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Tinnitus in Patients with Sensorineural Hearing Loss: Management, Quality of Life and Treatment Strategies
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Approximately 15% of Swedish people experience tinnitus, but only 2.4% experience severe problems. Treatment modalities for tinnitus vary, but the most common treatment is counseling. The majority of patients with tinnitus report some degree of hearing loss, and hearing aids have been used for many years in patients who suffer from both tinnitus and hearing impairment. The aim of the present thesis was to investigate disease management, determine quality of life and identify treatment strategies for patients with tinnitus and sensorineural hearing loss.

The first two studies described here are retrospective, descriptive studies of patients who sought care for tinnitus and hearing loss at two Ear-Nose-Throat (ENT) clinics in Östergötland County, Sweden, during the years 2004 - 2007. Study I showed that 70% of the cohort had tinnitus; however, many did not initially receive a diagnosis of tinnitus. Information about vertigo, heredity for hearing loss and tinnitus, diabetes history, cardiovascular disease history and other factors related to health was often missing from the patients’ medical records. The results could show that the overall scores using the Tinnitus Handicap Inventory (THI) were higher in female patients than in male patients. Although it is likely that hearing aids would be beneficial for the majority of these patients, 314 (44%) of the 714 total patients had hearing aids. Furthermore, the outcomes from study II demonstrated that a majority of the patients (61%) who were dissatisfied with the care they had obtained had no hearing aids. This finding may indicate that the fitting of hearing aids is an important treatment for patients with both tinnitus and hearing loss.

Studies III and IV were prospective studies. Data collection was based on patients who sought care for tinnitus and/or hearing loss at the ENT clinic in Linköping during 2012-2013. In study III, 92 patients were divided into two groups: one group contained individuals with both tinnitus and hearing loss, and the other group contained patients with only hearing loss. The patients were assessed using the Reading Span test, the Hearing in Noise Test (HINT) and three questionnaires (the THI, the Hearing Handicap Inventory for Elderly and the Pittsburg Sleep Quality Index) at baseline and follow-up. The results from the age-matched subgroups (n=30+30) generated from the full clinical groups (46+46) showed significantly improved Reading Span test performance and sleep quality in patients with both tinnitus and hearing loss. Similar results were observed in our full clinical population (n=46+46). However, the interpretation of this finding is difficult due to age differences between the groups. In conclusion, hearing aid fitting had a significantly positive impact on working memory capacity and sleep quality in patients with both tinnitus and hearing loss compared with patients with only hearing loss.

In study IV, a brief Motivational Interviewing (MI) guide was integrated into the hearing rehabilitation process for 23 patients with both tinnitus and hearing loss, and they were compared against a control group (n=23) of patients with both tinnitus and hearing loss who underwent traditional hearing rehabilitation. The results showed that the patients who received the brief MI guide required fewer visits to complete their hearing rehabilitation compared with the patients in the control group. In addition, there was a significant difference in THI scores between the groups, which indicated that the intervention reduced tinnitus annoyance more in the MI group. Furthermore, both groups showed higher scores at follow-up compared with baseline on the International Outcome Inventory for Hearing Aids (IOI-HA) scale, which indicated that both approaches showed a positive effect on hearing aid satisfaction.

Study V was a retrospective, descriptive study that focused on a part of a Stepped Care model and included patients who participated in half-day tinnitus information meetings from 2004 to 2011 in the audiology clinic at Linköping University Hospital. A total of 426 tinnitus patients with complete questionnaires (the THI and the Hospital Anxiety and Depression Scale, HADS) were included in the study. The results showed significant decreases in scores on the THI and the anxiety module of the HADS before and after the information session. However, there were no statistically significant changes in the depression module of the HADS.

In conclusion, this thesis underscores the importance of hearing impairment, cognitive variables and motivational procedures in the management of tinnitus. Multidisciplinary group information needs to be further validated.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. , 73 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1536
National Category
Otorhinolaryngology Neurology Public Health, Global Health, Social Medicine and Epidemiology Psychology
Identifiers
URN: urn:nbn:se:liu:diva-132163DOI: 10.3384/diss.diva-132163ISBN: 9789176856970 (Print)OAI: oai:DiVA.org:liu-132163DiVA: diva2:1038634
Public defence
2016-11-17, Graniten, Campus US, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2016-10-19 Created: 2016-10-19 Last updated: 2016-10-19Bibliographically approved
List of papers
1. A cohort study of patients with tinnitus and sensorineural hearing loss in a Swedish population
Open this publication in new window or tab >>A cohort study of patients with tinnitus and sensorineural hearing loss in a Swedish population
2013 (English)In: Auris, nasus, larynx, ISSN 0385-8146, E-ISSN 1879-1476, Vol. 40, no 1, 41-45 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: We aimed to describe a large cohort of patients with tinnitus and sensorineural hearing loss (SNHL) in Sweden, and also to explore the possibility of finding potential possible differences between various diagnoses within SNHL. It is also of great interest to see how a multidisciplinary team was used in the different subgroups and the frequency of hearing aids use in patients with tinnitus.

METHODS: Medical records of all patients who had received the diagnosis SNHL in Östergötland County, Sweden between 2004 and 2007 were reviewed. Patients between 20 and 80 years with tinnitus and a pure tone average (PTA) lower than 70dB HL were included in the study. Patients were excluded from the analyses if they had a cochlear implantation, middle ear disorders or had a hearing loss since birth or childhood. The investigators completed a form for each included patient, covering background facts, and audiograms taken at the yearly check up.

RESULTS: Of a total 1672 patients' medical record review, 714 patients were included. The majority of patients (79%) were in the age group over 50 years. In male patients with bilateral tinnitus, the PTA for the left ear was significantly higher than for the right ear. The results regarding the configuration of hearing loss revealed that 555 patients (78%) had symmetric and 159 (22%) asymmetric hearing loss. Retrocochlear examinations were done in 372 patients and MRI was the most common examination. In all patients, 400 had no hearing aids and out of those 220 had unilateral tinnitus and 180 patients had bilateral tinnitus. 219 patients had a PTA>20dB HL and did not have any hearing aid. Results demonstrated that the Stepped Care model was not used widely in the daily practice. In our study, patients with bilateral-, unilateral hearing loss or Mb Ménière were the most common patients included in the Stepped Care model.

CONCLUSION: In a large cohort of patients with SNHL and tinnitus, despite their hearing loss only 39% had hearing aids. It was observed that the medical record review often showed a lack of information about many background factors, such as; patients' general health condition, which could be a quality factor that needs improvement. Our results show that the Stepped Care model could be an effective option for providing a better access for tinnitus-focused treatment, although the number of patients in this study who were included in the Stepped Care model was low.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81411 (URN)10.1016/j.anl.2012.05.005 (DOI)22652486 (PubMedID)
Available from: 2012-09-13 Created: 2012-09-13 Last updated: 2016-10-19Bibliographically approved
2. Quality of life in patients with tinnitus and sensorineural hearing loss
Open this publication in new window or tab >>Quality of life in patients with tinnitus and sensorineural hearing loss
2014 (English)In: B-ENT, ISSN 1781-782X, Vol. 10, no 1, 41-51 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to evaluate the quality of life in patients with tinnitus and SNHL, to investigate patients’ mental and physical health and to measure the level of satisfaction concerning the care experienced by the patients.

Methods: Three questionnaires related to patients` physical and psychological health, were mailed to 714 Swedish patients with tinnitus and sensorineural hearing loss.

Results: Female patients had significantly higher Tinnitus Handicap Inventory scores than male patients. Patients who were satisfied with the care they obtained had significantly higher PTA. It was found that the satisfied group had significantly lower THI-scores. In the dissatisfied group, 61% of patients had no hearing aids compared to 42% in the satisfied group.

Conclusion: Our cohort of patients estimated their life quality and general health at a good level almost 4.5 years after their first report of tinnitus. Another finding was that 47% of patients were not satisfied with the treatment they obtained. In the dissatisfied group, 61% of patients had no hearing aids. Further research is required to find an approach that could motivate patients with both tinnitus and hearing impairment to use hearing aids.

Keyword
Tinnitus, Sensorineural hearing loss, Questionnaire, Quality of life
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-81412 (URN)000334566200007 ()24765828 (PubMedID)
Available from: 2012-09-13 Created: 2012-09-13 Last updated: 2016-10-19Bibliographically approved
3. Working Memory, Sleep, and Hearing Problems in Patients with Tinnitus and Hearing Loss Fitted with Hearing Aids
Open this publication in new window or tab >>Working Memory, Sleep, and Hearing Problems in Patients with Tinnitus and Hearing Loss Fitted with Hearing Aids
2016 (English)In: Journal of the American Academy of Audiology, ISSN 1050-0545 (Print); 2157-3107 (Online), 1-11 p.Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Tinnitus is a common condition and there is a need to evaluate effects of tinnitus management in relation to moderating factors such as degree of hearing loss. As it is possible that tinnitus influences concentration, and thus is likely to disturb cognitive processing, the role of cognitive functioning also needs to be investigated.

Purpose: To compare a group of patients with sensorineural hearing loss and tinnitus to a control group with only sensorineural hearing loss (and no tinnitus). To investigate working memory, sleep, and hearing problems measured before and after hearing rehabilitation.

Research Design: A prospective study.

Study Sample: The sample consisted of 100 patients, 50 with hearing loss and tinnitus, and 50 controls with hearing loss but no tinnitus. All patients were between 40 and 82 yr old and had a pure-tone average (PTA; average of 0.5, 1, 2, and 4 kHz) ,70 dB HL.

Intervention: Patients were tested before and after rehabilitation with hearing aids with regard to their working memory capacity, sleep quality, hearing problems, speech recognition, and tinnitus annoyance.

Data Collection and Analysis: Eight patients dropped out of the study. Thus, a total of 92 patients were included for analysis, with 46 in each group. As a consequence of unplanned age and PTA differences between the groups, an age-matched subsample (n 5 30 1 30) was selected for further analysis. Tests including the Reading Span, Hearing-in-Noise Test (HINT), Tinnitus Handicap Inventory (THI), Hearing Handicap Inventory for the Elderly (HHIE), and Pittsburgh Sleep Quality Index (PSQI) were administered before and after hearing aid rehabilitation.

Results: There were no between-group differences at baseline in the full sample (n 5 92), with the exception of the THI (p , 0.001) and the PSQI (p , 0.002), on which the hearing loss and tinnitus group had significantly higher scores. Pre/post changes were significant for both groups on the Reading Span, and HHIE. However, these improvements were significantly larger for the patients in the hearing loss and tinnitus group on the Reading Span test (p , 0.001) and the PSQI (p , 0.001). Patients with tinnitus and hearing loss also exhibited significantly improved THI scores at follow-up, compared to baseline ( p, 0.001). We conducted the same analyses for the age-matched subsample (n 5 30 1 30). For the baseline data, only the THI (p , 0.001) and the PSQI (p , 0.015) difference remained significant. With regard to the pre/post changes, we found the same differences in improvement in Reading Span ( p , 0.001) and the PSQI (p , 0.015) as in the full sample.

Conclusions: Patients with tinnitus benefited from hearing aid rehabilitation. The observed differences in cognitive function were unexpected, and there were larger score improvements on the Reading Span test in the hearing loss and tinnitus group than in the hearing loss group. Patients with tinnitus and hearing loss may receive extra benefit in terms of cognitive function following hearing aid rehabilitation.

Place, publisher, year, edition, pages
Ingenta, 2016
Keyword
sensorineural hearing loss; hearing aids; tinnitus; working memory capacity
National Category
Public Health, Global Health, Social Medicine and Epidemiology Neurology Otorhinolaryngology Psychology
Identifiers
urn:nbn:se:liu:diva-132160 (URN)10.3766/jaaa.16023 (DOI)
Available from: 2016-10-19 Created: 2016-10-19 Last updated: 2016-10-19Bibliographically approved
4. Motivational Interviewing as an Adjunct to Hearing Rehabilitation for Patients with Tinnitus: A Randomized Controlled Pilot Trial.
Open this publication in new window or tab >>Motivational Interviewing as an Adjunct to Hearing Rehabilitation for Patients with Tinnitus: A Randomized Controlled Pilot Trial.
2016 (English)In: Journal of the American Academy of Audiology, ISSN 2157-3107, Vol. 27, no 8, 669--676 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To test the effects of a brief motivational interviewing (MI) program as an adjunct to hearing aid rehabilitation for patients with tinnitus and sensorineural hearing loss.

RESEARCH DESIGN: This was a pilot randomized controlled trial.

STUDY SAMPLE: The sample consisted of 50 patients aged between 40 and 82 yr with both tinnitus and sensorineural hearing loss and a pure-tone average (0.5, 1, 2, and 4 kHz) < 70 dB HL. All patients were first-time hearing aid users.

INTERVENTION: A brief MI program was used during hearing aid fitting in 25 patients, whereas the remainder received standard practice (SP), with conventional hearing rehabilitation.

DATA COLLECTION AND ANALYSIS: A total of 46 patients (N = 23 + 23) with tinnitus were included for further analysis. The Tinnitus Handicap Inventory (THI) and the International Outcome Inventory for Hearing Aids (IOI-HA) were administered before and after rehabilitation. THI was used to investigate changes in tinnitus annoyance, and the IOI-HA was used to determine the effect of hearing aid treatment.

RESULTS: Self-reported tinnitus disability (THI) decreased significantly in the MI group (p < 0.001) and in the SP group (p < 0.006). However, there was greater improvement in the MI group (p < 0.013). Furthermore, the findings showed a significant improvement in patients' satisfaction concerning the hearing aids (IOI-HA, within both groups; MI group, p < 0.038; and SP group, p < 0.026), with no difference between the groups (p < 0.99).

CONCLUSION: Tinnitus handicap scores decrease to a greater extent following brief MI than following SP. Future research on the value of incorporating MI into audiological rehabilitation using randomized controlled designs is required.

Place, publisher, year, edition, pages
Reston: American Academy of Audiology, 2016
National Category
Other Medical Sciences
Identifiers
urn:nbn:se:liu:diva-131111 (URN)10.3766/jaaa.15126 (DOI)000381957200006 ()27564444 (PubMedID)
Available from: 2016-09-09 Created: 2016-09-09 Last updated: 2016-10-19Bibliographically approved

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