Seeking Help for Tinnitus and Satisfaction With Healthcare Providers Including Diagnosis, Clinical Services, and Treatment: A Scoping Review.

The objective of this scoping review was to describe the extent and type of evidence related to seeking help for tinnitus and satisfaction with healthcare providers including diagnosis, services and treatments along the clinical pathway. The selection criteria were adults aged 18 and over with tinnitus who sought help and where patient satisfaction with healthcare providers was reported. Online databases MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP) and CINAHL plus (EBSCO) were searched for original studies in English. The search had no date limit. Twenty-one records were eligible for data extraction. Studies reported that the most common healthcare providers seen were general practitioners, ear, nose and throat specialists and audiologists. Depression and tinnitus severity were related to an increase in the number of times help was sought and the type of healthcare provider seen may also impact patient satisfaction. The majority of participants were unlikely to receive a referral to a specialist at the initial GP consultation. Although there is limited research in this area, help-seekers for tinnitus were generally dissatisfied and reported negative interactions with healthcare providers. However, once in a specialised tinnitus clinical setting, studies reported that most help-seekers were satisfied and had positive interactions with healthcare providers.

The use of patient-report measures and intervention strategies for children and adolescents with chronic tinnitus: a scoping review.

BACKGROUND: Chronic tinnitus during childhood/adolescence can be associated with impaired quality of life. Guidelines for managing paediatric tinnitus recommend assessment and interventions are often based upon the experiences and opinions of guideline committee members. OBJECTIVE: To examine patient response tools used for the assessment and management of childhood tinnitus and how interventions had been evaluated. DESIGN: A structured scoping review (i) identifying and critically appraising patient response measures (PRMs) assessing tinnitus in children/adolescents, and (ii) critically appraising evidence supporting reported interventions. Original papers written in English, involving paediatric participants ≤19 years, reporting (i) application of established PRMs to assess the experience of chronic tinnitus or (ii) application and evaluation of tinnitus interventions were included. STUDY SAMPLE: Papers written in English, identifying, or assessing the experience of chronic tinnitus (>3 months) as a primary complaint during childhood/adolescence in participants ≤19 years of age using a PRM and studies evaluating the application of non-pharmaceutical interventions for tinnitus in children/adolescents. RESULTS: Six studies involving the assessment of tinnitus during childhood/adolescence using a PRM were identified and evaluated. Three established (previously named, described, and published) PRMs were applied of which none were developed specifically for children/adolescents. Three behavioural tinnitus interventions and three combination intervention strategies (coupling of psychological intervention with sound enrichment) had been applied to and evaluated within paediatric populations. CONCLUSIONS: Although clinicians are seeing children/adolescents with tinnitus, they are evaluating and managing children's distress without appropriate PRMs, and little evidence exists to support clinical interventions.

Prevalence of Hyperacusis and Its Relation to Health: The Busselton Healthy Ageing Study.

IMPORTANCE: The prevalence of hyperacusis and its relationship with mental and general health is unknown in a nonclinical sample. Therefore, we aimed to determine the prevalence of hyperacusis and its relation with hearing, general and mental health in a population-based study. STUDY DESIGN: Prospective population-based study. MATERIAL AND METHODS: This study uses data from the Busselton Healthy Ageing Study (BHAS). A sample of 5,107 eligible inhabitants aged 45 to 70 years completed a detailed questionnaire and a clinical assessment. A positive answer to "Do you consider yourself sensitive or intolerant to everyday sounds" was used to indicate hyperacusis. Logistic regression was used to examine the association between hearing, mental and general health factors, and hyperacusis. RESULTS: Of 5,107 participants, 775 (15.2%) reported hyperacusis. The majority of participants with hyperacusis reported an occasional effect on daily life (72.0%). Being female, older in age, having a lower income, physical or mental health difficulties, more severe hearing loss, and tinnitus were all associated with the presence of hyperacusis. Individuals who experience hearing impairment, poorer general or mental health have a higher possibility of hyperacusis having an effect on their daily life. CONCLUSIONS: In this community population-based cohort study, we found a prevalence of hyperacusis of 15.2%. Individuals with hearing loss, mental health problems, and lower physical health have a higher possibility of experiencing effects on their daily life associated with their hyperacusis. Unravelling the relationship between hyperacusis hearing, general and mental health can be of major importance for a better understanding of the condition and its consequences. LEVEL OF EVIDENCE: 2 Laryngoscope, 131:E2887-E2896, 2021.

Reducing the Impact of Tinnitus on Children and Adolescents' Lives: A Mixed-Methods Concept Mapping Study.

OBJECTIVES: To generate a conceptual framework describing what is done to reduce the impact of chronic tinnitus on the lives of children and adolescents. DESIGN: Views and experiences of 32 adults from two participant groups informed this concept mapping study: (i) a tinnitus group (adults who experienced tinnitus during childhood/adolescence, and primary carers of children/adolescents with tinnitus) and (ii) a clinicians' group (clinicians who provided care for children/adolescents with tinnitus). Participants produced statements describing what is done to reduce the impact of chronic tinnitus on the lives of children and adolescents who experience it. Through grouping and rating processes, they identified key concepts and inferred their associated benefit. RESULTS: The participants generated 102 unique statements across four concepts: (1) Education, Support, and Counselling; (2) Support from Parents and Teachers; (3) Clinical Assessments and Management; and (4) Self-Management Techniques. Many statements highlighted the need for child-friendly and patient-centred care. Adults with personal experience of childhood tinnitus tended to perceive many of the statements as more beneficial than did the clinician group. CONCLUSIONS: Although many children will develop management strategies to assist them with their tinnitus, both the adults who experienced tinnitus as children and their parents valued strategies involving clinical care, knowledge, and expertise. Participants from the tinnitus group perceived a greater degree of benefit associated with strategies from all four clusters than the clinicians' group. However, both groups perceived the greatest degree of benefit as being associated with activities and strategies within the Education, Support, and Counselling and the Clinical Assessments and Management clusters. Both groups identified that recognising the occurrence of tinnitus for children and adolescents, acknowledging the potential for associated distress, and initiating clinical care provide the nexus of effective management. Addressing the concerns and needs of parents was also perceived as valuable; hence, approaching the management of tinnitus during childhood and adolescence from a family-centred care framework is recommended.

Reflections on How Tinnitus Impacts the Lives of Children and Adolescents.

Objectives The aim of this study was to generate a conceptual framework describing which aspects of children and adolescents' lives are affected by chronic tinnitus. Design Views and experiences of 32 participants from two participant groups informed this study: (a) a tinnitus group, consisting of adults who had experienced tinnitus during childhood and/or adolescence and primary carers of children/adolescents with tinnitus, and (b) a clinicians' group, consisting of clinicians who provided care for children/adolescents with tinnitus. Participants produced statements describing aspects of children/adolescents' lives that may be affected by chronic tinnitus. Key concepts were identified through the processes of sorting the statements and rating them for degree of associated impact. Result Participants identified 118 unique aspects of the lives of children/adolescents who may be affected by chronic tinnitus. These were clustered into four concepts: (a) emotional well-being, (b) academic performances, (c) social/relationa, and (d) auditory/cognitive processing. At a group level, participants rated the impact of tinnitus as above a slight degree but below a moderate degree of impact. However, individual participant's ratings indicated a range of perceived impact for each statement. Conclusions The experience of chronic tinnitus during childhood and adolescence extends beyond the mere perception of sound. The perception of tinnitus may impact a child's emotional well-being, academic performances, social/relational, and auditory/cognitive processing. The impact of tinnitus in one aspect of a child's life may influence other aspects of their life. While at a group level, participants regarded the impact of tinnitus as "somewhat more than mild" to "less than moderate"; individual participant's ratings indicate that the impact from chronic tinnitus may be highly individual and highlighted the importance of individual assessment and management. Clinically, tinnitus management during childhood and adolescence may be improved if clinicians consider the impact and manifestation of tinnitus within each child's daily life and tailor tinnitus education and management strategies accordingly.

Tinnitus and its associations with general health, mental health and hearing loss.

BACKGROUND: A deeper knowledge of tinnitus is essential in order to better manage and treat tinnitus and its effects. Most studies to date are based on small samples and/or conducted in clinical settings. In this study we assessed the associations between tinnitus, general and mental health, hearing status and demographics in a large population cohort study. MATERIALS AND METHODS: The Busselton Healthy Aging Study recruited people born between 1946 and 1964. Data were collected between 2010 and 2015. Logistic regression was used to examine the associations between tinnitus and its effect on daily life, age, gender, hearing, self-reported mental and general health, and doctor diagnosed health conditions. RESULTS: Of 5107 participants, 1154 (22.6%) reported experiencing tinnitus. Of those, 32.4% reported that their tinnitus had an occasional effect on their daily lives, while for a further 8.9% the effect on their daily life was frequent or constant. The odds ratio for having a SF12-PCS was (OR 1.02 (95%CI 1.01-1.03). Furthermore, individuals who experience their tinnitus as having an effect on their daily life, have an increased risk of having a lower general health (OR 1.04 (95%CI 1.02-1.03)) than those without tinnitus. Higher levels of depression, anxiety and stress, as well as doctor diagnosed depression, were all significant risk factors for tinnitus. There were statistically significant worse hearing thresholds related to the presence of tinnitus. CONCLUSION: The outcomes raise the question for clinicians and researchers whether addressing the mental and general health of individuals will influence the presence or burden of tinnitus.

Reflections and perceptions of chronic tinnitus during childhood and adolescence.

OBJECTIVES: To enhance understanding of the lived experience of tinnitus during childhood/adolescence from the reflections of adults who experienced tinnitus during childhood/adolescence and the perceptions of primary carers and clinicians who care for children/adolescents who experience it. Secondly to develop a conceptual framework to better describe the experience of chronic tinnitus during childhood/adolescence and to guide approaches to assessment and management. DESIGN: Using a concept mapping approach, participants from two stakeholder groups generated statements describing what chronic tinnitus sounds and feels like to children/adolescents who experience it. Participants subsequently grouped and rated the statements to reveal key concepts. The first stakeholder group consisted of adults who had experienced chronic tinnitus as a child/adolescent and parents of children or adolescents who are experience chronic tinnitus. The second stakeholder group consisted of clinical professionals who provide care for children/adolescents experiencing chronic tinnitus. RESULTS: Participants identified 102 different descriptions of what chronic tinnitus sounds and feels like to children/adolescents, across five concepts: 1) Sounds of tinnitus; 2) Descriptions of tinnitus; 3) Perceptions of tinnitus; 4) Emotional responses to tinnitus and 5) Physical responses to tinnitus. CONCLUSIONS: The experience of chronic tinnitus during childhood/adolescence is heterogenous and multifaceted. It may involve the perception of sound, emotions and physiological sequalae. How a child/adolescent experiences their tinnitus will be influenced by the interplay between the sound they perceive, the number of accompanying senses involved and their interpretation of the sound. As well as the emotions and physical effects they experience.

Investigating the prevalence and impact of device-related problems associated with hearing aid use.

Objective: To explore the prevalence of device-related problems associated with hearing aid use, participants' help-seeking behaviours for these problems, and factors associated with hearing aid problems.Design: A prospective convenience cohort design surveying 413 adult hearing aid users (34-97 years of age) recruited from seven clinics across Australia.Results: Almost all participants (98%) indicated that they were experiencing at least one of the hearing aid problems included on the survey. The number of hearing aid related problems reported by participants ranged from 0 to 25 (of a possible 26), with a mean of 10 problems (SD = 5). The three most reported problems were related to difficulty hearing in noisy environments, hearing in windy environments, and understanding certain voices. Participants had reported less than half (46.33%) of the total problems identified to their clinic (range = 0-100%, mean = 43.40, SD = 13.92). Participants who reported experiencing a greater number of hearing aid problems also reported lower levels of hearing aid benefit, and satisfaction with their hearing aids.Conclusions: The majority of hearing aid owners experience problems with their hearing aids. Addressing these problems would likely contribute to improved hearing aid outcomes.

The impact of tinnitus upon cognition in adults: A systematic review.

OBJECTIVE: To systematically review and analyse experimental outcomes of studies exploring the impact of tinnitus upon cognitive function and their implications for clinical management of invasive tinnitus. DESIGN: A systematic and descriptive review. STUDY SAMPLE: Eighteen studies were identified investigating the impact of tinnitus on cognitive function. RESULTS: The 18 studies evaluated cognitive function using 24 different objective behavioural tests, nine electrophysiological recordings, one oculomotor test, and one self-report questionnaire. The studies spanned 18 years and revealed numerous interactions potentially contributing to the cognitive difficulties frequently reported by people with invasive tinnitus. The studies indicate a clear association between tinnitus and aspects of cognitive function, specifically the executive control of attention. CONCLUSIONS: Tinnitus impairs cognitive function by way of impact upon executive control of attention. Clinical management of patients reporting tinnitus and cognitive difficulties requires an understanding of the reciprocal relationship between tinnitus and cognitive function, with additive effects of anxiety, depression, and somatic cognitive bias. Further study is required to establish the impact of advancing age, hearing loss, anxiety, depression tinnitus duration, and distress upon cognitive function in people with invasive tinnitus.

Evaluating hearing aid handling skills: A systematic and descriptive review.

OBJECTIVE: To review and appraise the content and quality of surveys that evaluate hearing aid handling. DESIGN: A systematic and descriptive review. STUDY SAMPLE: Twelve surveys were identified as containing at least one item evaluating hearing aid handling. RESULTS: Fifteen aspects of hearing aid handling were evaluated. None of the surveys evaluated all aspects of handling skills identified. While the majority of studies reported some psychometric evaluation during survey development, the quality of the methodology used and extent of psychometric evaluation reported varied considerably. CONCLUSIONS: There is currently no single survey that evaluates handling skills comprehensively. In the absence of an ideal survey, the Practical Hearing aid Skills Test appears to be the most inclusive clinician-administered survey and the Hearing aid User's Questionnaire appears to be the most inclusive self-report survey evaluating hearing aid handling precision; however, there are limitations in the analysis of their psychometric properties. Nonetheless, use of these surveys in clinical practice could identify areas of handling that warrant additional training in order to improve hearing aid success. Research identifying the full range of hearing aid handling skills necessary for successful hearing aid use will further contribute knowledge to the complex construct of successful hearing aid-use.