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Hearing Disorders: HELP
Articles by Emily J. Thielman
Based on 23 articles published since 2009
(Why 23 articles?)
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Between 2009 and 2019, E. Thielman wrote the following 23 articles about Hearing Disorders.
 
+ Citations + Abstracts
1 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.

2 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.

3 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.

4 Article Progressive Tinnitus Management at Two Veterans Affairs Medical Centers: Clinical Implementation With Modified Protocols. 2019

Beck, Jenifer E / Zaugg, Tara L / Egge, Jessica L / Lima, Elizabeth N / Thielman, Emily J. ·Audiology and Speech Pathology Service, Charles George Veterans Affairs Medical Center, Asheville, North Carolina. · VA Rehabilitation Research and Development National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Oregon. · Audiology and Speech Pathology Service, Iowa City Veterans Affairs Health Care System, Iowa. · Learning Resources Service, Charles George Veterans Affairs Medical Center, Asheville, North Carolina. ·Am J Audiol · Pubmed #31022363.

ABSTRACT: Purpose This is a description of the clinical implementation and outcomes of progressive tinnitus management (PTM) at 2 Veterans Affairs (VA) medical centers: Both programs modified the protocol originally described by PTM developers. Method Modifications at both sites were classified according to an evidence-based framework set forth by Stirman, Miller, Toder, and Calloway (2013) . The Iowa City VA PTM program clinicians made 2 modifications and the Asheville, North Carolina, VA PTM program clinicians made 6 modifications to the standard PTM protocol. Pre-post outcome measures were analyzed for 20 veterans who completed the Iowa City program and for 200 veterans who completed the Asheville program. Results Veterans who completed the Iowa City program showed a statistically significant decrease in the average Tinnitus Handicap Inventory score ( Newman, Jacobson, & Spitzer, 1996 ). Veterans who completed the Asheville PTM program showed a statistically significant decrease in the average Tinnitus Functional Index (TFI) score. Outcomes in Asheville were compared to outcomes of a clinical trial of PTM conducted by the developers of PTM. The clinical work in Asheville resulted in a greater mean reduction on the TFI and a larger effect size using the TFI as compared to the results of the PTM clinical trial. Conclusions Clinician-directed modifications to PTM that are made to address the unique needs and circumstances of an individual clinic have potential to result in positive outcomes for patients. Clinicians providing care for patients with tinnitus using PTM who modify the protocol to meet the needs of their local setting are encouraged to collect and report the outcomes of their modifications to improve understanding of the impact of various types of modifications to PTM and other evidence-based practices.

5 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.

6 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.

7 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.

8 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.

9 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.

10 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.

11 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.

12 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.

13 Article Randomized Controlled Trial in Clinical Settings to Evaluate Effectiveness of Coping Skills Education Used With Progressive Tinnitus Management. 2017

Henry, James A / Thielman, Emily J / Zaugg, Tara L / Kaelin, Christine / Schmidt, Caroline J / Griest, Susan / McMillan, Garnett P / Myers, Paula / Rivera, Izel / Baldwin, Robert / Carlson, Kathleen. ·Veterans Affairs Rehabilitation Research and Development National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, ORDepartment of Otolaryngology - Head & Neck Surgery, Oregon Health & Science University, Portland. · Veterans Affairs Rehabilitation Research and Development National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, OR. · Psychology Service and Audiology Service, Veterans Affairs Connecticut Healthcare System, West HavenDepartment of Psychiatry, Yale University, New Haven, CT. · Department of Audiology, James A. Haley Veterans Hospital, Tampa, FL. · Harry S. Truman Memorial Veterans' Hospital, Columbia, MO. · Memphis Veterans Affairs Medical Center, TN. · Veterans Affairs Rehabilitation Research and Development National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, ORVeterans Affairs Health Services Research and Development Center of Innovation, Veterans Affairs Portland Health Care System, ORSchool of Public Health, Oregon Health & Science University, Portland. ·J Speech Lang Hear Res · Pubmed #28418492.

ABSTRACT: Purpose: This randomized controlled trial evaluated, within clinical settings, the effectiveness of coping skills education that is provided with progressive tinnitus management (PTM). Method: At 2 Veterans Affairs medical centers, N = 300 veterans were randomized to either PTM intervention or 6-month wait-list control. The PTM intervention involved 5 group workshops: 2 led by an audiologist (teaching how to use sound as therapy) and 3 by a psychologist (teaching coping skills derived from cognitive behavioral therapy). It was hypothesized that PTM would be more effective than wait-list control in reducing functional effects of tinnitus and that there would be no differences in effectiveness between sites. Results: At both sites, a statistically significant improvement in mean Tinnitus Functional Index scores was seen at 6 months for the PTM group. Combined data across sites revealed a statistically significant improvement in Tinnitus Functional Index relative to wait-list control. The effect size for PTM using the Tinnitus Functional Index was 0.36 (small). Conclusions: Results suggest that PTM is effective at reducing tinnitus-related functional distress in clinical settings. Although effect sizes were small, they provide evidence of clinical effectiveness of PTM in the absence of stringent research-related inclusion criteria and with a relatively small number of sessions of cognitive behavioral therapy.

14 Article Audiologic characteristics in a sample of recently-separated military Veterans: The Noise Outcomes in Servicemembers Epidemiology Study (NOISE Study). 2017

Gordon, J S / Griest, S E / Thielman, E J / Carlson, K F / Helt, W J / Lewis, M S / Blankenship, C / Austin, D / Theodoroff, S M / Henry, J A. ·VA RR&D, National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, OR, United States. Electronic address: jane.gordon@va.gov. · VA RR&D, National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, OR, United States; Oregon Health & Science University, Department of Otolaryngology/Head & Neck Surgery, Portland, OR, United States. · VA RR&D, National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, OR, United States. · VA RR&D, National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, OR, United States; Oregon Health & Science University, School of Public Health, Portland, OR, United States; Center to Improve Veteran Involvement in Care (CIVIC), Veterans Affairs Portland Health Care System, Portland, OR, United States. · VA RR&D, National Center for Rehabilitative Auditory Research (NCRAR), Veterans Affairs Portland Health Care System, Portland, OR, United States; Oregon Health & Science University, School of Public Health, Portland, OR, United States. ·Hear Res · Pubmed #27913314.

ABSTRACT: Military Service Members are often exposed to high levels of occupational noise, solvents, and other exposures that can be damaging to the auditory system. Little is known about hearing loss and how it progresses in Veterans following military service. This epidemiology study is designed to evaluate and monitor a cohort of Veterans for 20 years or more to determine how hearing loss changes over time and how those changes are related to noise exposure and other ototoxic exposures encountered during military service. Data reported here are from baseline assessments of the first 100 study participants (84 males; 16 females; mean age 33.5 years; SD 8.8; range 21-58). Each participant was asked to complete a comprehensive audiologic examination and self-report questionnaires regarding sociodemographic characteristics, noise and solvent exposures, health conditions common among post-deployment Veterans, and the social and emotional consequences of hearing loss. For this relatively young cohort, 29% exhibited hearing loss, defined as average hearing threshold >20 dB HL in the conventional audiometric range. Forty-two percent exhibited hearing loss in the extended-high-frequency audiometric range using the same criterion (average hearing threshold >20 dB HL). Certain factors were found to be associated with poorer hearing in both conventional and extended-high-frequency ranges, including age, type of military branch, years of military service, number of military deployments, noise exposure, tinnitus, and a positive screen for post-traumatic stress disorder. Although the majority of participants had hearing within normal limits, 27% reported a self-perceived mild/moderate hearing handicap and 14% reported a significant handicap. Further research is needed to identify a cause for this discrepancy in audiologic results versus self-report. The information obtained from this longitudinal study could be used in future resource planning with the goal of preventing, as much as possible, the development of hearing loss during military service, and the exacerbation of prevalent hearing loss after military service and over Veterans' lifetimes.

15 Article Subjective Reports of Trouble Tolerating Sound in Daily Life versus Loudness Discomfort Levels. 2016

Zaugg, Tara L / Thielman, Emily J / Griest, Susan / Henry, James A. ·United States Department of Veterans Affairs, Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR. · United States Department of Veterans Affairs, Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, ORDepartment of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland. ·Am J Audiol · Pubmed #27768802.

ABSTRACT: Purpose: A retrospective analysis of tonal and speech loudness discomfort levels (LDLs) relative to a subjective report of sound tolerance (SRST) was performed to explore the relation between the 2 commonly used clinical measures. Method: Tonal LDLs and SRST were measured for 139 U.S. military veterans who were recruited into a study providing intervention for tinnitus. Spearman's rank correlation coefficients were computed to assess the relation between the tonal and speech LDLs and the SRST. Results: Only weak correlations were found between tonal LDLs and SRST and between speech LDLs and SRST. Conclusion: If LDLs ratings of SRST measured the same phenomenon, the measures would be strongly negatively correlated. The weak correlations found between the measures suggest that LDLs do not accurately represent a patient's ability to tolerate sound in daily life.

16 Article Tinnitus Screener: Results From the First 100 Participants in an Epidemiology Study. 2016

Henry, James A / Griest, Susan / Austin, Don / Helt, Wendy / Gordon, Jane / Thielman, Emily / Theodoroff, Sarah M / Lewis, M Samantha / Blankenship, Cody / Zaugg, Tara L / Carlson, Kathleen. · ·Am J Audiol · Pubmed #27315442.

ABSTRACT: PURPOSE: In the Noise Outcomes in Servicemembers Epidemiology Study, Veterans recently separated from the military undergo comprehensive assessments to initiate long-term monitoring of their auditory function. We developed the Tinnitus Screener, a four-item algorithmic instrument that determines whether tinnitus is present and, if so, whether it is constant or intermittent, or whether only temporary tinnitus has been experienced. Predictive validity data are presented for the first 100 Noise Outcomes in Servicemembers Epidemiology Study participants. METHOD: The Tinnitus Screener was administered to participants by telephone. In lieu of a gold standard for determining tinnitus presence, the predictive validity of the tinnitus category assigned to participants on the basis of the Screener results was assessed when the participants attended audiologic testing. RESULTS: Of the 100 participants, 67 screened positive for intermittent or constant tinnitus. Three were categorized as "temporary" tinnitus only, and 30 were categorized as "no tinnitus." Tinnitus categorization was predictively valid with 96 of the 100 participants. CONCLUSIONS: These results provide preliminary evidence that the Screener may be suitable for quickly determining essential parameters of reported tinnitus. We have since revised the instrument to differentiate acute from chronic tinnitus and to identify occasional tinnitus. We are also obtaining measures that will enable assessment of its test-retest reliability.

17 Article Tinnitus Functional Index: Development, validation, outcomes research, and clinical application. 2016

Henry, James A / Griest, Susan / Thielman, Emily / McMillan, Garnett / Kaelin, Christine / Carlson, Kathleen F. ·VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR, USA; Department of Otolaryngology, Oregon Health & Science University, Portland, OR, USA. Electronic address: james.henry@va.gov. · VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR, USA; Department of Otolaryngology, Oregon Health & Science University, Portland, OR, USA. · VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR, USA. · VA HSR&D Center of Innovation, VA Portland Health Care System, Portland, OR, USA; Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR, USA. ·Hear Res · Pubmed #26074306.

ABSTRACT: The Tinnitus Research Consortium (TRC) issued a Request for Proposals in 2003 to develop a new tinnitus outcome measure that would: (1) be highly sensitive to treatment effects (validated for "responsiveness"); (2) address all major dimensions of tinnitus impact; and (3) be validated for scaling the negative impact of tinnitus. A grant was received by M. Meikle to conduct the study. In that observational study, all of the TRC objectives were met, with the final 25-item Tinnitus Functional Index (TFI) containing eight subscales. The study was published in 2012, and since then the TFI has received increasing international use and is being translated into at least 14 languages. The present study utilized data from a randomized controlled trial (RCT) that involved testing the efficacy of "telephone tinnitus education" as intervention for bothersome tinnitus. These data were used to confirm results from the original TFI study. Overall, the TFI performed well in the RCT with Cohen's d being 1.23. There were large differences between the eight different subscales, ranging from a mean 13.2-point reduction (for the Auditory subscale) to a mean 26.7-point reduction (for the Relaxation subscale). Comparison of TFI performance was made with the Tinnitus Handicap Inventory. All of the results confirmed sensitivity of the TFI along with its subscales. This article is part of a Special Issue entitled .

18 Article Tinnitus and hearing survey: a screening tool to differentiate bothersome tinnitus from hearing difficulties. 2015

Henry, James A / Griest, Susan / Zaugg, Tara L / Thielman, Emily / Kaelin, Christine / Galvez, Gino / Carlson, Kathleen F. · ·Am J Audiol · Pubmed #25551458.

ABSTRACT: PURPOSE: Individuals complaining of tinnitus often attribute hearing problems to the tinnitus. In such cases some (or all) of their reported "tinnitus distress" may in fact be caused by trouble communicating due to hearing problems. We developed the Tinnitus and Hearing Survey (THS) as a tool to rapidly differentiate hearing problems from tinnitus problems. METHOD: For 2 of our research studies, we administered the THS twice (mean of 16.5 days between tests) to 67 participants who did not receive intervention. These data allow for measures of statistical validation of the THS. RESULTS: Reliability of the THS was good to excellent regarding internal consistency (α=.86-.94), test-retest reliability (r=.76-.83), and convergent validity between the Tinnitus Handicap Inventory (Newman, Jacobson, & Spitzer, 1996; Newman, Sandridge, & Jacobson, 1998) and the A (Tinnitus) subscale of the THS (r=.78). Factor analysis confirmed that the 2 subscales, A (Tinnitus) and B (Hearing), have strong internal structure, explaining 71.7% of the total variance, and low correlation with each other (r=.46), resulting in a small amount of shared variance (21%). CONCLUSION: These results provide evidence that the THS is statistically validated and reliable for use in assisting patients and clinicians in quickly (and collaboratively) determining whether intervention for tinnitus is appropriate.

19 Article A Bayesian perspective on tinnitus pitch matching. 2014

McMillan, Garnett P / Thielman, Emily J / Wypych, Krystyn / Henry, James A. ·1VA RR&D National Center for Rehabilitative Auditory Research, VA Medical Center, Portland, Oregon, USA; 2Health Science Center, Louisiana State University, New Orleans, Louisiana, USA; and 3Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University (OHSU), Portland, Oregon, USA. ·Ear Hear · Pubmed #25166630.

ABSTRACT: OBJECTIVES: New tinnitus therapies are being developed and marketed that target the patient's tinnitus frequency. This frequency is estimated clinically by pitch matching, which has the patient identify the pure tone that is closest to the perceived tinnitus frequency. Though widely used, pitch matching is heavily criticized as unreliable, and the degree of reliability varies among patients. At the very least, it is recommended that multiple pitch matches be used to identify the patient's tinnitus frequency. Even so, it is not clear how many pitch matches to collect, how they should be combined, or how doing so will enhance the audiologist's certainty about the true tinnitus frequency. In this article, we describe a simple Bayesian method of sequentially combining pitch matches until acceptable precision is achieved and illustrate the method in 10 patients with chronic tinnitus. DESIGN: Subjects were recruited from previous study participants and support group attendees at the National Center for Rehabilitative Auditory Research. Thirty tinnitus pitch matches were elicited from 10 patients with chronic, monotonal tinnitus. RESULTS: A Bayesian sequential analysis yielded estimated tinnitus frequencies for 7 patients that were within one-quarter octave of their true value with 90% certainty. Between four and twenty pitch matches were required to achieve acceptable results in these seven patients. CONCLUSIONS: Despite criticism, pitch matching is widely used to estimate tinnitus frequency. We address reliability concerns with a Bayesian sequential analysis to jointly estimate tinnitus frequency and reliability. The method is easily applied.

20 Article Tinnitus loudness tracking: a "type V Békésy" pattern does not exist for pseudotinnitus. 2013

Steiger, James R / Thielman, Emily J / Henry, James A. ·School of Speech-Language Pathology and Audiology, University of Akron, Akron, OH; Northeast Ohio AuD Consortium. · VA RR&D National Center for Rehabilitative Auditory Research, VA Medical Center, Portland, OR. · VA RR&D National Center for Rehabilitative Auditory Research, VA Medical Center, Portland, OR; Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Portland, OR. ·J Am Acad Audiol · Pubmed #24384078.

ABSTRACT: BACKGROUND: Evaluation tools are lacking for the identification of patients exhibiting pseudotinnitus. It was hypothesized that tinnitus loudness traces might show a separation between continuous and pulsed tones for participants exhibiting pseudotinnitus, that is, the "type V" pattern shown for threshold tracking among participants exhibiting pseudohypacusis. It was further hypothesized that tinnitus loudness tracking might reveal unreliable tinnitus loudness matches among participants exhibiting pseudotinnitus due to their lack of an internal tinnitus standard. PURPOSE: To determine whether a tinnitus loudness tracking pattern exists for participants exhibiting pseudotinnitus. RESEARCH DESIGN: Nonrandomized posttest-only control design. The experimental group participants were those without tinnitus, and the control group participants were those with tinnitus. STUDY SAMPLE: There were 86 participants, including 45 with tinnitus and 41 without tinnitus. The participants' hearing varied from normal to severe hearing losses by pure-tone average at 1000, 2000, and 4000 Hz. INTERVENTION: Participants without tinnitus were asked to act as if they had tinnitus and to complete tinnitus loudness matching as if they were trying to convince the test (or computer) that they had tinnitus. DATA ANALYSIS: t-tests RESULTS: There were no statistically significant differences between individuals with tinnitus and participants acting out pseudotinnitus for any of six measures: (1) continuous tone tinnitus loudness tracking; (2) pulsed tone tinnitus loudness tracking; (3) differences between continuous and pulsed tone tinnitus loudness tracking; (4) continuous tone excursion width; (5) pulsed tone excursion width; and (6) differences between continuous and pulsed tone excursion width. CONCLUSIONS: Tinnitus loudness tracking does not appear to hold promise as a clinical tool for the identification of participants exhibiting pseudotinnitus.

21 Article Pilot study to develop telehealth tinnitus management for persons with and without traumatic brain injury. 2012

Henry, James A / Zaugg, Tara L / Myers, Paula J / Schmidt, Caroline J / Griest, Susan / Legro, Marcia W / Kaelin, Christine / Thielman, Emily J / Storzbach, Daniel M / McMillan, Garnett P / Carlson, Kathleen F. ·Department of Veterans Affairs, Rehabilitation Research and Development National Center for Rehabilitative AuditoryResearch, VA Medical Center, Portland, OR 97207, USA. james.henry@va.gov ·J Rehabil Res Dev · Pubmed #23341277.

ABSTRACT: Tinnitus, or "ringing in the ears," affects 10%-15% of adults; cases can be problematic and require lifelong management. Many people who have experienced traumatic brain injury (TBI) also experience tinnitus. We developed Progressive Tinnitus Management (PTM), which uses education and counseling to help patients learn how to self-manage their reactions to tinnitus. We adapted PTM by delivering the intervention via telephone and by adding cognitive-behavioral therapy. A pilot study was conducted to evaluate the feasibility and potential efficacy of this approach for individuals with and without TBI. Participants with clinically significant tinnitus were recruited into three groups: probable symptomatic mild TBI (n = 15), moderate to severe TBI (n = 9), and no symptomatic TBI (n = 12). Participants received telephone counseling (six sessions over 6 months) by an audiologist and a psychologist. Questionnaires were completed at baseline, 12 weeks, and 24 weeks. All groups showed trends reflecting improvement in self-perceived functional limitations due to tinnitus. A follow-up randomized clinical study is underway.

22 Article Feasibility of ecological momentary assessment of hearing difficulties encountered by hearing aid users. 2012

Galvez, Gino / Turbin, Mitchel B / Thielman, Emily J / Istvan, Joseph A / Andrews, Judy A / Henry, James A. ·VA RR&D National Center for Rehabilitative Auditory Research, VA Medical Center, Portland, Oregon, USA. ·Ear Hear · Pubmed #22531573.

ABSTRACT: OBJECTIVES: Measurement of outcomes has become increasingly important to assess the benefit of audiologic rehabilitation, including hearing aids, in adults. Data from questionnaires, however, are based on retrospective recall of events and experiences, and often can be inaccurate. Questionnaires also do not capture the daily variation that typically occurs in relevant events and experiences. Clinical researchers in a variety of fields have turned to a methodology known as ecological momentary assessment (EMA) to assess quotidian experiences associated with health problems. The objective of this study was to determine the feasibility of using EMA to obtain real-time responses from hearing aid users describing their experiences with challenging hearing situations. DESIGN: This study required three phases: (1) develop EMA methodology to assess hearing difficulties experienced by hearing aid users; (2) make use of focus groups to refine the methodology; and (3) test the methodology with 24 hearing aid users. Phase 3 participants carried a personal digital assistant 12 hr per day for 2 weeks. The personal digital assistant alerted participants to respond to questions four times a day. Each assessment started with a question to determine whether a hearing problem was experienced since the last alert. If "yes," then up to 23 questions (depending on contingent response branching) obtained details about the situation. If "no," then up to 11 questions obtained information that would help to explain why hearing was not a problem. Each participant completed the Hearing Handicap Inventory for the Elderly (HHIE) both before and after the 2-week EMA testing period to evaluate for "reactivity" (exacerbation of self-perceived hearing problems that could result from the repeated assessments). RESULTS: Participants responded to the alerts with a 77% compliance rate, providing a total of 991 completed momentary assessments (mean = 43.1 per participant). A substantial amount of data were obtained with the methodology. It is important to note that participants reported a "hearing problem situation since the last alert" 37.6% of the time (372 responses). The most common problem situation involved "face-to-face conversation" (53.8% of the time). The next most common problem situation was "telephone conversation" (17.2%) followed by "TV, radio, iPod, etc." (15.3%), "environmental sounds" (9.7%), and "movies, lecture, etc." (4.0%). Comparison of pre- and post-EMA mean HHIE scores revealed no significant difference (p > 0.05), indicating that reactivity did not occur for this group. It should be noted, however, that 37.5% of participants reported a greater sense of awareness regarding their hearing loss and use of hearing aids. CONCLUSIONS: Results showed participants were compliant, gave positive feedback, and did not demonstrate reactivity based on pre- and post-HHIE scores. We conclude that EMA methodology is feasible with patients who use hearing aids and could potentially inform hearing healthcare (HHC) services. The next step is to develop and evaluate EMA protocols that provide detailed daily patient information to audiologists at each stage of HHC. The advantages of such an approach would be to obtain real-life outcome measures, and to determine within- and between-day variability in outcomes and associated factors. Such information at present is not available from patients who seek and use HHC services.

23 Minor Reply to: Psychometric properties of the Tinnitus Functional Index (TFI): Assessment in a UK research volunteer population. 2017

Henry, J A / Thielman, E / Zaugg, T. ·VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR, United States; Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, OR, United States. Electronic address: james.henry@va.gov. · VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR, United States. ·Hear Res · Pubmed #27842215.

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