Characterizing the most Popular Tinnitus Inquiries: Is Tinnitus Incidence on the Rise Since COVID-19?

OBJECTIVE: Approximately 50 million US adults experience chronic tinnitus, yet search behaviors and topics of concern to these patients have not been investigated on a national level. STUDY DESIGN: Observational. SETTING: Online database and tertiary otology clinic. PATIENTS: Nationwide and institutional samples. INTERVENTIONS: None. MAIN OUTCOME MEASURE: A search engine optimization tool was utilized to extract metadata on "People Also Ask" (PAA) questions pertaining to tinnitus. Website quality was assessed using JAMA benchmark criteria. Search volume trends were investigated along with institutional-level data on tinnitus incidence. RESULTS: Of the 500 PAA questions assessed, the majority (54.0%) contained value-type content. The most popular question categories pertained to tinnitus treatment (29.3%), alternative treatment approaches (21.5%), technical details (16.9%), and timeline of symptoms (13.4%). Patients were most interested in treatment with wearable masking devices and most commonly searched for tinnitus as being attributable to a neurologic etiology. Online searches pertaining to unilateral tinnitus symptoms have increased >3-fold since the onset of the COVID-19 pandemic. Likewise, review of patient encounters at our tertiary otology clinic revealed a nearly 2-fold increase in tinnitus consultations since 2020. CONCLUSIONS: Topics of interest and concern identified herein may inform the development of patient education materials and help guide clinical practice. Online search data suggest an increase in tinnitus searches since the onset of COVID-19, which did correlate clinically with an increase in tinnitus consultations at our institution.

Experience of sudden sensorineural hearing loss following a mild COVID-19 infection.

A woman in her 30s was referred to an otolaryngologist with an acute onset of aural fullness, noise sensitivity, unilateral sudden onset hearing loss, vertigo and tinnitus. She had a confirmed COVID-19 infection 5 weeks prior. A pure tone audiogram confirmed sensorineural hearing loss. MRI identified an empty sella of the pituitary gland and without an obvious cause for hearing loss. Oral prednisolone and betahistine were prescribed, and her audiovestibular symptoms slowly improved over the subsequent months. The patient continues to experience intermittent tinnitus.

Tinnitus cases after COVID-19 vaccine administration, one institution's observations.

OBJECTIVE: After the role out of the COVID-19 vaccine in the United States, there has been increase in case reports of tinnitus attributed to the vaccine reported. We present our institution's experience over the initial 13 month period the vaccines were available. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary academic otology and general otolaryngology practice. PATIENTS: Patients who received a COVID-19 vaccine and a tinnitus diagnosis code. INTERVENTIONS: Observation, steroids (oral and intratympanic), diagnostic imaging and audiometry. MAIN OUTCOME MEASURES: Patients who received a COVID-19 vaccine in the time frame of 12/1/2020-12/31/21 with a diagnosis of tinnitus, an audiogram, and at least one visit with one of our Otolaryngologists were included in the study. Twenty-seven of the 1254 patients identified met these criteria. The patients ranged in age from 41 to 84 years old including seven male and twenty female patients. Sixteen received the Pfizer vaccine, seven received the Moderna vaccine and four patients received the Janssen vaccine. CONCLUSIONS: No definite correlation could be established between COVID-19 vaccine and tinnitus. Any concurrent sudden hearing loss should be treated as usual with oral or intratympanic steroids. Health care providers should be aware of the tinnitus onset and if new or recent onset, to refer for prompt audiogram and Otolaryngology evaluation.

Neuropsychiatric symptoms in post-COVID-19 long haulers.

BACKGROUND: Long haulers have been recently reported after contracting coronavirus disease (COVID-19). In the present study, we aimed to screen for the neuropsychiatric signs detected <1 to >6 months after infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to determine whether vaccination has an effect on them. METHODS: An online survey was conducted among participants who had been diagnosed with laboratory-confirmed SARS-CoV-2 infection. The clinical signs and durations of neuropsychiatric complaints and their correlations to sex, age, severity of COVID-19 signs, and vaccination status were screened. RESULTS: A total of 2218 individuals, including 1358 females and 860 males, with an age range of 12-70 years, submitted their responses. The respondents experienced cognitive dysfunction, mood alteration, depression, tinnitus, sleep disorders, and loss of taste and smell, with prevalence rates ranging from 18.9% (tinnitus) to 63.9% (loss of taste and smell). Of the respondents, 2.2-7.7% confirmed the persistence of symptoms for >6 months. Tinnitus was the least common complaint, and only 2.2% of the study participants had tinnitus for >6 months. Meanwhile, mood alteration persisted for >6 months in 7.6% of the study participants. More respondents who received two doses of BNT162b2 vaccine showed persistent symptoms than those in the other groups. Disease severity and female sex were identified as potential determinants of the development and persistency of such symptoms. CONCLUSION: Post-COVID neuropsychiatric symptoms were present in considerable percentages of the study participants with SARS-CoV-2 infection, persisting for >6 months in up to 7.6% of the participants.

Characterization of otologic symptoms appearing after COVID-19 vaccination.

OBJECTIVES: Anecdotal reports of sudden sensorineural hearing loss (SSNHL) following COVID-19 vaccination have emerged in the otolaryngology community. Studies have demonstrated no association between COVID-19 vaccination and SSNHL. We aim to characterize the spectrum of otologic symptoms following COVID-19 vaccination. METHODS: A cross-sectional study of patients seen in the otology clinic at an academic center was performed. Patients completed a questionnaire on the development of new otologic symptoms within 4 weeks of COVID-19 vaccination. Diagnostic and audiometric data was collected retrospectively for patients reporting otologic symptoms. RESULTS: Between May and July 2021, 500 patients were screened. Median age was 56.6 years old, with 59.4 % female and 40.2 % male. 420 patients (84.0 %) were vaccinated, with 58.4 % receiving Pfizer, 29.1 % receiving Moderna, and 3.8 % receiving Johnson & Johnson. 61 patients (14.5 %) reported one or more otologic symptoms within 4 weeks of vaccination, including 21 (5.0 %) with hearing loss, 26 (6.2 %) with tinnitus, 33 (7.9 %) with dizziness, and 19 (4.5 %) with vertigo. Of the 16 patients (3.2 %) reporting tinnitus with no associated hearing loss, 8 were diagnosed with subjective tinnitus and 4 were diagnosed with temporomandibular joint syndrome. Of the 18 patients reporting hearing loss, 11 had exacerbations of underlying pathologies (e.g. Meniere's disease, presbycusis) and 7 were newly diagnosed with SSNHL (1.4 %). CONCLUSIONS: Patients reporting otologic symptoms following COVID-19 vaccination received various diagnoses of uncertain etiology. The incidence of SSNHL in these patients is comparable to the general otology patient population. Additional studies are required to determine the incidence of specific diagnoses following vaccination.

Exploring the Effect of Silence on Auditory Network Regions in Young Female Adults who Experience Temporary Tinnitus on Exposure to Silence.

OBJECTIVES: To examine the differences in auditory evoked cortical responses that may underlie the tendency of some people to perceive tinnitus. The study hypothesis is that the mean ALR and P300 amplitudes in normal hearing adults who perceive temporary tinnitus after exposure to sustained silence will be larger than the mean ALR and P300 amplitudes in normal hearing adults who do not perceive temporary tinnitus after exposure to sustained silence. DESIGN: This was a prospective cross-sectional study. The approval for the study was obtained from the IRB and COVID ramp up committee of University of North Carolina Greensboro (UNCG). Participants completed comprehensive hearing screening and preand postsilence ALR and P300 recordings were obtained. After the first ALR/P300 recording participants were exposed to ten minutes of silence. Participants completed a Qualtrics questionnaire to report any tinnitus perception that emerged during silence exposure. Absolute N1, P2 and P300 waveform amplitudes and latencies were identified and were entered into an SPSS spreadsheet for data analysis. RESULTS: Thirty adult females with normal pure tone hearing thresholds and no history of persistent tinnitus were included in the study. The mean age of the participants was 22.5 ± 3.9 years. When exposed to silence, eight (26.7%) participants perceived temporary tinnitus. N1 and P300 waveforms were smaller in amplitude and faster in latency in the tinnitus perception group; however, the ALR and P300 waveform latencies and amplitudes did not statistically differ significantly between the participants who perceived temporary tinnitus in silence and those who did not (p>0.05). The difference in waveform morphology between the tinnitus perception group and the non-tinnitus perception group revealed a greater difference in P300 amplitude after exposure to silence. CONCLUSION: Differences in ALR and P300 latencies and amplitudes were observed between the tinnitus perception group and non-tinnitus perception group, with smaller P300 amplitudes appearing in the group perceiving tinnitus. While the results did not statistically significant, this pattern may reflect a mismatch between the neuronal response in the auditory cortex (N1 and P2 amplitudes and latencies) and the neuronal activity in the modulatory network regions (P300).

Healing From Home: Examination of an Online Mindfulness-Based Tinnitus Stress Reduction Course During the 2020 COVID Pandemic.

PURPOSE: The purpose of this study was to assess the effectiveness of an Internet delivered Mindfulness Based Tinnitus Stress Reduction (i-MBTSR) program during the COVID-19 pandemic. Tinnitus, often a chronic condition, is experienced by 15% of the population. For those with severe, bothersome tinnitus, quality of life is reduced and the treatment options are limited. We evaluated an approach intended to decrease tinnitus-related distress. METHOD: This study examined the data collected for an online i-MBTSR course using a retrospective design. The intervention included an 8-week self-paced i-MBTSR course, including didactic information about mindfulness and tinnitus, as well as meditation practices. Outcome measures included the Tinnitus Functional Index (TFI) and Perceived Stress Scale (PSS), which were measured at four time periods. These time points included pretreatment, midtreatment at 3 weeks, immediately posttreatment, and at 6-month follow-up. RESULTS: Forty-three participants completed the intervention. The mean preintervention tinnitus severity rating was 59.96 ("severe tinnitus") as measured by the TFI. Mean TFI scores dropped to 44.16 (p < .001) at midtreatment and to 34.23 (p = .001) at posttreatment. Repeated-measures analysis of variance and multivariate analysis of variance tests were conducted to determine changes in the two scales at the four time periods. There were significant differences in perceived stress and tinnitus self-function found in all measures and submeasures between the pre-, mid-, and posttreatment time points with the exception of the TFI Auditory subtest. These gains remained significant for those who completed the 6-month follow-up. CONCLUSIONS: The i-MBTSR course appears to be a viable and effective treatment modality. A shorter 3-week course may be effective. Case-control studies to more systematically investigate the effectiveness of i-MBTSR for tinnitus are required.

Evaluation of Disturbances in Hearing, Tinnitus, and Dizziness as Signs of COVID-19 Infection.

BACKGROUND: There have been reports and studies indicating audiovestibular disturbances in COVID-19 patients with variations in the percentage of sensorineural hearing loss (SNHL). The purpose of this study is to compare the incidence of newly diagnosed SNHL, sudden idiopathic hearing loss (SIHL), tinnitus, and vestibular disturbances between infected and uninfected patients, as well as to identify population groups at risk. METHODS: This study used TriNetX to obtain statistics on COVID-19 (+) and COVID-19 (-) patients from 61 healthcare organizations. Propensity score with 1:1 matching was used to control confounding variables. This study evaluated the relative risk of developing audiovestibular disturbances up to 1 month after a COVID-19 test and further investigated the incidence in COVID-19 (+) subset groups. RESULTS: Between COVID-19 (+) and COVID-19 (-) patients who had an audiogram, there was no statistically significant difference in SNHL or SIHL (SNHL: relative risk [RR] = 0.69, 95% confidence interval [CI] = 0.46-1.04; SIHL: RR = 1.00, 95% CI = 0.42-2.40). Race/ethnicity or specified comorbidity did not affect the incidence of SNHL or SIHL. There was a statistically significant difference in tinnitus and vestibular disturbances between the COVID-19 (+) and the COVID-19 (-) groups (RR = 1.29, 95% CI = 1.01-1.66; RR = 2.33, 95% CI = 2.19-2.48). CONCLUSION: New onset hearing loss is not more common in patients with a positive COVID-19 test than those with a negative COVID-19 test. Audiologic evaluation is needed to verify reported hearing disturbances. Although statistically significant in specific population groups, tinnitus and vestibular disturbances may not be clinically significant due to the low incidence.

[Thunder and lightning-a report on firework-associated acoustic trauma at New Year 2021/2022 (German version)]. / Schlag auf Schlag ­ Bericht über feuerwerksbedingte Knalltraumata zum Jahreswechsel 2021/2022.

BACKGROUND: This cross-sectional study aimed to assess the frequency and type of firework-associated acoustic trauma occurring in Germany on New Year's Eve 2021, despite the ban on firework sales due to the COVID-19 pandemic. MATERIALS AND METHODS: The survey period lasted 7 days, from 28 December 2021 to 03 January 2022. A questionnaire inquired date, type and treatment of trauma, sex, and age of the patient, and whether the trauma occurred when lighting or watching fireworks. Hearing impairment was classified according to the World Health Organization (WHO grades 0 to 4), and concomitant tinnitus, vertigo, or other injuries were recorded. The questionnaire was sent to the otorhinolaryngology departments of 171 hospitals in Germany. RESULTS: Of 37 otorhinolaryngology departments, 16 reported no and 21 reported 50 patients with firework-associated acoustic trauma. Mean age was 29 ± 16 years and 41 of 50 patients were males. Of these 50 patients, 22 presented without and 28 with hearing loss, 32 reported tinnitus and 3 vertigo; 20 patients were injured when lighting fireworks and 30 when watching. Hearing impairment was classified as 14â€¯× WHO grade 0, 5â€¯× WHO grade 1, 4â€¯× WHO grade 2, 2â€¯× WHO grade 3, and 3â€¯× WHO grade 4. Inpatient treatment was received by 8 patients and 11 suffered from concomitant burn injuries. CONCLUSION: Despite the sales ban, some firework-associated acoustic traumas occurred at New Year 2021/2022 in Germany. Some instances led to hospitalization, but an even higher number of unreported cases can be assumed. This study can serve as a baseline for further annual surveys to raise the awareness of the danger of seemingly harmless fireworks for the individual.

Immune response to the mRNA COVID-19 vaccine in hemodialysis patients: cohort study (preprint)

Background: End-stage renal disease (ESRD) patients experience immune compromise characterized by complex alterations of both innate and adaptive immunity, and results in higher susceptibility to infection and lower response to vaccination. This immune compromise, coupled with greater risk of exposure to infectious disease at hemodialysis (HD) centers, underscores the need for examination of the immune response to the COVID-19 mRNA-based vaccines.Methods: A transcriptomic analysis of the immune response to the Covid-19 BNT162b2 mRNA vaccine was assessed in 20 HD patients and cohort-matched controls. RNA sequencing of peripheral blood mononuclear cells (PBMCs) was performed longitudinally before and after each vaccination dose for a total of six time points per subject. Anti-spike antibody levels were quantified prior to the first vaccination dose (V1D0) and seven days after the second dose (V2D7) using anti-Spike IgG titers and antibody neutralization assays. Anti-spike IgG titers were additionally quantified six months after initial vaccination. Clinical history and lab values in HD patients were obtained to identify predictors of vaccination response.Results: Transcriptomic analyses demonstrated differing time courses of immune responses, with predominant T cell activity in controls one week after the first vaccination dose, compared to predominant myeloid cell activity in HD at this time point. HD demonstrated decreased metabolic activity and decreased antigen presentation compared to controls after the second vaccination dose. Anti-spike IgG titers and neutralizing function were substantially elevated in both controls and HD at V2D7, with a small but significant reduction in titers in HD groups (p < 0.05). Anti-spike IgG remained elevated above baseline at six months in both subject groups. Anti-spike IgG titers at V2D7 were highly predictive of 6-month titer levels. Transcriptomic biomarkers after the second vaccination dose and clinical biomarkers including ferritin levels were found to be predictive of antibody development.Conclusion: Overall, we demonstrate differing time courses of immune responses to the BTN162b2 mRNA COVID-19 vaccination in maintenance hemodialysis subjects (HD) comparable to healthy controls (HC) and identify transcriptomic and clinical predictors of anti-Spike IgG titers in HD. Analyzing vaccination as an in vivo perturbation, our results warrant further characterization of the immune dysregulation of end stage renal disease (ESRD). Funding: F30HD102093, F30HL151182, T32HL144909, R01HL138628This research has been funded by the University of Illinois at Chicago Center for Clinical and Translational Science (CCTS) award UL1TR002003

Multiple Sclerosis Presenting as Intracranial Hypertension in the Setting of COVID-19 Infection (preprint)

Background Multiple sclerosis (MS) and Idiopathic Intracranial Hypertension (IIH) occur more commonly in women of childbearing age. There is cerebral spinal fluid (CSF) altered dynamics in both diseases causing them to have similar presentation at times. Coronavirus disease 19 (COVID-19) have also been reported to affect the Central Nervous System (CNS) of any age.Case Presentation: We report A-19-year-old male who initially presented with headaches, and fever and was diagnosed with COVID-19 infection. A few days later, he developed acute severe left eye pain, blurred vision, diplopia, and left ear tinnitus. The patient was found to have reduced visual acuity, left sixth nerve palsy, esotropia and asymmetric bilateral papilledema. Later, he developed left facial nerve palsy. MRI of the brain showed extensive demyelinating lesions. Lumbar puncture revealed significantly increased intracranial pressure (ICP) and positive oligoclonal bands.Conclusion This is a unique case of MS presenting with intracranial hypertension (IH) in the setting of COVID-19 infection that could have been the trigger for the MS clinical attack.

Audiological and vestibular symptoms following SARS-CoV-2 infection and COVID-19 vaccination in children aged 5-11 years.

PURPOSE: The present study assessed the prevalence of audio-vestibular symptoms following SARS-COV-2 infection or COVID-19 vaccination among children, comparing the two groups. A further aim was to evaluate whether children with pre-existing unilateral hearing loss were more prone to adverse events. MATERIALS AND METHODS: This retrospective study included children aged 5-11 years with normal hearing or a proven history of unilateral hearing loss who contracted SARS-CoV-2 or received two doses of COVID-19 vaccine. Tinnitus, hyperacusis, aural fullness, otalgia, otorrhea, new-onset hearing loss, vertigo and dizziness were investigated as possible complications of SARS-CoV-2 infection or the COVID-19 vaccine. RESULTS: This study included 272 children (143 boys, 129 girls), with a mean age of 7.8 ± 2.3 years. Among these, 120 were affected by pre-existing unilateral hearing loss. The most common audio-vestibular symptoms reported by children following SARS-CoV-2 infection and COVID-19 vaccination were aural fullness (33/132, 25 %) and dizziness (5/140, 3.6 %), respectively. All symptoms following COVID-19 vaccination resolved within 24 h. Compared to children who received the COVID-19 vaccine, those infected with SARS-CoV-2 had a higher prevalence of tinnitus (p = 0.009), hyperacusis (p = 0.003), aural fullness (p < 0.001), otalgia (p < 0.001), otorrhea (p < 0.001), and vertigo (p = 0.006). Two girls also experienced new-onset unilateral sensorineural hearing loss following SARS-CoV-2 infection. Children with a known history of unilateral hearing loss did not have a higher prevalence of audio-vestibular symptoms than children with normal hearing. CONCLUSIONS: Our results suggest that the COVID-19 vaccine is safe and can be recommended for children with unilateral hearing loss without fear of possible audio-vestibular sequelae.

Associations Between Reported Post-COVID-19 Symptoms and Subjective Well-Being, Israel, July 2021 -April 2022 (preprint)

The impact of individual symptoms reported post-COVID-19 on subjective well-being (SWB) is unknown. We described associations between SWB and selected reported symptoms following SARS-CoV-2 infection. We analysed reported symptoms and subjective well being from 2295 participants (of which 576 reporting previous infection) in an ongoing longitudinal cohort study taking place in Israel. We estimated changes in SWB associated with reported selected symptoms at three follow-up time points (3-6, 6-12, and 12-18 months post infection) among participants reporting previous SARS-CoV-2 infection, adjusted for key demographic variables, using linear regression. Our results suggest that the biggest and most sustained changes in SWB stems from non-specific symptoms (fatigue -7.7 percentage points (pp), confusion/ lack of concentration -10.7 pp, and sleep disorders -11.5pp, p<0.005), whereas the effect of system-specific symptoms, such as musculoskeletal symptoms (weakness in muscles and muscle pain) on SWB, are less profound and more transient. Taking a similar approach for other symptoms and following individuals over time to describe trends in SWB changes attributable to specific symptoms will help understand the post-acute phase of COVID-19 and how it should be defined and better managed.

Cochleovestibular findings linked to COVID-19: A scoping review for clinical care planning in South Africa.

BACKGROUND:  On 30 January 2020, the World Health Organization (WHO) officially declared an outbreak of the coronavirus disease 2019 (COVID-19) to be a global health emergency. Research has focused on the impact and response to life-threatening symptoms of COVID-19 across the lifespan; however, there is a need to investigate the effects of COVID-19 on the cochleovestibular system, as viral infections are known to impact this system. This is particularly important for contexts where resources are limited and prioritisation of resources requires strong risk versus benefit evaluations. OBJECTIVE:  Therefore, the purpose of this scoping review was to investigate published evidence on the impact of COVID-19 on the cochleovestibular system across the lifespan in order to allow for strategic clinical care planning in South Africa, where capacity versus demand challenges exist. METHODS:  Electronic bibliographic databases such as CINAHL, EBSCOHost, MEDLINE, ProQuest, PubMed, Scopus and ScienceDirect were searched for peer-reviewed publications between January 2020 and January 2022. These had to be published in English and related to the impact of COVID-19 on the cochleovestibular system, where the question was: 'what evidence has been published on the impact of COVID-19 on the cochleovestibular system?' Review selection and characterisation was performed by the researcher with an independent review by a colleague using pretested forms. RESULTS:  Of a total of 24 studies that met the inclusion criteria, the current scoping review revealed limited conclusive published evidence linking COVID-19 to permanent hearing function symptoms. Current evidence supports the possibility of COVID-19, similar to other viral infections in adults, impacting the cochleovestibular system and causing tinnitus, vertigo and sudden sensorineural hearing loss (SSNHL), with the symptoms being generally temporary and resolving either partially or completely following therapy with steroids, with very inconclusive findings in the paediatric population. CONCLUSION:  These findings raise global implications for properly designed studies, which include longitudinal follow-up of cases across the lifespan, examining this link with some focus on establishing the pathophysiologic mechanisms at play as well. In the meanwhile, current findings raise the value of polymerase chain reaction (PCR) testing for all patients presenting with unexplained cochleovestibular symptoms during the pandemic, as these may be the only presenting symptoms indicating COVID-19, thus requiring careful treatment and management.

Prudent healthcare in practice: integration of audiology services into primary care.

BACKGROUND: Swansea Bay University Health Board (SB UHB) has been trialling a primary care audiology pathway since 2016. The pathway enables patients with hearing, tinnitus or wax problems to be triaged directly to the audiology department acting as the first point of contact, freeing up general practitioners, Ear, Nose and Throat consultants and nurses to see patients with more complex health conditions. PURPOSE: To evaluate the efficiency of the SB UHB primary care audiology pathway. PARTICULAR FOCUS: Clinical outcomes of patients seen through the SB UHB primary care audiology pathway. OVERVIEW: The vast majority of patients seen through the SB UHB primary care audiology pathway are managed without the need for onward referral (≥87%).

Coping With Tinnitus During the COVID-19 Pandemic.

Purpose The COVID-19 pandemic disrupted normal operations of health care services, broad sectors of the economy, and the ability to socialize freely. For those with tinnitus, such changes can be factors in exacerbating tinnitus. The purpose of this study was to determine tinnitus help-seeking behavior, which resources individuals utilized to cope during the pandemic, and what additional support is desired. Method An exploratory cross-sectional study design including 1,522 adults with tinnitus living in North America (Canada and the United States) was used. Data were collected through an online survey distributed by the American Tinnitus Association via e-mail. Free text from open-ended questions was analyzed using the automated content analysis. The responses to the structured questionnaire were analyzed using descriptive and nonparametric statistics. Results Significantly less tinnitus support was sought during the pandemic, and very few respondents utilized tinnitus support networks during the pandemic at the time the survey was conducted. Nonetheless, seeking support during the pandemic was significantly associated with significantly less tinnitus distress. The most frequently utilized resources for coping during the pandemic were contacting family and friends, spending time outdoors or in nature, relaxation, and exercise. Such tools for coping were associated with significantly less tinnitus distress. The support requested and advice provided by participants to health care services had overlap. The main support needs related to managing tinnitus included addressing hearing loss, providing peer support, finding cures, and accessing trained and understanding health care providers to help. The advice for professionals related to tinnitus management included the need for cures, personalized support, addressing hearing loss, targeting the tinnitus percept, and providing more information about the condition. Conclusions These findings provide suggestions on how to better support those with tinnitus at a time when health care is undergoing rapid changes. Findings can be used by stakeholders, clinical practitioners, and tinnitus support services to devise ways to work more effectively together to improve access to patient-driven, suitable, accessible, and evidence-based support. Supplemental Material https://doi.org/10.23641/asha.14558514.