Gameplay as a source of intrinsic motivation in a randomized controlled trial of auditory training

Background: Previous studies of frequency discrimination training (FDT) for tinnitus used repetitive task-based training programmes relying on extrinsic factors to motivate participation. Studies reported limited improvement in tinnitus symptoms. Purpose: To evaluate FDT exploiting intrinsic motivations by integrating training with computer-gameplay. Methods: Sixty participants were randomly assigned to train on a conventional taskbased training, or one of two interactive game-based training platforms over six weeks. Outcomes included assessment of motivation, tinnitus handicap, and performance on tests of attention. Results: Participants reported greater intrinsic motivation to train on the interactive game-based platforms, yet compliance of all three groups was similar (~70%) and changes in self-reported tinnitus severity were not significant. There was no difference between groups in terms of change in tinnitus severity or performance on measures of attention. Conclusion: FDT can be integrated within an intrinsically motivating game. Whilst this may improve participant experience, in this instance it did not translate to additional compliance or therapeutic benefit

Effects of frequency discrimination training on tinnitus:Results from two randomised controlled trials

That auditory perceptual training may alleviate tinnitus draws on two observations: (1) tinnitus probably arises from altered activity within the central auditory system following hearing loss and (2) sound-based training can change central auditory activity. Training that provides sound enrichment across hearing loss frequencies has therefore been hypothesised to alleviate tinnitus. We tested this prediction with two randomised trials of frequency discrimination training involving a total of 70 participants with chronic subjective tinnitus. Participants trained on either (1) a pure-tone standard at a frequency within their region of normal hearing, (2) a pure-tone standard within the region of hearing loss or (3) a high-pass harmonic complex tone spanning a region of hearing loss. Analysis of the primary outcome measure revealed an overall reduction in self-reported tinnitus handicap after training that was maintained at a 1-month follow-up assessment, but there were no significant differences between groups. Secondary analyses also report the effects of different domains of tinnitus handicap on the psychoacoustical characteristics of the tinnitus percept (sensation level, bandwidth and pitch) and on duration of training. Our overall findings and conclusions cast doubt on the superiority of a purely acoustic mechanism to underpin tinnitus remediation. Rather, the nonspecific patterns of improvement are more suggestive that auditory perceptual training affects impact on a contributory mechanism such as selective attention or emotional state. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s10162-012-0323-6) contains supplementary material, which is available to authorized users

Screenshots of the three training platforms.

<p><i>STAR2</i> background image rotates through a series of nature scenes unrelated to the task. <i>Treasure Hunter</i> is shown with an example of feedback after a level. <i>Submarine</i> is shown as successive snapshots to reflect movement across the screen, with an example of reward in the form of accrued points for each completed level.</p

Trial flow chart.

<p>Trial flow chart.</p

Baseline characteristics and training details.

<p>PTA: Pure Tone Average calculated as the average hearing threshold for 0.5, 1, 2 and 4 kHz, averaged across both ears. THQ: Tinnitus Handicap Questionnaire. VAS: Visual Analogue Scale.</p><p>Baseline characteristics and training details.</p

Global Tinnitus Handicap Questionnaire scores.

<p>Mean tinnitus handicap score (±95% CI) at the primary assessment points (T0 and T1 – black bars) and at follow up visits T2 and T3 (grey bars). n = 20 per group. Global score range in 0–2700.</p

Sustained and divided attention task scores before and after training.

<p>There was no significant change in the measure of sustained attention after training. There was a significant between groups difference on the divided attention task for Group A compared to Group B but there was no effect of time or interaction (*<i>p</i><0.05). n = 20 per group.</p