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Hearing Disorders: HELP
Articles by Derek J. Hoare
Based on 45 articles published since 2009
(Why 45 articles?)
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Between 2009 and 2019, D. Hoare wrote the following 45 articles about Hearing Disorders.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Review A scoping review to catalogue tinnitus problems in children. 2019

Smith, Harriet / Fackrell, Kathryn / Kennedy, Veronica / Barry, Johanna / Partridge, Lucy / Hoare, Derek J. ·NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 the Ropewalk, Nottingham, NG1 5DU, UK; Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK. Electronic address: harriet.smith@nottingham.ac.uk. · NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 the Ropewalk, Nottingham, NG1 5DU, UK; Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK. Electronic address: kathryn.fackrell@nottingham.ac.uk. · Bolton NHS Foundation Trust, Halliwell Health and Children's Centre, Bolton, BL1 3SQ, UK. Electronic address: veronica.kennedy@boltonft.nhs.uk. · Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK; Nottingham University Hospitals NHS Trust, Queens Medical Centre, Derby Road, Nottingham, NG7 2UH, UK. Electronic address: johanna.barry@nottingham.ac.uk. · Nuffield Hearing and Speech Centre, Royal National Throat Nose and Ear Hospital, 330 Gray's Inn Rd, London, WC1X 8DA, UK. Electronic address: lucypartridge@nhs.net. · NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 the Ropewalk, Nottingham, NG1 5DU, UK; Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK. Electronic address: derek.hoare@nottingham.ac.uk. ·Int J Pediatr Otorhinolaryngol · Pubmed #31029948.

ABSTRACT: BACKGROUND: The reported prevalence of tinnitus in children is similar to that in adults. However, unlike adults, there is relatively little understanding of the tinnitus-related problems children experience. Knowledge of the problems experienced by adults has led to the development of numerous clinical questionnaires used by health professionals in assessment and treatment practices; to date no child-specific questionnaire measure of tinnitus has been developed. To support development of a questionnaire measure of tinnitus in children, the aim of this scoping review was to catalogue the peer-reviewed and grey scientific literature according to 1) the methods used to identify problems experienced by children with tinnitus, 2) tinnitus-related problems observed in or reported by children, and 3) research recommendations suggested by investigators with regards to tinnitus in children. METHODS: A scoping review was conducted following an established methodological framework. Records were included where a tinnitus-related problem was reported in a child 18 years or younger, and tinnitus was reported as the primary complaint. Tinnitus problems were extracted and categorised into problem themes. RESULTS: Thirty-five records met the inclusion criteria for this review. Methods used to identify tinnitus-related problems in children, and the number and range of problems reported, varied across the records. Symptom impact was summarised according to six problem themes; Physical health, Cognitive health, Hearing and listening, Emotional health, Quality of life, and Feeling different/isolated. Identified research recommendations highlighted a demand for more standardised approaches. CONCLUSIONS: The findings evidence the detrimental impact tinnitus can have on a child's quality of life and emotional wellbeing. The current British Society of Audiology Tinnitus in Children Practice Guidance recommends management practices to address the most broadly reported problems identified in this review; sleep difficulties, emotional difficulties, and concentration and hearing problems at school. Given the finding of this review, we suggest problems relating to the impact of tinnitus on quality of life and feelings of isolation are also important problem domains to consider when managing a child who has tinnitus. Current variability in the approach to identifying children's tinnitus problems underlines the importance of developing a standardised and dedicated measure of tinnitus in children.

2 Review Hyperacusis: major research questions. 2018

Baguley, D M / Hoare, D J. ·NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, NG1 5DU, Nottingham, UK. david.baguley@nottingham.ac.uk. · Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK. david.baguley@nottingham.ac.uk. · NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, NG1 5DU, Nottingham, UK. · Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK. ·HNO · Pubmed #29392341.

ABSTRACT: BACKGROUND: Hyperacusis is a troublesome symptom that can have a marked negative impact on quality of life. OBJECTIVES: To identify major research questions in hyperacusis. MATERIALS AND METHODS: Review of gaps in knowledge regarding hyperacusis, and where opportunities may lie to address these. RESULTS: Eight major research questions were identified as priorities for future research. These were: What is the prevalence of hyperacusis in adults and children? What are the risk factors associated with hyperacusis? What is the natural history of hyperacusis? How is 'pain hyperacusis' perceived? What mechanisms are involved in hyperacusis? What is the relationship between hyperacusis and tinnitus? Can a questionnaire be developed that accurately measures the impact of hyperacusis and can be used as a treatment outcome measure? What treatments, alone or in combination, are effective for hyperacusis? CONCLUSION: This clinical/researcher-led project identified major research questions in hyperacusis. A further development to identify patient-prioritized research will follow.

3 Review Combined Amplification and Sound Generation for Tinnitus: A Scoping Review. 2018

Tutaj, Lindsey / Hoare, Derek J / Sereda, Magdalena. ·Department of Audiology, School of Allied Health Sciences, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom. · NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom. · Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom. ·Ear Hear · Pubmed #29189522.

ABSTRACT: OBJECTIVES: In most cases, tinnitus is accompanied by some degree of hearing loss. Current tinnitus management guidelines recognize the importance of addressing hearing difficulties, with hearing aids being a common option. Sound therapy is the preferred mode of audiological tinnitus management in many countries, including in the United Kingdom. Combination instruments provide a further option for those with an aidable hearing loss, as they combine amplification with a sound generation option. The aims of this scoping review were to catalog the existing body of evidence on combined amplification and sound generation for tinnitus and consider opportunities for further research or evidence synthesis. DESIGN: A scoping review is a rigorous way to identify and review an established body of knowledge in the field for suggestive but not definitive findings and gaps in current knowledge. A wide variety of databases were used to ensure that all relevant records within the scope of this review were captured, including gray literature, conference proceedings, dissertations and theses, and peer-reviewed articles. Data were gathered using scoping review methodology and consisted of the following steps: (1) identifying potentially relevant records; (2) selecting relevant records; (3) extracting data; and (4) collating, summarizing, and reporting results. RESULTS: Searches using 20 different databases covered peer-reviewed and gray literature and returned 5959 records. After exclusion of duplicates and works that were out of scope, 89 records remained for further analysis. A large number of records identified varied considerably in methodology, applied management programs, and type of devices. There were significant differences in practice between different countries and clinics regarding candidature and fitting of combination aids, partly driven by the application of different management programs. CONCLUSIONS: Further studies on the use and effects of combined amplification and sound generation for tinnitus are indicated, including further efficacy studies, evidence synthesis, development of guidelines, and recommended procedures that are based on existing knowledge, expert knowledge, and clinical service evaluations.

4 Review The natural history of subjective tinnitus in adults: A systematic review and meta-analysis of no-intervention periods in controlled trials. 2018

Phillips, John S / McFerran, Don J / Hall, Deborah A / Hoare, Derek J. ·Department of Otolaryngology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom. · Colchester Hospital University National Health Service Foundation Trust, Colchester, United Kingdom. · Nottingham Hearing Biomedical Research Unit, National Institute for Health Research, Nottingham, United Kingdom. · Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom. ·Laryngoscope · Pubmed #28425615.

ABSTRACT: OBJECTIVES: Tinnitus is a prevalent condition, but little has been published regarding the natural history of the condition. One technique for evaluating the long-term progression of the disease is to examine what happens to participants in the no-intervention control arm of a clinical trial. The aim of this study was to examine no-intervention or waiting-list data reported in trials, in which participants on the active arm received any form of tinnitus intervention. DATA SOURCES: CINAHL, PsychINFO, EMBASE, ASSIA, PubMed, Web of Science, Science Direct, EBSCO Host, and Cochrane. METHODS: Inclusion criteria followed the PICOS principles: Participants, adults with tinnitus; Intervention, none; Control, any intervention for alleviating tinnitus; Outcomes, a measure assessing tinnitus symptoms using a multi-item patient-reported tinnitus questionnaire. Secondary outcome measures included multi-item patient-reported questionnaires of mood and health-related quality of life and measures that quantified change in tinnitus loudness; Study design, randomized controlled trials or observational studies utilizing a no-intervention or waiting-list control group. Data were extracted and standardized mean difference was calculated for each study to enable meta-analysis. RESULTS: The evidence strongly favored a statistically significant decrease in the impact of tinnitus over time, though there was significant heterogeneity and clinical significance cannot be interpreted. Outcome data regarding secondary measures did not demonstrate any clinically significant change. CONCLUSIONS: Participants allocated to the no-intervention or waiting-list control arm of clinical trials for a tinnitus intervention show a small but significant improvement in self-reported measures of tinnitus with time; the clinical significance of this finding is unknown. There is, however, considerable variation across individuals. These findings support previous work and can cautiously be used when counseling patients. Laryngoscope, 128:217-227, 2018.

5 Review Clinical Interventions for Hyperacusis in Adults: A Scoping Review to Assess the Current Position and Determine Priorities for Research. 2017

Fackrell, Kathryn / Potgieter, Iskra / Shekhawat, Giriraj S / Baguley, David M / Sereda, Magdalena / Hoare, Derek J. ·NIHR Nottingham Biomedical Research Centre, Ropewalk House, Nottingham, UK. · Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK. · Health Systems and Audiology, The University of Auckland, Auckland, New Zealand. · Tinnitus Research Initiative, Regensburg, Germany. ·Biomed Res Int · Pubmed #29312994.

ABSTRACT: Background: There is no universally accepted definition for hyperacusis, but in general it is characterised by decreased sound tolerance to ordinary environmental sounds. Despite hyperacusis being prevalent and having significant clinical implications, much remains unknown about current management strategies. Purpose: To establish the current position of research on hyperacusis and identify research gaps to direct future research. Design and Sample: Using an established methodological framework, electronic and manual searches of databases and journals identified 43 records that met our inclusion criteria. Incorporating content and thematic analysis approaches, the definitions of hyperacusis, management strategies, and outcome measures were catalogued. Results: Only 67% of the studies provided a definition of hyperacusis, such as "reduced tolerance" or "oversensitivity to sound." Assessments and outcome measures included Loudness Discomfort Levels, the Hyperacusis Questionnaire, and Tinnitus Retraining Therapy (TRT) interview. Management strategies reported were Cognitive Behavioural Therapy, TRT, devices, pharmacological therapy, and surgery. Conclusions: Management strategies were typically evaluated in patients reporting hyperacusis as a secondary complaint or as part of a symptom set. As such the outcomes reported only provided an indication of their effectiveness for hyperacusis. Randomised Controlled Trials are needed to evaluate the effectiveness of management strategies for patients experiencing hyperacusis.

6 Review Hearing aids for mild to moderate hearing loss in adults. 2017

Ferguson, Melanie A / Kitterick, Pádraig T / Chong, Lee Yee / Edmondson-Jones, Mark / Barker, Fiona / Hoare, Derek J. ·NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Ropewalk House, 113 The Ropewalk, Nottingham, UK, NG1 5DU. ·Cochrane Database Syst Rev · Pubmed #28944461.

ABSTRACT: BACKGROUND: The main clinical intervention for mild to moderate hearing loss is the provision of hearing aids. These are routinely offered and fitted to those who seek help for hearing difficulties. By amplifying and improving access to sounds, and speech sounds in particular, the aim of hearing aid use is to reduce the negative consequences of hearing loss and improve participation in everyday life. OBJECTIVES: To evaluate the effects of hearing aids for mild to moderate hearing loss in adults. SEARCH METHODS: The Cochrane ENT Information Specialist searched the ENT Trials Register; the Cochrane Register of Studies Online; MEDLINE; PubMed; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 23 March 2017. SELECTION CRITERIA: Randomised controlled trials (RCTs) of hearing aids compared to a passive or active control in adults with mild to moderate hearing loss. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. The primary outcomes in this review were hearing-specific health-related quality of life and the adverse effect pain. Secondary outcomes were health-related quality of life, listening ability and the adverse effect noise-induced hearing loss. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. MAIN RESULTS: We included five RCTs involving 825 participants. The studies were carried out in the USA and Europe, and were published between 1987 and 2017. Risk of bias across the studies varied. Most had low risk for selection, reporting and attrition bias, and a high risk for performance and detection bias because blinding was inadequate or absent.All participants had mild to moderate hearing loss. The average age across all five studies was between 69 and 83 years. The duration of the studies ranged between six weeks and six months.There was a large beneficial effect of hearing aids on hearing-specific health-related quality of life associated with participation in daily life as measured using the Hearing Handicap Inventory for the Elderly (HHIE, scale range 1 to 100) compared to the unaided/placebo condition (mean difference (MD) -26.47, 95% confidence interval (CI) -42.16 to -10.77; 722 participants; three studies) (moderate-quality evidence).There was a small beneficial effect of hearing aids on general health-related quality of life (standardised mean difference (SMD) -0.38, 95% CI -0.55 to -0.21; 568 participants; two studies) (moderate-quality evidence). There was a large beneficial effect of hearing aids on listening ability (SMD -1.88, 95% CI -3.24 to -0.52; 534 participants; two studies) (moderate-quality evidence).Adverse effects were measured in only one study (48 participants) and none were reported (very low-quality evidence). AUTHORS' CONCLUSIONS: The available evidence concurs that hearing aids are effective at improving hearing-specific health-related quality of life, general health-related quality of life and listening ability in adults with mild to moderate hearing loss. The evidence is compatible with the widespread provision of hearing aids as the first-line clinical management in those who seek help for hearing difficulties. Greater consistency is needed in the choice of outcome measures used to assess benefits from hearing aids. Further placebo-controlled studies would increase our confidence in the estimates of these effects and ascertain whether they vary according to age, gender, degree of hearing loss and type of hearing aid.

7 Review Psychological Therapy for People with Tinnitus: A Scoping Review of Treatment Components. 2017

Thompson, Dean M / Hall, Deborah A / Walker, Dawn-Marie / Hoare, Derek J. ·1National Institute for Health Research Nottingham Hearing Biomedical Research Unit, Nottingham, United Kingdom; 2Otology and Hearing group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom; and 3Health Sciences, University of Southampton, Southampton, United Kingdom. ·Ear Hear · Pubmed #27541331.

ABSTRACT: BACKGROUND: Tinnitus is associated with depression and anxiety disorders, severely and adversely affecting the quality of life and functional health status for some people. With the dearth of clinical psychologists embedded in audiology services and the cessation of training for hearing therapists in the UK, it is left to audiologists to meet the psychological needs of many patients with tinnitus. However, there is no universally standardized training or manualized intervention specifically for audiologists across the whole UK public healthcare system and similar systems elsewhere across the world. OBJECTIVES: The primary aim of this scoping review was to catalog the components of psychological therapies for people with tinnitus, which have been used or tested by psychologists, so that they might inform the development of a standardized audiologist-delivered psychological intervention. Secondary aims of this article were to identify the types of psychological therapy for people with tinnitus, who were reported but not tested in any clinical trial, as well as the job roles of clinicians who delivered psychological therapy for people with tinnitus in the literature. DESIGN: The authors searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; Cochrane Central Register of Controlled Trials; PubMed; EMBASE; CINAHL; LILACS; KoreaMed; IndMed; PakMediNet; CAB Abstracts; Web of Science; BIOSIS Previews; ISRCTN; ClinicalTrials.gov; IC-TRP; and Google Scholar. In addition, the authors searched the gray literature including conference abstracts, dissertations, and editorials. No records were excluded on the basis of controls used, outcomes reached, timing, setting, or study design (except for reviews-of the search results. Records were included in which a psychological therapy intervention was reported to address adults (≤18 years) tinnitus-related distress. No restrictive criteria were placed upon the term tinnitus. Records were excluded in which the intervention included biofeedback, habituation, hypnosis, or relaxation as necessary parts of the treatment. RESULTS: A total of 5043 records were retrieved of which 64 were retained. Twenty-five themes of components that have been included within a psychological therapy were identified, including tinnitus education, psychoeducation, evaluation treatment rationale, treatment planning, problem-solving behavioral intervention, thought identification, thought challenging, worry time, emotions, social comparison, interpersonal skills, self-concept, lifestyle advice, acceptance and defusion, mindfulness, attention, relaxation, sleep, sound enrichment, comorbidity, treatment reflection, relapse prevention, and common therapeutic skills. The most frequently reported psychological therapies were cognitive behavioral therapy, tinnitus education, and internet-delivered cognitive behavioral therapy. No records reported that an audiologist delivered any of these psychological therapies in the context of an empirical trial in which their role was clearly delineated from that of other clinicians. CONCLUSIONS: Scoping review methodology does not attempt to appraise the quality of evidence or synthesize the included records. Further research should therefore determine the relative importance of these different components of psychological therapies from the perspective of the patient and the clinician.

8 Review Use and Mediating Effect of Interactive Design Features in Audiology Rehabilitation and Self-Management Internet-Based Interventions. 2016

Greenwell, Kate / Hoare, Derek J. ·NIHR Nottingham Hearing Biomedical Research Unit, Otology and Hearing group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom. ·Am J Audiol · Pubmed #27768188.

ABSTRACT: Purpose: The purpose of this study is to explore the presence of key interactive design features across Internet-based audiology rehabilitation and self-management interventions, and whether there is evidence of them mediating effects of the intervention. Method: Adult audiology interventions relevant to this review were identified through a literature search in Google Scholar and a hand search of key journals. Four key interactive design features that have been proposed to mediate the effects of Internet-based health interventions were reported for each intervention: social context and support, contacts with the intervention, tailoring, and self-management. Results: Five interventions were identified as representative examples of work in the field. Social context and support and contacts with the intervention were provided in most interventions, mainly through clinician guidance. Only 1 intervention utilized tailoring to personalize intervention content to individual users, but use was minimal. Self-management features were also used in all interventions but the precise nature of these features was poorly reported. Conclusion: Future studies should assess the optimal dose and combinations of intervention features for maximizing efficacy in audiology intervention. To be specific, the role of tailoring should be explored, which has been identified as a potential mediator of intervention outcome in the wider e-health literature.

9 Review Electrical Stimulation of the Ear, Head, Cranial Nerve, or Cortex for the Treatment of Tinnitus: A Scoping Review. 2016

Hoare, Derek J / Adjamian, Peyman / Sereda, Magdalena. ·NIHR Nottingham Hearing Biomedical Research Unit, Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG1 5DU, UK. · MRC Institute of Hearing Research, University Park, Nottingham NG7 2RD, UK. ·Neural Plast · Pubmed #27403346.

ABSTRACT: Tinnitus is defined as the perception of sound in the absence of an external source. It is often associated with hearing loss and is thought to result from abnormal neural activity at some point or points in the auditory pathway, which is incorrectly interpreted by the brain as an actual sound. Neurostimulation therapies therefore, which interfere on some level with that abnormal activity, are a logical approach to treatment. For tinnitus, where the pathological neuronal activity might be associated with auditory and other areas of the brain, interventions using electromagnetic, electrical, or acoustic stimuli separately, or paired electrical and acoustic stimuli, have been proposed as treatments. Neurostimulation therapies should modulate neural activity to deliver a permanent reduction in tinnitus percept by driving the neuroplastic changes necessary to interrupt abnormal levels of oscillatory cortical activity and restore typical levels of activity. This change in activity should alter or interrupt the tinnitus percept (reduction or extinction) making it less bothersome. Here we review developments in therapies involving electrical stimulation of the ear, head, cranial nerve, or cortex in the treatment of tinnitus which demonstrably, or are hypothesised to, interrupt pathological neuronal activity in the cortex associated with tinnitus.

10 Review A systematic review of techniques and effects of self-help interventions for tinnitus: Application of taxonomies from health psychology. 2016

Greenwell, Kate / Sereda, Magdalena / Coulson, Neil / El Refaie, Amr / Hoare, Derek J. ·a National Institute for Health Research - Nottingham Hearing Biomedical Research Unit , Nottingham , UK . · b Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham , Nottingham , UK . · c Division of Rehabilitation and Aging, School of Medicine , University of Nottingham , Nottingham , UK and. · d Speech and Hearing Department , School of Clinical Therapies, University College, Cork , Ireland. ·Int J Audiol · Pubmed #27146036.

ABSTRACT: OBJECTIVE: Self-help interventions are followed by people independently with minimal or no therapist contact. This review aims to assess the effectiveness of self-help interventions for adults with chronic tinnitus and systematically identify the self-help techniques used. DESIGN: Systematic review and application of health psychology taxonomies. Electronic database searches were conducted, supplemented by citation searching and hand-searching of key journals. Prospective controlled trials, which used measures of tinnitus distress, functional management, anxiety, depression, and quality of life, were included. Michie et al's behaviour change techniques (BCTs) taxonomy and Taylor et al's PRISMS taxonomy of self-management components were applied to describe interventions. STUDY SAMPLE: Five studies were included, providing low-to-moderate levels of evidence. RESULTS: Randomized controlled trial studies were too few and heterogeneous for meta-analysis to be performed. Studies comparing self-help interventions to therapist-guided interventions and assessing non tinnitus-specific psychosocial outcomes and functional management were lacking. Fifteen BCTs and eight self-management components were identified across interventions. CONCLUSIONS: A lack of high-quality and homogeneous studies meant that confident conclusions could not be drawn regarding the efficacy of self-help interventions for tinnitus. Better reporting and categorization of intervention techniques is needed for replication in research and practice and to facilitate understanding of intervention mechanisms.

11 Review The consequences of tinnitus and tinnitus severity on cognition: A review of the behavioural evidence. 2016

Mohamad, Najibah / Hoare, Derek J / Hall, Deborah A. ·National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU, UK; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Medical School, Nottingham NG7 2UH, UK; Department of Audiology, School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia. Electronic address: g_bah194@yahoo.com. · National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU, UK; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Medical School, Nottingham NG7 2UH, UK. Electronic address: derek.hoare@nottingham.ac.uk. · National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU, UK; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Medical School, Nottingham NG7 2UH, UK. Electronic address: deborah.hall@nottingham.ac.uk. ·Hear Res · Pubmed #26523370.

ABSTRACT: People with tinnitus report anecdotal difficulties in mental concentration and psychological treatments for tinnitus advise on concentration difficulties and how to manage them. Yet the literature lacks any coherent discussion about what precise theoretical cognitive constructs might be mediating reported concentration problems. This review addresses this gap by describing and critically appraising the behavioural evidence for the effects of tinnitus on cognitive performance (namely working memory and attention). Empirical evidence is somewhat limited, but there is some support that tinnitus interferes with executive attention, and mixed support that it impairs working memory and selective attention. We highlight a number of methodological considerations to help drive the field forward and we propose a putative model of the complex inter-relationships between tinnitus, cognition and confounding factors. This model provides a basis for hypothesis testing.

12 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.

13 Review Amplification with hearing aids for patients with tinnitus and co-existing hearing loss. 2014

Hoare, Derek J / Edmondson-Jones, Mark / Sereda, Magdalena / Akeroyd, Michael A / Hall, Deborah. ·National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, University of Nottingham, Ropewalk House, 113 The Ropewalk, Nottingham, UK, NG1 5DU. ·Cochrane Database Syst Rev · Pubmed #24482186.

ABSTRACT: BACKGROUND: Tinnitus is described as the perception of sound or noise in the absence of real acoustic stimulation. In the current absence of a cure for tinnitus, clinical management typically focuses on reducing the effects of co-morbid symptoms such as distress or hearing loss. Hearing loss is commonly co-morbid with tinnitus and so logic implies that amplification of external sounds by hearing aids will reduce perception of the tinnitus sound and the distress associated with it. OBJECTIVES: To assess the effects of hearing aids specifically in terms of tinnitus benefit in patients with tinnitus and co-existing hearing loss. SEARCH METHODS: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the search was 19 August 2013. SELECTION CRITERIA: Randomised controlled trials and non-randomised controlled trials recruiting adults with subjective tinnitus and some degree of hearing loss, where the intervention involves amplification with hearing aids and this is compared to interventions involving other medical devices, other forms of standard or complementary therapy, or combinations of therapies, no intervention or placebo interventions. DATA COLLECTION AND ANALYSIS: Three authors independently screened all selected abstracts. Two authors independently extracted data and assessed those potentially suitable studies for risk of bias. For studies meeting the inclusion criteria, we used the mean difference (MD) to compare hearing aids with other interventions and controls. MAIN RESULTS: One randomised controlled trial (91 participants) was included in this review. We judged the trial to have a low risk of bias for method of randomisation and outcome reporting, and an unclear risk of bias for other criteria. No non-randomised controlled trials meeting our inclusion criteria were identified. The included study measured change in tinnitus severity (primary measure of interest) using a tinnitus questionnaire measure, and change in tinnitus loudness (secondary measure of interest) on a visual analogue scale. Other secondary outcome measures of interest, namely change in the psychoacoustic characteristics of tinnitus, change in self reported anxiety, depression and quality of life, and change in neurophysiological measures, were not investigated in this study. The included study compared hearing aid use to sound generator use. The estimated effect on change in tinnitus loudness or severity as measured by the Tinnitus Handicap Inventory score was compatible with benefits for both hearing aids or sound generators but no difference was found between the two alternative treatments (MD -0.90, 95% confidence interval (CI) -7.92 to 6.12) (100-point scale); moderate quality evidence. No negative or adverse events were reported. AUTHORS' CONCLUSIONS: The current evidence base for hearing aid prescription for tinnitus is limited. To be useful, future studies should make appropriate use of blinding and be consistent in their use of outcome measures. Whilst hearing aids are sometimes prescribed as part of tinnitus management, there is currently no evidence to support or refute their use as a more routine intervention for tinnitus.

14 Review Recent technological advances in sound-based approaches to tinnitus treatment: a review of efficacy considered against putative physiological mechanisms. 2013

Hoare, Derek J / Adjamian, Peyman / Sereda, Magdalena / Hall, Deborah A. ·NIHR Nottingham Hearing Biomedical Research Unit, Ropewalk House, UK. derek.hoare@nottingham.ac.uk ·Noise Health · Pubmed #23571301.

ABSTRACT: The past decade has seen an escalating enthusiasm to comprehend chronic tinnitus from the perspective of both scientific understanding and clinical management. At the same time, there is a significant interest and commercial investment in providing targeted and individualized approaches to care, which incorporate novel sound-based technologies, with standard audiological and psychological strategies. Commercially produced sound-based devices for the tinnitus market include Co-ordinated Reset Neuromodulation ® , Neuromonics © , Serenade ® , and Widex ® Zen. Additionally, experimental interventions such as those based on frequency-discrimination training are of current interest. Many of these interventions overtly claim to target the underlying neurological causes of tinnitus. Here, we briefly summarize current perspectives on the pathophysiology of tinnitus and evaluate claims made by the device supporters from a critical point of view. We provide an opinion on how future research in the field of individualized sound-based interventions might best provide a reliable evidence-base in this growing area of translational medicine.

15 Review Ringing in my ears: tinnitus in pregnancy. 2012

Smith, Sandra / Hoare, Derek. ·NIHR Nottingham Hearing Biomedical Research Unit. ·Pract Midwife · Pubmed #23082396.

ABSTRACT: A number of ear, nose and throat symptoms are often associated with pregnancy, which although transient (most will disappear after birth), can have a significant impact on the woman's quality of life. It is essential therefore that midwives are aware of how such symptoms might present during pregnancy, in order to appropriately inform women and safely manage those symptoms. Tinnitus, the most common ear symptom experienced by women during pregnancy, for some will be a distressing experience and for others may indicate more serious conditions such as pre eclampsia, requiring careful monitoring and confident management.

16 Review Systematic review and meta-analyses of randomized controlled trials examining tinnitus management. 2011

Hoare, Derek J / Kowalkowski, Victoria L / Kang, Sujin / Hall, Deborah A. ·National Institute for Health Research National Biomedical Research Unit in Hearing, Nottingham, United Kingdom. derek.hoare@nottingham.ac.uk ·Laryngoscope · Pubmed #21671234.

ABSTRACT: OBJECTIVES/HYPOTHESIS: To evaluate the existing level of evidence for tinnitus management strategies identified in the UK Department of Health's Good Practice Guideline. STUDY DESIGN: Systematic review of peer-reviewed literature and meta-analyses. METHODS: Searches were conducted in PubMed, Cambridge Scientific Abstracts, Web of Science, and EMBASE (earliest to August 2010), supplemented by hand searches in October 2010. Only randomized controlled trials that used validated questionnaire measures of symptoms (i.e., measures of tinnitus distress, anxiety, depression) were included. RESULTS: Twenty-eight randomized controlled trials met our inclusion criteria, most of which provide moderate levels of evidence for the effects they reported. Levels of evidence were generally limited by the lack of blinding, lack of power calculations, and incomplete data reporting in these studies. Only studies examining cognitive behavioral therapy were numerous and similar enough to perform meta-analysis, from which the efficacy of cognitive behavioral therapy (moderate effect size) appears to be reasonably established. Antidepressants were the only drug class to show any evidence of potential benefit. CONCLUSIONS: The efficacy of most interventions for tinnitus benefit remains to be demonstrated conclusively. In particular, high-level assessment of the benefit derived from those interventions most commonly used in practice, namely hearing aids, maskers, and tinnitus retraining therapy needs to be performed.

17 Review The efficacy of auditory perceptual training for tinnitus: a systematic review. 2010

Hoare, Derek J / Stacey, Paula C / Hall, Deborah A. ·National Biomedical Research Unit in Hearing, 113 The Ropewalk, Nottingham, UK. derek.hoare@nottingham.ac.uk ·Ann Behav Med · Pubmed #20668974.

ABSTRACT: Auditory perceptual training affects neural plasticity and so represents a potential strategy for tinnitus management. We assessed the effects of auditory perceptual training on tinnitus perception and/or its intrusiveness via a systematic review of published literature. An electronic database search using the keywords 'tinnitus and learning' or 'tinnitus and training' was conducted, updated by a hand search. The ten studies identified were reviewed independently by two reviewers, data were extracted, study quality was assessed according to a number of specific criteria and the information was synthesised using a narrative approach. Nine out of the ten studies reported some significant change in either self-reported or psychoacoustic outcome measures after auditory training. However, all studies were quality rated as providing low or moderate levels of evidence for an effect. We identify a need for appropriately randomised and controlled studies that will generate high-quality unbiased and generalisable evidence to ascertain whether or not auditory perceptual training has a clinically relevant effect on tinnitus.

18 Clinical Trial Agreement and reliability of tinnitus loudness matching and pitch likeness rating. 2014

Hoare, Derek J / Edmondson-Jones, Mark / Gander, Phillip E / Hall, Deborah A. ·National Institute for Health Research, Nottingham Hearing Biomedical Research Unit, Nottingham, United Kingdom; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom. · National Institute for Health Research, Nottingham Hearing Biomedical Research Unit, Nottingham, United Kingdom; Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America. ·PLoS One · Pubmed #25478690.

ABSTRACT: The ability to reproducibly match tinnitus loudness and pitch is important to research and clinical management. Here we examine agreement and reliability of tinnitus loudness matching and pitch likeness ratings when using a computer-based method to measure the tinnitus spectrum and estimate a dominant tinnitus pitch, using tonal or narrowband sounds. Group level data indicated a significant effect of time between test session 1 and 2 for loudness matching, likely procedural or perceptual learning, which needs to be accounted in study design. Pitch likeness rating across multiple frequencies appeared inherently more variable and with no systematic effect of time. Dominant pitch estimates reached a level of clinical acceptability when sessions were spaced two weeks apart. However when dominant tinnitus pitch assessments were separated by three months, acceptable agreement was achieved only for group mean data, not for individual estimates. This has implications for prescription of some sound-based interventions that rely on accurate measures of individual dominant tinnitus pitch.

19 Clinical Trial Evaluation of the acoustic coordinated reset (CR®) neuromodulation therapy for tinnitus: study protocol for a double-blind randomized placebo-controlled trial. 2013

Hoare, Derek J / Pierzycki, Robert H / Thomas, Holly / McAlpine, David / Hall, Deborah A. ·National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, University of Nottingham, Ropewalk House, Nottingham, UK. Derek.Hoare@nottingham.ac.uk ·Trials · Pubmed #23842505.

ABSTRACT: BACKGROUND: Current theories of tinnitus assume that the phantom sound is generated either through increased spontaneous activity of neurons in the auditory brain, or through pathological temporal firing patterns of the spontaneous neuronal discharge, or a combination of both factors. With this in mind, Tass and colleagues recently tested a number of temporally patterned acoustic stimulation strategies in a proof of concept study. Potential therapeutic sound regimes were derived according to a paradigm assumed to disrupt hypersynchronous neuronal activity, and promote plasticity mechanisms that stabilize a state of asynchronous spontaneous activity. This would correspond to a permanent reduction of tinnitus. The proof of concept study, conducted in Germany, confirmed the safety of the acoustic stimuli for use in tinnitus, and exploratory results indicated modulation of tinnitus-related pathological synchronous activity with potential therapeutic benefit. The most effective stimulation paradigm is now in clinical use as a sound therapy device, the acoustic coordinated reset (CR®) neuromodulation (Adaptive Neuromodulation GmbH (ANM), Köln, Germany). METHODS/DESIGN: To measure the efficacy of CR® neuromodulation, we devised a powered, two-center, randomized controlled trial (RCT) compliant with the reporting standards defined in the Consolidated Standards of Reporting Trials (CONSORT) Statement. The RCT design also addresses the recent call for international standards within the tinnitus community for high-quality clinical trials. The design uses a between-subjects comparison with minimized allocation of participants to treatment and placebo groups. A minimization approach was selected to ensure that the two groups are balanced with respect to age, gender, hearing, and baseline tinnitus severity. The protocol ensures double blinding, with crossover of the placebo group to receive the proprietary intervention after 12 weeks. The primary endpoints are the pre- and post-treatment measures that provide the primary measures of efficacy, namely a validated and sensitive questionnaire measure of the functional impact of tinnitus. The trial is also designed to capture secondary changes in tinnitus handicap, quality (pitch, loudness, bandwidth), and changes in tinnitus-related pathological synchronous brain activity using electroencephalography (EEG). DISCUSSION: This RCT was designed to provide a confident high-level estimate of the efficacy of sound therapy using CR® neuromodulation compared to a well-matched placebo intervention, and uniquely in terms of sound therapy, examine the physiological effects of the intervention against its putative mechanism of action. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01541969.

20 Article A multidisciplinary European guideline for tinnitus: diagnostics, assessment, and treatment. 2019

Cima, R F F / Mazurek, B / Haider, H / Kikidis, D / Lapira, A / Noreña, A / Hoare, D J. ·Faculty of Psychology and Neuroscience, Department of clinical Psychological Science, Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands. r.cima@maastrichtuniversity.nl. · Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands. r.cima@maastrichtuniversity.nl. · Tinnituscenter, Charité-Universitätsmedizin Berlin, Berlin, Germany. · ENT department, Hospital Cuf Infante Santo, Lisbon, Portugal. · 1st Department of Otolaryngology, National and Kapodistrian University of Athens, Athens, Greece. · Malta University, Valetta, Malta. · Sensory systems and neuroplasticity, Aix-Marseille Université, Marseille, France. · National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Ropewalk House, University of Nottingham, 113 The Ropewalk, NG1 5DU, Nottingham, United Kingdom. · Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, NG7 2UH, Berlin, Germany. ·HNO · Pubmed #30847513.

ABSTRACT: -- No abstract --

21 Article Sound therapy (using amplification devices and/or sound generators) for tinnitus. 2018

Sereda, Magdalena / Xia, Jun / El Refaie, Amr / Hall, Deborah A / Hoare, Derek J. ·NIHR Nottingham Biomedical Research Centre, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Ropewalk House, 113 The Ropewalk, Nottingham, UK, NG1 5DU. ·Cochrane Database Syst Rev · Pubmed #30589445.

ABSTRACT: BACKGROUND: Tinnitus affects 10% to 15% of the adult population, with about 20% of these experiencing symptoms that negatively affect quality of life. In England alone there are an estimated ¾ million general practice consultations every year where the primary complaint is tinnitus, equating to a major burden on healthcare services. Clinical management strategies include education and advice, relaxation therapy, tinnitus retraining therapy (TRT), cognitive behavioural therapy (CBT), sound enrichment using ear-level sound generators or hearing aids, and drug therapies to manage co-morbid symptoms such as insomnia, anxiety or depression. Hearing aids, sound generators and combination devices (amplification and sound generation within one device) are a component of many tinnitus management programmes and together with information and advice are a first line of management in audiology departments for someone who has tinnitus. OBJECTIVES: To assess the effects of sound therapy (using amplification devices and/or sound generators) for tinnitus in adults. SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL, via the Cochrane Register of Studies); Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 23 July 2018. SELECTION CRITERIA: Randomised controlled trials (RCTs) recruiting adults with acute or chronic subjective idiopathic tinnitus. We included studies where the intervention involved hearing aids, sound generators or combination hearing aids and compared them to waiting list control, placebo or education/information only with no device. We also included studies comparing hearing aids to sound generators, combination hearing aids to hearing aids, and combination hearing aids to sound generators. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. Our primary outcomes were tinnitus symptom severity as measured as a global score on multi-item tinnitus questionnaire and significant adverse effects as indicated by an increase in self-reported tinnitus loudness. Our secondary outcomes were depressive symptoms, symptoms of generalised anxiety, health-related quality of life and adverse effects associated with wearing the device such as pain, discomfort, tenderness or skin irritation, or ear infections. We used GRADE to assess the quality of evidence for each outcome; this is indicated in italics. MAIN RESULTS: This review included eight studies (with a total of 590 participants). Seven studies investigated the effects of hearing aids, four combination hearing aids and three sound generators. Seven studies were parallel-group RCTs and one had a cross-over design. In general, risk of bias was unclear due to lack of detail about sequence generation and allocation concealment. There was also little or no use of blinding.No data for our outcomes were available for any of our three main comparisons (comparing hearing aids, sound generators and combination devices with a waiting list control group, placebo or education/information only). Data for our additional comparisons (comparing these devices with each other) were also few, with limited potential for data pooling.Hearing aid only versus sound generator device onlyOne study compared patients fitted with sound generators versus those fitted with hearing aids and found no difference between them in their effects on our primary outcome, tinnitus symptom severity measured with the Tinnitus Handicap Inventory (THI) at 3, 6 or 12 months (low-quality evidence). The use of both types of device was associated with a clinically significant reduction in tinnitus symptom severity.Combination hearing aid versus hearing aid onlyThree studies compared combination hearing aids with hearing aids and measured tinnitus symptom severity using the THI or Tinnitus Functional Index. When we pooled the data we found no difference between them (standardised mean difference -0.15, 95% confidence interval -0.52 to 0.22; three studies; 114 participants) (low-quality evidence). The use of both types of device was again associated with a clinically significant reduction in tinnitus symptom severity.Adverse effects were not assessed in any of the included studies.None of the studies measured the secondary outcomes of depressive symptoms or depression, anxiety symptoms or generalised anxiety, or health-related quality of life as measured by a validated instrument, nor the newly developed core outcomes tinnitus intrusiveness, ability to ignore, concentration, quality of sleep and sense of control. AUTHORS' CONCLUSIONS: There is no evidence to support the superiority of sound therapy for tinnitus over waiting list control, placebo or education/information with no device. There is insufficient evidence to support the superiority or inferiority of any of the sound therapy options (hearing aid, sound generator or combination hearing aid) over each other. The quality of evidence for the reported outcomes, assessed using GRADE, was low. Using a combination device, hearing aid or sound generator might result in little or no difference in tinnitus symptom severity.Future research into the effectiveness of sound therapy in patients with tinnitus should use rigorous methodology. Randomisation and blinding should be of the highest quality, given the subjective nature of tinnitus and the strong likelihood of a placebo response. The CONSORT statement should be used in the design and reporting of future studies. We also recommend the use of validated, patient-centred outcome measures for research in the field of tinnitus.

22 Article Why Is Tinnitus a Problem? A Qualitative Analysis of Problems Reported by Tinnitus Patients. 2018

Watts, Emily J / Fackrell, Kathryn / Smith, Sandra / Sheldrake, Jacqueline / Haider, Haúla / Hoare, Derek J. ·1 School of Medicine, University of Nottingham, UK. · 2 NIHR Nottingham Biomedical Research Centre, Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, UK. · 3 The Tinnitus and Hyperacusis Centre, London, UK. · 4 ENT Department, Hospital Cuf Infante Santo, Nova Medical School, Lisbon, Portugal. ·Trends Hear · Pubmed #30482102.

ABSTRACT: Tinnitus is a prevalent complaint, and people with bothersome tinnitus can report any number of associated problems. Yet, to date, only a few studies, with different populations and relatively modest sample sizes, have qualitatively evaluated what those problems are. Our primary objective was to determine domains of tinnitus problem according to a large clinical data set. This was a retrospective analysis of anonymized clinical data from patients who attended a U.K. Tinnitus Treatment Center between 1989 and 2014. Content analysis was used to code and collate the responses of 678 patients to the clinical interview question "Why is tinnitus a problem?" into categories of problems (domains). We identified 18 distinct domains of tinnitus-associated problems. Reduced quality of life, tinnitus-related fear, and constant awareness were notably common problems. Clinicians need to be mindful of the numerous problem domains that might affect their tinnitus patients. Current questionnaires, as well as being measures of severity, are useful clinical tools for identifying problem domains that need further discussion and possibly measurement with additional questionnaires. The domains identified in this work should inform clinical assessment and the development of future clinical tinnitus questionnaire.

23 Article Findings and Ethical Considerations From a Thematic Analysis of Threads Within Tinnitus Online Support Groups. 2018

Ainscough, Eve / Smith, Sandra N / Greenwell, Kate / Hoare, Derek J. ·School of Medicine, University of Nottingham, United Kingdom. · National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom. · Centre for Clinical and Community Applications of Health Psychology, University of Southampton, United Kingdom. ·Am J Audiol · Pubmed #30452754.

ABSTRACT: Purpose: Tinnitus is the perception of noise without a corresponding external stimulus. Current management typically aims to moderate associated psychosocial stressors and allow sufferers to retain an adequate quality of life. With the increasing recognition of the Internet as a repository for health advice, information, and support, the online support group has become a popular coping strategy for those living with chronic conditions such as tinnitus. Patients find that communicating with each other, providing encouragement, and sharing information in the absence of physical and temporal boundaries are invaluable ways of managing their condition. The purpose of this study was to explore the potential positive and negative consequences of participating in online support groups for tinnitus. Method: Discussion forum threads were collated from across 4 public online support group websites. All threads were initiated between February and April 2016. Texts from these threads were coded by 3 separate analysts using both inductive and deductive thematic analysis, until data saturation was reached. Results: Analysis of 75 threads (641 individual posts) found 9 independent themes pertaining to aspects of participation in tinnitus online support groups. The results revealed that using the forums allowed users to exchange knowledge and experiences, express complex emotions, profit from a network of support, and engage in everyday conversation away from the burden of their tinnitus. However, some experiences appeared to be compromised by negative messages, limited communication, and informational issues such as conflicting advice or information overload. Conclusions: This study represents the 1st research into discussion forums in tinnitus online support groups. A nonintrusive (passive) analysis method was used, whereby messages comprising the dataset were retrieved without direct interaction with the discussion forum. Individuals and the community of tinnitus online support groups are deemed to be at low risk from potential harm in this study. Most tinnitus patients likely benefit from accessing online support groups, for example, they discover they are not alone, and they find new coping strategies. However, for those who are particularly vulnerable or prone to psychological stress, accessing these groups could be detrimental.

24 Article Tinnitus services in the United Kingdom: a survey of patient experiences. 2018

McFerran, Don / Hoare, Derek J / Carr, Simon / Ray, Jaydip / Stockdale, David. ·Colchester Hospital University NHS Foundation Trust, Department of Otolaryngology, Essex County Hospital, Lexden Rd, Colchester, Essex, CO3 3NB, UK. donmcferran@aol.com. · NIHR Nottingham Hearing Biomedical Research Centre, Otology and Hearing Group, Division of Clinical Neuroscience, University of Nottingham, Nottingham, NH1 5DU, UK. · Regional Department of Neurotology, Department of Otolaryngology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK. · British Tinnitus Association, Ground Floor, Unit 5, Acorn Business Park, Woodseats Close, Sheffield, S8 0TB, UK. ·BMC Health Serv Res · Pubmed #29433479.

ABSTRACT: BACKGROUND: Tinnitus service provision in the United Kingdom has been investigated from the healthcare provider's perspective demonstrating considerable regional variation particularly regarding availability of psychological treatments. An audiological-based tinnitus service, however, was reportedly available for all tinnitus patients in the UK. The aim of the current study was to define and evaluate nationwide tinnitus healthcare services from the patients' viewpoint. METHODS: Secondary analyses were performed on data from a 33-item questionnaire provided by the British Tinnitus Association. The questionnaire had been distributed via email and social media. RESULTS: Responses from 937 participants who had or had previously experienced tinnitus were analysed. All but one person had at some time consulted their GP. About one in five received medication in primary care. The majority were referred to secondary care, generally an ENT surgeon or audiovestibular physician; some were referred directly to audiological services. In secondary care the majority underwent audiometric testing and over half underwent MRI scanning. Drugs were prescribed less frequently in secondary care. About one third of patients were referred onwards from diagnostic services in secondary care to receive therapeutic interventions for tinnitus. Therapy was generally delivered by an audiologist or hearing therapist. Just under two fifths of people discharged from secondary care returned to their GP, with most returning within one year. Over a third of this group were re-referred to secondary care. Few patients saw a psychologist (2.6%) though some psychological treatments were delivered by appropriately trained audiologists. Negative counselling from healthcare professionals in both primary and secondary care settings was reported. CONCLUSIONS: Although the UK has developed a national service for patients with tinnitus many people find it difficult to access, being blocked at the primary care level or after secondary care diagnostic services. Many of those discharged from secondary care return to their GP within a short space of time and are re-referred to secondary care creating an unsatisfactory and expensive revolving-door pattern of healthcare. Despite psychological treatment modalities having the best evidence base for successful tinnitus management, only a minority of tinnitus patients ever get to meet a psychologist.

25 Article Patients' and Clinicians' Views of the Psychological Components of Tinnitus Treatment That Could Inform Audiologists' Usual Care: A Delphi Survey. 2018

Thompson, Dean M / Taylor, John / Hall, Deborah A / Walker, Dawn-Marie / McMurran, Mary / Casey, Amanda / Stockdale, David / Featherstone, Debbie / Hoare, Derek J. ·National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham, United Kingdom. ·Ear Hear · Pubmed #28930785.

ABSTRACT: OBJECTIVES: The aim of this study was to determine which components of psychological therapies are most important and appropriate to inform audiologists' usual care for people with tinnitus. DESIGN: A 39-member panel of patients, audiologists, hearing therapists, and psychologists completed a three-round Delphi survey to reach consensus on essential components of audiologist-delivered psychologically informed care for tinnitus. RESULTS: Consensus (≥80% agreement) was reached on including 76 of 160 components. No components reached consensus for exclusion. The components reaching consensus were predominantly common therapeutic skills such as Socratic questioning and active listening, rather than specific techniques, for example, graded exposure therapy or cognitive restructuring. Consensus on educational components to include largely concerned psychological models of tinnitus rather than neurophysiological information. CONCLUSIONS: The results of this Delphi survey provide a tool to develop audiologists' usual tinnitus care using components that both patients and clinicians agree are important and appropriate to be delivered by an audiologist for adults with tinnitus-related distress. Research is now necessary to test the added effects of these components when delivered by audiologists.

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