Publications by authors named "Eldre W Beukes"

34 Publications

Dismantling internet-based cognitive behavioral therapy for tinnitus. The contribution of applied relaxation: A randomized controlled trial.

Internet Interv 2021 Sep 12;25:100402. Epub 2021 May 12.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA.

Background: Internet-based cognitive behavioral therapy (ICBT) for tinnitus is an evidence-based intervention. The components of ICBT for tinnitus have, however, not been dismantled and thus the effectiveness of the different therapeutic components is unknown. It is, furthermore, not known if heterogeneous tinnitus subgroups respond differently to ICBT.

Aims: This dismantling study aimed to explore the contribution of applied relaxation within ICBT for reducing tinnitus distress and comorbidities associated with tinnitus. A secondary aim was to assess whether outcomes varied for three tinnitus subgroups, namely those with significant tinnitus severity, those with low tinnitus severity, and those with significant depression.

Methods: A parallel randomized controlled trial design ( = 126) was used to compare audiologist-guided applied relaxation with the full ICBT intervention. Recruitment was online and via the intervention platform. Assessments were completed at four-time points including a 2-month follow-up period. The primary outcome was tinnitus severity as measured by the Tinnitus Functional Index. Secondary outcomes were included for anxiety, depression, insomnia, negative tinnitus cognitions, health-related quality of life, hearing disability, and hyperacusis. Treatment engagement variables including the number of logins, number of modules opened, and the number of messages sent. Both an intention-to-treat analysis and completer's only analysis were undertaken.

Results: Engagement was low which compromised results as the full intervention was undertaken by few participants. Both the ICBT and applied relaxation resulted in large reduction of tinnitus severity (within-group effect sizes  = 0.87 and 0.68, respectively for completers only analysis), which were maintained, or further improved at follow-up. These reductions in tinnitus distress were greater for the ICBT group, with a small effect size differences (between-group  = 0.15 in favor of ICBT for completers only analysis). Tinnitus distress decreased the most at post-intervention for those with significant depression at baseline. Both ICBT and applied relaxation contributed to significant reductions on most secondary outcome measures, with no group differences, except for a greater reduction of hyperacusis in the ICBT group.

Conclusion: Due to poor compliance partly attributed to the COVID-19 pandemic results were compromised. Further studies employing strategies to improve compliance and engagement are required. The intervention's effectiveness increased with initial level of tinnitus distress; those with the highest scores at intake experienced the most substantial changes on the outcome measures. This may suggest tailoring of interventions according to tinnitus severity. Larger samples are needed to confirm this.
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http://dx.doi.org/10.1016/j.invent.2021.100402DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141772PMC
September 2021

Development and Preliminary Evaluation of the Tinnitus Severity Short Form.

Am J Audiol 2021 Jun 24;30(2):404-415. Epub 2021 May 24.

Department of Psychological & Brain Sciences, Washington University in St. Louis, MO.

Purpose Tinnitus, or the perception of sounds that occur without an external sound source, is a prevalent condition worldwide. For a subset of adults, tinnitus causes significant distress and impairment. Several patient-reported outcome measures have been developed to assess severity of tinnitus distress. However, at present, the field lacks a brief measure that is sensitive to treatment change. The purpose of the current study was to develop and preliminarily validate a brief questionnaire for tinnitus severity from two existing measures of tinnitus-related distress, the Tinnitus Handicap Inventory (THI) and Tinnitus Functional Index (TFI). Method Using data from nine study samples in the United States and United Kingdom, we conducted exploratory and confirmatory factor analyses to identify a short measure with good psychometric properties. We also assessed sensitivity to treatment-related change by examining associations with change in the TFI and THI. Finally, we conducted a confirmatory factor analysis of the final short questionnaire in a new sample of adults seeking treatment for tinnitus-related distress. Results We identified 10 items from the THI and TFI that exhibited limited loadings on secondary factors. The resulting Tinnitus Severity Short Form achieved good to excellent fit, including in a unique sample of individuals seeking online treatment for tinnitus, and appeared sensitive to treatment-related change. Conclusions The Tinnitus Severity Short Form developed in the current study may be a useful tool for the assessment of subjective severity and distress associated with tinnitus, especially when patient burden is a concern. Further research is necessary to fully validate the questionnaire for the assessment of treatment-related change.
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http://dx.doi.org/10.1044/2021_AJA-20-00164DOI Listing
June 2021

Coping With Tinnitus During the COVID-19 Pandemic.

Am J Audiol 2021 Jun 12;30(2):385-393. Epub 2021 May 12.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX.

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.
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http://dx.doi.org/10.1044/2021_AJA-20-00188DOI Listing
June 2021

Suggestions for shaping tinnitus service provision in Western Europe: Lessons from the COVID-19 pandemic.

Int J Clin Pract 2021 Jul 8;75(7):e14196. Epub 2021 May 8.

Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.

Background: Tinnitus severity has been exacerbated because of the COVID-19 pandemic and those with tinnitus require additional support. Such support should be informed by patient preferences and needs. The objective of this study was to gather information from individuals with tinnitus living in Europe to inform stakeholders of the (a) support they needed in relation to changes associated with the COVID-19 pandemic and (b) suggestions regarding tinnitus care for the future.

Methods: A cross-sectional mixed method study design was used using closed and open-ended questions via an online survey. Data were gathered from 710 adults experiencing tinnitus in Western Europe, with the majority living in The Netherlands, Belgium and Sweden. Data were analysed using qualitative content analysis and descriptive statistics.

Results: Those with tinnitus indicated the following support needs during the pandemic (a) support for tinnitus, (b) support for hearing-related difficulties, (c) social support and (d) pandemic-related support. Five directions for future tinnitus care were provided, namely, (a) need for understanding professional support and access to multidisciplinary experts, (b) greater range of therapies and resources, (c) access to more information about tinnitus, (d) prioritising tinnitus research and (e) more support for hearing protection and hearing loss prevention.

Conclusions: The findings point to the need for accessible (remote), patient-centred, suitable and evidence-based tinnitus care. Insights from the current study can be used by various stakeholders including clinical practitioners and tinnitus support services to ensure those with tinnitus have access to the help and support required in order to reduce service provision insufficiencies.
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http://dx.doi.org/10.1111/ijcp.14196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250123PMC
July 2021

Exploring tinnitus heterogeneity.

Prog Brain Res 2021 24;260:79-99. Epub 2020 Jul 24.

National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Ropewalk House, Nottingham, United Kingdom; Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Nottingham Audiology Services, Nottingham University Hospitals, Nottingham, United Kingdom.

Introduction: Tinnitus experiences differ widely. A greater understanding of the core processes underlying these variations is needed. Moreover, meaningful definitions for different subgroups are required to better manage this heterogeneous population. The objective of the present research was to contribute toward the understanding of tinnitus heterogeneity by identifying factors that can predict tinnitus severity and to ascertain if distinct subgroups of tinnitus presentation can be identified.

Methods: This cross-sectional study consisted of 326 adults subdivided into subgroups of those with mild tinnitus (n=32; 10%), significant tinnitus (n=99; 30%) and severe tinnitus (n=195; 60%) according to their scores from the Tinnitus Functional Index. Multiple regression was used to identify factors associated with tinnitus severity. These factors included personal traits, tinnitus-related traits, treatment modalities and clinical comorbidities.

Results: Insomnia, hearing distress, and anxiety were the best predictors of tinnitus severity (explaining 53% of the variability). These comorbidities were stronger predictors than any demographical factors (that explained 11% of the variability). Distinct subgroups based on tinnitus severity (mild, significant, and severe) and anxiety levels were evident. Those with severe tinnitus had significantly more severe comorbidities compared with the mild and significant groups.

Conclusions: This study highlights that people with tinnitus could initially be grouped according to tinnitus severity to direct further management. Those with higher tinnitus severity should receive more immediate and intensive care. Due to the strong associations between tinnitus severity and tinnitus-related comorbidities (e.g., insomnia, hearing disability, and anxiety), tinnitus assessment and interventions should focus on these comorbidities.
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http://dx.doi.org/10.1016/bs.pbr.2020.05.022DOI Listing
July 2020

Perspectives of a new sport-specific Para Shooting classification system for athletes with vision impairment.

J Sports Sci 2020 Dec 15:1-11. Epub 2020 Dec 15.

School of Pyschology and Sports Science, Anglia Ruskin University, Cambridge, UK.

The International Paralympic Committee (IPC) and individual sports federations have established the need to develop evidence-based systems of classification for athletes with vision impairment (VI) that may differ depending on the visual demands of each sport. As a consequence, research has been conducted that led to a new classification system for athletes competing in VI shooting. The purpose of this study was to canvas the experiences of key stakeholders (athletes, coaches and classifiers) when the new system of classification was implemented. Twenty-eight participants (17 athletes, 7 coaches and 4 classifiers) completed a questionnaire to rate their experiences of the previous and new classification systems and were interviewed to gain richer insights into their opinions. It was apparent that the changes to the classification system were not adequately communicated to the athletes in particular, and that the classifiers may require a better understanding of the principles of evidence-based classification. The new system was perceived to be significantly more specific for VI shooting and intentional misrepresentation was observed to be significantly less likely than when using the old system. This research provides valuable insights into both the positive and negative experiences of key stakeholders experiencing change in a classification system.
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http://dx.doi.org/10.1080/02640414.2020.1851923DOI Listing
December 2020

Changes in Tinnitus Experiences During the COVID-19 Pandemic.

Front Public Health 2020 5;8:592878. Epub 2020 Nov 5.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, United States.

The COVID-19 pandemic has disrupted delivery of healthcare, economic activity, and affected social interactions. Identifying and supporting those most affected by the pandemic is required. The purpose of this study was to determine the impact of the pandemic on individuals with tinnitus and to identify mediating factors. This is a mixed-methods exploratory cross-sectional study, using data collected via an online survey from 3,103 individuals with tinnitus from 48 countries. The greatest representation was from North America (49%) and Europe (47%) and other countries were only marginally represented. Although the study was aimed at those with pre-existing tinnitus, 7 individuals reported having COVID-19 initiated tinnitus. Having COVID-19 symptoms exacerbated tinnitus in 40% of respondents, made no change in 54%, and improved tinnitus in 6%. Other mediating factors such as the social and emotional consequences of the pandemic made pre-existing tinnitus more bothersome for 32% of the respondents, particularly for females and younger adults, better for 1%, and caused no change to tinnitus for 67%. Pre-existing tinnitus was significantly exacerbated for those self-isolating, experiencing loneliness, sleeping poorly, and with reduced levels of exercise. Increased depression, anxiety, irritability, and financial worries further significantly contributed to tinnitus being more bothersome during the pandemic period. These findings have implications for tinnitus management, because they highlight the diverse response both internal and external factors have on tinnitus levels. Clinical services should be mindful that tinnitus may be caused by contracting COVID-19 and pre-existing tinnitus may be exacerbated, although in the majority of respondents there was no change. Additional support should be offered where tinnitus severity has increased due to the health, social, and/or emotional effects of the COVID-19 pandemic. Tinnitus may be more bothersome for those experiencing loneliness, having fewer social interactions, and who are more anxious or worried.
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http://dx.doi.org/10.3389/fpubh.2020.592878DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676491PMC
May 2021

Contact lens wear and care in Spain during the COVID-19 pandemic.

Cont Lens Anterior Eye 2020 Nov 11:101381. Epub 2020 Nov 11.

Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK. Electronic address:

Aim: To establish contact lens wear and care practices during the COVID-19 pandemic in Spain.

Method: A 58-item anonymous online survey was distributed during the period 30th April to 10th May via Qualtrics. The survey explored: a) demographic characteristics (age, sex, general health and where they were living during lockdown), b) changes in their contact lens use during lockdown, c) hygiene and contact lens compliance and d) concerns associated with contact lens wear and ways to support wearers during the pandemic.

Results: Two hundred and sixty responses were analysed (38.8 ± 11.4 years old, 75% female). Three-quarters of participants reported that they were self-isolating or rigorously following social distancing advice. Sixty-seven percent of participants reported using their contact lenses less during the pandemic. Respondents were found to be compliant with handwashing prior to inserting and removing contact lenses (in both cases 97% doing this 'most times' or 'every time'). However, only 44 % complied with the '20 s rule' and 48 % used a shared towel to dry their hands. A higher proportion of hydrogen peroxide users replaced the lens case monthly compared to multi-purpose users (64% vs.49%; p < 0.001). Twenty-four percent admitted wearing lenses whilst showering and 16% did not consider ceasing lens wear if feeling unwell with flu/cold symptoms.

Conclusion: Eye care practitioners should continue to educate contact lens wearers to ensure safe contact lens wear to minimise the chance of developing contact lens related complications during the pandemic. Modifiable factors that need particular attention in Spain include: handwashing for at least 20s before lens handling, drying hands with single use paper towels, including a rub-and-rinse step for reusable lenses, lens case cleaning and renewal, avoidance of water exposure and when to cease lens wear during the pandemic.
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http://dx.doi.org/10.1016/j.clae.2020.11.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657612PMC
November 2020

A Content Analysis of YouTube Videos Related to Hearing Aids.

J Am Acad Audiol 2020 10 20;31(9):636-645. Epub 2020 Nov 20.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, Texas.

Background: Increasingly, people access Internet-based health information about various chronic conditions including hearing loss and hearing aids. YouTube is one media source that has gained much popularity in recent years.

Purpose: The current study examines the source, content, understandability, and actionability of YouTube videos related to hearing aids.

Research Design: Cross-sectional design by analyzing the videos at single point in time.

Study Sample: One hundred most frequently viewed videos in YouTube.

Intervention: Not applicable.

Data Collection And Analysis: The 100 most-viewed English language videos targeting individuals seeking information regarding hearing aids were identified and manually coded. Data collection included general information about the video (e.g., source, title, authorship, date of upload, duration of video), popularity-driven measures (e.g., number of views, likes, dislikes), and the video source (consumer, professional, or media). The video content was analyzed to examine what pertinent information they contained in relation to a predetermined fact sheet. Understandability and actionability of the videos were examined using the Patient Education Material Assessment Tool for Audiovisual Materials.

Results: Of the 100 most-viewed videos, 11 were consumer-based, 80 were created by professionals, and the remaining 9 were media-based. General information about hearing aids, hearing aid types, and handling and maintenance of hearing aids were the most frequently discussed content categories with over 50% of all videos commenting on these areas. Differences were noted between source types in several content categories. The overall understandability scores for videos from all sources were 74%, which was considered adequate; however, the actionability scores for all the videos were 68%, which is considered inadequate.

Conclusion: YouTube videos about hearing aids focused on a range of issues and some differences were found between source types. The poor actionability of these videos may result in incongruous consumer actions. Content and quality of the information in hearing aid YouTube videos needs to be improved with input from professionals.
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http://dx.doi.org/10.1055/s-0040-1717123DOI Listing
October 2020

Features, Functionality, and Acceptability of Internet-Based Cognitive Behavioral Therapy for Tinnitus in the United States.

Am J Audiol 2020 Sep 28;29(3):476-490. Epub 2020 Jul 28.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX.

Objective Although tinnitus is one of the most commonly reported symptoms in the general population, patients with bothersome tinnitus are challenged by issues related to accessibility of care and intervention options that lack strong evidence to support their use. Therefore, creative ways of delivering evidence-based interventions are necessary. Internet-based cognitive behavioral therapy (ICBT) demonstrates potential as a means of delivering this support but is not currently available in the United States. This article discusses the adaptation of an ICBT intervention, originally used in Sweden, Germany, and the United Kingdom, for delivery in the United States. The aim of this study was to (a) modify the web platform's features to suit a U.S. population, (b) adapt its functionality to comply with regulatory aspects, and (c) evaluate the credibility and acceptability of the ICBT intervention from the perspective of health care professionals and patients with bothersome tinnitus. Materials/Method Initially, the iTerapi ePlatform developed in Sweden was adopted for use in the United States. Functional adaptations followed to ensure that the platform's functional and security features complied with both institutional and governmental regulations and that it was suitable for a U.S. population. Following these adaptations, credibility and acceptance of the materials were evaluated by both health care professionals ( = 11) and patients with bothersome tinnitus ( = 8). Results Software safety and compliance regulatory assessments were met. Health care professionals and patients reported favorable acceptance and satisfaction ratings regarding the content, suitability, presentation, usability, and exercises provided in the ICBT platform. Modifications to the features and functionality of the platform were made according to user feedback. Conclusions Ensuring that the ePlatform employed the appropriate features and functionalities for the intended population was essential to developing the Internet-based interventions. The favorable user evaluations indicated that the intervention materials were appropriate for the tinnitus population in the United States.
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http://dx.doi.org/10.1044/2020_AJA-20-00002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7842846PMC
September 2020

Portrayal of Hearing Loss in YouTube Videos: An Exploratory Cross-Sectional Analysis.

Am J Audiol 2020 Sep 13;29(3):450-459. Epub 2020 Jul 13.

Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.

Objective The objective of the current study was to examine the source, content, understandability, and actionability of hearing loss information on YouTube videos. Method The study used a cross-sectional design. One hundred of the most frequently viewed YouTube videos were identified, and various data were manually coded (i.e., video source, video content, popularity measures such as number of views, likes, and dislikes). In addition, the understandability and actionability of each video were evaluated using the Patient Education Materials Assessment Tool for Audiovisual Materials rating scale. Results Of the 100 most viewed videos, 16 were created by consumers, 62 were professional created, and 22 were media based. Symptoms, causes, and treatment or management of hearing loss were the most frequently discussed content categories, with over 60% of all videos commenting on these areas. The overall understandability and actionability scores for the 100 videos included were 77% and 31%, respectively, indicating adequate understandability and poor actionability. Conclusions The YouTube videos on hearing loss focus on a range of issues. The poor actionability of these videos was a concern, as these videos may not lead to appropriate consumer actions in addressing their hearing loss. Efforts are needed to improve the quality and content of these videos to promote appropriate behavior change.
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http://dx.doi.org/10.1044/2020_AJA-19-00121DOI Listing
September 2020

Quality, Readability, and Suitability of Hearing Health-Related Materials: A Descriptive Review.

Am J Audiol 2020 Sep 18;29(3):513-527. Epub 2020 Jun 18.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX.

Objectives The objective of this descriptive review was to determine the quality, readability, and suitability of ear and hearing health information and materials for patients and their significant others. Method A literature search was conducted between August 2018 and April 2019 in the databases CINAHL Complete, MEDLINE, and PsychInfo. Inclusion and exclusion criteria were used to shortlist studies. Data regarding quality, suitability, and readability were extracted from the included studies. Data were assessed qualitatively. Results There were 34 studies included in this review. Of those, eight examined quality, 33 assessed readability, and four investigated the suitability of materials. The range of materials assessed included diagnostic reports, patient education materials (PEMs), patient-reported outcome measures, and websites. Quality elements were examined in studies focusing on website information. Findings indicated that most websites were of poor quality. Suitability was examined in studies focusing on PEMs such as hearing aid user guides. Findings indicated that most of the existing materials were not suitable for the intended populations. The reading grade level of information across all four categories was found to be higher than the recommended fifth or sixth reading grade level for health-related materials. Revisions of some diagnostic reports and PEMs showed that improvements are possible. Conclusions This review suggests that ear- and hearing-related materials generally have lower quality and suitability with higher readability (more difficult to read). Development of materials that are suitable, of high quality, and at the appropriate readability levels is required to improve accessibility of ear- and hearing-related materials.
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http://dx.doi.org/10.1044/2020_AJA-19-00040DOI Listing
September 2020

Media Use by Older Adults With Hearing Loss: An Exploratory Survey.

Am J Audiol 2020 Jun 29;29(2):218-225. Epub 2020 Apr 29.

Department of Otolaryngology, Hearing and Balance Research Unit, University of Tampere, Finland.

Objectives There has been a substantial increase in people with health conditions seeking health-related information online. The aim of this study was to examine the media usage by older adults with hearing loss. Method The study used a cross-sectional survey design. A total of 556 older adults with hearing loss (Hearing Tracker website users) completed the survey that was focused on (a) demographic information, (b) general electronic media usage, (c) sources of hearing health information, and (d) social media use for hearing health information. Data were analyzed using descriptive statistics and chi-square tests. Results When seeking hearing health care information, the majority of the participants turned to the Internet (54%) followed by health professionals (34%) as the first response to their symptoms. Both sources were also rated as the easiest means of obtaining hearing health information. The information from health care providers was rated as more reliable and important for decision making than that from the Internet. Facebook and YouTube were the most frequently used social media platforms with over 40% of the respondents using them "most of the time" or "sometimes." All the social media platforms were rated less favorably than other sources for ease of finding information, reliability, and importance in decision making. Conclusion Older adults with hearing loss use various forms of electronic media for seeking hearing health information. They place the most trust on the information obtained from hearing health care professionals. These professionals need to be aware of the quality of information available on the Internet and social media sources in order to direct patients to credible sources. Supplemental Material https://doi.org/10.23641/asha.12170397.
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http://dx.doi.org/10.1044/2020_AJA-19-00039DOI Listing
June 2020

Quality and readability of English-language Internet information for vestibular disorders.

J Vestib Res 2020 ;30(2):63-72

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA.

Background: The Internet has become a powerful, accessible resource for many patients to use for their own medical management and knowledge. Vestibular disorders are prevalent, especially in the elderly. As the Internet is increasingly a major source of health-related information to the general public, it is often used to search for information regarding dizziness and vertigo. Ensuring that the information is accessible, unbiased, and appropriate can aid informed decision-making.

Objective: To evaluate the quality and readability of English-language Internet information related to vestibular disorders.

Methods: A cross-sectional website search using three keywords (nausea, dizziness, and vertigo) in five country-specific versions of the most commonly used Internet search engine was conducted in March 2018. The language was limited to English for all websites. Quality was assessed by presence of Health on the Net (HON) certification and DISCERN scores. Readability was assessed using the Flesch Reading Ease (FRE) score, Flesch-Kincaid Grade Level Formula (F-KGL), and Simple Measure of Gobbledygook (SMOG).

Results: In total, 112 websites were included and analyzed. The majority were commercial (61%) websites. A total of 42% had obtained HON certification. No association was found between the presence of HON certification and the resource of the website. The DISCERN scores had a mean of 2.52 (SD 1.1). Readability measures indicated that an average of 14-18 years of education was required to read and understand the Internet information provided regarding vestibular disorders.

Conclusions: To ensure the accessible to the general population, it is necessary to improve the quality and readability of Internet-based information regarding vestibular disorders.
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http://dx.doi.org/10.3233/VES-200698DOI Listing
June 2021

Readability Following Cultural and Linguistic Adaptations of an Internet-Based Intervention for Tinnitus for Use in the United States.

Am J Audiol 2020 Jun 26;29(2):97-109. Epub 2020 Feb 26.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX.

Purpose An Internet-based tinnitus intervention for use in the United States could improve the provision of tinnitus-related services. Although clinical trials of such interventions were completed in Europe, the United Kingdom, and Australia, their suitability for adults with tinnitus in the United States is yet to be established. The aim of this study was to improve the cultural and linguistic suitability, and lower the readability level, of an existing program for tinnitus to ensure its suitability for U.S. English- and Spanish-speaking populations. Method Guidelines for adaptation were followed and involved four phases: (a) cultural adaptations, as interventions targeted at specific cultures have been shown to improve outcomes; (b) creating Spanish materials to improve access of the materials to the large Spanish-speaking population in the United States; (c) professional review of the materials for acceptability as an intervention tool for a U.S. population; and (d) literacy-level adjustments to make the content accessible to those with lower levels of health literacy skills. Results Cultural adaptations were made by using word substitutions, changing examples, and modifying the spelling of certain words. The materials were then translated into Spanish and cross-checked. Professional review ensured suitability of the chapters. Literacy-level adjustments ensured all chapters were within the guidelines for readability grade levels below the sixth-grade level. Conclusions The previously developed tinnitus materials were revised to adhere to best practice guidelines and ensure cultural suitability for adults with tinnitus in the United States. As it is also available in Spanish, members of the large Hispanic community also have access to the intervention in their first language. Further studies should determine whether these changes improve patients' self-efficacy, engagement, and motivation to complete the intervention.
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http://dx.doi.org/10.1044/2019_AJA-19-00014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839022PMC
June 2020

Translation and adaptation of three English tinnitus patient-reported outcome measures to Spanish.

Int J Audiol 2020 07 29;59(7):513-518. Epub 2020 Jan 29.

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA.

The objective of this study was to improve the range of standardised tinnitus Spanish Patient-Reported Outcome Measures (PROMS) available by translating and ensuring cross-cultural adaptation of three English PROMs to Spanish. The Tinnitus and Hearing Survey, Tinnitus Cognition Questionnaire, and Tinnitus Qualities Questionnaire were translated to Spanish using recently established good practice guidelines. The translation process addressed 22 items included in six main steps specified in the guidelines. The translated PROMs were field tested on a sample of tinnitus patients who were recruited through convenience sampling using cognitive debriefing ( = 5) and pilot testing ( = 10) methods. The translation process employed the required steps and provided specific details about the process and procedures. In addition, practical issues encountered while translating and adapting the questionnaires that may influence future translations were revealed. This is the first account of translating and adapting PROMs from one language to another using the good practice guidelines specific to hearing-related questionnaires. Following the rigorous procedures should ensure that the translated PROMs have linguistic and cultural equivalence to the original versions, although psychometric evaluation would remain necessary to confirm the functional equivalence.
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http://dx.doi.org/10.1080/14992027.2020.1717006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7385997PMC
July 2020

Internet-Based Interventions for Adults With Hearing Loss, Tinnitus, and Vestibular Disorders: A Systematic Review and Meta-Analysis.

Trends Hear 2019 Jan-Dec;23:2331216519851749

9 Department of Behavioral Sciences and Learning, Linköping University, Sweden.

Internet-based interventions have been developed to improve access to audiovestibular health care. This review aimed to identify outcomes of Internet interventions for adults with hearing loss, tinnitus, and vestibular disorders. Electronic databases and manual searches were performed to identify studies meeting eligibility for inclusion. Fifteen studies (1,811 participants) met the inclusion criteria, with nine studies targeting tinnitus distress, five considering hearing loss, and one for vestibular difficulties. Only the tinnitus and hearing loss Internet intervention studies were eligible for data synthesis. Internet-based interventions for hearing loss were diverse. Overall, they showed no significant effects, although a statistically significant moderate effect ( = 0.59) was found after removing the study with the highest risk of bias (as a result of high attrition). Most Internet-based interventions for tinnitus provided cognitive behavioural therapy. They yielded statistically significant mean effect sizes for reducing tinnitus distress compared with both inactive ( = 0.59) and active controls ( = 0.32). Significant effects were also present for the secondary outcomes of anxiety, depression, insomnia, and quality of life (combined effect  = 0.28). Only Internet-based interventions for tinnitus evaluated the 1-year postintervention effects indicated that results were maintained long term ( = 0.45). Scientific study quality was appraised using the Grading of Recommendations Assessment, Development and Evaluation approach and found to vary from very low to moderate. This review indicates the potential of Internet interventions for tinnitus to provide evidence-based accessible care. There is a need for additional high-quality evidence before conclusive results can be established regarding the effects of audiovestibular Internet interventions.
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http://dx.doi.org/10.1177/2331216519851749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647231PMC
December 2019

Representation of Hearing Loss and Hearing Aids in the U.S. Newspaper Media: Cross-Sectional Analysis of Secondary Data.

Am J Audiol 2019 Mar;28(1):11-25

Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX.

Purpose News media plays an important role in formulating people's knowledge and opinions about various aspects of life, including health. The current study explored how hearing loss and hearing aids are represented in the U.S. newspaper media. Method A cross-sectional study design was selected to analyze publicly available newspaper media data. The data sets were generated from the database, the U.S. Major Dailies by ProQuest, by searching key words for newspapers published during 1990-2017. Cluster analysis (i.e., text pattern analysis) and chi-square tests were performed using Iramuteq software. Results The hearing loss data set had 1,527 texts (i.e., articles). The cluster analysis resulted in 7 clusters, which were named as (1) causes and consequences (26.1%), (2) early identification and diagnosis (9%), (3) health promotion and prevention (22.1%), (4) recreational noise exposure (10.4%), (5) prevalence (14.3%), (6) research and development (12.4%), and (7) cognitive hearing science (5.6%). The hearing aids data set had 2,667 texts. The cluster analysis resulted in 8 clusters, which were named as (1) signal processing (20.2%), (2) insurance (8.9%), (3) prevalence (12.4%), (4) research and development (5.4%), (5) activities and relation (16.2%), (6) features to address background noise (13.8%), (7) innovation (12%), and (8) wireless and connectivity (11.1%). Time series analysis of clusters in both "hearing loss" and "hearing aids" data sets indicated changes in the pattern of information presented in the newspaper media during 1990-2016 (e.g., Cluster 7 focuses on cognitive hearing science in a hearing loss data set emerging only since the year 2012 and growing rapidly). Conclusions The text pattern analysis showed that the U.S. newspaper media focuses on a range of issues when considering hearing loss and hearing aids and that patterns or trends change over time. The study results can be helpful for hearing health care professionals to understand what presuppositions society in general may have as the media has the ability to influence societal perception and opinions.
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http://dx.doi.org/10.1044/2018_AJA-18-0058DOI Listing
March 2019

Problems and Life Effects Experienced by Tinnitus Research Study Volunteers: An Exploratory Study Using the ICF Classification.

J Am Acad Audiol 2018 Nov/Dec;29(10):936-947

Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden.

Background: Tinnitus is one of the most distressing hearing-related symptoms. It is often associated with a range of physiological and psychological complications, such as depression, anxiety, and insomnia. Hence, approaching tinnitus from a biopsychological perspective may be more appropriate than from purely a biomedical model.

Objective: The present study was aimed at determining the relationship between tinnitus and the problems and life effects experienced by UK-based tinnitus research study volunteers. Open-ended questions were used. Responses were classified using the International Classification of Functioning, Disability and Health (ICF) framework to understand the impact of tinnitus in a multidimensional manner using a biopsychosocial perspective.

Research Design: A cross-sectional survey design was used.

Study Sample: Study sample included a sample of 240 adults with tinnitus who were interested in undertaking an Internet-based intervention for tinnitus.

Data Collection And Analysis: The data were collated using two open-ended questions. The first focused on problems related to having tinnitus and the second to life effects as a result of tinnitus. Responses were analyzed using a simplified content analysis approach to link concepts to ICF categories in accordance with established linking rules. A Wilcoxon signed-rank test was performed to compare the number of responses between the two questions.

Results: There were 764 responses related to problems identified, 797 responses associated with life effects due to tinnitus, and 37 responses that did not fit into any ICF category. No significant differences were observed in the number of responses between the two questions. In addition, no significant association between the number of responses reported and demographic variables was found. Most of the problems and life effects experienced by tinnitus sufferers were related to body function, followed by activity limitations, and participation restrictions. Only a few responses were related to environmental and personal factors. The most frequent responses related to body function involved "emotional functions" (b152), "sleep functions" (b134), "hearing functions" (b230), "sustaining attention" (b1400), and "energy level" (b1300). For activity limitations and participation restrictions they were "communicating with-receiving-spoken messages" (d310), "socialization" (d9205), "handling stress and other psychological demands" (d240), and "recreation and leisure" (d920). The most frequently occurring responses related to environmental factors were "sound intensity" (e2500), "sound quality" (e2501), and "general products and technology for communication" (e1250). "Coping styles" was the most frequently occurring personal factor.

Conclusions: The study highlights the use of open-ended questions in gathering useful information about the impact of tinnitus. The responses coded to ICF show that tinnitus impacts many domains, not only particularly body function, but also activity limitations and participation restrictions. The results demonstrate the heterogeneous nature of the impact of tinnitus on people affected.
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http://dx.doi.org/10.3766/jaaa.17094DOI Listing
October 2019

Internet-based interventions for adults with hearing loss, tinnitus and vestibular disorders: a protocol for a systematic review.

Syst Rev 2018 11 23;7(1):205. Epub 2018 Nov 23.

Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.

Background: Internet-based interventions are emerging as an alternative way of delivering accessible healthcare for various conditions including hearing and balance disorders. A comprehensive review regarding the evidence-base of Internet-based interventions for auditory-related conditions is required to determine the existing evidence of their efficacy and effectiveness. The objective of the current protocol is to provide the methodology for a systematic review regarding the effects of Internet-based interventions for adults with hearing loss, tinnitus and vestibular disorders.

Method: This protocol was developed according to the Preferred Reporting Items for Systematic reviews and Meta-analyses for Protocols (PRISMA-P) 2015 guidelines. Electronic database searches will include EBSCOhost, PubMed and Cochrane Central Register performed by two researchers. This will be complemented by searching other resources such as the reference lists for included studies to identify studies meeting the eligibility for inclusion with regard to study designs, participants, interventions, comparators and outcomes. The Cochrane risk of bias tool (RoB 2) for randomised trials will be used for the bias assessments in the included studies. Criteria for conducting meta-analyses were defined.

Discussion: The result of this systematic review will be of value to establish the effects of Internet-based interventions for hearing loss, tinnitus and vestibular disorders. This will be of importance to guide future planning of auditory intervention research and clinical services by healthcare providers, researchers, consumers and stakeholders.

Systematic Review Registration: PROSPERO CRD42018094801.
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http://dx.doi.org/10.1186/s13643-018-0880-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6260838PMC
November 2018

Long-Term Efficacy of Audiologist-Guided Internet-Based Cognitive Behavior Therapy for Tinnitus.

Am J Audiol 2018 Nov;27(3S):431-447

Department of Behavioural Sciences and Learning, Linköping University, Sweden.

Purpose: The purpose of this study was to investigate the long-term outcomes 1 year after undertaking an audiologist-guided Internet-based cognitive behavioral therapy (iCBT) intervention for tinnitus. Secondary aims were to identify any predictors of outcome and whether there were any unwanted events related to undertaking iCBT for tinnitus.

Method: Participants who had previously undertaken a randomized iCBT efficacy trial for tinnitus were invited to participate. Of the 146 who were initially randomized for the efficacy trial, 104 participants completed the 1-year postintervention assessment measures. The primary outcome was a change in tinnitus distress as assessed by the Tinnitus Functional Index. Secondary assessment measures were included for insomnia, anxiety, depression, hearing handicap, hyperacusis, cognitive failures, and satisfaction with life. An intention-to-treat analysis using repeated-measures analysis of variance and hierarchical multiple regression was used for statistical analysis. Unwanted effects were categorized according to the unwanted events checklist.

Results: Undertaking iCBT for tinnitus led to significant improvements 1 year postintervention for tinnitus and related difficulties, for example, insomnia, anxiety, depression, hearing handicap, hyperacusis, and life satisfaction. The best predictors of improving tinnitus severity at 1-year postintervention were greater baseline tinnitus severity scores, reading more of the modules, and higher satisfaction with the intervention. Unwanted events were reported by 11% of the participants and were more likely to be reported by women than men. These events were related to worsening of symptoms, the emergence of new symptoms, negative well-being, and prolongation of treatment.

Conclusions: The clinical benefits of audiologist-guided iCBT for tinnitus and tinnitus-related difficulties were sustained 1 year postintervention. Predictors of outcome indicated that the intervention is applicable to a wide range of participants regardless of their demographic backgrounds. Attempts should be made to minimize unwanted events in subsequent trials.
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http://dx.doi.org/10.1044/2018_AJA-IMIA3-18-0004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018448PMC
November 2018

Participants' experiences of an Internet-based cognitive behavioural therapy intervention for tinnitus.

Int J Audiol 2018 12 8;57(12):947-954. Epub 2018 Oct 8.

k Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden.

Objective: This study aimed to explore participants' experiences after undertaking an Internet-based cognitive behavioural therapy intervention (ICBT) for tinnitus.

Design: Semi-structured telephone interviews were conducted 6-8 months after participants undertook the ICBT intervention. Qualitative thematic analysis was used to interpret the interview data.

Study Sample: A purposeful sampling strategy was used to identify a diverse range of participants. Semi-structured interviews were carried out with 15 participants. The mean age was 58.5 years, 7 men and 8 women participated.

Results: The analysis generated the following main themes: (1) expectations and motivation for doing the intervention, (2) experiences of the intervention, (3) intervention engagement and (4) intervention effects. Most participants' expectations were hopeful that the intervention would lessen the impact of their tinnitus. Aspects of the intervention that were beneficial, as well as difficult, were identified together with the impact they had on engagement. Intervention effects were evident on both tinnitus and activities of daily life.

Conclusions: The benefits described by participants indicate the potential of ICBT as an alternate form of intervention delivery. The difficulties that hampered engagement need to be addressed to enhance the application and to optimise the clinical acceptability of ICBT for tinnitus.
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http://dx.doi.org/10.1080/14992027.2018.1514538DOI Listing
December 2018

Effectiveness of Guided Internet-Based Cognitive Behavioral Therapy vs Face-to-Face Clinical Care for Treatment of Tinnitus: A Randomized Clinical Trial.

JAMA Otolaryngol Head Neck Surg 2018 12;144(12):1126-1133

National Institute for Health Research, Nottingham Biomedical Research Centre, Ropewalk House, Nottingham, United Kingdom.

Importance: Accessible clinical care is not always available to individuals with distressing tinnitus. Internet-based cognitive behavioral therapy has the potential to increase access to evidence-based services that manage tinnitus. Research comparing the effectiveness of this internet-based intervention with face-to-face care is required.

Objective: To evaluate whether an internet-based cognitive behavioral therapy intervention is at least as effective as established individualized face-to-face clinical care in reducing tinnitus distress and tinnitus-related difficulties.

Design, Setting, And Participants: A randomized, multicenter, 2-arm parallel group, noninferiority trial with 2-month follow-up was performed between October 4, 2016, and July 14, 2017. Invited to participate were 374 adults based in the United Kingdom who had been referred to their local tinnitus clinics because of bothersome tinnitus. The experimental group received the internet-based intervention online, and the active control group underwent the usual face-to-face tinnitus care at 1 of 3 UK-based National Health Service hospitals. Participants were randomly assigned (1:1) to either intervention using variable permuted block sizes of 4 and 6. Of 92 participants who were randomized (46 each in the experimental and control groups), 88 participants completed the assessment immediately after intervention and 74 participants completed the follow-up assessment.

Interventions: Participants were randomized to receive either 8 weeks of guided internet-based cognitive behavioral therapy or a mean of 2 to 3 individualized face-to-face appointments in a tinnitus clinic.

Main Outcomes And Measures: The primary outcome was a change in tinnitus distress (assessed by the Tinnitus Functional Index). Secondary assessment measures were included for insomnia, anxiety, depression, hearing disability, hyperacusis, cognitive failures, and satisfaction with life.

Results: Of 92 patients overall, 55 (60%) were men with a mean (SD) age of 52.96 (12.07) years and mean (SD) tinnitus duration of 6.54 (9.25) years. The between-group difference in the Tinnitus Functional Index scores after intervention were 5.18 (95% CI, -4.17 to 14.53) at the initial assessment and 5.52 (95% CI, -4.60 to 15.61) at follow-up; both differences were within the noninferiority margin of 13 points for the lower 95% CI. For the secondary outcomes, only outcomes for insomnia fell outside the noninferiority margin, both after intervention and at follow-up, favoring internet-based cognitive behavioral therapy.

Conclusions And Relevance: This is the first trial, to our knowledge, to compare an internet-based intervention with standard individualized face-to-face care for tinnitus. It revealed that both interventions are equally effective for reducing tinnitus distress and most tinnitus-related difficulties.

Trial Registration: ClinicalTrials.gov identifier: NCT02665975.
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http://dx.doi.org/10.1001/jamaoto.2018.2238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583080PMC
December 2018

Comments on Tao et al. (2017), "Multiple-Frequency Matching Treatment Strategy for Tinnitus".

J Int Adv Otol 2018 08;14(2):344-345

Department of Speech and Hearing Sciences, Lamar University School of Medicine, Beaumont, Texas, USA.

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http://dx.doi.org/10.5152/iao.2018.5537DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6354455PMC
August 2018

Audiologist-Guided Internet-Based Cognitive Behavior Therapy for Adults With Tinnitus in the United Kingdom: A Randomized Controlled Trial.

Ear Hear 2018 May/Jun;39(3):423-433

Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden.

Objectives: Specialist tinnitus services are in high demand as a result of the negative effect tinnitus may have on quality of life. Additional clinically and cost-effective tinnitus management routes are needed. One potential route is providing Cognitive Behavioural Therapy for tinnitus via the Internet (iCBT). This study aimed to determine the efficacy of guided iCBT, using audiological support, on tinnitus distress and tinnitus-related comorbidities, in the United Kingdom. A further aim was to establish the stability of intervention effects 2-months postintervention. The hypothesis was that iCBT for tinnitus would be more effective at reducing tinnitus distress than weekly monitoring.

Design: A randomized, delayed intervention efficacy trial, with a 2-month follow-up was implemented to evaluate the efficacy of iCBT in the United Kingdom. Participants were randomly assigned to the experimental (n = 73) or weekly monitoring control group (n = 73) after being stratified for tinnitus severity and age. After the experimental group completed the 8-week long iCBT intervention, the control group undertook the same intervention. Intervention effects were, therefore, evaluated in two independent groups at two time points. The primary outcome was a change in tinnitus distress between the groups as assessed by the Tinnitus Functional Index. Secondary assessment measures were included for insomnia, anxiety, depression, hearing disability, hyperacusis, cognitive failures, and satisfaction with life. These were completed at baseline, postintervention, and at a 2-month postintervention follow-up.

Results: After undertaking the iCBT intervention, the experimental group had a greater reduction in tinnitus distress when compared with the control group. This reduction was statistically significant (Cohen's d = 0.7) and was clinically significant for 51% of the experimental group and 5% of the control group. This reduction was evident 4 weeks after commencing the iCBT intervention. Furthermore, the experimental group had a greater reduction in insomnia, depression, hyperacusis, cognitive failures, and a greater improvement in quality of life, as evidenced by the significant differences in these assessment measures postintervention. Results were maintained 2 months postintervention.

Conclusions: Guided (using audiological support) iCBT for tinnitus resulted in statistically significant reductions in tinnitus distress and comorbidities (insomnia, depression, hyperacusis, cognitive failures) and a significant increase in quality of life. These effects remained stable at 2-months postintervention. Further trials to determine the longer term efficacy of iCBT to investigate predictors of outcome and to compare iCBT with standard clinical care in the United Kingdom are required.Registered at clinicaltrials.gov: NCT02370810 on 5/03/2015.
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http://dx.doi.org/10.1097/AUD.0000000000000505DOI Listing
March 2019

Process evaluation of Internet-based cognitive behavioural therapy for adults with tinnitus in the context of a randomised control trial.

Int J Audiol 2018 02 9;57(2):98-109. Epub 2017 Oct 9.

i Department of Behavioral Sciences and Learning , Linköping University , Linköping , Sweden , and.

Objective: The research objective was to identify processes that could either facilitate or hinder clinical implementation of an Internet-based cognitive behavioural therapy intervention for tinnitus in the UK. This was done by exploring the research context, the intervention components and the factors that contributed to the outcomes obtained.

Design: This study investigated eight processes including the recruitment strategies, reach, research context, treatment dose delivered and received, implementation fidelity, barriers to implementation and effectiveness of the intervention.

Study Sample: Of the 169 registered participants, 146 were randomly assigned to the experimental or control groups (23 were excluded). The mean age was 55.57 years with an average tinnitus duration of 11.63 years.

Results: The intended sample of people with distressing tinnitus who were underserved with evidence-based tinnitus interventions was reached. The full guided intervention was delivered. The recommended modules were read more than the optional modules. Intervention components such as the easily readable format and the benefits of the applied relaxation programme facilitated significant positive post-intervention outcomes. Barriers hampering the intervention application included time pressures and low self-motivation.

Conclusions: Results of this process evaluation together with the outcome data can be used to facilitate translating this research into clinical practice.
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http://dx.doi.org/10.1080/14992027.2017.1384858DOI Listing
February 2018

Situationally influenced tinnitus coping strategies: a mixed methods approach.

Disabil Rehabil 2018 12 9;40(24):2884-2894. Epub 2017 Aug 9.

a Department of Vision and Hearing Sciences , Anglia Ruskin University , Cambridge , UK.

Purpose: The primary aim of this study was to identify coping strategies used to manage problematic tinnitus situations. A secondary aim was to determine whether different approaches were related to the level of tinnitus distress, anxiety, depression, and insomnia experienced.

Materials And Methods: A cross-sectional survey design was implemented. The study sample was adults interested in undertaking an Internet-based intervention for tinnitus. Self-reported measures assessed the level of tinnitus distress, depression, anxiety, and insomnia. An open-ended question was used to obtain information about how problematic tinnitus situations were dealt with. Responses were investigated using qualitative content analysis to identify problematic situations. Further data analysis comprised of both qualitative and quantitative methods.

Results: There were 240 participants (137 males, 103 females), with an average age of 48.16 years (SD: 22.70). Qualitative content analysis identified eight problematic tinnitus situations. Participants had either habituated to their tinnitus (7.9%), used active (63.3%), or passive (28.8%) coping styles to manage these situations. Those who had habituated to tinnitus or used active coping strategies had lower levels of tinnitus distress, anxiety, and depression.

Conclusions: The main problematic tinnitus situations for this cohort were identified. Both active and passive coping styles were applied to approach these situations. The coping strategies used most frequently and utilised in the widest range of problematic situations were using sound enrichment and diverting attention. Implications for Rehabilitation The main problematic tinnitus situations for this group of participants were identified. Overall, a limited range of strategies were used to deal with individual problematic situations. The use of sound enrichment and diverting attention was applied in the widest range of problematic situations. The use of both active and passive coping styles was evident to approach these situations. The use of passive strategies in certain situations was associated with higher levels of tinnitus distress, depression, and anxiety over the last week as measured by self-reported questionnaires.
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http://dx.doi.org/10.1080/09638288.2017.1362708DOI Listing
December 2018

Social Representation of "Loud Music" in Young Adults: A Cross-Cultural Study.

J Am Acad Audiol 2017 Jun;28(6):522-533

The Department of Health and Welfare Studies, Malmö University, Malmö, Sweden.

Background: Exposure to recreational noise, particularly music exposure, is considered one of the biggest public health hazards of our time. Some important influencing factors such as socioeconomic status, educational background, and cross-cultural perspectives have previously been found to be associated with attitudes toward loud music and the use of hearing protection. Although culture seems to play an important role, there is relatively little known about how it influences perceptions regarding loud music exposure in young adults.

Purpose: The present study was aimed to explore cross-cultural perceptions of and reactions to loud music in young adults (18-25 yr) using the theory of social representations.

Research Design: The study used a cross-sectional survey design.

Study Sample: The study sample included young adults (n = 534) from five different countries (India, Iran, Portugal, the United States, and the United Kingdom) who were recruited using convenience sampling.

Data Collection And Analysis: Data were collected using a questionnaire. Data were analyzed using a content analysis, co-occurrence analysis, and also χ² analysis.

Results: Fairly equal numbers of positive and negative connotations (∼40%) were noted in all countries. However, the χ² analysis showed significant differences between the countries (most positive connotations were found in India and Iran, whereas the most negative connotations were found in the United Kingdom and Portugal) regarding the informants' perception of loud music. The co-occurrence analysis results generally indicate that the category "negative emotions and actions" occurred most frequently, immediately followed by the category "positive emotions and actions." The other most frequently occurring categories included "acoustics," "physical aliment," "location," and "ear and hearing problems." These six categories formed the central nodes of the social representation of loud music exposure in the global index. Although some similarities and differences were noted among the social representations toward loud music among countries, it is noteworthy that more similarities than differences were noted among countries.

Conclusions: The study results suggest that "loud music" is perceived to have both positive and negative aspects within society and culture. We suggest that the health promotion strategies should focus on changing societal norms and regulations to be more effective in decreasing the noise- and/or music-induced auditory symptoms among young adults.
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http://dx.doi.org/10.3766/jaaa.16046DOI Listing
June 2017

Guided Internet-based versus face-to-face clinical care in the management of tinnitus: study protocol for a multi-centre randomised controlled trial.

Trials 2017 04 21;18(1):186. Epub 2017 Apr 21.

Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.

Background: Innovative strategies are required to improve access to evidence-based tinnitus interventions. A guided Internet-based cognitive behavioural therapy (iCBT) intervention for tinnitus was therefore developed for a U.K.

Population: Initial clinical trials indicated efficacy of iCBT at reducing tinnitus severity and associated comorbidities such as insomnia and depression. The aim of this phase III randomised controlled trial is to compare this new iCBT intervention with an established intervention, namely face-to-face clinical care for tinnitus.

Methods/design: This will be a multi-centre study undertaken across three hospitals in the East of England. The design is a randomised, two-arm, parallel-group, non-inferiority trial with a 2-month follow-up. The experimental group will receive the guided iCBT intervention, whereas the active control group will receive the usual face-to-face clinical care. An independent researcher will randomly assign participants, using a computer-generated randomisation schedule, after stratification for tinnitus severity. There will be 46 participants in each group. The primary assessment measure will be the Tinnitus Functional Index. Data analysis will establish whether non-inferiority is achieved using a pre-defined non-inferiority margin.

Discussion: This protocol outlines phase III of a clinical trial comparing a new iCBT with established face-to-face care for tinnitus. If guided iCBT for tinnitus proves to be as effective as the usual tinnitus care, it may be a viable additional management route for individuals with tinnitus. This could increase access to evidence-based effective tinnitus care and reduce the pressures on existing health care systems.

Trial Registration: ClinicalTrials.gov identifier: NCT02665975 . Registered on 22 January 2016.
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http://dx.doi.org/10.1186/s13063-017-1931-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5399814PMC
April 2017

Internet-Based Intervention for Tinnitus: Outcome of a Single-Group Open Trial.

J Am Acad Audiol 2017 Apr;28(4):340-351

Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden.

Background: Managing chronic tinnitus is challenging, and innovative ways to address the resulting health-care burden are required. Internet-based cognitive behavioral therapy (iCBT) for tinnitus shows promise as a cost-effective treatment option. The feasibility and effectiveness of iCBT in the United Kingdom are yet to be explored. Furthermore, it is not known if iCBT can be supported by an audiologist rather than a psychologist.

Purpose: This study aimed to determine the feasibility of guided iCBT using audiological support on tinnitus distress and tinnitus-related comorbidities. Furthermore, it aimed to establish the feasibility of iCBT for tinnitus distress in the United Kingdom, by determining recruitment, attrition, and compliance rates. Finally, it aimed to identify which aspects of the protocol require refinement for subsequent clinical trials.

Research Design: A single-group open trial design was implemented. This study would serve as a prerequisite study, to identify barriers, before undertaking effectiveness trials.

Study Sample: Participants consisted of 37 adults (18 males, 19 females), with an age range of between 50 and 59 yr. The mean preintervention tinnitus severity rating was 56.15 (standard deviation = 18.35), which is categorized as "severe tinnitus" as measured by the Tinnitus Functional Index (TFI). Five participants withdrew during the study, and 29 of the remaining participants completed the postintervention questionnaire.

Intervention: The guided iCBT intervention ran over an eight-week period and consisted of 16 obligatory modules and five optional modules. The intervention was designed to be interactive, interesting, and stimulating. A key element was the provision of support from an audiologist throughout the program.

Data Collection And Analysis: Online questionnaires were used throughout the study. These were administered at baseline and postintervention to determine attrition and compliance rates and to facilitate sample size estimates for further clinical trials. Outcome measures for tinnitus severity, hearing handicap, insomnia, cognitive functioning, hyperacusis, anxiety, depression, and life satisfaction were used to investigate the effects of iCBT with audiological support. In addition, a weekly questionnaire was incorporated to monitor change in tinnitus distress while undertaking the intervention.

Results: Feasibility was established using an audiologist to support this guided iCBT intervention, as a significant change postintervention was found for tinnitus severity, as measured by the TFI and the Tinnitus Handicap Inventory, Screening version. The attrition rate was 22% and compliance was variable. Although these results were based on a small sample, they provide encouraging evidence for the feasibility of delivering iCBT treatment for tinnitus symptoms with audiology support in the United Kingdom.

Conclusions: An Internet-based intervention of tinnitus appears to be feasible in the United Kingdom when using audiological support. Randomized controlled trials to further investigate the effectiveness of iCBT for tinnitus in the United Kingdom are required.
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http://dx.doi.org/10.3766/jaaa.16055DOI Listing
April 2017
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