Patient uptake and experiences of Internet-based cognitive behavioural therapy for tinnitus in the US: Process evaluation of a randomized controlled trial

Introduction: An internet-based cognitive behavioral therapy (ICBT) offers a way to increase access to evidence-based tinnitus care. To increase the accessibility of this intervention, the materials were translated into Spanish to reach Spanish as well as English speakers. A clinical trial indicated favorable outcomes of ICBT for tinnitus for the population of the United States. In view of later dissemination, a way to increase the applicability of this intervention is required. Such understanding is best obtained by considering the perspectives and experiences of participants of an intervention. This study aimed to identify the processes that could facilitate or hinder the clinical implementation of ICBT in the United States. Methods: This study evaluated the processes regarding enrolment, allocation, intervention delivery, the outcomes obtained, and the trial implementation. The study sample consisted of 158 participants who were randomly assigned to the experimental and control group. Results: Although the recruitment was sufficient for English speakers, recruiting the Spanish participants and participants belonging to ethnic minority groups was difficult despite using a wide range of recruitment strategies. The allocation processes were effective in successfully randomizing the groups. The intervention was delivered as planned, but not all the participants chose to engage with the materials provided. Compliance for completing the outcome measures was low. The personal and intervention factors were identified as barriers for the implementation whereas the facilitators included the support received, being empowering, the accessibility of the intervention, and its structure. Conclusion: An understanding regarding the factors contributing to the outcomes obtained, the barriers and facilitators of the results, engagement, and compliance were obtained. These insights will be helpful in preparing for the future dissemination of such interventions

Third-party disability for significant others of individuals with tinnitus : a cross-sectional survey design

DATA AVAILABILITY : The dataset is obtainable at http://doi.org/10.6084/m9.figshare.1506 2691 (accessed on 27 July 2021).There is currently increasing awareness of third-party disability, defined as the disability and functioning of a significant other (SO) due to the health condition of one of their family members. The effects of third-party disability on the SOs of individuals with tinnitus have received little attention. To address this knowledge gap, this study investigated third-party disability in the significant others (SOs) of individuals with tinnitus. A cross-sectional survey design included 194 pairs of individuals from the USA with tinnitus and their significant others. The SO sample completed the Consequences of Tinnitus on Significant Others Questionnaire (CTSOQ). Individuals with tinnitus completed standardized self-reported outcome measures for tinnitus severity, anxiety, depression, insomnia, hearing-related quality of life, tinnitus cognitions, hearing disability, and hyperacusis. The CTSOQ showed that 34 (18%) of the SOs were mildly impacted, 59 (30%) were significantly impacted, and 101 (52%) were severely impacted. The clinical variables of tinnitus severity, anxiety, and hyperacusis in individuals with tinnitus were the best predictors of the impact of tinnitus on SOs. These results show that the SOs of individuals with tinnitus may experience third-party disability. The effect of the individual’s tinnitus on their SO may be greater when the individual with tinnitus has a higher level of tinnitus severity, anxiety, and hyperacusis.National Institute on Deafness and Other Communication Disorders (NIDCD) of the National Institute of Health (NIH).https://www.mdpi.com/journal/audiolresSpeech-Language Pathology and Audiolog

Reply to Aldè et al. Comment on “Manchaiah et al. Social Representations of “Tinnitus” and “Health” among Individuals with Tinnitus Seeking Online Psychological Interventions. Audiol. Res. 2023, 13, 207–220

No abstract available.https://www.mdpi.com/journal/audiolresSpeech-Language Pathology and Audiolog

Adverse COVID-19 vaccination effects in Finnish patients with Meniere's disease : a cross-sectional study

DATA AVAILABILITY : UNDERLYING DATA : Figshare: COVID 19 vaccine in Ménière’s disease, https://doi.org/10.6084/m9.figshare.19519801. This project contains the following underlying data: - COVID vaccine in MD for repository.xslx (raw data). EXTENDED DATA : Figshare: COVID 19 vaccine in Ménière’s disease, https://doi.org/10.6084/m9.figshare.19519801. This project contains the following extended data: - Finnish_MD COVID Vaccination Questionnaire - English_MD COVID Vaccination Questionnaire - S 1S1 The STROBE Checklist. Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).BACKGROUND : The association between reporting adverse coronavirus disease 2019 (COVID-19) vaccination effects and those with a history of audiovestibular difficulties is unknown. The aim of this research is therefore to investigate adverse vaccination effects in adults with a history of Ménière’s disease. Specifically, the incidence of adverse effects, the factors associated with those reporting adverse effects and the relationship between the reporting of audiovestibular and other adverse effects. METHODS : A mixed-methods exploratory cross-sectional survey study design was used. Data were collected from 333 members of the Finnish Ménière Association. The survey was designed to obtain demographic information that may be associated with having adverse effects or not, vaccination-specific information and adverse vaccination effects. Both health and audiovestibular adverse events were identified. Data analysis included comparing those reporting and not reporting adverse vaccination effects. RESULTS : The mean age was 63 years with 81% being female. Of the 327 respondents who had one of the COVID-19 vaccinations (Comirnatry/ Pfizer, Astra Zeneca, or Moderna), 203 (62%) reported no adverse effects. The type of or number of vaccinations were not related to the reporting of adverse effects. The most frequently reported adverse effects were injection site tenderness (38%), arm pain (21%), fever (15%) and headaches (15%). Post-vaccination tinnitus and vertigo (both 7%) were the most frequently reported audiovestibular-related symptoms, followed by aural fullness (6%) and hearing loss (4%). Those reporting previous pre-vaccination vertigo were more likely to have post-vaccination vertigo. The presence of post-vaccination tinnitus, hearing loss, and aural fullness, predicted the presence of post-vaccination vertigo. CONCLUSIONS : A small proportion of patients with a history of Ménière’s disease may experience adverse post-vaccination effects. Further research is required to explore whether adverse postvaccination audiovestibular effects are more prevalent in those with a history of otological disorders compared with the general population.http://f1000research.comam2023Speech-Language Pathology and Audiolog

The effects of tinnitus on significant others

Although chronic conditions could cause third-party disability for significant others (SOs), little is known regarding the impact of tinnitus on SO. This study aimed to identify the effects of tinnitus on SOs. SOs of individuals with tinnitus were invited to participate in this study. SOs completed three open-ended questions focusing on the effects of tinnitus. Individuals with tinnitus completed the Tinnitus Functional Index as a self-reported measure of tinnitus severity. A mixedmethods analysis approach was undertaken. Of the 156 SOs responding, 127 (85%) reported that tinnitus impacted them. The impact surrounded sound adjustments, activity limitations, additional demands, emotional toll, and helplessness. Tinnitus negatively affected the relationship for 92 (58%) due to communication frustrations and growing apart. When asked if tinnitus had any positive effects, 64 (47%) SOs reported positive lifestyle adaptions, personal development, health awareness, and a changed outlook. There was no association between the level of tinnitus severity and SOs reporting that tinnitus had an impact on them individually, their relationships, or those reporting positive experiences. The study highlighted the third-party disability many SOs of individuals with tinnitus experience. The results indicate that SOs may benefit from a shared intervention to help mitigate the negative effects through a better understanding of tinnitus.National Institute on Deafness and Communication Disorders (NIDCD) of the National Institute of Health (NIH).https://www.mdpi.com/journal/jcmSpeech-Language Pathology and Audiolog

Internet-based audiologist-guided cognitive behavioral therapy for tinnitus : randomized controlled trial

BACKGROUND : Tinnitus is a symptom that can be very distressing owing to hearing sounds not related to any external sound source. Managing tinnitus is notoriously difficult, and access to evidence-based care is limited. Cognitive behavioral therapy (CBT) is a tinnitus management strategy with the most evidence of effectiveness but is rarely offered to those distressed by tinnitus. The provision of internet-based CBT for tinnitus overcomes accessibility barriers; however, it is not currently readily available in the United States. OBJECTIVE : The aim of this study is to investigate the efficacy of internet-based CBT compared with that of weekly monitoring for the management of tinnitus in reducing tinnitus distress; reducing tinnitus-related comorbidities, including tinnitus cognitions, insomnia, anxiety, and depression; and assessing the stability of the intervention effects 2 months after the intervention. METHODS : A 2-arm randomized clinical trial comparing audiologist-guided internet-based CBT (n=79) to a weekly monitoring group (n=79) with a 2-month follow-up assessed the efficacy of internet-based CBT. Eligible participants included adults seeking help for tinnitus. Recruitment was conducted on the web using an open-access website. Participants were randomized via 1:1 allocation, but blinding was not possible. The study was undertaken by English or Spanish speakers on the web. The primary outcome was a change in tinnitus distress as measured using the Tinnitus Functional Index. Secondary outcome measures included anxiety, depression, insomnia, tinnitus cognition, hearing-related difficulties, and quality of life. RESULTS : Internet-based CBT led to a greater reduction in tinnitus distress (mean 36.57, SD 22) compared with that in weekly monitoring (mean 46.31, SD 20.63; effect size: Cohen d=0.46, 95% CI 0.14-0.77) using an intention-to-treat analysis. For the secondary outcomes, there was a greater reduction in negative tinnitus cognition and insomnia. The results remained stable over the 2-month follow-up period. No important adverse events were observed. Further, 16% (10/158) of participants withdrew, with low overall compliance rates for questionnaire completion of 72.3% (107/148) at T1, 61% (91/148) at T2, and 42% (62/148) at T3. CONCLUSIONS : This study is the first to evaluate and indicate the efficacy of audiologist-delivered internet-based CBT in reducing tinnitus distress in a US population. It was also the first study to offer internet-based CBT in Spanish to accommodate the large Hispanic population in the United States. The results have been encouraging, and further work is indicated in view of making such an intervention applicable to a wider population. Further work is required to improve compliance and attract more Spanish speakers.The National Institute on Deafness and Other Communication Disorders of the National Institute of Healthhttp://www.jmir.orghj2022Speech-Language Pathology and Audiolog

A comparative study of readability, acceptability, and the adaptation of an internet-based cognitive behavioral therapy for tinnitus

BACKGROUND : Internet-based cognitive behavioral therapy has shown effectiveness in managing chronic tinnitus. Internet-based cognitive behavioral therapy is currently available in only a few languages (English, Swedish, Spanish, and German). The current study aimed to adapt, evaluate, and compare the readability and acceptability of the Turkish internet-based cognitive behavioral therapy materials compared to previous versions. METHODS : Internet-based cognitive behavioral therapy materials were adapted from the preexisting American English to the Turkish population in a 4-step process: (1) cultural adaptations, (2) acceptability adaptation of materials to the Turkish-speaking population, and (3) literacy-level adjustments. Experts (n = 11) and patients (n = 11) rated the intervention materials and the ePlatform for acceptability, including usability, content, presentation, and suitability (4). RESULTS : Literacy-level adjustments generated acceptable and readability levels of the Turkish version of the internet-based cognitive behavioral therapy program. The average readability score was 76.15 ± 0.35. The Turkish internet-based cognitive behavioral therapy (Mdn: 7.00) was statistically lower compared to the Swedish (Mdn: 9.00) but higher when compared to the American English and Spanish (Mdn: 5.00) versions. There were no statistical differences between the British English and Turkish versions in readability scores. Acceptability in the internet-based cognitive behavioral therapy platform was rated favorably. CONCLUSION : The Turkish internet-based cognitive behavioral therapy was found to be user-friendly and easy to understand, with navigations that are straightforward, have clear information, and are supported by audiologists. The readability score of the Turkish internet-based cognitive behavioral therapy is within recommended limits to ensure comprehensibility. We suggest that an online cognitive behavioral therapy program is adaptable for other languages for countries with a limited number of clinicians focused on cognitive behavioral therapy and tinnitus.https://www.advancedotology.orgeo2024Speech-Language Pathology and AudiologySDG-03:Good heatlh and well-bein

Internet‑delivered cognitive behavioral therapy for tinnitus compared to Internet‑delivered mindfulness for tinnitus : a study protocol of a randomized controlled trial

AVAILABILITY OF DATA AND MATERIALS : After the publication of trial results, a de-identified dataset will be available from the PI upon a reasonable request.BACKGROUND : Tinnitus affects around 15% of the population and can be a debilitating condition for a sizeable part of them. However, effective evidence-based treatments are scarce. One recommended treatment for tinnitus is cognitive behavioral therapy which has been found to be effective when delivered online. However, more treatments including mindfulness-based interventions have been studied recently in an attempt to facilitate the availability of effective treatments. There are promising findings showing great effects in reducing tinnitus-induced distress and some evidence about the efficacy of such intervention delivered online. However, there is a lack of evidence on how these two treatments compare against one another. Therefore, the aim of this study will be to compare Internet-delivered cognitive behavioral therapy for tinnitus against an Internet-delivered mindfulness-based tinnitus stress reduction intervention in a three-armed randomized controlled trial with a waiting list control condition. METHODS : This study will be a randomized controlled trial seeking to recruit Lithuanian-speaking individuals suffering from chronic tinnitus. The self-report measure Tinnitus Handicap Inventory will be used. Self-referred participants will be randomized into one of three study arms: Internet-delivered cognitive behavioral therapy, Internet-delivered mindfulness- based tinnitus stress reduction intervention, or a waiting-list control group. Post-treatment measures will be taken at the end of the 8-week-long intervention (or waiting). Long-term efficacy will be measured 3 and 12 months post-treatment. DISCUSSION : Internet-delivered interventions offer a range of benefits for delivering evidence-based treatments. This is the first randomized controlled trial to directly compare Internet-delivered CBT and MBTSR for tinnitus in a noninferiority trial. TRIAL REGISTRATION : ClinicalTrials.gov NCT05705323. Registered on January 30, 2023.The Research Council of Lithuania (LMTLT).https://trialsjournal.biomedcentral.comam2023Speech-Language Pathology and AudiologySDG-03:Good heatlh and well-bein