<p>Denna uppsats är uppdelad i två delstudier där syftet med delstudie ett var att utarbeta ett tinnitusspecifikt självskattningsformulär för acceptans, samt undersöka dess psykometriska egenskaper, normer och faktorstruktur. Syftet med delstudie två var att bland tinnituspatienter undersöka det prediktiva värdet av acceptans avseende senare tinnitusbesvär och livskvalitet, när man kontrollerar för depression och ångest. Detta då acceptans i en rad studier visat sig vara relaterat till ett antal mått på livskvalitet, psykopatologi, stress, smärta, jobbprestation och negativ affektivitet (Hayes, Luoma et al., 2006).</p><p>Delstudie två var en longitudinell korrelationsstudie med ett tidsintervall på 7 månader. Deltagarna i studierna var tinnituspatienter från Öronmottagningen på Universitetssjukhuset i Linköping och uppgick i delstudie ett till 77 personer och i delstudie två till 47.</p><p>Resultaten i delstudie ett visar att ett tinnitusspecifikt acceptansmått kunde utarbetas med adekvat frekvensdistribution samt god intern konsistens och test-retest reliabilitet. Detta acceptansmått har två faktorer där den första är activity engagement och den andra är tinnitus willingness.</p><p>Resultaten i delstudie två visar att såväl specifik som generell acceptans har ett starkt signifikant samband med senare tinnitusbesvär och ett måttligt signifikant samband med senare livskvalitet. Vid partiell korrelationsanalys och multipla regressioner visar det sig dock att utfallsvariablernas baslinjevärden är de mått som bäst predicerar utfallet vid uppföljningen. Slutsatsen blir att acceptans prediktiva förklaringsvärde avseende tinnitusbesvär och livskvalitet försvinner när baslinjevärden på dessa utfallsvariabler tas med i beräkningen.</p>

<p>Syftet med denna litteraturstudie var att sammanfatta vetenskapligt dokumenterade resultat kring vilka psykologiska, sociala och psykosociala konsekvenser som</p><p>tinnitus kan orsaka. Elva artiklar, tre kvalitativa och åtta kvantitativa, valdes ut vid litteratursökningen och analyserades. Analysen resulterade i tre resultatdelar, primära konsekvenser där psykologiska konsekvenser sorterades in, sekundära konsekvenser där sociala konsekvenser sorterades in och en för psykosociala konsekvenser. Den primära resultatdelen visade att personer med svår tinnitus ofta led av koncentrationsproblem,</p><p>sömnproblem och psykologiska problem som exempelvis depressioner. Den sekundära resultatdelen visade att personer med svår tinnitus fungerade sämre i det sociala livet och undvek aktiviteter, jämfört med en population som inte har tinnitus. De psykosociala konsekvenserna som fanns dokumenterade var få. En artikel avvek från de övriga och visade liten påverkan på alla områden. Detta togs upp i diskussionen då artikelns författare ansåg att demografiska och kulturella faktorer kunde ha en positiv inverkan. Detta befanns vara intressanta faktorer som liksom hela det psykosociala området kräver ytterligare forskning. I</p><p>diskussionen påpekades även att man inte kan fastställa om de psykologiska problemen har kommit som en biverkan av tinnitus eller var närvarande innan.</p>

Tinnitus is the experience of sounds without an appropriate external auditory source. These auditory sensations are intertwined with emotional and attentional processing. Drawing on theories of mental control, we predicted that suppressing an affectively negative sound mimicking the psychoacoustic features of tinnitus would result in decreased persistence in a mentally challenging task (mental arithmetic) that required participants to ignore the same sound, but that receiving a mindfulness exercise would reduce this effect. Normal hearing participants (N = 119) were instructed to suppress an affectively negative sound under cognitive load or were given no such instructions. Next, participants received either a mindfulness induction or an attention control task. Finally, all participants worked with mental arithmetic while exposed to the same sound. The length of time participants could persist in the second task served as the dependent variable. As hypothesized, results indicated that an auditory suppression rationale reduced time of persistence relative to no such rationale, and that a mindfulness induction counteracted this detrimental effect. The study may offer new insights into the mechanisms involved in the development of tinnitus interference. Implications are also discussed in the broader context of attention control strategies and the effects of emotional sound on task performance. The ironic processes of mental control may have an analog in the experience of sounds. / <p>On the day of the defence date the status of this article was <em>Manuscript</em>.</p>

Aims: This study addressed the challenge of evaluating and improving patient education material as well as recall of information from a tinnitus counselling session. The first aim was to examine the readability and suitability of two tinnitus patient education brochures provided by an audiology clinic to new tinnitus patients. If the readability of the brochures were higher than international recommendations for reading grade level (RGL), then an attempt to rewrite a brochure to a suitable RGL would be made. The second aim was to investigate a) the amount of information tinnitus patients can successfully recall directly following their initial appointment, b) the amount of information that is retained one to two weeks following their appointment, c) whether the amount of information recalled is related to patient variables, and d) the themes that arose from interviews with the patients. Method: To address study aim 1, readability analyses were completed for two patient tinnitus brochures provided to new patients at a private hearing aid clinic using several readability formulas. If found to have a readability level over 5th grade level one brochure would be rewritten to an acceptable readability level while attempting to maintain the initial level of content. The suitability of the brochures was assessed by two experts in the area of health literacy using the Suitability Assessment of Material (SAM). To address study aim 2, eight participants consulting for tinnitus services were prospectively identified by a clinical audiologist at a private hearing aid clinic. Immediately following the initial tinnitus counselling session, participants took part in a digitally-recorded seven-item open-ended interview and provided demographic and audiological information. One to two weeks later, a second interview using the same questions was conducted. Results: After analyzing the readability of the brochures it was evident that both exceeded the recommended RGL on the Flesch-Kincaid (F-K), Fry, Fog, and Simple Measure of Gobbledygook (SMOG). The experts rated Brochure 1 as “unsuitable” for patient education and Brochure 2 as “adequate” for patient education using the SAM. Brochure 1 was revised and was within the internationally recommended RGL as measured by the F-K, Fry, and Fog, whilst keeping the content similar to the original. Overall, participants correctly recalled only a small amount of information in the immediate (36.8%) and one to two weeks later (33.7%). There was no significance difference in amount of correctly recalled information between appointments, and none of the correlations performed for recall and participant variables were statistically significant. Effect sizes were calculated and no trend was found for audiometric variables, although demographic variables did tend to explain more of the variance in recall in the short-term than immediately. The most notable themes identified in the interview immediately after the appointment were: Hearing aids, Understanding/Empowerment, and Masking/Music therapy. At the short-term follow up interview, Hearing aids, Cost, and Hope/Positive were commonly reported. Conclusions: As over half of New Zealanders do not have adequate health literacy skills to meet the demands of life and work (Ministry of Health, 2010) it follows that written and verbal health information should be easy understandable to allow patients to take an active role in their health care and experience the best possible health outcomes. Overall, participants only remembered modest amounts, only one brochure was adequate for patient education, and the RGL of both brochures were higher than recommended. There is a great need for more studies examining suitability, readability, and patient recall not only in tinnitus, but in all areas of healthcare.

Denna uppsats är uppdelad i två delstudier där syftet med delstudie ett var att utarbeta ett tinnitusspecifikt självskattningsformulär för acceptans, samt undersöka dess psykometriska egenskaper, normer och faktorstruktur. Syftet med delstudie två var att bland tinnituspatienter undersöka det prediktiva värdet av acceptans avseende senare tinnitusbesvär och livskvalitet, när man kontrollerar för depression och ångest. Detta då acceptans i en rad studier visat sig vara relaterat till ett antal mått på livskvalitet, psykopatologi, stress, smärta, jobbprestation och negativ affektivitet (Hayes, Luoma et al., 2006). Delstudie två var en longitudinell korrelationsstudie med ett tidsintervall på 7 månader. Deltagarna i studierna var tinnituspatienter från Öronmottagningen på Universitetssjukhuset i Linköping och uppgick i delstudie ett till 77 personer och i delstudie två till 47. Resultaten i delstudie ett visar att ett tinnitusspecifikt acceptansmått kunde utarbetas med adekvat frekvensdistribution samt god intern konsistens och test-retest reliabilitet. Detta acceptansmått har två faktorer där den första är activity engagement och den andra är tinnitus willingness. Resultaten i delstudie två visar att såväl specifik som generell acceptans har ett starkt signifikant samband med senare tinnitusbesvär och ett måttligt signifikant samband med senare livskvalitet. Vid partiell korrelationsanalys och multipla regressioner visar det sig dock att utfallsvariablernas baslinjevärden är de mått som bäst predicerar utfallet vid uppföljningen. Slutsatsen blir att acceptans prediktiva förklaringsvärde avseende tinnitusbesvär och livskvalitet försvinner när baslinjevärden på dessa utfallsvariabler tas med i beräkningen.

Diss. Linköping : Univ., 2003.

The ability of neurons to regulate their activity (homeostatic plasticity) is thought to be responsible for changes in neural responsiveness/gain induced by sensory deprivation, or augmented stimulation. For example, following auditory deprivation, excitatory and inhibitory synaptic transmission is strengthened and weakened, respectively. Abnormally high neural gain results in an 'over amplification' of spontaneous and stimulus-evoked firing rates, and may result in aberrant auditory perceptions including tinnitus and/or hyperacusis, respectively. The first manuscript in the thesis 'Pump up the Volume' (Chapter Three) provides a summary of the neural gain mechanism in the adult auditory system. Aspects of neural gain, including temporal characteristics and frequency specificity, had not been systematically investigated. Therefore, the aim of this thesis was to investigate characteristics of the neural gain mechanism. The thesis comprises three related studies involving normal hearing adult listeners: two studies involved short term sensory deprivation and one study involved short term augmented stimulation. The main outcome measures were the acoustic reflex threshold (ART), auditory brainstem response (ABR) and loudness. In Study One, the time course, frequency specificity and anatomical location of changes in the ART, following 6 days of unilateral earplug use (ca 30 dB attenuation at 2-4 kHz), were investigated. The reduction in ART in the treatment ear was greatest at day 4 and at frequencies most attenuated by the earplug. Ipsilateral and contralateral ARTs were similar when stimuli were presented to the treatment ear. ARTs were not statistically significant from baseline when measured 4 and 24 hours after earplug removal. In Study Two, the ART and ABR were measured at baseline and after 7 days of unilateral and bilateral hearing aid use (13-17 dB real ear insertion gain), to compare the effect of symmetrical and asymmetrical inputs. There was no change in ART and ABR after treatment, suggesting that the augmented stimulation was insufficient to modify neural gain. In Study Three, ARTs, ABRs and loudness were investigated after 4 days of unilateral earplug use (30 dB attenuation at 2-4 kHz). There was a significant reduction in ART (ca 6 dB) in the treatment ear, which returned to baseline within 1-2 hours of earplug removal. There was an unexpected but significant 35 nV decrease in the ABR wave V peak-to-trough amplitude in the treatment ear, and a 12 nV increase in the control ear. The change in ABR was opposite in direction to the change in ART. There was no change in loudness. The thesis has provided information on the threshold of deprivation/stimulation required to elicit a change in neural gain, along with the frequency specificity and temporal characteristics of the gain control mechanism. The anatomical location for changes in neural gain is around the level of the cochlear nucleus. The change in ABR was in the opposite direction to those predicted, but could be due a difference in the compensatory changes of contralateral and ipsilateral inputs at the level of the inferior colliculus.

Subjective tinnitus is the perception of sound despite the absence of an external stimulus. This challenging sensory event affects millions of people per year. There currently is no cure for tinnitus, but there have been many different options researched to help patients manage its effects, albeit with varying efficacy. In a viral internet video, the Beating the Heavenly Drum maneuver, found in the Eastern practice of Qigong, was said to eliminate the perception of tinnitus for the participants. In this current study, the Beating the Heavenly Drum maneuver was compared to a sham maneuver and evaluated for effectiveness in relieving tinnitus. To be included in this study, participants had experienced tinnitus for at least 6 months and were not currently receiving other tinnitus care. Exclusionary criteria included a diagnosis of Post-Traumatic Stress Disorder, Traumatic Brain Injury, any neurological condition, whiplash, neck injury, or severe anxiety or depression, as determined by the Hospital Anxiety and Depression Scale. Participants completed a tinnitus case history form, Tinnitus Functional Index (TFI), Tinnitus Handicap Index (THI), and Visual Analog Scale (VAS) ranking the annoyance of their tinnitus. Participants were assigned to groups in an alternating fashion, with odd identifiers in Group 1 and even identifiers in Group 2. In Group 2, participants received the experimental maneuver (Beating the Heavenly Drum) during the first session and the sham maneuver (circles rubbed at the base of the skull) during the second. In Group 1, participants received a sham maneuver during the first session and the experimental maneuver during the second session. Within 48 hours after each session, participants completed the TFI, THI, and rated the annoyance of their tinnitus on a scale of 0 to 10 (keeping the same parameters from the VAS) via phone call. Of the twelve participants, two reported that the experimental maneuver, Qigong, was effective for tinnitus relief; while five reported the sham condition relieved their tinnitus. The remaining five participants stated that neither maneuver altered their tinnitus sensation. Across all participants, there were no significant difference scores on the THI, and only one significant difference score on the TFI. While participants reported some change in their tinnitus with either maneuver, none of the questionnaire measures corroborated their subjective report. Additionally, the sham maneuver was perceived as more effective than the experimental maneuver. The Qigong maneuver was not effective for tinnitus relief in this study. It should be noted that a limitation to this study is the small sample size. While this Qigong maneuver did not relieve tinnitus, there are other Internet tinnitus “cures” that should be investigated for their effectiveness in tinnitus relief. With the rise of the Internet and more patients searching for “quick fixes” to tinnitus, it is vital that clinicians provide appropriate education and research to best help patients manage their tinnitus.

Musicians are a unique population in the world of audiology. It has been reported that on average, they exceed the recommended daily dose of noise exposure before the middle of their day. This significantly increases the risk of a permanent noise- or music- induced hearing loss. Such a hearing loss may influence their perception of timbre, pitch, and loudness thereby affecting their ability to play and enjoy music. Therefore, early identification of hearing problems is critical to this population. Twelve subjects with a variety of musical backgrounds and experiences were recruited for the study that had three primary purposes. The first was to design and implement a sensitive hearing assessment protocol to identify early signs of hearing loss in young musicians. The second was to determine the presence and significance of hearing loss, tinnitus (perception of sound when no actual external signal is present, commonly referred to as “ringing in the ears”), and hyperacusis (experience of everyday life sounds being perceived as intrusively loud, uncomfortable, or even painful) among musicians. The third was to determine if and when hearing protection devices were used in this population. All subjects completed a thorough case history that included history of noise exposure, musical background, habits and preferences for hearing protection device use, as well as screening for mental and physical health concerns. When indicated by patient responses to the case history, questionnaires about tinnitus, vertigo, hyperacusis, and hearing were administered and scored. The test battery included an evaluation of middle-ear function (otoscopy, tympanometry, and acoustic reflex), cochlear function based on distortion product otoacoustic emissions (DPOAEs), audiometry using conventional test frequencies (0.25-8 kHz) and extended high-frequencies (8-16 kHz), and the Words in Noise (WIN) test which uses monosyllabic words to quantify the loss of speech understanding in adverse listening situations. Results revealed that six subjects experience bothersome tinnitus (four, of whom had WIN scores in the mild range and three of whom reported hyperacusis). One of these seven also had absent DPOAES, absent acoustic reflexes, and a mild to moderate hearing loss from 6 – 16kHz. Case history indicated that the majority of subjects were not using hearing protection devices, suggesting a need for further education and preventative efforts. It also revealed a positive trend between anxiety/depression and tinnitus, hyperacusis, and dizziness severity. In our test protocol the WIN test was the most effective tool for identifying difficulty in adverse listening situations but asking subjects about experiencing tinnitus was a more reliable predictor of functional change to the auditory system (even in patients with thresholdsfrequencies). Together, these assessments could provide clinicians, musicians, and school administrators the value of music students using hearing protection when practicing, performing, or attending live shows.

Background: Patients often report that living with a condition such as tinnitus can be debilitating, worrying, and frustrating. Efficient ways to foster management strategies for individuals with tinnitus and promoting tinnitus self-efficacy are needed. Internet-based cognitive behavioral therapy (ICBT) for tinnitus shows promise as an evidence-based intervention in Europe, but is not available in the United States. The aim of this pilot study was to evaluate the feasibility of an ICBT intervention for tinnitus in the United States. Method: This study reports the Phase 1 trial intended to support implementation of a larger randomized clinical trial (RCT) comparing ICBT to a weekly monitoring group. As a pilot study, a single-group pretest–posttest design was used to determine outcome potential, recruitment strategy, retention, and adherence rates of ICBT for tinnitus. The primary outcome was a change in tinnitus distress. Secondary outcome measures included measures of anxiety, depression, insomnia, tinnitus cognitions, hearing-related difficulties, and quality of life. Results: Of the 42 screened participants, nine did not meet the inclusion criteria and six withdrew. There were 27 participants who completed the intervention, with a mean age of 55.48 (± 9.9) years. Feasibility was established, as a large pretest–posttest effect size of d = 1.6 was found for tinnitus severity. Large pretest–posttest effect sizes were also found for tinnitus cognitions and hearing-related effects, and a medium effect was found for insomnia and quality of life. Treatment adherence varied with a retention rate of 85% (n = 23) at post-intervention assessment and 67% (n = 18) for the follow-up assessment. Conclusions: This pilot study supported the feasibility of ICBT for tinnitus in the United States. Ways of improving intervention retention and recruitment rates need to be explored in future ICBT studies. Protocol refinements that were identified will be implemented prior to further RCTs to investigate the efficacy of ICBT for tinnitus in the United States.