Mining for knowledge to build decision support system for diagnosis and treatment of tinnitus

Tinnitus problems affect a significant portion of the population and are difficult to treat. Treatment processes are plentiful, yet not completely understood. In this dissertation, we present a knowledge discovery approach which can be used to build a decision support system for supporting tinnitus treatment. Our approach is based on a significant enlargement of the initial tinnitus database by adding many new tables containing new temporal features related to tinnitus evaluation and treatment outcome. Research presented in this thesis includes knowledge discovery with temporal, text, and quantitative data from a patient dataset of 3013 visits representing 758 unique patient tuples. Additionally, a new rule generating technique and clustering methods are presented and used to develop additional new temporal features and knowledge in this complex domain. Of particular interest is the role that emotions play in treatment success for tinnitus following the TRT method developed by Dr. Pawel Jastreboff. The ultimate goal of understanding the relationships among the treatment factors and measurements in order to better understand tinnitus treatment will result in the design foundations of a decision support system to aid in tinnitus treatment effectiveness

Problems and life effects experienced by tinnitus research study volunteers: an exploratory study using the ICF classification

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 current 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 in order to understand the impact of tinnitus in a multidimensional manner using a bio-psychosocial perspective. Method: A cross-sectional survey design was used in a sample of 240 adults with tinnitus who were interested in undertaking an Internet-based intervention for tinnitus. 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 analysed using a simplified content analysis approach to link concepts to ICF categories according to 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. Also, no significant association between the number of responses reported and demographic variables were 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 style 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, particularly body function, but also activity limitations and participation restrictions. The results demonstrate the heterogeneous nature of the impact of tinnitus on people affected

Problems and life effects experienced by tinnitus research study volunteers: an exploratory study using the ICF classification

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 current 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 in order to understand the impact of tinnitus in a multidimensional manner using a bio-psychosocial perspective. Method: A cross-sectional survey design was used in a sample of 240 adults with tinnitus who were interested in undertaking an Internet-based intervention for tinnitus. 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 analysed using a simplified content analysis approach to link concepts to ICF categories according to 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. Also, no significant association between the number of responses reported and demographic variables were 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 style 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, particularly body function, but also activity limitations and participation restrictions. The results demonstrate the heterogeneous nature of the impact of tinnitus on people affected

Role of the Cochlear Nucleus Circuitry in Tinnitus and Hyperacusis

Tinnitus is the disorder of phantom sound perception, while hyperacusis is abnormally increased loudness growth. Tinnitus and hyperacusis are both associated with hearing loss, but hearing loss does not always occur with either condition, implicating central neural activity as the basis for each disorder. Furthermore, while tinnitus and hyperacusis can co-occur, either can occur exclusively, suggesting that separate pathological neural processes underlie each disorder. Mounting evidence suggests that pathological neural activity in the cochlear nucleus, the first central nucleus in the auditory pathway, underpins hyperacusis and tinnitus. The cochlear nucleus is comprised of a ventral and dorsal subdivision, which have separate principal output neurons with distinct targets. Previous studies have shown that dorsal cochlear nucleus fusiform cells show tinnitus-related increases in spontaneous firing with minimal alterations to sound-evoked responses. In contrast, sound-evoked activity in ventral cochlear nucleus bushy cells is enhanced following noise-overexposure, putatively underlying hyperacusis. While the fusiform-cell contribution to tinnitus has been well characterized with behavioral and electrophysiological studies, the bushy-cell contribution to tinnitus or hyperacusis has been understudied. This dissertation examines how pathological neural activity in cochlear nucleus circuitry relates to tinnitus and hyperacusis in the following three chapters. In the first chapter, I characterize the development of a high-throughput tinnitus behavioral model, which combines and optimizes existing paradigms. With this model, I show that animals administered salicylate, a drug that reliably induces tinnitus at high doses in both humans and animals, show behavioral evidence of tinnitus in two separate behavioral tests. Moreover, in these same animals, I show that dorsal-cochlear-nucleus fusiform cells exhibit frequency-specific increases in spontaneous firing activity, consistent with the increased spontaneous firing observed in animal models of noise-induced tinnitus. In the second chapter, I show that following noise-overexposure, ventral-cochlear-nucleus bushy cells demonstrate hyperacusis-like neural firing patterns, but not tinnitus-specific increases in spontaneous activity. I contrast the bushy-cell neural activity with established fusiform-cell neural signatures of tinnitus, to highlight the bushy-cell, but not fusiform-cell contribution to hyperacusis. These analyses suggest that tinnitus and hyperacusis likely arise from distinct neural substrates. In the third chapter, I use computational modelling of the auditory periphery and bushy-cell circuitry to examine potential mechanisms that underlie hyperacusis-like neural firing patterns demonstrated in the second chapter. I then relate enhanced bushy-cell firing patterns to alterations in the auditory brainstem response, a sound-evoked electrical potential generated primarily by bushy cells. Findings in this chapter suggest that there are multiple hyperacusis subtypes, arising from separate mechanisms, which could be diagnosed through fine-tuned alterations to the auditory brainstem response.PHDBiomedical EngineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/163087/1/damartel_1.pd

the COMIT’ID study protocol for using a Delphi process and face-to-face meetings to establish consensus

Background The reporting of outcomes in clinical trials of subjective tinnitus indicates that many different tinnitus-related complaints are of interest to investigators, from perceptual attributes of the sound (e.g. loudness) to psychosocial impacts (e.g. quality of life). Even when considering one type of intervention strategy for subjective tinnitus, there is no agreement about what is critically important for deciding whether a treatment is effective. The main purpose of this observational study is, therefore to, develop Core Outcome Domain Sets for the three different intervention strategies (sound, psychological, and pharmacological) for adults with chronic subjective tinnitus that should be measured and reported in every clinical trial of these interventions. Secondary objectives are to identify the strengths and limitations of our study design for recruiting and reducing attrition of participants, and to explore uptake of the core outcomes. Methods The ‘Core Outcome Measures in Tinnitus: International Delphi’ (COMIT’ID) study will use a mixed-methods approach that incorporates input from health care users at the pre-Delphi stage, a modified three-round Delphi survey and final consensus meetings (one for each intervention). The meetings will generate recommendations by stakeholder representatives on agreed Core Outcome Domain Sets specific to each intervention. A subsequent step will establish a common cross-cutting Core Outcome Domain Set by identifying the common outcome domains included in all three intervention-specific Core Outcome Domain Sets. To address the secondary objectives, we will gather feedback from participants about their experience of taking part in the Delphi process. We aspire to conduct an observational cohort study to evaluate uptake of the core outcomes in published studies at 7 years following Core Outcome Set publication. Discussion The COMIT’ID study aims to develop a Core Outcome Domain Set that is agreed as critically important for deciding whether a treatment for subjective tinnitus is effective. Such a recommendation would help to standardise future clinical trials worldwide and so we will determine if participation increases use of the Core Outcome Set in the long term. Trial registration This project has been registered (November 2014) in the database of the Core Outcome Measures in Effectiveness Trials (COMET) initiative

AUTOMATED META-ACTIONS DISCOVERY FOR PERSONALIZED MEDICAL TREATMENTS

Healthcare, among other domains, provides an attractive ground of work for knowl- edge discovery researchers. There exist several branches of health informatics and health data-mining from which we find actionable knowledge discovery is underserved. Actionable knowledge is best represented by patterns of structured actions that in- form decision makers about actions to take rather than providing static information that may or may not hint to actions. The Action rules model is a good example of active structured action patterns that informs us about the actions to perform to reach a desired outcome. It is augmented by the meta-actions model that rep- resents passive structured effects triggered by the application of an action. In this dissertation, we focus primarily on the meta-actions model that can be mapped to medical treatments and their effects in the healthcare arena. Our core contribution lies in structuring meta-actions and their effects (positive, neutral, negative, and side effects) along with mining techniques and evaluation metrics for meta-action effects. In addition to the mining techniques for treatment effects, this dissertation provides analysis and prediction of side effects, personalized action rules, alternatives for treat- ments with negative outcomes, evaluation for treatments success, and personalized recommendations for treatments. We used the tinnitus handicap dataset and the Healthcare Cost and Utilization Project (HCUP) Florida State Inpatient Databases (SID 2010) to validate our work. The results show the efficiency of our methods

Measuring the Moment-to-Moment Variability of Tinnitus: The TrackYourTinnitus Smart Phone App

Tinnitus, the phantom perception of sound without a corresponding external sound, is a frequent disorder which causes significant morbidity. So far there is no treatment available that reliably reduces the tinnitus perception. The research is hampered by the large heterogeneity of tinnitus and the fact that the tinnitus perception fluctuates over time. It is therefore necessary to develop tools for measuring fluctuations of tinnitus perception over time and for analyzing data on single subject basis. However, this type of longitudinal measurement is difficult to perform using the traditional research methods such as paper-and-pencil questionnaires or clinical interviews. Ecological momentary assessment (EMA) represents a research concept that allows the assessment of subjective measurements under real-life conditions using portable electronic devices and thereby enables the researcher to collect longitudinal data under real-life conditions and high cost efficiency. Here we present a new method for recording the longitudinal development of tinnitus perception using a modern smartphone application available for iOS and Android devices with no costs for the users. The TrackYourTinnitus (TYT) app is available and maintained since April 2014. A number of 857 volunteers with an average age of 44.1 years participated in the data collection between April 2014 and February 2016. The mean tinnitus distress at the initial measurement was rated on average 13.9 points on the Mini-Tinnitus Questionnaire (Mini-TQ; max. 24 points). Importantly, we could demonstrate that the regular use of the TYT app has no significant negative influence on the perception of the tinnitus loudness nor on the tinnitus distress. The TYT app can therefore be proposed as a safe instrument for the longitudinal assessment of tinnitus perception in the everyday life of the patient

Core outcome domains for early-phase clinical trials of sound-, psychology-, and pharmacology-based interventions to manage chronic subjective tinnitus in adults: the COMIT'ID study protocol for using a Delphi process and face-to-face meetings to establish consensus

Background: The reporting of outcomes in clinical trials of subjective tinnitus indicates that many different tinnitus-related complaints are of interest to investigators, from perceptual attributes of the sound (e.g. loudness) to psychosocial impacts (e.g. quality of life). Even when considering one type of intervention strategy for subjective tinnitus, there is no agreement about what is critically important for deciding whether a treatment is effective. The main purpose of this observational study is therefore to develop Core Outcome Domain Sets for the three different intervention strategies (sound, psychological, and pharmacological) for adults with chronic subjective tinnitus that should be measured and reported in every clinical trial of these interventions. Secondary objectives are to identify the strengths and limitations of our study design for recruiting and reducing attrition of participants, and to explore uptake of the core outcomes. Methods: The ‘Core Outcome Measures in Tinnitus: International Delphi’ (COMIT’ID) study will use a mixed methods approach that incorporates input from healthcare users at the pre-Delphi stage, a modified three round Delphi survey and final consensus meetings (one for each intervention). The meetings will generate recommendations by stakeholder representatives on agreed Core Outcome Domain Sets specific to each intervention. A subsequent step will establish a common cross-cutting Core Outcome Domain Set by identifying the common outcome domains included in all three intervention-specific Core Outcome Domain Sets. To address the secondary objectives, we will gather feedback from participants about their experience of taking part in the Delphi process. We aspire to conduct an observational cohort study to evaluate uptake of the core outcomes in published studies at 7 years following core outcome set publication. Discussion: The COMIT’ID study aims to develop a Core Outcome Domain Set that are agreed as critically important for deciding whether a treatment for subjective tinnitus is effective. Such a recommendation would help to standardise future clinical trials worldwide and so we will determine if participation increases use of the core outcome set in the long term. Trial registration: This project has been registered in the database of the Core Outcome Measures in Effectiveness Trials (COMET) initiative

Otoacoustic emissions and medial olivocochlear system: patients with tinnitus and no hearing loss

BACKGROUND: tinnitus. AIM: to compare the results of otoacoustic emissions for transitory stimulus (TEOAE) and the functioning of the olivocochlear medial system, in individuals with normal hearing sensibility, with and without tinnitus. METHOD: participants of this study were 60 subjects, with tonal thresholds and acoustic imitance measurements within normal standards, distributed in two groups: group one - 30 subjects with tinnitus and group two - 30 subjects without tinnitus, paired up by gender and age. Both groups were submitted to the TEOAE test, with and without the presence of white contralateral white noise at 60dB NPS. For the 19 subjects who presented unilateral tinnitus, TEOAE and suppression results were compared regarding the variables of side, taking in consideration the presence of tinnitus. RESULTS: in the group comparison, with and without tinnitus, there was no significant statistical difference for the incidence of TEOAE, response levels, and incidence of the suppression effect. Significant statistical difference was not observed between the right and left ears in the group with tinnitus. For the 19 subjects with unilateral tinnitus, a higher amplitude of the responses and a higher suppression incidence were observed for the right ear, as well as a higher incidence of tinnitus and a lower incidence of suppression for the left ear. CONCLUSION: there was no significant statistical difference for both TEOAE incidence and response levels, as well as for the functioning of the olivocochlear medial system between the subjects, with normal hearing sensibility, with and without tinnitus. For the subjects who presented unilateral tinnitus, the overall TEOAE reponse levels was significantly higher in the ear with no tinnitus and the olivocochlear medial system was significantly less efficient in the ear with tinnitus.TEMA: zumbido. OBJETIVO: comparar os resultados das emissões otoacústicas transitório por estímulo (EOAT) e do funcionamento do sistema olivococlear medial, em indivíduos com sensibilidade auditiva normal, com e sem zumbido. MÉTODO: a casuística deste estudo foi composta por 60 sujeitos, com limiares tonais e medidas da imitância acústica dentro dos padrões da normalidade distribuídos em dois grupos: grupo um formado por 30 sujeitos com zumbido e grupo dois por 30 sujeitos sem zumbido, pareados por gênero e idade. Os dois grupos foram submetidos ao teste das EOAT com e sem ruído branco contralateral a 60dB NPS. Em 19 sujeitos que apresentavam zumbido unilateral comparou-se os resultados das EOAT e supressão em relação à variável lado, considerando-se o lado do zumbido. RESULTADOS: na comparação entre os grupos com e sem zumbido não houve diferença estatisticamente significante quanto à ocorrência das EOAT, à amplitude de resposta, e à ocorrência do efeito de supressão. Não se observou diferença estatisticamente significante entre as orelhas direita (OD) e esquerda (OE) no grupo com zumbido. Nos 19 sujeitos com zumbido unilateral, observou-se maior amplitude de resposta e maior ocorrência de supressão à direita e maior ocorrência de zumbido e menor ocorrência de supressão à esquerda. CONCLUSÃO: não houve diferença estatisticamente significante tanto na ocorrência e amplitude de respostas das EOAT quanto no funcionamento do sistema olivococlear medial entre os sujeitos, com sensibilidade auditiva normal, com e sem zumbido. Nos sujeitos que apresentaram zumbido unilateral, observou-se que a amplitude geral das EOAT foi maior na orelha sem zumbido e que o sistema olivococlear medial foi menos eficiente na orelha com zumbido de forma estatisticamente significante.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaAudiologia do Centro de Especialização em Fonoaudiologia ClínicaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Otorrinolaringologia e Distúrbios da Comunicação HumanaUNIFESP, EPM, Depto. de Otorrinolaringologia e Distúrbios da Comunicação HumanaSciEL