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Hearing Disorders: HELP
Articles by James A. Henry
Based on 43 articles published since 2010
(Why 43 articles?)

Between 2010 and 2020, J. A. Henry wrote the following 43 articles about Hearing Disorders.
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline Clinical practice guideline: tinnitus executive summary. 2014

Tunkel, David E / Bauer, Carol A / Sun, Gordon H / Rosenfeld, Richard M / Chandrasekhar, Sujana S / Cunningham, Eugene R / Archer, Sanford M / Blakley, Brian W / Carter, John M / Granieri, Evelyn C / Henry, James A / Hollingsworth, Deena / Khan, Fawad A / Mitchell, Scott / Monfared, Ashkan / Newman, Craig W / Omole, Folashade S / Phillips, C Douglas / Robinson, Shannon K / Taw, Malcolm B / Tyler, Richard S / Waguespack, Richard / Whamond, Elizabeth J. ·Otolaryngology-Head and Neck Surgery, Johns Hopkins Outpatient Center, Baltimore, Maryland, USA dtunkel@jhmi.edu. · Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA. · Partnership for Health Analytic Research, LLC, Los Angeles, California, USA. · Department of Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, New York, USA. · New York Otology, New York, New York, USA. · Department of Research and Quality Improvement, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA. · Divisions of Rhinology & Sinus Surgery and Facial Plastic & Reconstructive Surgery, University of Kentucky, Lexington, Kentucky, USA. · Department of Otolaryngology, University of Manitoba, Winnipeg, MB, Canada. · Department of Otolaryngology, Tulane University, New Orleans, Louisiana, USA. · Division of Geriatric Medicine and Aging, Columbia University, New York, New York, USA. · National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, Oregon, USA. · ENT Specialists of Northern Virginia, Falls Church, Virginia, USA. · Ochsner Health System, Kenner, Louisiana, USA. · Mitchell & Cavallo, P.C., Houston, Texas, USA. · Department of Otology and Neurotology, The George Washington University, Washington, DC, USA. · Department of Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA. · Morehouse School of Medicine, East Point, Georgia, USA. · Department of Head and Neck Imaging, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA. · Department of Psychiatry, University of California, San Diego, La Jolla, California, USA. · Department of Medicine, UCLA Center for East-West Medicine, Los Angeles, California, USA. · Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA. · Department of Surgery, University of Alabama School of Medicine, Birmingham, Alabama, USA. · Consumers United for Evidence-based Healthcare, Fredericton, New Brunswick, Canada. ·Otolaryngol Head Neck Surg · Pubmed #25274374.

ABSTRACT: The American Academy of Otolaryngology--Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Tinnitus. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 13 recommendations developed address the evaluation of patients with tinnitus, including selection and timing of diagnostic testing and specialty referral to identify potential underlying treatable pathology. It will then focus on the evaluation and treatment of patients with persistent primary tinnitus, with recommendations to guide the evaluation and measurement of the impact of tinnitus and to determine the most appropriate interventions to improve symptoms and quality of life for tinnitus sufferers.

2 Editorial Tinnitus management: state of the art and looking ahead. 2014

Henry, James A. ·VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), VA Medical Center Portland, OR and Department of Otolaryngology/Head and Neck Surgery Oregon Health and Science University Portland, OR. ·J Am Acad Audiol · Pubmed #24622857.

ABSTRACT: -- No abstract --

3 Review Coping with tinnitus. 2016

Martz, Erin / Henry, James A. · ·J Rehabil Res Dev · Pubmed #27997668.

ABSTRACT: This narrative article on coping with tinnitus has four primary objectives. First, theoretical perspectives about defining and categorizing coping are discussed. Second, an overview of the empirical research on coping with tinnitus is provided, focusing on how coping with tinnitus has been measured and on the trends that were found in research on coping with tinnitus. Third, the problems related to the current state of research on coping with tinnitus are highlighted. Fourth, suggestions are provided on ways that researchers can improve research on coping with tinnitus.

4 Review "Measurement" of Tinnitus. 2016

Henry, James A. ·VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System and Science University, Portland, Oregon. ·Otol Neurotol · Pubmed #27518136.

ABSTRACT: Chronic tinnitus is the persistent sensation of hearing a sound that exists only inside the head. The prevalence of tinnitus in adults in the United States is estimated at 10 to 15%. For about 20% of these individuals the tinnitus is significantly bothersome. Although myriad therapies for tinnitus are offered (often at significant cost), most are not evidence based. Difficulty in the assessment and further development of interventions for tinnitus stems from the limitations of techniques used to evaluate these interventions. Questionnaires are widely available to "measure" (tinnitus can only be indirectly measured) functional effects of tinnitus, such as difficulty sleeping and concentrating, and negative emotions such as anxiety, depression, and annoyance. Questionnaires have recently been documented for sensitivity to change in response to intervention (i.e., "responsiveness"). All of these questionnaires function well to assess the overall impact of tinnitus. The limitations mentioned pertain primarily to measures of tinnitus perception, which typically include the psychoacoustic measures of tinnitus loudness and pitch matches, tinnitus spectral content, minimum masking levels, and residual inhibition. These measures, which are obtained routinely in many clinics and as part of research studies, have not been validated for being diagnostic, prognostic, discriminative, or responsive. In order for these measures to become clinically meaningful, normative standards are needed, both for baseline measures and for repeated measures of tinnitus perception. Evidence-based intervention for tinnitus requires accurately measuring both the perception of, and reactions to, tinnitus.

5 Review Hearing impairment and tinnitus: prevalence, risk factors, and outcomes in US service members and veterans deployed to the Iraq and Afghanistan wars. 2015

Theodoroff, Sarah M / Lewis, M Samantha / Folmer, Robert L / Henry, James A / Carlson, Kathleen F. · ·Epidemiol Rev · Pubmed #25600417.

ABSTRACT: Hearing loss and tinnitus are the 2 most prevalent service-connected disabilities among veterans in the United States. Veterans of Operations Enduring Freedom, Iraqi Freedom, and New Dawn have been exposed to multiple hazards associated with these conditions, such as blasts/explosions, ototoxic chemicals, and most notably high levels of noise. We conducted a systematic literature review of evidence on 1) prevalence of, 2) risk and protective factors for, and 3) functional and quality-of-life outcomes of hearing impairment and tinnitus in US Operations Enduring Freedom, Iraqi Freedom, and New Dawn veterans and military personnel. We identified studies published from 2001 through 2013 using PubMed, PsycINFO, REHABDATA, Cochrane Library, pearling, and expert recommendation. Peer-reviewed English language articles describing studies of 30 or more adults were included if they informed one or more key questions. A total of 839 titles/abstracts were reviewed for relevance by investigators trained in critical analysis of literature; 14 studies met inclusion criteria. Of these, 13 studies presented data on prevalence and 4 on risk/protective factors, respectively. There were no included studies reporting on outcomes. Findings from this systematic review will help inform clinicians, researchers, and policy makers on future resource and research needs pertaining to hearing impairment and tinnitus in this newest generation of veterans.

6 Review Sound therapy for tinnitus management: practicable options. 2014

Hoare, Derek J / Searchfield, Grant D / El Refaie, Amr / Henry, James A. ·National Institute for Health Research (NIHR), Nottingham Hearing Biomedical Research Unit, University of Nottingham, Nottingham, United Kingdom; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom. · Section of Audiology and Centre for Brain Research, University of Auckland, New Zealand. · Human Communication Sciences, La Trobe University, Melbourne, Australia. · VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), VA Medical Center, Portland, OR; Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, OR. ·J Am Acad Audiol · Pubmed #24622861.

ABSTRACT: BACKGROUND: The authors reviewed practicable options of sound therapy for tinnitus, the evidence base for each option, and the implications of each option for the patient and for clinical practice. PURPOSE: To provide a general guide to selecting sound therapy options in clinical practice. INTERVENTION: Practicable sound therapy options. DATA COLLECTION AND ANALYSIS: Where available, peer-reviewed empirical studies, conference proceedings, and review studies were examined. Material relevant to the purpose was summarized in a narrative. RESULTS: The number of peer-reviewed publications pertaining to each sound therapy option reviewed varied significantly (from none to over 10). Overall there is currently insufficient evidence to support or refute the routine use of individual sound therapy options. It is likely, however, that sound therapy combined with education and counseling is generally helpful to patients. CONCLUSIONS: Clinicians need to be guided by the patient's point of care, patient motivation and expectations of sound therapy, and the acceptability of the intervention both in terms of the sound stimuli they are to use and whether they are willing to use sound extensively or intermittently. Clinicians should also clarify to patients the role sound therapy is expected to play in the management plan.

7 Review Cognitive-behavioral treatments for tinnitus: a review of the literature. 2014

Cima, Rilana F F / Andersson, Gerhard / Schmidt, Caroline J / Henry, James A. ·Department of Clinical Psychological Science, Maastricht University, the Netherlands; Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands. · Department of Behavioural Sciences and Learning, Linnaeus Centre HEAD, Swedish Institute for Disability Research, Linköping University, Sweden; Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institute, Stockholm, Sweden. · Psychology Service, VA Connecticut Healthcare System, West Haven, CT; Department of Psychiatry, Yale School of Medicine, New Haven, CT. · VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), VA Medical Center, Portland, OR; Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, OR. ·J Am Acad Audiol · Pubmed #24622860.

ABSTRACT: BACKGROUND: Tinnitus can be defined as the perception of an auditory sensation, perceivable without the presence of an external sound. PURPOSE: The aim of this article is to systematically review the peer-reviewed literature on treatment approaches for tinnitus based on cognitive-behavioral therapy (CBT) and to provide a historical overview of developments within these approaches. RESEARCH DESIGN: Experimental studies, (randomized) trials, follow-up assessments, and reviews assessing educational, counseling, psychological, and CBT treatment approaches were identified as a result of an electronic database metasearch. RESULTS: A total of 31 (of the initial 75 studies) were included in the review. Results confirm that CBT treatment for tinnitus management is the most evidence-based treatment option so far. Though studied protocols are diverse and are usually a combination of different treatment elements, and tinnitus diagnostics and outcome assessments vary over investigations, a common ground of therapeutic elements was established, and evidence was found to be robust enough to guide clinical practice. CONCLUSIONS: Treatment strategy might best be CBT-based, moving toward a more multidisciplinary approach. There is room for the involvement of different disciplines, using a stepped-care approach. This may provide brief and effective treatment for a larger group of tinnitus patients, and additional treatment steps can be provided for those suffering on a more severe level.

8 Review Underlying mechanisms of tinnitus: review and clinical implications. 2014

Henry, James A / Roberts, Larry E / Caspary, Donald M / Theodoroff, Sarah M / Salvi, Richard J. ·VA RR&D National Center for Rehabilitative Auditory Research (NCRAR), VA Medical Center, Portland, OR; Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, OR. · Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Ontario, Canada. · Pharmacology Department, Southern Illinois University School of Medicine, Springfield, IL. · Center for Hearing and Deafness, University of Buffalo, Buffalo, NY. ·J Am Acad Audiol · Pubmed #24622858.

ABSTRACT: BACKGROUND: The study of tinnitus mechanisms has increased tenfold in the last decade. The common denominator for all of these studies is the goal of elucidating the underlying neural mechanisms of tinnitus with the ultimate purpose of finding a cure. While these basic science findings may not be immediately applicable to the clinician who works directly with patients to assist them in managing their reactions to tinnitus, a clear understanding of these findings is needed to develop the most effective procedures for alleviating tinnitus. PURPOSE: The goal of this review is to provide audiologists and other health-care professionals with a basic understanding of the neurophysiological changes in the auditory system likely to be responsible for tinnitus. RESULTS: It is increasingly clear that tinnitus is a pathology involving neuroplastic changes in central auditory structures that take place when the brain is deprived of its normal input by pathology in the cochlea. Cochlear pathology is not always expressed in the audiogram but may be detected by more sensitive measures. Neural changes can occur at the level of synapses between inner hair cells and the auditory nerve and within multiple levels of the central auditory pathway. Long-term maintenance of tinnitus is likely a function of a complex network of structures involving central auditory and nonauditory systems. CONCLUSIONS: Patients often have expectations that a treatment exists to cure their tinnitus. They should be made aware that research is increasing to discover such a cure and that their reactions to tinnitus can be mitigated through the use of evidence-based behavioral interventions.

9 Review A triage guide for tinnitus. 2010

Henry, James A / Zaugg, Tara L / Myers, Paula J / Kendall, Caroline J / Michaelides, Elias M. ·Veterans Affairs RR and D National Center for Rehabilitative Auditory Research, VA Medical Center, Portland, OR, USA. james.henry@va.gov ·J Fam Pract · Pubmed #20625568.

ABSTRACT: -- No abstract --

10 Clinical Trial Evaluating psychoacoustic measures for establishing presence of tinnitus. 2013

Henry, James A / McMillan, Garnett P / Thielman, Emily J / Galvez, Gino / Zaugg, Tara L / Porsov, Edward / Silaski, Grayson. ·VA Medical Center, Portland, OR 97207, USA. james.henry@va.gov ·J Rehabil Res Dev · Pubmed #23934876.

ABSTRACT: The Department of Veterans Affairs (VA) considers tinnitus a disability. Veterans can claim tinnitus as a "service-connected" disability if the tinnitus is thought to be connected to military service. The VA adjudicates each claim and determines whether reasonable evidence exists to support it. Currently, determining the presence of tinnitus is based on subjective reporting-objective measures do not exist. The aim of this study was to develop and document a test for detecting the presence/absence of tinnitus with high confidence. Using our computer-automated, self-guided tinnitus evaluation system, we conducted three phases of testing to compare psychoacoustic measures of tinnitus between participants with versus without tinnitus. Phase 1 measures included loudness match, pitch match, minimum masking level, residual inhibition, Békésy, and forced-choice double staircase. Phases 2 and 3 measures were chosen based on results of the previous phase. The number of tests and time of testing decreased during each successive phase. Differences were seen between groups; most notably, higher low-frequency loudness matches and higher median pitch matches were observed for participants with tinnitus. Results of this study suggest that further efforts can produce a defined psychoacoustic test battery for identifying the presence/absence of tinnitus.

11 Clinical Trial Computer-automated tinnitus assessment: noise-band matching, maskability, and residual inhibition. 2013

Henry, James A / Roberts, Larry E / Ellingson, Roger M / Thielman, Emily J. ·VA RR&D National Center for Rehabilitative Auditory Research, VA Medical Center, Portland, OR 97207, USA. james.henry@va.gov ·J Am Acad Audiol · Pubmed #23886426.

ABSTRACT: BACKGROUND: Psychoacoustic measures of tinnitus typically include loudness and pitch match, minimum masking level (MML), and residual inhibition (RI). We previously developed and documented a computer-automated tinnitus evaluation system (TES) capable of subject-guided loudness and pitch matching. The TES was further developed to conduct computer-aided, subject-guided testing for noise-band matching (NBM), MML, and RI. PURPOSE: The purpose of the present study was to document the capability of the upgraded TES to obtain measures of NBM, MML, and RI, and to determine the test-retest reliability of the responses obtained. RESEARCH DESIGN: Three subject-guided, computer-automated testing protocols were developed to conduct NBM. For MML and RI testing, a 2-12 kHz band of noise was used. All testing was repeated during a second session. STUDY SAMPLE: Subjects meeting study criteria were selected from those who had previously been tested for loudness and pitch matching in our laboratory. A total of 21 subjects completed testing, including seven females and 14 males. RESULTS: The upgraded TES was found to be fairly time efficient. Subjects were generally reliable, both within and between sessions, with respect to the type of stimulus they chose as the best match to their tinnitus. Matching to bandwidth was more variable between measurements, with greater consistency seen for subjects reporting tonal tinnitus or wide-band noisy tinnitus than intermediate types. Between-session repeated MMLs were within 10 dB of each other for all but three of the subjects. Subjects who experienced RI during Session 1 tended to be those who experienced it during Session 2. CONCLUSIONS: This study may represent the first time that NBM, MML, and RI audiometric testing results have been obtained entirely through a self-contained, computer-automated system designed specifically for use in the clinic. Future plans include refinements to achieve greater testing efficiency.

12 Clinical Trial The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus. 2012

Meikle, Mary B / Henry, James A / Griest, Susan E / Stewart, Barbara J / Abrams, Harvey B / McArdle, Rachel / Myers, Paula J / Newman, Craig W / Sandridge, Sharon / Turk, Dennis C / Folmer, Robert L / Frederick, Eric J / House, John W / Jacobson, Gary P / Kinney, Sam E / Martin, William H / Nagler, Stephen M / Reich, Gloria E / Searchfield, Grant / Sweetow, Robert / Vernon, Jack A. ·Oregon Health & Science University, Portland, Oregon 97207, USA. ·Ear Hear · Pubmed #22156949.

ABSTRACT: OBJECTIVES: Chronic subjective tinnitus is a prevalent condition that causes significant distress to millions of Americans. Effective tinnitus treatments are urgently needed, but evaluating them is hampered by the lack of standardized measures that are validated for both intake assessment and evaluation of treatment outcomes. This work was designed to develop a new self-report questionnaire, the Tinnitus Functional Index (TFI), that would have documented validity both for scaling the severity and negative impact of tinnitus for use in intake assessment and for measuring treatment-related changes in tinnitus (responsiveness) and that would provide comprehensive coverage of multiple tinnitus severity domains. DESIGN: To use preexisting knowledge concerning tinnitus-related problems, an Item Selection Panel (17 expert judges) surveyed the content (175 items) of nine widely used tinnitus questionnaires. From those items, the Panel identified 13 separate domains of tinnitus distress and selected 70 items most likely to be responsive to treatment effects. Eliminating redundant items while retaining good content validity and adding new items to achieve the recommended minimum of 3 to 4 items per domain yielded 43 items, which were then used for constructing TFI Prototype 1.Prototype 1 was tested at five clinics. The 326 participants included consecutive patients receiving tinnitus treatment who provided informed consent-constituting a convenience sample. Construct validity of Prototype 1 as an outcome measure was evaluated by measuring responsiveness of the overall scale and its individual items at 3 and 6 mo follow-up with 65 and 42 participants, respectively. Using a predetermined list of criteria, the 30 best-functioning items were selected for constructing TFI Prototype 2.Prototype 2 was tested at four clinics with 347 participants, including 155 and 86 who provided 3 and 6 mo follow-up data, respectively. Analyses were the same as for Prototype 1. Results were used to select the 25 best-functioning items for the final TFI. RESULTS: Both prototypes and the final TFI displayed strong measurement properties, with few missing data, high validity for scaling of tinnitus severity, and good reliability. All TFI versions exhibited the same eight factors characterizing tinnitus severity and negative impact. Responsiveness, evaluated by computing effect sizes for responses at follow-up, was satisfactory in all TFI versions.In the final TFI, Cronbach's alpha was 0.97 and test-retest reliability 0.78. Convergent validity (r = 0.86 with Tinnitus Handicap Inventory [THI]; r = 0.75 with Visual Analog Scale [VAS]) and discriminant validity (r = 0.56 with Beck Depression Inventory-Primary Care [BDI-PC]) were good. The final TFI was successful at detecting improvement from the initial clinic visit to 3 mo with moderate to large effect sizes and from initial to 6 mo with large effect sizes. Effect sizes for the TFI were generally larger than those obtained for the VAS and THI. After careful evaluation, a 13-point reduction was considered a preliminary criterion for meaningful reduction in TFI outcome scores. CONCLUSIONS: The TFI should be useful in both clinical and research settings because of its responsiveness to treatment-related change, validity for scaling the overall severity of tinnitus, and comprehensive coverage of multiple domains of tinnitus severity.

13 Clinical Trial Pilot study to evaluate ecological momentary assessment of tinnitus. 2012

Henry, James A / Galvez, Gino / Turbin, Mitchel B / Thielman, Emily J / McMillan, Garnett P / Istvan, Joseph A. ·VA RR&D National Center for Rehabilitative Auditory Research, VA, Medical Center, Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon 97207, USA. james.henry@va.gov ·Ear Hear · Pubmed #21960147.

ABSTRACT: OBJECTIVES: Because audiometric evaluation, symptom histories, questionnaires, and similar standard assessment tools may not adequately sample the effects of chronic tinnitus on day-to-day activities, there is a need for alternative methodological approaches to study the impact of tinnitus on day-to-day life. An innovative methodological approach that has shown great promise in the study of chronic health problems characterized by reported temporal and/or situational variability in symptoms and distress is known as ecological momentary assessment (EMA). EMA involves the real-time measurement of states, situational factors, and symptoms by individuals as they go about their day-to-day activities. The objective of this pilot investigation was to explore the feasibility of using EMA methods to examine within- and between-day effects of tinnitus. DESIGN: This study was conducted in three phases: (1) design and development of an EMA methodology that could be used to assess effects of tinnitus; (2) refinement of the methodology through the use of two focus groups; and (3) field-test the methodology with individuals who experienced bothersome tinnitus. For Phase 3, each of the 24 participants wore, throughout their waking hours for 2 weeks, a personal digital assistant that produced alerts four times a day. The alerts prompted participants to respond to 19 questions, including 9 relating to situational and mood factors and 10 comprising the Tinnitus Handicap Inventory-Screening version (THI-S). To evaluate for potential reactive effects of performing the EMA protocol, each participant completed the paper-and-pencil version of the full 25-item THI before and after the 2-week EMA period. RESULTS: Participants responded to the alerts with a 90% compliance rate, providing a total of 1210 completed surveys. At the time of their response, participants indicated that they were in their house or apartment (67.7%), alone (50.2%), happy (50%), and calm (54.5%). Across most responses, participants could hear their tinnitus (97%), and the loudness of their tinnitus averaged 4.7 on a 7-point increasing-loudness scale. The mean THI-S index score (out of a possible maximum 40 points for greatest tinnitus severity) was 17.0 (moderate self-perceived tinnitus handicap). Repeated THI-S index scores varied considerably both within and between participants. Mean 25-item THI scores were not significantly different before and after the EMA period, suggesting little reactivity of the EMA. CONCLUSIONS: The high compliance rate, positive feedback from participants, lack of reactivity as a result of performing the EMA protocol, and data collected indicate that EMA methodology is feasible with patients who have tinnitus. Outcome data obtained with this methodology cannot be obtained any other way because retrospective questionnaires cannot capture the day-to-day reactions. This methodology has the potential to provide more in-depth and accurate assessments of patients receiving therapy for tinnitus.

14 Article Clinical Protocol to Promote Standardization of Basic Tinnitus Services by Audiologists. 2019

Henry, James A / Manning, Candice. ·Veterans Affairs Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR. · Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland. ·Am J Audiol · Pubmed #31022366.

ABSTRACT: 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.

15 Article Perception Versus Reaction: Comparison of Tinnitus Psychoacoustic Measures and Tinnitus Functional Index Scores. 2019

Manning, Candice / Thielman, Emily J / Grush, Leslie / Henry, James A. ·National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR. · Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland. ·Am J Audiol · Pubmed #31022361.

ABSTRACT: 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.

16 Article Health Care Utilization and Mental Health Diagnoses Among Veterans With Tinnitus. 2019

Carlson, Kathleen F / Gilbert, Tess A / O'Neil, Maya E / Zaugg, Tara L / Manning, Candice A / Kaelin, Christine / Thielman, Emily J / Reavis, Kelly M / Henry, James A. ·VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR. · VA Health Services Research & Development Service Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System, OR. · OHSU-PSU School of Public Health, Oregon Health & Science University, Portland. · Department of Medical Informatics & Clinical Epidemiology and Department of Psychiatry, Oregon Health & Science University, Portland. · Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland. ·Am J Audiol · Pubmed #31022360.

ABSTRACT: 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.

17 Article Comparison of Tinnitus Loudness Measures: Matching, Rating, and Scaling. 2019

Manning, Candice / Grush, Leslie / Thielman, Emily / Roberts, Larry / Henry, James A. ·National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR. · Department of Otolaryngology/Head & Neck Surgery, Oregon Health and Science University, Portland. · McMaster University, Hamilton, Ontario, Canada. ·Am J Audiol · Pubmed #30938558.

ABSTRACT: 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.

18 Article Impact of Tinnitus on Military Service Members. 2019

Henry, James A / Griest, Susan E / Blankenship, Cody / Thielman, Emily J / Theodoroff, Sarah M / Hammill, Tanisha / Carlson, Kathleen F. ·VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR. · Department of Otolaryngology/Head & Neck Surgery, Oregon Health & Science University, Portland, OR. · Department of Defense, Hearing Center of Excellence, San Antonio, TX. · School of Public Health, Oregon Health & Science University, Portland, OR. · Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR. ·Mil Med · Pubmed #30901434.

ABSTRACT: OBJECTIVES: The Noise Outcomes in Servicemembers Epidemiology (NOISE) Study is obtaining longitudinal data to evaluate the effects of noise and other exposures on auditory function in military personnel. A gap in the literature is the lack of studies concerning how active-duty Service members might be impacted by having tinnitus. The present study reports NOISE Study data that address this gap. METHODS: Data are reported from current Service members and recently-separated (within 2.5 years) Veterans, enabling a direct comparison of results between active and post-military samples. Data were collected from two sites: VA Portland Health Care System, Portland, OR and Department of Defense Hearing Center of Excellence, San Antonio, TX. Participants completed comprehensive audiometric testing and numerous questionnaires. RESULTS: Results are presented from n = 428 participants across the two sites, including 246 Veterans and 182 Service members. The data reveal that, for both Service members and Veterans, the presence of tinnitus has effects on job performance, concentration, anxiety, depression, and sleep. CONCLUSIONS: This study has revealed that, for these samples of study participants, tinnitus has an impact on military Service members that is comparable to how it affects Veterans who have completed their military service within the previous 2.5 years.

19 Article Telephone-Based Progressive Tinnitus Management for Persons With and Without Traumatic Brain Injury: A Randomized Controlled Trial. 2019

Henry, James A / Thielman, Emily J / Zaugg, Tara L / Kaelin, Christine / McMillan, Garnett P / Schmidt, Caroline J / Myers, Paula J / Carlson, Kathleen F. ·VA Rehabilitation Research & Development National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon, USA. · Department of Otolaryngology - Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA. · Psychology Service and Audiology Service, VA Connecticut Healthcare System, West Haven, Connecticut, USA. · Department of Psychiatry, Yale University, New Haven, Connecticut, USA. · Department of Audiology, James A. Haley Veterans Hospital, Tampa, Florida, USA. · VA Health Services Research & Development Center of Innovation, VA Portland Health Care System, Portland, Oregon, USA. · School of Public Health, Oregon Health & Science University, Portland, Oregon, USA. ·Ear Hear · Pubmed #29847413.

ABSTRACT: OBJECTIVES: This randomized controlled trial evaluated the efficacy of delivering coping skills education from Progressive Tinnitus Management (PTM) by telephone (Tele-PTM). The trial followed a previous pilot study that showed positive results for Tele-PTM. DESIGN: Participants included individuals with bothersome tinnitus (N = 205) located anywhere within the United States. A special emphasis was given to including individuals who had experienced one or more traumatic brain injuries (TBIs). Participants were randomized to either Tele-PTM intervention or 6-month wait-list control (WLC). The Tele-PTM intervention involved five telephone appointments-two led by an audiologist (teaching how to use therapeutic sound) and three by a psychologist (teaching coping skills derived from cognitive-behavioral therapy). It was hypothesized that Tele-PTM would be more effective than WLC in reducing functional effects of tinnitus as measured with the Tinnitus Functional Index. Additional outcome measures included the Self-Efficacy for Managing Reactions to Tinnitus questionnaire and the Hospital Anxiety and Depression Scale. The effect of Tele-PTM on outcomes was estimated using linear mixed models. RESULTS: Overall results showed convincingly that the Tele-PTM group had significantly better outcomes than the WLC group. These results were consistent across all outcome measures, indicating not only a reduction of tinnitus functional distress but also increased self-efficacy. Improvements in measures of anxiety and depression were also observed. Tele-PTM participants in all TBI categories showed significant improvement. CONCLUSIONS: Results provide strong support for use of Tele-PTM methodology for persons with bothersome tinnitus, regardless of whether the person also has TBI symptoms. The effect size for Tele-PTM was high for the primary outcome measure, the Tinnitus Functional Index, and all other outcome measures showed significant improvement. Combined with our previous pilot study, the Tele-PTM method is validated for potential nationwide provision of tinnitus services.

20 Article A qualitative study of implementation and adaptations to Progressive Tinnitus Management (PTM) delivery. 2018

Tuepker, Anaïs / Elnitsky, Christine / Newell, Summer / Zaugg, Tara / Henry, James A. ·Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Healthcare System, Portland, Oregon, United States of America. · Division of General Internal Medicine, Oregon Health & Science University, Portland, Oregon, United States of America. · University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America. · National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Healthcare System, Portland, Oregon, United States of America. · Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, United States of America. ·PLoS One · Pubmed #29768430.

ABSTRACT: BACKGROUND: Tinnitus is a common condition, especially prevalent among military Veterans. Progressive Tinnitus Management (PTM) is an interdisciplinary, structured, stepped-care approach to providing clinical services, including teaching coping skills, to people bothered by tinnitus. PTM has been shown to be effective at reducing functional distress, but implementation of the intervention outside of a research setting has not been studied, even though dissemination is underway within the Veterans Health Administration (VHA) system in the United States. This study was designed to address a gap in knowledge of PTM clinical implementation to date, with a focus on factors facilitating or hindering implementation in VHA audiology and mental health clinic contexts, and whether implementing sites had developed intervention adaptations. METHODS: Qualitative interviews were conducted with 21 audiology and mental health clinicians and service chiefs across a regional service network. Interviews were transcribed and coded using a hybrid inductive-deductive analytic approach guided by existing implementation research frameworks and then iteratively developed for emergent themes. RESULTS: PTM prioritization was rare overall, with providers across disciplines challenged by lack of capacity for implementation, but with differences by discipline in challenges to prioritization. Where PTM was prioritized and delivered, this was facilitated by perception of unique value, provider's own experience of tinnitus, observation/experience with PTM delivery, intervention fit with provider's skills, and an environment with supportive leadership and adaptive reserve. PTM was frequently adapted to local contexts to address delivery challenges and diversify patient options. Adaptations included shifting from group to individual formats, reducing or combining sessions, and employing novel therapeutic approaches. CONCLUSIONS: Existing adaptations highlight the need to better understand mechanisms underlying PTM's effectiveness, and research on the impact of adaptations on patient outcomes is an important next step. Prioritization of PTM is a key barrier to the scale up and spread of this evidence-based intervention. Developing clinician champions may facilitate dissemination, especially if accompanied by signals of systemic prioritization. Novel approaches exposing clinicians and administrators to PTM may identify and develop clinical champions. Acknowledging the potential for PTM adaptations may make delivery more feasible in the context of existing system constraints and priorities.

21 Article Comparison of acoustic therapies for tinnitus suppression: a preliminary trial. 2018

Schad, Maggie L / McMillan, Garnett P / Thielman, Emily J / Groon, Katherine / Morse-Fortier, Charlotte / Martin, Jennifer L / Henry, James A. ·a Communication Sciences & Disorders , University of Cincinnati , Cincinnati , OH , USA. · b VA RR&D National Center for Rehabilitative Auditory Research , VA Portland Health Care System , Portland , OR , USA. · c Hearing, Speech, and Language Sciences , Gallaudet University , Washington, D.C , USA , and. · d Department of Otolaryngology - Head & Neck Surgery , Oregon Health & Science University , Portland , OR , USA. ·Int J Audiol · Pubmed #29022411.

ABSTRACT: OBJECTIVE: This study obtained preliminary data using two types of sound therapy to suppress tinnitus and/or reduce its functional effects: (1) Notched noise (1000-12,000 Hz notched within a 1-octave range centred around the tinnitus pitch match [PM] frequency); and (2) Matched noise (1-octave wide band of noise centred around the PM frequency). A third (Placebo) group listened to low frequency noise (250-700 Hz). DESIGN: Participants with bothersome tinnitus were randomised into one of the three groups and instructed to listen to the acoustic stimulus for 6 hours a day for 2 weeks. Stimuli were delivered using an iPod Nano, and tinnitus counselling was not performed. Outcome measures were recorded at the 0, 2 and 4 week study visits. STUDY SAMPLE: Thirty participants with constant and bothersome tinnitus were recruited and randomised. RESULTS: All groups showed, on average, overall improvement, both immediately post-treatment and 2 weeks following treatment. Outcomes varied between groups on the different measures and at the two outcome points. CONCLUSION: This study showed improvement for all of the groups, lending support to the premise that any type of sound stimulation is beneficial for relieving effects of tinnitus. These results may serve as a preliminary evidence for a larger study.

22 Article Randomized Controlled Trial of a Novel Device for Tinnitus Sound Therapy During Sleep. 2017

Theodoroff, Sarah M / McMillan, Garnett P / Zaugg, Tara L / Cheslock, Megan / Roberts, Chan / Henry, James A. ·VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR. · Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland. ·Am J Audiol · Pubmed #29090311.

ABSTRACT: Purpose: The aim of this study was to determine if a customized stimulus from the Otoharmonics Levo System reduces tinnitus perceptions and reactions for people with bothersome tinnitus. Method: Sixty participants were randomized to 1 of 3 groups that used sound therapy devices during sleep that differed in their acoustic stimulus: (a) tinnitus-matched (TM), (b) noise stimulus (NS), and (c) bedside sound generator (BSG). Outcome measures were the Tinnitus Functional Index (TFI), numeric rating scale of tinnitus loudness, and tinnitus loudness match. A Bayesian hierarchical model was fit to estimate the differences in treatment efficacy among groups. Results: Average tinnitus reactions and perceptions improved across treatment groups. We are at least 87% certain that treatment with TM or NS reduces mean TFI compared to treatment with BSG, with an estimated relative efficacy of 4.5-5 points greater reduction. We are at least 95% certain that treatment with TM results in greater reduction in mean numeric rating scale (NRS) of tinnitus loudness compared to the other groups, with an estimated relative efficacy of about 0.75 points greater reduction. Conclusions: This study offers some support for greater average improvement in reactions to tinnitus with TM or NS devices compared to the BSG device. The TM group, compared to the BSG and NS groups, showed a greater reduction in ratings of tinnitus loudness on the NRS on average. Supplemental Material: https://doi.org/10.23641/asha.5545759.

23 Article Progressive Tinnitus Management Level 3 Skills Education: A 5-Year Clinical Retrospective. 2017

Edmonds, Catherine M / Ribbe, Cheri / Thielman, Emily J / Henry, James A. ·Audiology and Speech Pathology Service, Bay Pines VA Health Care System, FL. · Audiology and Speech Pathology Service, Boston VA Health Care System, MA. · Veterans Affairs Rehabilitation Research & Development, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR. · Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland. ·Am J Audiol · Pubmed #28880980.

ABSTRACT: Purpose: The primary purpose of this study was to determine whether progressive tinnitus management Level 3 skills education workshops conducted at the Bay Pines and Boston Veterans Affairs hospitals result in consistent use of the presented tinnitus management strategies by patients 1-5 years after completing the workshops. Method: In fiscal year (FY) 2015, the tinnitus workshop follow-up form was mailed to all veterans who completed the Level 3 workshops between FY 2010 and FY 2014. Data were compiled to determine which, if any, of the skills taught in the workshops were being used 1-5 years after completion of the workshops and the impact on quality-of-life indicators. Results: All self-management skills were being utilized up to 5 years postcompletion; therapeutic sound was utilized the most. The majority of patients reported an improved ability to manage reactions to tinnitus and improved quality-of-life indicators. Over 90% of patients from both sites recommended the program to others with tinnitus. Conclusion: The self-management skills taught in the progressive tinnitus management Level 3 workshops are sustained over time even when limited resources prevent the full complement of workshops or the involvement of mental health services. The workshops can also be successfully implemented through remote delivery via videoconferencing (telehealth). Supplemental Materials: https://doi.org/10.23641/asha.5370883.

24 Article Development and field testing of a smartphone "App" for tinnitus management. 2017

Henry, James A / Thielman, Emily / Zaugg, Tara / Kaelin, Christine / Choma, Christie / Chang, Bill / Hahn, Shira / Fuller, Bret. ·a Veterans Affairs Rehabilitation Research and Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System , Portland , OR , USA. · b Department of Otolaryngology-Head and Neck Surgery , Oregon Health and Science University , Portland , OR , USA. · c GN Advanced Science , Glenview , IL , USA , and. · d Mental Health Service, VA Portland Health Care System , Portland , OR , USA. ·Int J Audiol · Pubmed #28669224.

ABSTRACT: OBJECTIVE: This study's objective was to develop and test a smartphone app that supports learning and using coping skills for managing tinnitus. DESIGN: The app's content was based on coping skills that are taught as a part of progressive tinnitus management (PTM). The study involved three phases: (1) develop a prototype app and conduct usability testing; (2) conduct two focus groups to obtain initial feedback from individuals representing potential users; and (3) conduct a field study to evaluate the app, with three successive groups of participants. STUDY SAMPLE: Participants were adults with bothersome tinnitus. For Phase 2, two focus groups were attended by a total of 17 participants. Phase 3 involved three consecutive rounds of participants: five from the focus groups followed by two rounds with 10 participants each who had not seen the app previously. RESULTS: In both the focus groups and field studies, participants responded favourably to the content. Certain features, however, were deemed too complex. CONCLUSION: Completion of this project resulted in the development and testing of the delivery of PTM coping skills via a smartphone app. This new approach has the potential to improve access to coping skills for those with bothersome tinnitus.

25 Article Tinnitus Management: Randomized Controlled Trial Comparing Extended-Wear Hearing Aids, Conventional Hearing Aids, and Combination Instruments. 2017

Henry, James A / McMillan, Garnett / Dann, Serena / Bennett, Keri / Griest, Susan / Theodoroff, Sarah / Silverman, Shien Pei / Whichard, Susan / Saunders, Gabrielle. ·National Center for Rehabilitative Auditory Research, VA RR&D Service, VA Portland Health Care System, Portland, OR. · Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, OR. · Phonak LLC, Warrenville, IL. ·J Am Acad Audiol · Pubmed #28590898.

ABSTRACT: BACKGROUND: Whereas hearing aids have long been considered effective for providing relief from tinnitus, controlled clinical studies evaluating this premise have been very limited. PURPOSE: The purpose of this study was to systematically determine the relative efficacy of conventional receiver-in-the-canal hearing aids (HA), the same hearing aids with a sound generator (HA+SG), and extended-wear, deep fit hearing aids (EWHA), to provide relief from tinnitus through a randomized controlled trial. Each of these ear-level devices was a product of Phonak, LLC. RESEARCH DESIGN: Participants were randomized to HA, HA+SG, or EWHA and wore bilaterally fit devices for about 4 months. Fittings, adjustments, and follow-up appointments were conducted to comply with company guidelines and to ensure that all participants attended appointments on the same schedule. At 4-5 months, participants returned to complete final outcome measures, which concluded their study participation. STUDY SAMPLE: Participants were 55 individuals (mean age: 63.1 years) with mild to moderately-severe hearing loss who: (a) did not currently use hearing aids; (b) reported tinnitus that was sufficiently bothersome to warrant intervention; and (c) were suitable candidates for each of the study devices. DATA COLLECTION AND ANALYSIS: The primary outcome measure was the Tinnitus Functional Index (TFI). Secondary outcome measures included hearing-specific questionnaires and the Quick Speech in Noise test (QuickSIN). The goal of the analysis was to evaluate efficacy of the EWHA and HA+SG devices versus the HA standard device. RESULTS: There were 18 participants in each of the HA and EWHA groups and 19 in the HA+SG group. Gender, age, and baseline TFI severity were balanced across treatment groups. Nearly all participants had a reduction in tinnitus symptoms during the study. The average TFI change (improvement) from baseline was 21 points in the HA group, 31 points in the EWHA group, and 33 points in the HA+SG group. A "clinically significant" improvement in reaction to tinnitus (at least 13-point reduction in TFI score) was seen by 67% of HA, 82% of EWHA, and 79% of HA+SG participants. There were no statistically significant differences in the extent to which the devices reduced TFI scores. Likewise, the hearing-specific questionnaires and QuickSIN showed improvements following use of the hearing aids but these improvements did not differ across device groups. CONCLUSIONS: There is insufficient evidence to conclude that any of these devices offers greater relief from tinnitus than any other one tested. However, all devices appear to offer some improvement in the functional effects of tinnitus.