnitus. This open-label, two-arm multicentre randomised controlled feasibility trial gathered data around recruitment, acceptability and outcome assessments to determine the feasibility of conducting a large randomised controlled trial investigating the effectiveness of hearing aids for tinnitus management. Methods: Adults referred to audiology for tinnitus, with an aidable hearing loss were recruited at five UK audiology clinics. They were randomised 1:1 to either education and advice (treatment as usual (TAU), n = 41) or TAU plus hearing aids (n = 42). Outcomes were collected by questionnaires 12 weeks after randomisation. After participation, interviews were conducted with a subset of both participants and clinicians from each trial centre. Results: Eighty three participants from five sites were randomised. Non-aidable hearing loss was the main reason for ineligibility to participate in the trial reported by the sites. Seventy three percent of participants returned the 12-week questionnaires, with return rates by site ranging from 61 to 100%. Fifteen out of 33 participants (45%) reported using hearing aids for the clinician-recommended time, or longer, during the day. The Tinnitus Functional Index (TFI) was the outcome measure most responsive to change. The majority of participants also agreed it was relevant to their tinnitus and hearing loss. Qualitative data demonstrated that the trial was acceptable to participants. Feedback from clinicians revealed a potential lack of equipoise. It also highlighted the differences in referral and treatment pathways between departments and differences in audiometric criteria for fitting hearing aids. Health economic measures were well completed for those returned. No change in health-related quality of life was observed. Costs were higher in the intervention arm, but self-reports of healthcare service use indicated participant confusion in treatment pathways. Conclusions: This feasibility trial is the first step towards obtaining high quality evidence to determine potential clinical effectiveness and cost effectiveness of hearing aids for tinnitus versus usual care. A definitive trial was deemed to be feasible, with some modifications based on feasibility findings and using the TFI as the primary outcome. This trial was funded by the National Institute for Health Research, Research for Patient Benefit Programme (PB-PG-0816–20,014) and registered with ISRCTN (ISRCTN14218416). [ABSTRACT FROM AUTHOR]

Objectives: Internet-delivered psychological treatments were developed more than 20 years ago, and tinnitus was among the first target conditions. The aim of this review article is to describe the history of Internet treatments for tinnitus and to comment on the evidence base. Challenges for future research and implementations will be mentioned. Method: A narrative historical review was conducted. Findings: There are now several studies including controlled trials on Internet interventions based on cognitive behavior therapy (ICBT) for tinnitus. Effects in controlled trials are moderate to large with regard to tinnitus annoyance. While the treatment format now exists in four languages, there is a large treatment versus demand gap as very few clients with tinnitus receive ICBT. There is a lack of research on related conditions with the exception of hearing loss. However, there is substantial support for Internet interventions for comorbid conditions such as insomnia and depression but not specifically in association with tinnitus. Conclusions: ICBT is a promising treatment approach for tinnitus and will hopefully increase access to evidence-based treatment to reduce tinnitus distress. More research is needed for related conditions such as hyperacusis and larger trials on tinnitus. [ABSTRACT FROM AUTHOR]

Aim: Aging is related to deterioration of bodily and neural functions, leading to various disorders and symptoms, including the development of dementia, hearing loss, or tinnitus. Understanding how these phenomena are intertwined and how aging affects those is crucial for prevention and the future development of interventions., Methods: We utilized the UK Biobank which includes a total of 502,382 participants between 40 and 70 years old. We used logistic regression models and cox proportional hazard models and compared hazard ratios., Results: The odds of reporting tinnitus in the older age group (i.e., older than 58 years) were increased by 53.6 % and a one decibel increase in the speech-reception thresholds enhanced the odds for tinnitus by 13.0 %. For our second analysis regarding hearing loss, the risk of dementia increased by 14.0 % with an increase by one decibel in the speech-reception threshold score. In terms of aging, each additional year increased the risk by 17.3 %. Tinnitus alone showed a significant influence with a hazard ratio of 52.1 %, however, when adding hearing loss, age and various covariates, the effect vanished., Conclusion: Findings confirm that tinnitus is indeed related to aging, but presumably independent of the aging processes accompanying the development of dementia. This highlights the urge to further investigate the impact of aging on neural processes that are relevant for alterations in the auditory systems (e.g., leading to the development of tinnitus or hearing loss) as well as for increased vulnerability in terms of neurodegenerative diseases., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

The Tinnitus Functional Index (TFI) was developed to be responsive to small treatment-related changes in the impact of tinnitus. Yet, no studies have integrated anchor-based and distribution-based techniques to produce a single Minimal Important Change (MIC) score. Here, we evaluated the responsiveness and interpretability of the TFI, determining for the first time a robust MIC score in a UK clinical population. Two-hundred and fifty-five patients with tinnitus participated in this prospective longitudinal validation study. Distribution-based estimates (Standard Error of Measurement, Smallest Detectable Change and Effect size) and anchor-based estimates of important change (minimal clinically important difference and Receiver Operator Curve optimal value) were calculated and then integrated using a visual anchor-based MIC distribution plot. A reduction in score of −14 was determined as the MIC estimate that exceeds the measurement error, most of the variability and reliably identifies patients demonstrating true improvement. It is therefore recommended that a reduction of 14 points should be used as a minimum change required when calculating statistical power and sample size in tinnitus intervention studies and assessing patients in clinical practice. [ABSTRACT FROM AUTHOR]

Background Hyperacusis can be defined as an intolerance of certain everyday sounds, which are perceived as too loud or uncomfortable and which cause significant distress and impairment in the individual's day-to-day activities. It is important to assess symptoms of sound intolerance and their impact on the patient's life, so as to evaluate the need for treatment and to assess the effectiveness of treatments. Purpose The aim was to evaluate the psychometric properties of the Hyperacusis Impact Questionnaire (HIQ), and the Sound Sensitivity Symptoms Questionnaire (SSSQ). The 8-item HIQ focuses on assessing the impact of hyperacusis on the patient, while the 5-item SSSQ is designed to assess the type and severity of sound intolerance symptoms. Research Design This was a retrospective cross-sectional study. Study Sample In total, 266 consecutive patients who attended a Tinnitus and Hyperacusis Therapy Clinic in the United Kingdom within a 6-month period. Fifty-five percent were female. The average age was 54 years (standard deviation = 16 years). Data Collection and Analysis Data were collected retrospectively from the records of patients held at the audiology department. Audiological measures were pure-tone audiometry and Uncomfortable Loudness Levels (ULLs). Questionnaires administered in addition to the HIQ and SSSQ were: Tinnitus Handicap Inventory, Hyperacusis Questionnaire (HQ), and Screening for Anxiety and Depression in Tinnitus. Results Exploratory factor analysis suggested one-factor solutions for both the HIQ and SSSQ. Multiple-causes multiple-indicators (MIMIC) models showed some small influences of gender but negligible effects of age for both the HIQ and SSSQ. Receiver Operating Characteristic (ROC) analysis showed no significant effects of covariates on the ROC curves. Cronbach's α was 0.93 for the HIQ, and 0.87 for the SSSQ, indicating high internal consistency. Convergent validity was supported by moderate correlations between HQ and HIQ scores and between SSSQ scores and ULLs. Conclusion The HIQ and SSSQ are internally consistent questionnaires that can be used in clinical and research settings. [ABSTRACT FROM AUTHOR]

This study surveyed the effects of the COVID-19 pandemic on the audiology workplace. The study used a cross-sectional survey design for audiologists across the globe (n = 337) using an online survey (June–August 2020) focussing on changes to the workplace during the pandemic. Participants represented varied work settings and audiology services. Only a third (31.5%) provided psychosocial support, which may be important during the pandemic, as part of their services. Almost all (97%) audiologists reported changes to their workplace, with 76.4% reporting reduced caseloads during the COVID-19 pandemic. When rating their current and anticipated work conditions, 38.7% reported reduced working hours although only 13.8% anticipated reduced working hours in 6-months' time. Audiologists ranked services such as access to hearing assessment, hearing device adjustment and maintenance, and general audiological support as being more important during the pandemic than services such as psychosocial, emotional and tinnitus support. The COVID-19 pandemic has resulted in significant disruptions to audiological practice that highlights the need to adapt and incorporate new audiological practices including telehealth, to ensure patients have continued access to care and clinics remain sustainable during the ongoing COVID-19 pandemic and recovery phase. [ABSTRACT FROM AUTHOR]

Tinnitus is often triggered by cochlear damage and has been linked with aberrant patterns of neuronal activity. Acoustic Coordinated Reset (CR®) Neuromodulation is a sound therapy hypothesised to reduce tinnitus symptoms by desynchronising pathological brain activity using a portable acoustic device (the T30 neurostimulator). We report results of a pivotal trial to test the efficacy of this intervention. This two-centre, double-blind randomised controlled trial with long-term open-label extension, was undertaken between February 2012 and February 2014 in the UK. Participants were 100 adults with tinnitus as a primary complaint, recruited through hearing clinics and media advertisements. Intervention was the device programmed either with the proprietary sound sequence or placebo algorithm, fit by one of five trained audiologists. Minimisation software provided group allocation (1:1 randomisation), with groups matched for age, gender, hearing loss and tinnitus severity. Allocation was masked from participants and assessors during the trial. The primary measure of efficacy was change in tinnitus symptom severity between groups, measured using the Tinnitus Handicap Questionnaire at 12 weeks. Secondary outcomes were other measures of tinnitus symptom severity, health-related quality of life, and perceptual characteristics (pitch, loudness, bandwidth) at 12 weeks, and Tinnitus Handicap Questionnaire at 36 weeks (open-label extension). A statistician blinded to the allocation conducted an intention-to-treat analysis that employed linear regressions on minimisation variables, trial centre and intervention group, with multiple imputations for missing data. The study was registered on clinicaltrials.gov (NCT01541969). We screened 391 individuals and assigned interventions to 100 eligible participants. The primary outcome was not statistically significant between groups (mean group = −0.45, 95% CI −5.25 to 4.35; p = 0.85), nor were any of the secondary outcomes. Four adverse events occurred during the trial. Analysis of tinnitus symptom severity data collected across the 24-week open-label extension showed no statistically significant within-group changes after 12, 24, or 36 weeks treatment with the proprietary sound sequence. While individual participants may benefit from sound therapy, Acoustic CR® Neuromodulation did not lead to group-mean reductions on tinnitus symptom severity or other measures compared to placebo, or over time. [ABSTRACT FROM AUTHOR]

Purpose: Auditory problems, such as hearing loss and tinnitus, have been associated with mental health problems and alcohol misuse in the UK general population and in the US Armed Forces; however, few studies have examined these associations within the UK Armed Forces. The present study examined the association between auditory problems and probable common mental disorders, post-traumatic stress disorder and alcohol misuse. Methods: 5474 serving and ex-service personnel from the UK Armed Forces were examined, selected from those who responded to phase two (data collection 2007–09) and phase three (2014–16) of a military cohort study. Multivariable logistic regression was used to examine the association between auditory problems at phase two and mental health problems at phase three. Results: 9.7% of participants reported ever experiencing hearing problems alone, 7.9% reported tinnitus within the last month alone, and 7.8% reported hearing problems with tinnitus. After adjustment, hearing problems with tinnitus at phase two was associated with increased odds of probable common mental disorders (AOR = 1.50, 95% CI 1.09–2.08), post-traumatic stress disorder (AOR = 2.30, 95% CI 1.41–3.76), and alcohol misuse (AOR = 1.94, 95% CI 1.28–2.96) at phase three. Tinnitus alone was associated with probable post-traumatic stress disorder (AOR = 1.80, 95% CI 1.03–3.15); however, hearing problems alone were not associated with any outcomes of interest. Conclusions: The association between auditory problems and mental health problems emphasises the importance of the prevention of auditory problems in the Armed Forces: through enhanced audiometric screening, improved hearing protection equipment, and greater levels of utilisation of such equipment. [ABSTRACT FROM AUTHOR]

Background and Purpose The aim of this study was to assess whether the severity of tinnitus, as measured using ratings of tinnitus loudness, annoyance, and effect on life, was influenced by the lockdown related to the coronavirus disease 2019 (COVID-19) pandemic. Research Design This was a retrospective study. Study Sample The data for 105 consecutive patients who were seen at a tinnitus clinic in an audiology department in the United Kingdom during the COVID-19 lockdown between April and June 2020 and 123 patients seen in the same period of the previous year, prior to the COVID-19 pandemic were included. Data Collection Demographic data for the patients, results of their pure-tone audiometry, and their score on visual analog scale (VAS) of tinnitus loudness, annoyance, and effect on life were imported from their records held at the audiology department. This was a retrospective survey comparing ratings on the VAS of tinnitus loudness, annoyance, and effect on life for consecutive patients seen during the COVID-19 lockdown and consecutive patients seen in the same period of the previous year, prior to the COVID-19 pandemic. Patients seen prior to lockdown used a pen and paper version of the VAS, while the patients who were assessed during the COVID-19 lockdown used an adapted version of the VAS, via telephone. All patients were seeking help for their tinnitus for the first time. Results The mean scores for tinnitus loudness, annoyance, and effect on life did not differ significantly for the groups seen prior to and during lockdown. Conclusion Any changes in psychological well-being or stress produced by the lockdown did not significantly affect ratings of the severity of tinnitus. [ABSTRACT FROM AUTHOR]

Tinnitus, the phantom perception of noise originating from the inner ear, has been reported by 15% of the world's population, with many patients reporting major deficits to cognition and mood. However, both objective diagnostic tools and targeted therapeutic strategies have yet to be established. To better understand the underlying genes that may preclude tinnitus, we performed a genome-wide association study of the UK Biobank's 49,960 whole exome sequencing participants to identify any loci strongly associated with tinnitus. We identified 17 suggestive single nucleotide polymorphisms (p < 1e−5) spanning 13 genes in two sex-separated cohorts reporting chronic, bothersome tinnitus (control males n = 7,315, tinnitus males n = 226, control females n = 11,732, tinnitus females n = 300). We also found a significant missense mutation in WDPCP (p = 3.959e−10) in the female cohort, a mutation which has been previously implicated in typical neuronal functioning through axonal migration and structural reinforcement, as well as in Bardet-Biedl syndrome-15, a ciliopathy. Additionally, in situ hybridization in the embryonic and P56 mouse brain demonstrated that the majority of these genes are expressed within the dorsal cochlear nucleus, the region of the brain theorized to initially induce tinnitus. Further RT-qPCR and RNAScope data also reveals this expression pattern. The results of this study indicate that predisposition to tinnitus may span across multiple genomic loci and be established by weakened neuronal circuitry and maladaptive cytoskeletal modifications within the dorsal cochlear nucleus. [ABSTRACT FROM AUTHOR]

Objective: The Audiology Department at the Royal Surrey County Hospital usually offers face-to-face audiologist-delivered cognitive behavioural therapy (CBT) for tinnitus rehabilitation. During COVID-19 lockdown, patients were offered telehealth CBT via video using a web-based platform. This study evaluated the proportion of patients who took up the offer of telehealth sessions and factors related to this. Design: Retrospective service evaluation. Study sample: 113 consecutive patients whose care was interrupted by the lockdown. Results: 80% of patients accepted telehealth. The main reasons for declining were not having access to a suitable device and the belief that telehealth appointments would not be useful. Compared to having no hearing loss in the better ear, having a mild or moderate hearing loss increased the chance of declining telehealth by factors of 3.5 (p=0.04) and 14.9 (p=0.038), respectively. High tinnitus annoyance as measured via the visual analogue scale increased the chance of declining telehealth appointments by a factor of 1.4 (p=0.019). Conclusions: Although CBT via telehealth was acceptable to most patients, alternatives may be necessary for the 20% who declined. These tended to have worse hearing in their better ear and more annoying tinnitus. [ABSTRACT FROM AUTHOR]

To document changes in audiology practice resulting from COVID-19 restrictions and to assess audiologists' opinions about teleaudiology. A survey consisting of closed-set and open-ended questions that assessed working practices during the COVID-19 restrictions and audiologists' attitudes towards teleaudiology. About 120 audiologists in the UK recruited via snowball sampling through social media and emails. About 30% of respondents said they had used teleaudiology prior to COVID-19 restrictions; 98% had done at the time of survey completion, and 86% said they would continue to do so even when restrictions are lifted. Reasons for prior non-use of teleaudiology were associated with clinical limitations/needs, available infrastructure and patient preferences. Respondents believe teleaudiology will improve travel, convenience, flexibility and scheduling, that it will have little/no impact on satisfaction and quality of care, but that it will negatively impact personal interactions. Concerns about teleaudiology focussed on communication, inability to conduct some clinical procedures and technology. Respondents' experience with teleaudiology has generally been positive however improvements to infrastructure and training are necessary, and because many procedures must be conducted in-person, it will always be necessary to have hybrid-care pathways available. [ABSTRACT FROM AUTHOR]

Background and Purpose The aim of this study was to assess the incidence of the perception of tinnitus in dreams among patients seeking help for tinnitus and/or hyperacusis and to assess whether this is related to the severity of tinnitus and/or hyperacusis. Research Design This was a retrospective study. Study Sample The data for 148 consecutive adult patients who attended a tinnitus/ hyperacusis clinic in the United Kingdom were included. The average age of the patients was 56 years (standard deviation [SD] = 15 years). Data Collection Data were collected retrospectively from their records held at the audiology department. Audiological measures were pure-tone audiometry and uncomfortable loudness levels. Questionnaires administered were: Tinnitus Handicap Inventory (THI), Hyperacusis Questionnaire, Insomnia Severity Index, Visual Analogue Scale (VAS) of tinnitus loudness, annoyance, and effect on life, Generalized Anxiety Disorder, and Patient Health Questionnaire. Patients were also asked "If you dream have you ever perceived tinnitus in your dreams?" Results Five percent of patients (7/148) reported hearing tinnitus in their dreams. There was a nonsignificant trend for patients who reported hearing tinnitus in their dreams to be younger (mean age = 46 years, SD = 15 years) than those who did not (mean age = 57 years, SD = 15 years). The mean scores for the THI and VAS for effect of tinnitus on life were significantly higher (worse) for patients who reported hearing tinnitus in their dreams than for those who did not. Conclusion A small proportion of patients reported hearing tinnitus in their dreams and this was associated with higher tinnitus handicap as measured via the THI and more effect of tinnitus on life as measured via the VAS. These preliminary results may indicate that those who are greatly affected by their tinnitus are more likely to hear it in their dreams or to be woken by it. Future studies should use methods that can be used to reliably assess if and when tinnitus is perceived during the sleep cycle, using more physiological measures and testing a wider population. [ABSTRACT FROM AUTHOR]

Background and purpose: Visual snow syndrome is a recently described condition of unknown prevalence. We investigated the prevalence in a representative population sample from the UK and tested the hypothesis that visual snow syndrome is associated with young age, headache, tinnitus and mood impairment. Methods: Using a crowdsourcing platform, we recruited a representative sample of 1015 adult laypeople from the UK, matched for age, gender and ethnicity according to national census data. Participants were unprimed, i.e. were inquired about the 'frequency of certain medical conditions' but not 'visual snow syndrome'. Results: A total of 38 of 1015 participants reported symptoms compatible with visual snow [3.7%; 95% confidence interval (CI), 2.7–5.2] and 22/1015 met criteria for visual snow syndrome (2.2%; 95% CI, 1.4–3.3). The female‐to–male ratio for visual snow syndrome was 1.6:1. Subjects with visual snow syndrome were older (50.6 ± 14 years) than the population mean (44.8 ± 15 years), although this was not statistically different (P = 0.06). Of 22 participants with visual snow syndrome, 16 had mood symptoms (72.7%; P = 0.01), 12 had headache (54.5%; P = 0.06), including five with visual migraine aura (22.7%; P = 0.15) and 13 had tinnitus (59.1%; P < 0.001). No participant had diabetes or a cleft lip (control questions). Following a multivariable regression analysis to adjust for age and gender, only the association between visual snow syndrome and tinnitus remained significant (odds ratio, 3.93; 95% CI, 1.63–9.9; P = 0.003). Conclusions: The UK prevalence of visual snow syndrome is around 2%. We confirmed an association with tinnitus, but unprimed laypeople with visual snow syndrome are on average older than those seeking medical attention. [ABSTRACT FROM AUTHOR]

Background: The most common management strategy for tinnitus provided in the UK audiology clinics is education and advice. This may also be combined with some form of sound therapy (e.g. digital hearing aids). While education and advice is generally provided by all clinics, there is a marked variability in provision of hearing aids that depends very much on clinical decisions. A recent Cochrane review concluded a lack of evidence to support or refute hearing aid use as a routine intervention for people with tinnitus and hearing loss. This lack of evidence is reflected in the inconsistency of tinnitus management in the UK. The aim of the HUSH trial is to determine the feasibility of conducting a definitive randomised controlled trial (RCT) of the effectiveness and cost-effectiveness of hearing aids for adults with tinnitus and hearing loss. Methods: This is a multicentre randomised controlled feasibility trial. Up to 100 adults, aged 18 and over, presenting to 5 UK audiology clinics with a complaint of tinnitus and measurable hearing loss are being randomised to receive either (i) education and advice (treatment as usual) or (ii) education and advice with digital hearing aids. Feasibility outcomes are being collected around recruitment, retention, patient and healthcare professional acceptability and clinical outcome assessment. Outcomes are being collected via postal questionnaire at 12 weeks post baseline. A nested interview study will supplement clinical and other outcome data, providing a detailed understanding of participants' and audiologists' experience of both tinnitus management and the research processes. Discussion: This feasibility trial will help us to (i) determine if it is feasible to conduct a multicentre RCT comparing treatment as usual and treatment as usual plus digital hearing aids; (ii) optimise the design of a future definitive, multicentre RCT; and (iii) inform which outcome(s) is/are relevant for patients. This work presents an important first step in determining the effectiveness of hearing aids as a tinnitus management strategy. Trial registration: ISRCTN, ISRCTN14218416. Registered on 30 July 2018. [ABSTRACT FROM AUTHOR]

Background: Many patients seeking help for tinnitus also suffer from insomnia. Adverse childhood experiences may affect the likelihood of insomnia in later life for such patients. Purpose: To explore whether parental separation and parental mental health during childhood are related to the severity of insomnia among patients with tinnitus and/or hyperacusis seen in an Audiology clinic. Research Design: This was a retrospective cross-sectional study. Study Sample: One hundred seventy-four consecutive patients who attended a tinnitus/hyperacusis clinic in the United Kingdom were included. Data Collection: Data were based on responses to questionnaires for people seeking help for tinnitus. Results: Sixteen percent of patients (27/174) reported that during the first 18 years of life, their parents were separated or divorced and 41% (72/174) reported that their parent(s) suffered from a mental illness. The mean score for the insomnia severity index (ISI) was not significantly affected by parental separation or divorce. However, the mean ISI score was significantly worse for patients whose parents had a mental illness. A multinomial logistic regression model, adjusted for the presence of hyperacusis, hearing loss, age, and gender, indicated that for individuals experiencing tinnitus, a history of parental mental illness during their childhood increased the chance of severe insomnia by a factor of 3.4 (95% confidence interval: 1.1 to 10.8, p = 0.04). The risk of having severe insomnia was 3.8 times greater for patients with hyperacusis than for those without. Conclusions: Among patients seeking help for tinnitus/hyperacusis, poor parental mental health was associated with severe insomnia. [ABSTRACT FROM AUTHOR]

Objective: It is possible that tinnitus, hearing loss and insomnia are all linked to oxidative stress. If so, there should be a relationship between insomnia and hearing loss among patients with tinnitus. The aim of this study was to assess the relationship between insomnia and hearing thresholds for patients with tinnitus. Design: This was a retrospective study. Study sample: Data were gathered from records of 1066 consecutive patients (≥18 years old) with tinnitus who were seen in an audiology clinic in the UK. Results: Seventy percent of patients experienced some form of insomnia as measured via the Insomnia Severity Index (ISI). Thirty eight percent of patients had hearing loss. Regression models showed that the average hearing threshold across ears and frequencies (0.5–4 kHz), adjusted for age and gender, did not predict ISI scores: regression coefficient (b) = 0.02 (95% confidence interval, CI: –0.013 to 0.05, p = 0.25). Moreover, the ISI scores did not predict the severity of hearing loss: b = 0.07 (95% CI: –0.05 to 0.18, p = 0.25). Conclusion: The data do not support the idea that high levels of oxidative stress, which are associated with insomnia, have a strong influence on hearing loss among patients with tinnitus. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the views of patients who completed audiologist-delivered cognitive behavioral therapy (CBT) about (a) the effectiveness of the treatment, (b) the acceptability of receiving CBT from audiologists, and (c) the most effective treatment components. Design: This was a service evaluation survey with a cross-sectional design. Study Sample: The study population comprised 40 consecutive adult patients who received a full course of audiologist-delivered CBT for tinnitus and/or hyperacusis management at a Tinnitus and Hyperacusis Therapy Specialist Clinic in the United Kingdom over a 1-year period. Thirty-one of 40 patients who attended their final session as planned completed the survey questionnaire. Data Collection and Analysis: As a part of their routine care, all patients completed a wide range of questionnaires before and after receiving audiologist-delivered CBT. These comprised Tinnitus Handicap Inventory (Newman, Sandridge, & Bolek, 2008); Hyperacusis Questionnaire (Khalfa et al., 2002); Insomnia Severity Index (Bastien, Vallieres, & Morin, 2001); Visual Analogue Scale (Maxwell, 1978) for tinnitus loudness, tinnitus annoyance, and effect of tinnitus on life; Generalized Anxiety Disorder (Spitzer, Kroenke, Williams, & Lowe, 2006) questionnaire; and Patient Health Questionnaire (Kroenke, Spitzer, & Williams, 2001). In addition, patients were asked to complete the survey questionnaire at their final session to provide feedback with regard to their therapy. Results: The majority of patients reported that it was very acceptable to them to receive CBT focused on tinnitus and hyperacusis from a specialist audiologist; the median response was 10/10. The majority of patients felt that the CBT was very effective (median response 8/10) and that they were able to manage their tinnitus and/or hyperacusis well (median response 9/10). The effect sizes of treatment based on pre- and postintervention comparison of scores for the Tinnitus Handicap Inventory, Visual Analogue Scale of tinnitus annoyance and effect on life, Hyperacusis Questionnaire, Insomnia Severity Index, Generalized Anxiety Disorder, and Patient Health Questionnaire were large. Conclusions: Audiologist-delivered CBT is acceptable to patients and is effective in the management of tinnitus and/or hyperacusis from the patients' perspectives. [ABSTRACT FROM AUTHOR]

Background: People with tinnitus and/or hyperacusis often experience insomnia. However, it is unclear what factors are most strongly associated with insomnia. Purpose: To explore factors related to insomnia in patients with tinnitus and/or hyperacusis. Research Design: This was a retrospective study using multiple-regression analysis. Study Sample: Data were assessed for 444 consecutive patients who sought help concerning their tinnitus and/or hyperacusis from a specialist audiology center in the UK National Health Service. The average age of the patients was 54 years (standard deviation = 15 years). Data Collection and Analysis: The results of audiological tests and self-report questionnaires were gathered retrospectively from the records of the patients. Multiple-regression analysis was used to assess the relationship between insomnia and other variables. Results: Sixty-nine percent of patients with tinnitus experienced some form of insomnia as measured via the Insomnia Severity Index (ISI). A multiple-regression model showed that ISI scores were significantly associated with depression scores measured via the depression subscale of the Hospital Anxiety and Depression Scale (HADS) (regression coefficient [b] = 0.44, p < 0.001), tinnitus annoyance measured via the visual analog scale (VAS) (b = 0.49, p = 0.001), anxiety measured via the anxiety subscale of the HADS (b = 0.21, p = 0.012), and tinnitus handicap measured via the Tinnitus Handicap Inventory (b = 0.07, p < 0.001). The model explained 45% of the variance in ISI scores. VAS scores for tinnitus loudness, hyperacusis-related measures, hearing thresholds, age, and gender were not significantly related to insomnia. Conclusions: The prevalence of insomnia in patients with tinnitus is high. Both tinnitus-related factors and psychological factors are related to the severity of insomnia. Hyperacusis is not significantly associated with insomnia. [ABSTRACT FROM AUTHOR]

Background: Parental mental illness is a risk factor for mental health disorders in the offspring. However, the relationship between parental illness in childhood and mental health disorders in adulthood among patients with tinnitus and/or hyperacusis is not known. Purpose: The aim was to explore the relationship between parental mental health in childhood and anxiety and depression for patients experiencing tinnitus and/or hyperacusis. Research Design: This was a retrospective cross-sectional study with a correlational design. Study Sample: Two hundred eighty-seven consecutive patients who attended a Tinnitus and Hyperacusis Therapy Specialist Clinic in the United Kingdom were included. Their average age was 52.5 years. Data Collection and Analysis: The association was explored between anxiety and depression measured via the Generalized Anxiety Disorder questionnaire (GAD-7) and the Patient Health questionnaire (PHQ-9) and responses to the question "While you were growing up during the first 18 years of life did your parent(s) have depression or mental illness?" Results: Thirty-nine percent of patients (111/287) responded "yes" to the question about their parents' mental health, which is about double the incidence in the general population. Regression analysis showed that parental mental illness significantly increased the risk of anxiety and depression, with unadjusted odds ratios (ORs) of 2.7 (95% confidence interval [CI]: 1.5-4.9, p = 5 0.001) for the PHQ-9 and 2.6 (95% CI: 1.4-4.8, p = 0.002) for the GAD-7. However, when the models were adjusted for the effects of age, gender, tinnitus handicap as measured via the Tinnitus Handicap Inventory, hyperacusis handicap as measured via the Hyperacusis questionnaire, uncomfortable loudness levels, GAD-7 scores (for the depression model only), and PHQ-9 scores (for the anxiety model only), parental mental health was only significantly associated with depression, with an OR of 2.7 (95% CI: 1.08-6.7, p = 0.033). Conclusions: Audiologists offering tinnitus and hyperacusis rehabilitation should screen patients for parental mental illness in childhood, especially for those with comorbid depression, and make onward referral to appropriate mental health services when needed. Future research should analyze the breadth and type of adverse childhood experiences among patients with tinnitus and hyperacusis and their relationship with mental problems and treatment efficacy. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to explore the relationship between parental mental illness in childhood with suicidal and self-harm ideations in adults seeking help for their tinnitus and/or hyperacusis. Method: This was a retrospective, cross-sectional study. The data for 292 consecutive patients who attended a Tinnitus and Hyperacusis Therapy Specialist Clinic in the United Kingdom were included. Results: Forty-six of 292 patients, or 15.75% of the patients, expressed that they have been bothered by suicidal and self-harm ideations within the last 2 weeks. Furthermore, 38.7% of the patients (113/292) reported that, while they were growing up during the first 18 years of life, their parent(s) were suffering from a mental illness. Logistic regression analysis showed a significant relationship between suicidal and self-harm ideations and the history of parental mental illness after adjusting the model for (a) tinnitus disability as measured via the Tinnitus Handicap Inventory (Newman, Jacobson, & Spitzer, 1996), (b) hyperacusis as measured via the Hyperacusis Questionnaire (Khalfa et al., 2002), (c) anxiety as measured via the Generalized Anxiety Disorder Questionnaire (Spitzer, Kroenke, Williams, & Löwe, 2006), (d) depression as measured via the Patient Health Questionnaire (Kroenke, Spitzer, & Williams, 2001), and (e) age and gender. Adjusted odds ratio was 2.5 (95% CI [1.14, 5.6], p = .022). The only other variable that was significantly related to the risk of suicidal and self-harm ideations was depression; adjusted odds ratio was 7.7 (95% CI [2.6, 26.3], p = .001). Conclusions: Clinicians who offer tinnitus and hyperacusis rehabilitation should screen for suicidal and self-harm ideations among patients, especially for those with symptoms of depression and a childhood history of parental mental illness. Patients with suicidal and self-harm ideations should be referred to mental health services for further diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background: Hearing loss is often associated with the phantom sound of tinnitus. However, the degree of the association between severity of hearing loss and tinnitus loudness taking into account the impact of other variables (e.g., emotional disturbances) is not fully understood. This is an important question for audiologists who are specialized in tinnitus rehabilitation as patients often ask whether the loudness of their tinnitus will increase if their hearing gets worse. Purpose: To explore the relationship between tinnitus loudness and pure tone hearing thresholds. Research Design: This was a retrospective cross-sectional study. Study Sample: 445 consecutive patients who attended a Tinnitus and Hyperacusis Therapy Specialist Clinic in UK were included. Data Collection and Analysis: The results of audiological tests and self-report questionnaires were gathered retrospectively from the records of the patients. Multiple-regression analysis was used to assess the relationship between tinnitus loudness, hearing loss and other variables. Results: The regression model showed a significant relationship between the pure tone average (PTA) at the frequencies 0.25, 0.5, 1, 2, and 4 kHz of the better ear and the tinnitus loudness asmeasured via visual analogue scale (VAS), r (regression coefficient) 5 0.022 (p < 0.001). Other variables significantly associated with tinnitus loudness were tinnitus annoyance (r = 0.49, p < 0.001) and the effect of tinnitus on life (r = 0.09, p = 0.006). The regression model explained 52% of the variance of tinnitus loudness. Conclusions: Although increased tinnitus loudness was associated with worse PTA, the relationship was very weak. Tinnitus annoyance and impact of tinnitus on life were more strongly correlated with tinnitus loudness than PTA. [ABSTRACT FROM AUTHOR]

Purpose: Subjective tinnitus is a common symptom with potentially negative impact on quality of life. More research is required to gain a deeper understanding of the disease and its clinical presentation. To estimate the incidence of tinnitus and to describe patient-related characteristics such as lifestyle factors and comorbidities. Patients and methods: Using the Clinical Practice Research Datalink, we calculated incidence rates of first-time diagnosed tinnitus in an adult population between 2000 and 2016. We stratified incidence rates by sex, age, and year of diagnosis. Additionally, we performed a 1:1 matched case-control study comparing body mass index, lifestyle factors and selected comorbidities between patients with incident tinnitus and tinnitus-free controls. Results: We identified 109 783 adults with a first-time diagnosis of tinnitus between 2000 and 2016, yielding an overall age-standardized incidence rate of 25.0 new tinnitus cases per 10,000 person-years (95% CI: 24.6–25.5). There was a steady increase in tinnitus incidence throughout the study period. Approximately 80% of tinnitus cases were diagnosed at age 40 years or older. We observed the highest incidence rate in individuals aged 60–69 years (41.2 per 10,000 person-years, 95% CI: 40.7–41.7). Smokers and alcohol drinkers were at lower risk of being diagnosed with tinnitus compared with non-smokers and non-drinkers, respectively. The occurrence of tinnitus was strongly associated with a recent diagnosis of several otological and vestibular disorders as well as head and neck disorders. Conclusion: The present observational study found an increasing incidence of tinnitus over time, emphasizing the continuously growing health burden. The findings on patient characteristics, lifestyle factors, and selected comorbidities contribute to a better understanding of risk factors for tinnitus. [ABSTRACT FROM AUTHOR]

Purpose: There is concern that some generic preference-based measures (GPMs) of health-related quality of life may be insensitive to interventions that improve hearing. Establishing where sensitivity arises could contribute to the design of improved measures. Accordingly, we compared the sensitivity of four widely used GPMs to a clinically effective treatment-cochlear implantation-which restores material degrees of hearing to adults with little or no functional hearing.Methods: Participants (N = 147) received implants in any of 13 hospitals in the UK. One month before implantation and 9 months after, they completed the HUI2, HUI3, EQ5D3L, and SF-6D questionnaires, together with the EuroQoL visual-analogue scale as a direct measure of health, a performance test of speech reception, and a self-report measure of annoyance due to tinnitus.Results: Implantation was associated with a large improvement in speech reception and a small improvement in tinnitus. HUI2 and HUI3 were sensitive to the improvement in speech reception through their Sensation and Hearing dimensions; EQ5D3L was sensitive to the improvement in tinnitus through its Anxiety/Depression dimension; SF-6D was sensitive to neither. Participants reported no overall improvement in health. Variation in health was associated with variation in tinnitus, not variation in speech reception.Conclusions: None of the four GPMs was sensitive to the improvements in both speech reception and tinnitus that were associated with cochlear implantation. To capture fully the benefits of interventions for auditory disorders, developments of current GPMs would need to be sensitive to both the health-related and non-health-related aspects of auditory dysfunction. [ABSTRACT FROM AUTHOR]

Objective: To assess the relationship between the loudness of tinnitus and insomnia via a mediation analysis. Design: Retrospective cross-sectional. Study Sample: 417 consecutive patients seeking treatment for tinnitus in an Audiology Department in the UK. Results: Mediation analysis showed that the relationship between tinnitus loudness measured using the visual analogue scale (VAS) and insomnia measured using the insomnia severity index was fully mediated via depression measured using the Patient Health Questionnaire, tinnitus handicap measured using the Tinnitus Handicap Inventory and tinnitus annoyance measured using the VAS. The regression coefficients for the indirect effects of tinnitus loudness on insomnia were: via depression b = 0.53 (95% confidence interval, CI: 0.35-0.71); via the VAS for tinnitus annoyance, b = 0.33 (95% CI: -0.004-0.66); and via tinnitus handicap, b = 0.38 (95% CI: 0.16-0.6). The coefficient for the total indirect effect was b = 1.23 (95% CI: 0.89-1.58). The coefficient for the direct effect of tinnitus loudness on insomnia was b = 0.11 (95% CI: -0.27-0.51), a non-significant effect. Conclusions: Insomnia is not directly related to tinnitus loudness. Depression, tinnitus handicap and tinnitus annoyance mediate the relationship between tinnitus loudness and insomnia. [ABSTRACT FROM AUTHOR]

Objective: The aim was to assess the effectiveness of cognitive behavioral therapy (CBT) for tinnitus and/or hyperacusis delivered by audiologists working in the National Health Service in the United Kingdom. Design: This was a retrospective study, based on questionnaires assessing tinnitus and hyperacusis and insomnia before and after CBT. Study Sample: Data were gathered for 68 consecutive patients (average age = 52.5 years) who enrolled for CBT. Results: All measures showed significant improvements after CBT. Effect sizes for patients who completed CBT were 1.13 for Tinnitus Handicap Inventory scores; 0.76 for Hyperacusis Questionnaire scores; 0.71, 0.95, and 0.93 for tinnitus loudness, annoyance, and effect on life, respectively, measured using the Visual Analog Scale; and 0.94 for the Insomnia Severity Index score. An analysis including those who dropped out also showed significant improvements for all measures. Conclusion: Audiologist-delivered CBT led to significant improvements in self-report measures of tinnitus and hyperacusis handicap and insomnia. The methods described here may be used when designing future randomized controlled trials of efficacy. [ABSTRACT FROM AUTHOR]

Objectives: To explore the relationships between parental separation and parental mental health in childhood with tinnitus and hyperacusis disability in adulthood. Design: Retrospective cross-sectional. Study sample: The data for consecutive patients who attended a tinnitus and hyperacusis clinic in the UK over a six months period were included (n = 184). Results: 14.7% of patients reported that while they were growing up, their parents were separated or divorced. There were no significant differences in Tinnitus Handicap Inventory (THI) and Hyperacusis Questionnaire (HQ) between patients with and without history of parental separation. About 40.2% reported history of mental health disorders in their parents. The scores on THI and HQ were worse in the group that reported mental health disorders in their parents (p < .01). Parental mental health illness did not significantly relate to THI, however, it was significantly related to the risk of hyperacusis (odds ratio [OR], after adjusting for age and gender: 2.05, p = .026). The adjusted OR for a subgroup of patients with a diagnosis of hyperacusis was 6.7 (p = .011), indicating a stronger relationship for this subgroup. Conclusions: Among patients seeking help for their tinnitus and hyperacusis, poor parental mental health was associated with increased hyperacusis disability. [ABSTRACT FROM AUTHOR]

Self-help has the potential to provide low-cost and effective ways of improving access to psychological support for people with tinnitus. When developing and evaluating resources it is important to consider issues that may influence successful implementation. This Survey explored clinicians’ use and views on self-help, and barriers to implementation. An online survey was distributed to 220 UK audiology departments. One-hundred and twenty-four clinicians responded to the survey (91 audiologists, 32 hearing therapists, 1 clinical psychologist), each representing a different tinnitus department. Two-thirds of respondents reported providing or recommending self-help resources. Potential benefits were patient empowerment and providing a means of engaging patients in their care. Almost half of respondents felt that there is insufficient training or guidance for clinicians on using or promoting self-help. Clinicians felt that for patients with low-level tinnitus severity, self-help may reduce the number of audiology appointments required. For patients with more complex needs self-help may be useful to engage with between clinical appointments. Further research is needed to determine effectiveness, who benefits, and by what mechanism, before clinicians can confidently recommend or implement self-help. Clinicians will benefit from formal guidance on promoting and supporting use of self-help for tinnitus. [ABSTRACT FROM AUTHOR]

The article offers information on tinnitus and what can be done to restore some peace and quiet. Topics discussed include causes of tinnitus related to the ear, variations in the type and severity of symptoms of tinnitus, and ways to ease the symptoms of tinnitus. Treatments for the more likely case of hearing loss or stress are also mentioned.

Objective: Young adults' music-listening behaviours may put them at risk of developing permanent hearing loss and tinnitus. This study aimed to assess knowledge of permanent tinnitus and whether this knowledge may influence listening behaviours to a greater degree than knowledge of hearing loss., Materials and Methods: A two-group (between subjects), randomised post-test only, single-factor experimental design was used to determine the effects of health message focus (permanent tinnitus vs. permanent hearing loss) on the main outcome measure of protective behavioural intention. The sample included 109 male and 287 female adults, aged 18 to 25 years, living in the United Kingdom. The young adults' existing knowledge of either permanent hearing loss or permanent tinnitus was measured, and after exposure to a health message, their perceptions and resultant behavioural intentions were assessed and compared. The pooled data were used to test a proposed model of factors influencing hearing protective behavioural intention using path analysis., Results: Whilst 83% knew about the link with hearing loss, only 75% knew that loud music may cause permanent tinnitus. The participants viewed tinnitus as closer temporally than hearing loss, perceived themselves as equally susceptible to both, but perceived hearing loss as more severe. There was no significant difference in behavioural intention between the groups., Conclusion: Perceived susceptibility and severity have a positive effect on behavioural intentions. In light of these results, recommendations for future noise-damage prevention campaigns are made.

Purpose: The purpose of this study was to investigate the long-term outcomes 1 year after undertaking an audiologist-guided Internet-based cognitive behavioral therapy (iCBT) intervention for tinnitus. Secondary aims were to identify any predictors of outcome and whether there were any unwanted events related to undertaking iCBT for tinnitus. Method: Participants who had previously undertaken a randomized iCBT efficacy trial for tinnitus were invited to participate. Of the 146 who were initially randomized for the efficacy trial, 104 participants completed the 1-year postintervention assessment measures. The primary outcome was a change in tinnitus distress as assessed by the Tinnitus Functional Index. Secondary assessment measures were included for insomnia, anxiety, depression, hearing handicap, hyperacusis, cognitive failures, and satisfaction with life. An intention-to-treat analysis using repeated-measures analysis of variance and hierarchical multiple regression was used for statistical analysis. Unwanted effects were categorized according to the unwanted events checklist. Results: Undertaking iCBT for tinnitus led to significant improvements 1 year postintervention for tinnitus and related difficulties, for example, insomnia, anxiety, depression, hearing handicap, hyperacusis, and life satisfaction. The best predictors of improving tinnitus severity at 1-year postintervention were greater baseline tinnitus severity scores, reading more of the modules, and higher satisfaction with the intervention. Unwanted events were reported by 11% of the participants and were more likely to be reported by women than men. These events were related to worsening of symptoms, the emergence of new symptoms, negative well-being, and prolongation of treatment. Conclusions: The clinical benefits of audiologist-guided iCBT for tinnitus and tinnitus-related difficulties were sustained 1 year postintervention. Predictors of outcome indicated that the intervention is applicable to a wide range of participants regardless of their demographic backgrounds. Attempts should be made to minimize unwanted events in subsequent trials. [ABSTRACT FROM AUTHOR]

Background: Tinnitus is one of the most distressing hearing-related symptoms. It is often associated with a range of physiological and psychological complications, such as depression, anxiety, and insomnia. Hence, approaching tinnitus from a biopsychological perspective may be more appropriate than from purely a biomedical model. Objective: The present study was aimed at determining the relationship between tinnitus and the problems and life effects experienced by UK-based tinnitus research study volunteers. Open-ended questions were used. Responses were classified using the International Classification of Functioning, Disability and Health (ICF) framework to understand the impact of tinnitus in a multidimensional manner using a biopsychosocial perspective. Research Design: A cross-sectional survey design was used. Study Sample: Study sample included a sample of 240 adults with tinnitus who were interested in undertaking an Internet-based intervention for tinnitus. Data Collection and Analysis: The data were collated using two open-ended questions. The first focused on problems related to having tinnitus and the second to life effects as a result of tinnitus. Responses were analyzed using a simplified content analysis approach to link concepts to ICF categories in accordance with established linking rules. A Wilcoxon signed-rank test was performed to compare the number of responses between the two questions. Results: There were 764 responses related to problems identified, 797 responses associated with life effects due to tinnitus, and 37 responses that did not fit into any ICF category. No significant differences were observed in the number of responses between the two questions. In addition, no significant association between the number of responses reported and demographic variables was found. Most of the problems and life effects experienced by tinnitus sufferers were related to body function, followed by activity limitations, and participation restrictions. Only a few responses were related to environmental and personal factors. The most frequent responses related to body function involved "emotional functions" (b152), "sleep functions" (b134), "hearing functions" (b230), "sustaining attention" (b1400), and "energy level" (b1300). For activity limitations and participation restrictions they were "communicating with--receiving--spoken messages" (d310), "socialization" (d9205), "handling stress and other psychological demands" (d240), and "recreation and leisure" (d920). The most frequently occurring responses related to environmental factors were "sound intensity" (e2500), "sound quality" (e2501), and "general products and technology for communication" (e1250). "Coping styles" was the most frequently occurring personal factor. Conclusions: The study highlights the use of open-ended questions in gathering useful information about the impact of tinnitus. The responses coded to ICF show that tinnitus impacts many domains, not only particularly body function, but also activity limitations and participation restrictions. The results demonstrate the heterogeneous nature of the impact of tinnitus on people affected. [ABSTRACT FROM AUTHOR]

Objective: Recruiting into clinical trials on time and on target is a major challenge and yet often goes unreported. This study evaluated the adjustment to procedures, recruitment and screening methods in two multi-centre pharmaceutical randomised controlled trials (RCTs) for hearing-related problems in adults. Design: Recruitment monitoring and subsequent adjustment of various study procedures (e.g. eligibility criteria, increasing recruiting sites and recruitment methods) are reported. Participants were recruited through eight overarching methods: trial registration, posters/flyers, print publications, Internet, social media, radio, databases and referrals. The efficiency of the recruitment was measured by determining the number of people: (1) eligible for screening as a percentage of those who underwent telephone prescreening and (2) randomised as a percentage of those screened. Study sample: A total of 584 participants completed the pre-screening steps, 491 screened and 169 participants were randomised. Results: Both RCTs completed adjustments to the participant eligibility, added new study sites and additional recruitment methods. No single recruitment method was efficient enough to serve as the only route to enrolment. Conclusion: A diverse portfolio of methods, continuous monitoring, mitigation strategy and adequate resourcing were essential for achieving our recruitment goals. [ABSTRACT FROM AUTHOR]

Purpose: The purpose was to assess the proportion of patients seeking help for tinnitus and/or hyperacusis who have severe hyperacusis and to examine factors associated with severe hyperacusis. Research Design: This was a retrospective cross-sectional study based on 362 consecutive patients who attended a National Health Service audiology clinic for tinnitus and/or hyperacusis rehabilitation and for whom uncomfortable loudness levels (ULLs) had been measured. The criterion for severe hyperacusis was taken as a ULL of 30 dB HL or less for at least one of the measured frequencies for at least one ear. Results: Thirteen patients had severe hyperacusis, and eight of those had normal hearing. The lowest average ULL across frequencies was 28 dB HL. The difference in average ULLs between ears was 5 dB or less for nine patients. The range of ULLs across frequencies was between 5 and 60 dB, ULLs often being lowest at 8 kHz. Eleven patients had tinnitus, eight had otological abnormalities, twelve had mental health problems, and six were taking antidepressants. Conclusions: Severe hyperacusis is characterized by low ULLs for specific frequencies and no or mild hearing loss. Given the high incidence of tinnitus, otological abnormalities, and mental health problems, the management of patients with severe hyperacusis should involve otologists and psychiatrists in addition to audiologists. [ABSTRACT FROM AUTHOR]

Objective: The aim was to determine the proportion and characteristics of patients who were offered, enrolled in and completed an audiologist-delivered cognitive behavioural therapy (CBT) programme for tinnitus and/or hyperacusis in a specialist Audiology Department in the National Health Service, UK. Design: This was a retrospective study. Study sample: Data were gathered for 266 consecutive patients with an average age of 56 y (standard deviation =15 y). Results: Following an initial assessment session, 68% of patients were judged to have problems sufficient for them to be offered audiologist-delivered CBT. The remaining 32% were discharged. Of those enrolled for CBT, 31% were discharged after the first CBT session, because they were judged to have insufficient tinnitus and/or hyperacusis distress. Of those offered continuing CBT, 45% declined to continue. Patients who continued were younger, had worse insomnia and had better hearing in their better ear than patients who declined. Of those who continued, 68% completed the six sessions of CBT. Conclusion: Although CBT is resource intensive, only 17% of the total patient sample received the full course of six sessions of CBT. Patients who accepted continuing CBT were younger, had worse insomnia and had better hearing than those who declined. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to gain insights related to positive experiences reported by adults with tinnitus living in the United Kingdom. Design: A cross‐sectional survey design was used in a sample of adults with tinnitus who were interested in undertaking an Internet‐based intervention for tinnitus. Setting: The study was UK wide and data collection was online. Participants: Participants consisted of 240 adults (137 males, 103 females), with an average age of 48.16 years and average tinnitus duration of 11.52 years (SD: 11.88). Main outcome measures: Tinnitus severity was measured by means of the Tinnitus Functional Index. To evaluate the secondary effects of tinnitus, the Insomnia Severity Index, the Hearing Handicap Inventory for Adults‐Screening Version and the Cognitive Failures Questionnaires were administered. Positive experiences related to tinnitus were explored using an open‐ended question format. Results: Around a third of participants (32.5%) reported positive experiences associated with tinnitus. The number of positive responses ranged from one to eight responses per participant, although there were fewer participants with more than one positive response. The predominant themes concerned for (i) coping; (ii) personal development; (iii) support, and to a lesser extent (iv) outlook. Younger participants, those with a lower hearing disability and those with fewer cognitive failures were more likely to report positive experiences associated with having tinnitus. Conclusions: This study has identified that personal development and a positive outlook are possible despite experiencing tinnitus. Ways to facilitate positive experiences related to tinnitus should be promoted, as these may reduce the negative consequences associated with tinnitus. The most prevalent positive theme was the ability to cope with tinnitus. Positive experiences were also drawn from having clinical and other support networks. This highlights the importance of providing tinnitus interventions that can assist people in coping with tinnitus, particularly to those less likely to relate tinnitus to any positive experiences. Those most likely to be helped include those who are older with greater cognitive difficulties and a greater hearing disability. [ABSTRACT FROM AUTHOR]