Health Care Utilization and Mental Health Diagnoses Among Veterans With Tinnitus.

Purpose Tinnitus is prevalent among military Veterans and may frequently co-occur with mental health disorders. This study examined health care utilization and mental health diagnoses among Veterans with and without tinnitus who receive Department of Veterans Affairs (VA) health care. Method We randomly sampled 10% of VA health care users for a 5-year period between 2011 and 2016. Tinnitus and other diagnoses were identified using International Classification of Diseases diagnosis codes; Veterans assigned 1 or more inpatient codes or 2 or more outpatient codes were considered to have the respective diagnosis. We examined demographics, military service, clinical characteristics, and health care utilization of Veterans with and without tinnitus diagnoses. Bivariable and multivariable logistic regression was used to estimate associations between tinnitus and mental health diagnoses of interest. Results Among 617,534 eligible Veterans, 3.8% met criteria for tinnitus diagnosis. Prevalence of tinnitus was associated with sex, age, race, marital status, and VA service connection status; additionally, hearing loss and traumatic brain injury were frequently codiagnosed with tinnitus. Veterans with tinnitus had higher annual health care utilization than those without. While controlling for potential confounders, tinnitus diagnoses were associated with mental health diagnoses, including anxiety, depression, and substance use disorders. Conclusion Findings suggest that Veterans who are diagnosed with tinnitus have more health care utilization and are more frequently diagnosed with mental health disorders than Veterans who are not diagnosed with tinnitus. This suggests a need for coordinated tinnitus and mental health care services for Veterans in the VA system of care.

Perception Versus Reaction: Comparison of Tinnitus Psychoacoustic Measures and Tinnitus Functional Index Scores.

Purpose Psychoacoustic characteristics of tinnitus include its loudness and pitch. These characteristics are commonly measured and reported; however, it has not been shown that they are associated with the impact, or bothersomeness, of tinnitus. This study addressed this question by determining correlations between measures of tinnitus loudness, tinnitus pitch, and functional effects of tinnitus. Method Tinnitus loudness matches, pitch matches, a numeric rating scale (NRS) of tinnitus loudness, and responses to the 25-item tinnitus functional index (TFI) were obtained from 223 participants who experienced tinnitus for at least 6 months. Estimates of tinnitus pitch were calculated by use of a Bayesian sequential analysis technique. Results The total TFI score, as well as each of its 8 subscales, had weak or no correlations with both loudness matches and pitch matches, but moderate correlations with the NRS. Conclusions Psychoacoustic measurements used to estimate aspects of tinnitus perception appear unrelated to the impact of tinnitus, as assessed by a subjective outcome instrument. These psychoacoustic measurements do not assess reactions to tinnitus. These reactions should be measured by validated questionnaires, such as the TFI, which are designed to measure tinnitus impact. The moderate correlations between the NRS and the TFI suggest that self-reported tinnitus loudness is more a measure of tinnitus reactions than perception.

Clinical Protocol to Promote Standardization of Basic Tinnitus Services by Audiologists.

Purpose Clinical services for tinnitus are needed by millions of people annually. These services have not been standardized, and patients are vulnerable to receiving services that may appear legitimate but are not based on research evidence. The purpose of this clinical focus article is to promote standardization of tinnitus services by proposing an efficient clinical protocol for audiologists. Method The suggested clinical protocol is based primarily on research conducted at the National Center for Rehabilitative Auditory Research for the past 2 decades, with the focus on 2 randomized controlled trials completed recently that showed efficacy of an audiologic protocol involving hearing aids and brief tinnitus counseling. The protocol is mostly consistent with clinical practice guidelines that have been published. Results The two National Center for Rehabilitative Auditory Research randomized controlled trials revealed significant reduction of tinnitus functional effects for both hearing aids and "combination instruments" (hearing aids with a built-in sound generator), although there were no significant differences between devices. Existing clinical practice guidelines for tinnitus are summarized with respect to their common recommendations for assessment and intervention. Conclusions A defined clinical protocol is suggested for audiologists, which includes a case history, appropriate referral, audiologic assessment, use of the Tinnitus and Hearing Survey ( Henry, Griest, et al., 2015 ), brief tinnitus counseling, hearing aids or combination instruments as warranted, follow-up assessment, and criteria for determining if further tinnitus-specific services are needed. Use of this protocol can help to promote standardization of tinnitus practice by audiologists.

Comparison of Tinnitus Loudness Measures: Matching, Rating, and Scaling.

Purpose Chronic tinnitus ("ringing in the ears") is a phantom auditory perception with no cure. A goal of treatment is often to reduce the loudness of tinnitus. However, tinnitus loudness cannot be measured objectively. It is most commonly assessed by obtaining a loudness match (LM) with a pure tone and by using a numeric rating scale (NRS). Constrained loudness scaling (CLS) is a more recent measure of tinnitus loudness that utilizes auditory training of a fixed loudness scale to guide tinnitus loudness judgments. The purpose of this study was to compare results using these 3 measures of tinnitus loudness. Method This study obtained tinnitus loudness measures of LM, NRS, and CLS with 170 participants. These participants are part of a larger study obtaining repeated measures over 6 months. Only baseline data are presented. Results Correlations between all measures were weak to moderate: LM versus CLS ( r = .46), CLS versus NRS ( r = .49), and LM versus NRS ( r = .38). Conclusion Further systematic research is needed to more fully understand the relationships between these different measures and to establish a valid measure of tinnitus loudness.

The effect of sensorineural hearing loss and tinnitus on speech recognition over air and bone conduction military communications headsets.

Military personnel are at risk for hearing loss due to noise exposure during deployment (USACHPPM, 2008). Despite mandated use of hearing protection, hearing loss and tinnitus are prevalent due to reluctance to use hearing protection. Bone conduction headsets can offer good speech intelligibility for normal hearing (NH) listeners while allowing the ears to remain open in quiet environments and the use of hearing protection when needed. Those who suffer from tinnitus, the experience of perceiving a sound not produced by an external source, often show degraded speech recognition; however, it is unclear whether this is a result of decreased hearing sensitivity or increased distractibility (Moon et al., 2015). It has been suggested that the vibratory stimulation of a bone conduction headset might ameliorate the effects of tinnitus on speech perception; however, there is currently no research to support or refute this claim (Hoare et al., 2014). Speech recognition of words presented over air conduction and bone conduction headsets was measured for three groups of listeners: NH, sensorineural hearing impaired, and/or tinnitus sufferers. Three levels of speech-to-noise (SNR = 0, -6, -12 dB) were created by embedding speech items in pink noise. Better speech recognition performance was observed with the bone conduction headset regardless of hearing profile, and speech intelligibility was a function of SNR. Discussion will include study limitations and the implications of these findings for those serving in the military.