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Background Tinnitus is a leading cause of disease burden globally. Several therapeutic strategies are recommended in guidelines for the reduction of tinnitus distress; however, little is known about the potential increased effectiveness of a combination of treatments and personalized treatments for each tinnitus patient. Methods Within the Unification of Treatments and Interventions for Tinnitus Patients project, a multicenter, randomized clinical trial is conducted with the aim to compare the effectiveness of single treatments and combined treatments on tinnitus distress (UNITI-RCT). Five different tinnitus centers across Europe aim to treat chronic tinnitus patients with either cognitive behavior therapy, sound therapy, structured counseling, or hearing aids alone, or with a combination of two of these treatments, resulting in 4 treatment arms with single treatment and 6 treatment arms with combinational treatment. This statistical analysis plan describes the statistical methods to be deployed in the UNITI-RCT. Discussion The UNITI-RCT trial will provide important evidence about whether a combination of treatments is superior to a single treatment alone in the management of chronic tinnitus patients. This pre-specified statistical analysis plan details the methodology for the analysis of the UNITI trial results. Trial registration ClinicalTrials.gov NCT04663828 (https://clinicaltrials.gov/ct2/show/NCT04663828). The trial is ongoing. Date of registration: December 11, 2020. The main RCT analyses will start by the end of December 2022 and will include data from patients who have finished their treatment by the 19th of December 2022.

Background Dizziness and imbalance are common symptoms that are often inadequately diagnosed or managed, due to a lack of dedicated specialists. Decision Support Systems (DSS) may support first-line physicians to diagnose and manage these patients based on personalised data. Aim To examine the diagnostic accuracy and application of the EMBalance DSS for diagnosis and management of common vestibular disorders in primary care. Methods Patients with persistent dizziness were recruited from primary care in Germany, Greece, Belgium and the UK and randomised to primary care clinicians assessing the patients with (+ DSS) versus assessment without (− DSS) the EMBalance DSS. Subsequently, specialists in neuro-otology/audiovestibular medicine performed clinical evaluation of each patient in a blinded way to provide the “gold standard” against which the + DSS, − DSS and the DSS as a standalone tool (i.e. without the final decision made by the clinician) were validated. Results One hundred ninety-four participants (age range 25–85, mean = 57.7, SD = 16.7 years) were assigned to the + DSS (N = 100) and to the − DSS group (N = 94). The diagnosis suggested by the + DSS primary care physician agreed with the expert diagnosis in 54%, compared to 41.5% of cases in the − DSS group (odds ratio 1.35). Similar positive trends were observed for management and further referral in the + DSS vs. the − DSS group. The standalone DSS had better diagnostic and management accuracy than the + DSS group. Conclusion There were trends for improved vestibular diagnosis and management when using the EMBalance DSS. The tool requires further development to improve its diagnostic accuracy, but holds promise for timely and effective diagnosis and management of dizzy patients in primary care. Trial registration number NCT02704819 (clinicaltrials.gov).

Voice loss constitutes a crucial disorder which is highly associated with social isolation. The use of multimodal information sources, such as, audiovisual information, is crucial since it can lead to the development of straightforward personalized word prediction models which can reproduce the patient’s original voice. In this work we designed a multimodal approach based on audiovisual information from patients before loss-of-voice to develop a system for automated lip-reading in the Greek language. Data pre-processing methods, such as, lip-segmentation and frame-level sampling techniques were used to enhance the quality of the imaging data. Audio information was incorporated in the model to automatically annotate sets of frames as words. Recurrent neural networks were trained on four different video recordings to develop a robust word prediction model. The model was able to correctly identify test words in different time frames with 95% accuracy. To our knowledge, this is the first word prediction model that is trained to recognize words from video recordings in the Greek language.

BACKGROUND Balance rehabilitation programs constitute the most common treatment for balance disorders. Nonetheless, lack of resources and of highly expert physiotherapists barriers for patients to have individualized rehabilitation sessions and the required in person monitoring of the rehabilitation program. Therefore, balance rehabilitation programs are often transferred to the home environment, with a high risk of the patient mis-performing the exercises or failing to follow the programme at all. OBJECTIVE Holobalance is a persuasive coaching system with the capacity to offer full-scale rehabilitation services at home. Holobalance comprises of several modules, from rehabilitation program management to Augmented Reality (AR) coach presentation. One of the modules is the scoring module, which assesses the performance of the patient using wearable devices. METHODS The data-driven scoring module described in the present work is based on an extensive dataset (~1300 rehabilitation exercise sessions) collected during the Holobalance pilot study. Its scope is to be used as a training and testing dataset for training machine learning (ML) models, which can infer the scoring components of all physical rehabilitation exercises. RESULTS The results of the trained model improved the performance of the scoring module, in terms of more accurate assessment of a performed exercise, when compared to a rule-based scoring model deployed at an early phase of the system (k-statistic value of 15.9% for the sitting exercises, 20.8% for the standing exercises and 26.8% for the walking exercises). CONCLUSIONS Finally, the resulting performance of the model resembles the threshold of the interobserver variability, enabling the trustworthy usage of the scoring module to the closed-loop chain of the Holobalance coaching system.

Physical inactivity and sedentary time are associated with all-cause mortality, chronic non-communicable diseases and falls in the elderly. Objective of this review is to assess and summarize recommendations from clinical guidelines for physical activity (PA) of older adults in general and related to falls. A scoping review of the existing clinical guidelines was conducted. The included studies should have been developed under the auspices of a health organization and their methodology should be described in detail. Nine clinical guidelines providing specific recommendations for the elderly were identified. There was a strong agreement across the guidelines regarding goals, activities parameters, adverse effects of PA, in addition to reference for preventing falls. Keeping even the minimum of physical activity, introducing balance exercises and strengthening exercises for preventing falls, avoiding unexpected accelerations in the intensity of the activities, applying the necessary precautions and consulting a health professional are the main pillars of recommendations. Despite any deficiencies in definitions, monitoring and optimal dosage consistency of recommendations, is an ideal incentive for countries and organizations to adopt and enhance physical activity as an antidote to the degeneration of human's health and quality of life.

Background Tinnitus represents a relatively common condition in the global population accompanied by various comorbidities and severe burden in many cases. Nevertheless, there is currently no general treatment or cure, presumable due to the heterogeneity of tinnitus with its wide variety of etiologies and tinnitus phenotypes. Hence, most treatment studies merely demonstrated improvement in a subgroup of tinnitus patients. The majority of studies are characterized by small sample sizes, unstandardized treatments and assessments or applications of intervention targeting only a single organ level. Combinatory treatment approaches, potentially targeting multiple systems as well as treatment personalization might provide remedy and enhance treatment responses. The aim of the present study is to systematically examine established tinnitus therapies both alone and in combination in a large sample of tinnitus patients. Further it wants to provide the basis for personalized treatment approaches by evaluating a specific decision support system developed as part of an EU-funded collaborative project (Unification of treatments and interventions for tinnitus patients; UNITI-project). Methods/ Study design: This is a multi-center parallel-arm randomized clinical trial conducted at five different clinical sites over the EU. The effect of four different tinnitus therapy approaches (sound therapy, structured counselling, hearing aids, cognitive behavioral therapy) applied over a time period of 12 weeks as a single or rather a combinatory treatment in a total number of 500 chronic tinnitus patients will be investigated. Assessments and interventions are harmonized over the involved clinical sites. The primary outcome measure focuses on the domain tinnitus distress assessed via the Tinnitus Handicap Inventory. Discussion Results and conclusions from the current study might not only provide an essential contribution to combinatory and personalized treatment approaches in tinnitus but could also provide more profound insights in the heterogeneity of tinnitus, representing an important step towards a cure for tinnitus. Trial registration: ClinicalTrials.gov: NCT04663828. Registered on 11. December 2020

Tinnitus treatment, diagnosis and management across Europe varies significantly. The lack of national clinical guidelines for tinnitus management in most European countries and the absence of a common language across all disciplines involved is reflected in the diversification of healthcare practices. Interprofessional Training for Tinnitus Researchers and Clinicians (Tin-TRAC) is an Erasmus+ project that aims to develop common educational ground in the form of an e-Learning platform, co-created by patients, researchers and clinicians, which is able to unify tinnitus diagnosis and treatment strategies across Europe. A pan-European thematic educational platform integrating the best practices and latest research achievements with regard to tinnitus diagnosis and management has the potential to act as a facilitator of the reduction of interdisciplinary and interregional practice diversification. A detailed analysis of the educational needs of clinicians and researchers across disciplines will be followed by the co-creative development of the curriculum. Reusable learning objects will incorporate the training contents and will be integrated in an open e-Learning platform. Tin-TRAC envisions that its output will answer the need to create a common language across the clinicians and researchers of different disciplines that are involved in tinnitus management, and reduce patients’ prolonged suffering, non-adherence and endless referral trajectories.

Residual Inhibition is considered as tinnitus alteration immediately after exposure to sound. Its clinical significance and correlation with the pathophysiology and treatment prognosis of tinnitus remain enigmatic. The objective of this review is to critically appraise scientific evidence regarding the residual inhibition prevalence and how it is correlated with different sound stimuli.A systematic review of tinnitus Residual Inhibition (RI) studies was performed, focusing on prevalence, methods used, stimuli presented and responses obtained. A literature search (PubMed, Cochrane Central Register of Controlled Trials, Scopus, MEDLINE) was conducted. Seventeen studies involving 1066 patients fulfilled the inclusion criteria. Sound stimulation was performed using pure tones, customized sounds, narrow- and broadband noises, and modulated sounds.Sound stimuli exposure produced complete RI of tinnitus in 34.5% of patients (range 5.6-72%), with higher RI rates after stimulation with pure tones and narrowband noise centered to the tinnitus perceived pitch. RI duration tends to increase when stimuli duration increases.RI is frequent and can be induced by narrow-band noise (NBN), broadband noise (BBN), pure tones, customized sounds and modulated sounds. Adequate evidence to support the use of RI as a tool for tinnitus phenotyping or as a management option is pending. Further clinical research exploring the profile of patients with RI and its potential use as prognostic factor should be conducted.

Tinnitus is a common symptom of a phantom sound perception with a considerable socioeconomic impact. Tinnitus pathophysiology is enigmatic and its significant heterogeneity reflects a wide spectrum of clinical manifestations, severity and annoyance among tinnitus sufferers. Although several interventions have been suggested, currently there is no universally accepted treatment. Moreover, there is no well-established correlation between tinnitus features or patients' characteristics and projection of treatment response. At the clinical level, this practically means that selection of treatment is not based on expected outcomes for the particular patient.The complexity of tinnitus and lack of well-adapted prognostic factors for treatment selection highlight a potential role for a decision support system (DSS). A DSS is an informative system, based on big data that aims to facilitate decision-making based on: specific rules, retrospective data reflecting results, patient profiling and predictive models. Therefore, it can use algorithms evaluating numerous parameters and indicate the weight of their contribution to the final outcome. This means that DSS can provide additional information, exceeding the typical questions of superiority of one treatment versus another, commonly addressed in literature.The development of a DSS for tinnitus treatment selection will make use of an underlying database consisting of medical, epidemiological, audiological, electrophysiological, genetic and tinnitus subtyping data. Algorithms will be developed with the use of machine learning and data mining techniques. Based on the profile features identified as prognostic these algorithms will be able to suggest whether additional examinations are needed for a robust result as well as which treatment or combination of treatments is optimal for every patient in a personalized level.In this manuscript we carefully define the conceptual basis for a tinnitus treatment selection DSS. We describe the big data set and the knowledge base on which the DSS will be based and the algorithms that will be used for prognosis and treatment selection.

Tinnitus is the perception of a phantom sound and the patient's reaction to it. Although much progress has been made, tinnitus remains a scientific and clinical enigma of high prevalence and high economic burden, with an estimated prevalence of 10%-20% among the adult population. The EU is funding a new collaborative project entitled "Unification of Treatments and Interventions for Tinnitus Patients" (UNITI, grant no. 848261) under its Horizon 2020 framework. The main goal of the UNITI project is to set the ground for a predictive computational model based on existing and longitudinal data attempting to address the question of which treatment or combination of treatments is optimal for a specific patient group based on certain parameters. Clinical, epidemiological, genetic and audiological data, including signals reflecting ear-brain communication, as well as patients' medical history, will be analyzed making use of existing databases. Predictive factors for different patient groups will be extracted and their prognostic relevance validated through a Randomized Clinical Trial (RCT) in which different patient groups will undergo a combination of tinnitus therapies targeting both auditory and central nervous systems. From a scientific point of view, the UNITI project can be summarized into the following research goals: (1) Analysis of existing data: Results of existing clinical studies will be analyzed to identify subgroups of patients with specific treatment responses and to identify systematic differences between the patient groups at the participating clinical centers. (2) Genetic and blood biomarker analysis: High throughput Whole Exome Sequencing (WES) will be performed in well-characterized chronic tinnitus cases, together with Proximity Extension Assays (PEA) for the identification of blood biomarkers for tinnitus. (3) RCT: A total of 500 patients will be recruited at five clinical centers across Europe comparing single treatments against combinational treatments. The four main treatments are Cognitive Behavioral Therapy (CBT), hearing aids, sound stimulation, and structured counseling. The consortium will also make use of e/m-health applications for the treatment and assessment of tinnitus. (4) Decision Support System: An innovative Decision Support System will be implemented, integrating all available parameters (epidemiological, clinical, audiometry, genetics, socioeconomic and medical history) to suggest specific examinations and the optimal intervention strategy based on the collected data. (5) Financial estimation analysis: A cost-effectiveness analysis for the respective interventions will be calculated to investigate the economic effects of the interventions based on quality-adjusted life years. In this paper, we will present the UNITI project, the scientific questions that it aims to address, the research consortium, and the organizational structure.

Professional musicians are at high risk of developing tinnitus due to their over-exposure to music at both occupational and recreational level. This is a 5-year long prospective case series study performed in the Musicians/Performing Arts Medicine Clinic of the 1st Otorhinolaryngology Department of the National and Kapodistrian University of Athens. A total of 274 professional musicians underwent thorough medical history, history of music exposure, assessment of the impact their hearing status has on their professional life (Musicians Hearing Handicap Index), behavioral (Pure Tone Audiometry, standard and extended high frequency) and objective audiometric tests (TEOAE and DPOAE). Standard pure tone audiometry thresholds were correlated with the presence of tinnitus only at high frequencies. Musicians with tinnitus had a clinical and significant higher MHHI score and the incidence of tinnitus was significantly higher in participants suffering from musculoskeletal disease and those with abnormal PTA. Participants' hours of practice were similar in those with tinnitus and those without. The tinnitus group (and in order of descending effect size) had significantly worse thresholds in high frequency audiometry (≥3000Hz) as well as lower signal to noise ratios in DPOAE at almost all frequencies and in TEOAE at high frequencies (2.8 and 4kHz). A subgroup analysis of the musicians with normal PTA, showed that those with tinnitus showed elevated thresholds in the extended high frequency. In conclusion, tinnitus occurrence in musicians with normal audiogram is potentially correlated with high frequency hearing loss and impaired otoacoustic emissions and these two examinations should be considered in this group.

Tinnitus is a common symptom of a phantom sound perception with a considerable socioeconomic impact. Tinnitus pathophysiology is enigmatic and its significant heterogeneity reflects a wide spectrum of clinical manifestations, severity and annoyance among tinnitus sufferers. Although several interventions have been suggested, currently there is no universally accepted treatment. Moreover, there is no well-established correlation between tinnitus features or patients' characteristics and projection of treatment response. At the clinical level, this practically means that selection of treatment is not based on expected outcomes for the particular patient.The complexity of tinnitus and lack of well-adapted prognostic factors for treatment selection highlight a potential role for a decision support system (DSS). A DSS is an informative system, based on big data that aims to facilitate decision-making based on: specific rules, retrospective data reflecting results, patient profiling and predictive models. Therefore, it can use algorithms evaluating numerous parameters and indicate the weight of their contribution to the final outcome. This means that DSS can provide additional information, exceeding the typical questions of superiority of one treatment versus another, commonly addressed in literature.The development of a DSS for tinnitus treatment selection will make use of an underlying database consisting of medical, epidemiological, audiological, electrophysiological, genetic and tinnitus subtyping data. Algorithms will be developed with the use of machine learning and data mining techniques. Based on the profile features identified as prognostic these algorithms will be able to suggest whether additional examinations are needed for a robust result as well as which treatment or combination of treatments is optimal for every patient in a personalized level.In this manuscript we carefully define the conceptual basis for a tinnitus treatment selection DSS. We describe the big data set and the knowledge base on which the DSS will be based and the algorithms that will be used for prognosis and treatment selection.

Tinnitus is the perception of a phantom sound and the patient's reaction to it. Although much progress has been made, tinnitus remains a scientific and clinical enigma of high prevalence and high economic burden, with an estimated prevalence of 10%-20% among the adult population. The EU is funding a new collaborative project entitled "Unification of Treatments and Interventions for Tinnitus Patients" (UNITI, grant no. 848261) under its Horizon 2020 framework. The main goal of the UNITI project is to set the ground for a predictive computational model based on existing and longitudinal data attempting to address the question of which treatment or combination of treatments is optimal for a specific patient group based on certain parameters. Clinical, epidemiological, genetic and audiological data, including signals reflecting ear-brain communication, as well as patients' medical history, will be analyzed making use of existing databases. Predictive factors for different patient groups will be extracted and their prognostic relevance validated through a Randomized Clinical Trial (RCT) in which different patient groups will undergo a combination of tinnitus therapies targeting both auditory and central nervous systems. From a scientific point of view, the UNITI project can be summarized into the following research goals: (1) Analysis of existing data: Results of existing clinical studies will be analyzed to identify subgroups of patients with specific treatment responses and to identify systematic differences between the patient groups at the participating clinical centers. (2) Genetic and blood biomarker analysis: High throughput Whole Exome Sequencing (WES) will be performed in well-characterized chronic tinnitus cases, together with Proximity Extension Assays (PEA) for the identification of blood biomarkers for tinnitus. (3) RCT: A total of 500 patients will be recruited at five clinical centers across Europe comparing single treatments against combinational treatments. The four main treatments are Cognitive Behavioral Therapy (CBT), hearing aids, sound stimulation, and structured counseling. The consortium will also make use of e/m-health applications for the treatment and assessment of tinnitus. (4) Decision Support System: An innovative Decision Support System will be implemented, integrating all available parameters (epidemiological, clinical, audiometry, genetics, socioeconomic and medical history) to suggest specific examinations and the optimal intervention strategy based on the collected data. (5) Financial estimation analysis: A cost-effectiveness analysis for the respective interventions will be calculated to investigate the economic effects of the interventions based on quality-adjusted life years. In this paper, we will present the UNITI project, the scientific questions that it aims to address, the research consortium, and the organizational structure.

Background: Residual Inhibition is considered as tinnitus alteration immediately after exposure to sound. Its clinical significance and correlation with the pathophysiology and treatment prognosis of tinnitus remain enigmatic. The objective of this review is to critically appraise scientific evidence regarding the residual inhibition prevalence and how it is correlated with different sound stimuli. Methods: A systematic review of tinnitus Residual Inhibition (RI) studies was performed, focusing on prevalence, methods used, stimuli presented and responses obtained. A literature search (PubMed, Cochrane Central Register of Controlled Trials, Scopus, MEDLINE) was conducted. Seventeen studies involving 1066 patients fulfilled the inclusion criteria. Sound stimulation was performed using pure tones, customized sounds, narrow- and broadband noises, and modulated sounds. Results: Sound stimuli exposure produced complete RI of tinnitus in 34.5% of patients (range 5.6–72%), with higher RI rates after stimulation with pure tones and narrowband noise centered to the tinnitus perceived pitch. RI duration tends to increase when stimuli duration increases. Conclusions: RI is frequent and can be induced by narrow-band noise (NBN), broadband noise (BBN), pure tones, customized sounds and modulated sounds. Adequate evidence to support the use of RI as a tool for tinnitus phenotyping or as a management option is pending. Further clinical research exploring the profile of patients with RI and its potential use as prognostic factor should be conducted.

Loss of voice, which may be due to problems in various organs of the human voice system is a major disability which most of the time results in social isolation. In most cases of complete voice loss, the problem cannot be improved over time and despite the fact that methods have been developed to reconstruct voice, none come close to the natural pitch of the person’s voice. The present work proposes a novel personalized system that integrates audiovisual information and autonomous learning in order to reconstruct a disabled person’s voice. The system makes use of a smartphone’s camera and microphone while the majority of computations will not be performed locally but in the cloud. Using computational methods for signal processing as well as machine learning algorithms we believe that, a voice similar to the user’s own voice can be reproduced. Finally the aforementioned technologies will be incorporated into a personalized multimedia interface and and the system will be evaluated during a multi-phase period by patients with serious chronic voice problems.

Tinnitus remains a scientific and clinical problem whereby, in spite of increasing knowledge on effective treatment and management for tinnitus, very little impact on clinical practice has been observed. There is evidence that prolonged, obscure and indirect referral trajectories persist in usual tinnitus care.ObjectiveIt is widely acknowledged that efforts to change professional practice are more successful if barriers are identified and implementation activities are systematically tailored to the specific determinants of practice. The aim of this study was to administer a health service evaluation survey to scope current practice and knowledge of standards in tinnitus care across Europe. The purpose of this survey was to specifically inform the development process of a European clinical guideline that would be implementable in all European countries.DesignA health service evaluation survey was carried out.SettingThe survey was carried out online across Europe.ParticipantsClinical experts, researchers and policy-makers involved in national tinnitus healthcare and decision-making.Outcome measuresA survey was developed by the study steering group, piloted on clinicians from the TINNET network and underwent two iterations before being finalised. The survey was then administered to clinicians and policy-makers from 24 European countries.ResultsData collected from 625 respondents revealed significant differences in national healthcare structures, use of tinnitus definitions, opinions on characteristics of patients with tinnitus, assessment procedures and particularly in available treatment options. Differences between northern and eastern European countries were most notable.ConclusionsMost European countries do not have national clinical guidelines for the management of tinnitus. Reflective of this, clinical practices in tinnitus healthcare vary dramatically across countries. This equates to inequities of care for people with tinnitus across Europe and an opportunity to introduce standards in the form of a European clinical guideline. This survey has highlighted important barriers and facilitators to the implementation of such a guideline.

PurposeThe EU-funded research project EVOTION has brought together clinical, technical, and public health experts with the aim to offer a solution for the holistic management of hearing loss. This report presents the challenges, strengths, and key take-home messages of working in this multidisciplinary consortium.MethodFifteen consortium members completed an online survey with 6 open-ended questions. Responses were analyzed using a thematic approach.ResultsAnalysis identified 4 main themes: (a)communication, that is, cross-disciplinary communication difficulties but also range of expertise; (b)opportunities, that is, innovation, learning, and collaborations; (c)technology, that is, technical requirements and data collection and management issues; and (d)local constraints, that is, institutional limitations, resources, and planning.ConclusionsAlthough the challenges reported differed by country and specialty, there was consensus about the value, expertise, and opportunities of the project. It is recommended that in future similar multidisciplinary projects in audiology, researchers establish a common language and assess technical requirements and local constraints prior to initiating research activities.

IntroductionApproximately one in three of all older adults fall each year, with wide ranging physical, psychosocial and healthcare-related consequences. Exercise-based interventions are the cornerstone for falls prevention programmes, yet these are not consistently provided, do not routinely address all components of the balance system and are often not well attended. The HOLOBalance system provides an evidence-based balance training programme delivered to patients in their home environment using a novel technological approach including an augmented reality virtual physiotherapist, exergames and a remote monitoring system. The aims of this proof-of-concept study are to (1) determine the safety, acceptability and feasibility of providing HOLOBalance to community dwelling older adults at risk for falls and (2) provide data to support sample size estimates for a future trial.MethodsA single (assessor) blinded pilot randomised controlled proof of concept study. 120 participants will be randomised to receive an 8-week home exercise programme consisting of either: (1) HOLOBalance or (2) The OTAGO Home Exercise Programme. Participants will be required to complete their exercise programme independently under the supervision of a physiotherapist. Participants will have weekly telephone contact with their physiotherapist, and will receive home visits at weeks 0, 3 and 6. Outcome measures of safety, acceptability and feasibility, clinical measures of balance function, disability, balance confidence and cognitive function will be assessed before and immediately after the 8 week intervention. Acceptability and feasibility will be explored using descriptive statistics, and trends for effectiveness will be explored using general linear model analysis of variance.Ethics and disseminationThis study has received institutional ethical approvals in Germany (reference: 265/19), Greece (reference: 9769/24-6-2019) and the UK (reference: 19/LO/1908). Findings from this study will be submitted for peer-reviewed publications.Trial registration numberNCT04053829.Protocol versionV.2, 20 January 2020

The holistic management of hearing loss (HL) requires appropriate public health policies for HL prevention, early diagnosis, long-term treatment and rehabilitation; detection and prevention of cognitive decline; protection from noise; and socioeconomic inclusion of HL patients. However, currently the evidential basis for forming such policies is limited. Holistic HL management policies require the analysis of heterogeneous data, including Hearing Aid (HA) usage, noise episodes, audiological, physiological, cognitive, clinical and medication, personal, behavioural, life style, occupational and environmental data. To utilise these data in forming holistic HL management policies, EVOTION, a new European research and innovation project, aims to develop an integrated platform supporting: (a) the analysis of related datasets to enable the identification of causal and other effects amongst them using various forms of big data analytics, (b) policy decision making focusing on the selection of effective interventions related to the holistic management of HL, based on the outcomes of (a) and the formulation of related public health policies, and (c) the specification and monitoring of such policies in a sustainable manner. In this paper, we describe the EVOTION approach.

Objective: The aim of this study was to develop Greek Sentence Based Speech Audiometry Test in quiet test for Hearing Impaired (HI) children (G-SEBSAT).\ud \ud Methods: Seventy-six children were recruited following approval by the local ethics committee and after obtaining informed consent from their parents. The collection of vocabulary was based on showing pictures selected from popular reading materials in Greek to hearing impaired HI children. A grammatical content analysis was carried out to determine the average syntactic and morphological structures of the sentences used by the HI children. Ten picture related sentence lists were developed based on the vocabulary and the grammatical analysis, and recorded by a male native speaker of standard Modern Greek. These were presented to both normal hearing (NH) and HI children, and the average speech response threshold (SRT) as well as the slope of the SRT curve at the SRT level of 50% correct responses (S50) were recorded in both groups. Sentence lists were validated with respect to the variability of their difficulty within each group, as well the test-retest variability of the respective SRT scores.\ud \ud Results: The average speech response threshold (SRT) across all lists for HI children was 65.27 dB and the slope of the SRT curve at the SRT level of 50% correct responses was 3.11%/dB. The corresponding results across all lists for NH children were 17.66 dB and 9.7%/dB, respectively. The SRT of HI children were strongly positively correlated, in a statistically significant manner with the PTA in both the test and the retest sessions (test: r=0.750, P < 0.0005; retest: r=0.753, P < 0.0005). The Spearman correlation of the rankings of SRT values and the slope values was 0.998 and 0.997 respectively for the HI and 0.939 and 0.88, for the NH group, indicating very low variability across the test and retest sessions. In addition, the analysis of variance (ANOVA) of the average SRT in NH children and the SRT residuals in the HI group indicated that the different sentences were of the same difficulty within each group. ((F(9,81)=0.401, p=0.930 and (F(9,93)=2.241, p=0.025 respectively).\ud \ud Conclusions: A validated sentence based speech audiometry test was created in Greek for the first time. SRT and S50 values for both NH and HI children are comparable to similar tests developed in other languages.

Background Balance problems are caused by multiple factors and often lead to falls and related fractures, bringing large socio-economic costs. The complexity of balance control mechanisms, the lack of medical expertise, and the absence of specialised equipment contribute to the delayed or incorrect diagnosis and management ofthese patients. Advances in computer science have allowed the development of computer systems that support clinical diagnosis and treatment decisions based on individualised patient data. The aim of the EMBalance decision support system (DSS) is to support doctors facing this clinical challenge, to make a definitive diagnosis and implement an effective management plan. The EMBalance study will determine the accuracy of this supportive tool when used by non-specialist doctors. This study is funded by the European Union’s Seventh Framework Programme. Methods/design EMBalance is a proof-of-concept study designed as a non-commercial, international, multi-centre, single-blind, parallel-group randomised controlled trial to be carried out at four clinical sites in the United Kingdom, Germany, Greece and Belgium. The study is comprised of three stages: internal pilot, phase I (diagnosis) and stage II (management). For this purpose, 200 patients presenting with persistent dizziness (>3 months’ duration) to primary care services will be randomised to either the intervention group (diagnostic assessment with the DSS) or a control group (diagnostic assessment without the DSS). Patients allocated to the intervention group will be assessed by a doctor with the support of the EMBalance DSS, while patients allocated to the control group will receive a visit as per standard practice. Ultimately, all patients’ diagnoses and management plans will be certified by a consultant in neuro-otology. Discussion EMBalance is the first trial to test the accuracy of a DSS in both the diagnosis of and the management plan for vestibular disorders across the healthcare systems of four different countries. The EMBalance study is the result of a combined effort of engineers and physicians to develop an accurate tool to support non-specialist doctors, with no risk for the patient. This trial will provide reliable information about the benefits of implementing DSSs in primary care while supporting the feasibility of testing the EMBalance algorithms in further research. Trial registration ClinicalTrials.gov NCT02704819. Registered 29 February 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1568-x) contains supplementary material, which is available to authorized users.

In this work we present a framework for the analysis and mining of multiparametric data related to balance disorders. The overall concept is to define the schema of the analysis that provides optimal results for diagnostic decision support in balance disorders. The work is part of the integrated EMBalance platform which targets the management of patients with balance disorders, from the diagnosis to treatment and evolution of the disease. The obtained results in four different balance disorders range from 76.4% to 92.1%.

In this work we present the decision support of the EMBalance platform. EMBalance is a platform for the management of balance disorders in terms of diagnosis, treatment and evolution. The EMBalance platform aims to extend existing but generic and currently uncoupled balance modelling activities leading to a multi-scale and patient-specific balance model, which will be incorporated in a Decision Support System (DSS), towards the early diagnosis, prediction and the efficient treatment planning of balance disorders. The diagnosis part of the decision support system uses various data ranging from demographic characteristics to clinical examinations, auditory and vestibular tests. Currently we present some initial technical choices and indicative results of the decision support system for diagnosing balance disorders, based on data mining techniques and clinical guidelines.

In this work, we present the concept, the methodological ideas and the architecture of the EMBALANCE platform. EMBALANCE platform extends existing but generic and currently uncoupled balance modeling activities, leading to a multi-scale and patient-specific balance Hypermodel, which is incorporated to a Decision Support System (DSS), towards the early diagnosis, prediction and the efficient treatment planning of balance disorders. Various data feed the intelligent system increasing the dimensionality and personalization of the system. Human Computer Interaction techniques are utilized in order to develop the required interfaces in a user-intuitive and efficient way, while interoperable web services enhance the accessibility and acceptance of the system. The platform will be validated using both retrospective as well as prospective experimental and clinical data. The final tool will be a powerful web-based platform provided to primary and secondary care physicians across specialties, levels of training and geographical boundaries, targeting wider clinical acceptance as well as the increased confidence in the developed DSS towards the early diagnostic evaluation, behaviour prediction and effective management planning of balance problems. Currently we focus and present the management and modeling of the balance disorders.

In this work, we present the concept, the methodological ideas and the architecture of the EMBALANCE platform. EMBALANCE platform extends existing but generic and currently uncoupled balance modeling activities, leading to a multi-scale and patient-specific balance Hypermodel, which is incorporated to a Decision Support System (DSS), towards the early diagnosis, prediction and the efficient treatment planning of balance disorders. Various data feed the intelligent system increasing the dimensionality and personalization of the system. Human Computer Interaction techniques are utilized in order to develop the required interfaces in a user-intuitive and efficient way, while interoperable web services enhance the accessibility and acceptance of the system. The platform will be validated using both retrospective as well as prospective experimental and clinical data. The final tool will be a powerful web-based platform provided to primary and secondary care physicians across specialties, levels of training and geographical boundaries, targeting wider clinical acceptance as well as the increased confidence in the developed DSS towards the early diagnostic evaluation, behaviour prediction and effective management planning of balance problems. Currently we focus and present the management and modeling of the balance disorders.

Both epistaxis and hypertension are frequent problems in the adult population. The relationship between the level of arterial pressure and incidence of epistaxis in a patient with hypertension is a question that appears frequently in the clinical practice. A systematic review of the literature regarding the relation of arterial hypertension with epistaxis was performed through MEDLINE and EMBASE. All studies, whether examining the correlation of arterial pressure at presentation of a patient with nasal bleeding or the repercussion of episodes of epistaxis in hypertensive patients, were included in this review. Studies were evaluated independently by two reviewers according to a standard evaluation form. Overall, nine studies fulfilled our inclusion criteria. Five of them were single-group (patient) studies, while the remaining four included a control group. In eight studies, the patient group included patients with epistaxis, while one focused on hypertensive patients. Six out of nine studies agree that arterial pressure is higher at the time of epistaxis, as compared to the control group or to the general population. Seven out of nine studies conclude that there is cross-correlation between arterial pressure and the actual incident of epistaxis. The presence of high arterial blood pressure during the actual episode of nasal bleeding cannot establish a causative relationship with epistaxis, because of confounding stress and possible white coat phenomenon, but may lead to initial diagnosis of an already installed arterial hypertension.

The aim of this study was to report our experience with cartilage tympanoplasty (CT) in smokers and compare it with that of non-smokers using a retrospective chart review at a tertiary referral center. Between September 2008 and September 2010, cartilage tympanoplasty was performed in 52 patients. Among them, 27 were active smokers and 25 former or non-smokers. The entire tympanic membrane was replaced with conchal cartilage, shaped either as a shield for cases with intact canal wall mastoidectomies, or crashed for cases with canal wall down procedures. The mean post-operative follow-up was 12 months (range 6-18 months). A complete pre- and post-operative audiologic evaluation was obtained in all patients. Graft take was successful in all patients. The overall average pre-operative and post-operative pure tone average air-bone gaps (PTA-ABG) was 52.2 dB ± 17.7 dB and 35.4 dB ± 17.9 dB, respectively, with an overall improvement of 16.8 dB (p < 0.001). A post-operative PTA-ABG of 25 dB or less was achieved in 39 (75 %) patients (p < 0.001). In smokers, the hearing improvement was 17.6 dB (p < 0.001) with a PTA-ABG of 25 dB or less in 19 (70 %). In non-smokers, the average hearing improvement was 16.8 dB (p < 0.0005) with a post-operative PTA-ABG of 25 dB or less in 19 (76 %), (p < 0.001). The results showed that the CT technique is a very effective procedure for smokers. Excellent graft take and satisfactory hearing results can be accomplished regardless of smoking habits.

Background and Aim: It is estimated that 10–15% of the general population suffers from tinnitus, including 60% of all otologic patients. Quality of life is reportedly affected in approximately 0.5% ...

In Europe alone, over 70 million people experience tinnitus; for seven million people, it creates a debilitating condition. Despite its enormous socioeconomic relevance, progress in successfully treating the condition is somewhat limited. The European Union has approved funding to create a pan-European tinnitus research collaboration network (2014-2018). The goal of one working group is to establish an international standard for outcome measurements in clinical trials of tinnitus. Importantly, this would enhance tinnitus research by informing sample-size calculations, enabling meta-analyses, and facilitating the identification of tinnitus subtypes, ultimately leading to improved treatments. The first meeting followed a workshop on ``Agreed Standards for Measurement: An International Perspective{''} with invited talks on clinimetrics and existing international initiatives to define core sets for outcome measurements in hearing loss (International classification of functioning, disability, and health core sets for hearing loss) and eczema (Harmonizing outcome measures for eczema). Both initiatives have taken an approach that clearly distinguishes the specification of what to measure from that of how to measure it. Meeting delegates agreed on taking a step-wise roadmap for which the first output would be a consensus on what outcome domains are essential for all trials. The working group seeks to embrace inclusivity and brings together clinicians, tinnitus researchers, experts on clinical research methodology, statisticians, and representatives of the health industry. People who experience tinnitus are another important participant group. This meeting report is a call to those stakeholders across the globe to actively participate in the initiative.} publishersversion published