Expectations for Tinnitus Treatment and Outcomes: A Survey Study of Audiologists and Patients

Abstract

Background:

Roughly 10–15% of the general population is affected by tinnitus and this percentage is estimated to rise in future. Because there is currently no cure for tinnitus, treatment is limited and is primarily achieved through management of symptoms and counseling.

Purpose:

This study compared audiologists’ and patients’ responses to related survey questions about their expectations regarding tinnitus treatment. Two separate surveys were created, one for patients with tinnitus, and one for practicing audiologists who may treat such patients. The surveys included several related questions, such that comparison of the two could reveal where patients’ and audiologists’ expectations for tinnitus care were in agreement and areas in which they differed.

Research Design:

The surveys for audiologists and adults with tinnitus were 31- and 38-item questionnaires, respectively. Both surveys comprised demographic questions followed by several tinnitus-related questions in either multiple-choice or Likert-scale format.

Study Sample:

We received 230 completed Patient Surveys and 68 completed Audiologist Surveys.

Data Collection and Analysis:

All survey recruitment was completed online. Responses were collected via the Survey Monkey web tool (http://www.surveymonkey.com/). Responses were analyzed within and between surveys and grouped into topical categories (assessment, counseling, current available tinnitus information, satisfaction and expectations, improving tinnitus management). For data within each survey, descriptive statistics and correlation analyses were used. For selected comparisons between surveys, cross-tabulations were used. Hierarchical regression modeling was conducted to further explore (1) the perceived effectiveness of treatment received, and (2) how each group defined treatment success.

Results:

Differences were noted between the two groups’ responses to the question on the definition of treatment success; audiologists reported decreased awareness (77%), stress/anxiety relief (63%), and increased knowledge of tinnitus (63%) most commonly, whereas patients reported reduction of tinnitus loudness (63%) and complete elimination of tinnitus (57%) most often. The topic of greatest agreement was the desire for more information on tinnitus; 62% of patients felt more information from their healthcare provider would be the most important factor for improved tinnitus management, and 67% of audiologists reported currently having “some access” or less to appropriate resources for tinnitus treatment. Modeling results for effective tinnitus management and definitions of treatment success highlighted the importance of resource access and information sharing for both audiologists and patients.

Conclusions:

Patients and audiologists differed in terms of their expectations for successful treatment, with the patients focusing on perceptual factors and the audiologists on the reaction to the sound. Patient satisfaction with tinnitus treatment may be improved through access to more information, specifically, more information about current tinnitus treatment options and how these focus on the patient’s reaction to the tinnitus rather than the percept itself. Providing credible tinnitus information resources to audiologists, and focusing resources on training a small number of tinnitus specialist audiologists could greatly improve patient satisfaction with the current state of tinnitus palliative care.

Key Words

audiologist - counseling - expectations - management - survey - tinnitus

Preliminary results from the study were presented orally at the Tinnitus Research Initiative’s 10th International Conference, Nottingham, United Kingdom, March 16–18, 2016.

• REFERENCES

• Bartels H, Middel BL, van der Laan BF, Staal MJ, Albers FW. 2008; The additive effect of co-occurring anxiety and depression on health status, quality of life and coping strategies in help-seeking tinnitus sufferers. Ear Hear 29 (06) 947-956
• Beauregard M. 2009; Effect of mind on brain activity: evidence from neuroimaging studies of psychotherapy and placebo effect. Nord J Psychiatry 63 (01) 5-16
• Brown WA. 1998; The placebo effect. Sci Am 278 (01) 90-95
• Burns KE, Duffett M, Kho ME, Meade MO, Adhikari NK, Sinuff T, Cook DJ. ACCADEMY Group 2008; A guide for the design and conduct of self-administered surveys of clinicians. CMAJ 179 (03) 245-252
• Davis A, Rafaie EA. 2000. Epidemiology of tinnitus. In: Tyler RS. Tinnitus Handbook. San Diego, CA: Singular; 1-24
• Dawn AG, McGwin Jr G, Lee PP. 2005; Patient expectations regarding eye care: development and results of the Eye Care Expectations Survey (ECES). Arch Ophthalmol 123 (04) 534-541
• Department of Health 2009. Provision of Services for Adults with Tinnitus. A Good Practice Guide. London, United Kingdom: Central Office of Information;
• de Saintonge CDM, Herxheimer A. 1994; Harnessing placebo effects in health care. Lancet 344 8928 995-998
• Dobie RA. 2004. Overview: Suffering from tinnitus. In: Snow JB. Tinnitus: Theory and Management. Hamilton, ON, Canada: BC Decker Inc.; 1-7
• El-Shunnar SK, Hoare DJ, Smith S, Gander PE, Kang S, Fackrell K, Hall DA. 2011; Primary care for tinnitus: practice and opinion among GPs in England. J Eval Clin Pract 17 (04) 684-692
• Fackrell K, Hoare DJ, Smith S, McCormack A, Hall DA. 2012; An evaluation of the content and quality of tinnitus information on websites preferred by general practitioners. BMC Med Inform Decis Mak 12: 70
• Ferreira LM, Ramos Júnior AN, Mendes EP. 2009; Characterization of tinnitus in the elderly and its possible related disorders. Rev Bras Otorrinolaringol (Engl Ed) 75 (02) 249-255
• Gander PE, Hoare DJ, Collins L, Smith S, Hall DA. 2011; Tinnitus referral pathways within the National Health Service in England: a survey of their perceived effectiveness among audiology staff. BMC Health Serv Res 11: 162
• Hall DA, Haider H, Kikidis D, Mielczarek M, Mazurek B, Szczepek AJ, Cederroth CR. 2015 Toward a global consensus on outcome measures for clinical trials in tinnitus: report from the First International Meeting of the COMiT Initiative, November 14, 2014, Amsterdam, The Netherlands. Trends Hear 19:2331216515580272
• Hall DA, Láinez MJ, Newman CW, Sanchez TG, Egler M, Tennigkeit F, Koch M, Langguth B. 2011; Treatment options for subjective tinnitus: self reports from a sample of general practitioners and ENT physicians within Europe and the USA. BMC Health Serv Res 11: 302
• Halpert A, Dalton CB, Palsson O, Morris C, Hu Y, Bangdiwala S, Hankins J, Norton N, Drossman DA. 2010; Irritable bowel syndrome patients’ ideal expectations and recent experiences with healthcare providers: a national survey. Dig Dis Sci 55 (02) 375-383
• Henry JA, Schechter MA, Loovis CL, Zaugg TL, Kaelin C, Montero M. 2005; Clinical management of tinnitus using a “progressive intervention” approach. J Rehabil Res Dev 42 (04) (Suppl 2) 95-116
• Henry JL, Wilson PH. 2000. The Psychological Management of Chronic Tinnitus: A Cognitive-Behavioral Approach. Boston, MA: Allyn & Bacon;
• Henry JA, Zaugg TL, Myers PJ, Kendall CJ. 2010. Progressive Tinnitus Management: Clinical Handbook for Audiologists. San Diego, CA: Plural Publishing Inc.;
• Hoare DJ, Gander PE, Collins L, Smith S, Hall DA. 2012; Management of tinnitus in English NHS audiology departments: an evaluation of current practice. J Eval Clin Pract 18 (02) 326-334
• Hoare DJ, Hall DA. 2011; Clinical guidelines and practice: a commentary on the complexity of tinnitus management. Eval Health Prof 34: 413-420
• Jastreboff MM, Jastreboff PJ. 2002; Decreased sound tolerance and tinnitus retraining therapy (TRT). Aust N Z J Audiol 24: 74-84
• Klinger R, Flor H. 2014; Clinical and ethical implications of placebo effects: enhancing patients’ benefits from pain treatment. Handb Exp Pharmacol 225: 217-235
• Kochkin S, Tyler R. 2008; Tinnitus treatment and the effectiveness of hearing aids: hearing care professional perceptions. Hear Rev 15: 14-18
• McNeill C, Távora-Vieira D, Alnafjan F, Searchfield GD, Welch D. 2012; Tinnitus pitch, masking, and the effectiveness of hearing aids for tinnitus therapy. Int J Audiol 51 (12) 914-919
• Mitera G, Zhang L, Sahgal A, Barnes E, Tsao M, Danjoux C, Holden L, Chow E. 2012; A survey of expectations and understanding of palliative radiotherapy from patients with advanced cancer. Clin Oncol (R Coll Radiol) 24 (02) 134-138
• Mohamad N, Hoare DJ, Hall DA. 2016; The consequences of tinnitus and tinnitus severity on cognition: a review of the behavioural evidence. Hear Res 332: 199-209
• Oskay-Özcelik G, Lehmacher W, Könsgen D, Christ H, Kaufmann M, Lichtenegger W, Bamberg M, Wallwiener D, Overkamp F, Diedrich K, von Minckwitz G, Höffken K, Seeber S, Mirz R, Sehouli J. 2007; Breast cancer patients’ expectations in respect of the physician-patient relationship and treatment management results of a survey of 617 patients. Ann Oncol 18 (03) 479-484
• Roland LT, Lenze EJ, Hardin FM, Kallogjeri D, Nicklaus J, Wineland AM, Fendell G, Peelle JE, Piccirillo JF. 2015; Effects of mindfulness based stress reduction therapy on subjective bother and neural connectivity in chronic tinnitus. Otolaryngol Head Neck Surg 152 (05) 919-926
• Shekhawat GS, Searchfield GD, Stinear CM. 2013; Role of hearing AIDS in tinnitus intervention: a scoping review. J Am Acad Audiol 24 (08) 747-762
• Steinmetz LG, Zeigelboim BS, Lacerda AB, Morata TC, Marques JM. 2008; Evaluating tinnitus in industrial hearing loss prevention programs. Int Tinnitus J 14 (02) 152-158
• Tunkel DE, Bauer CA, Sun GH. 2014; Clinical practice guideline: tinnitus. Otolaryngol Head Neck Surg 151 (02) (Suppl) S1-S40
• Tyler RS, Haskell G, Preece J, Bergan C. 2001; Nurturing patient expectations to enhance the treatment of tinnitus. Seminars in Hearing 22: 15-21
• Tyler RS, Noble W, Coelho C, Haskell G, Bardia A. 2009. Tinnitus and Hyperacusis In: Katz J, Burkard R, Medwetsky L, Hood L. Handbook of Clinical Audiology. 6th ed. Baltimore, MD: Lippincott, Williams & Wilkins;
• Tyler RS, Gogel SA, Gehringer AK. 2007; Tinnitus activities treatment. Prog Brain Res 166: 425-434
• Waljee J, McGlinn EP, Sears ED, Chung KC. 2014; Patient expectations and patient-reported outcomes in surgery: a systematic review. Surgery 155 (05) 799-808
• Yueh B, Shapiro N, MacLean CH, Shekelle PG. 2003; Screening and management of adult hearing loss in primary care: scientific review. JAMA 289 (15) 1976-1985