Goal Attainment Scale in tinnitus (GAS-T): treatment goal priorities by chronic tinnitus patients in a real-world setting.

PURPOSE: Standard treatment for tinnitus is cognitive behavioral therapy, although level of evidence of effectiveness is low. There is need for a Goal Attainment Scale to evaluate treatment effects based on patient satisfaction. Preliminary work in a clinical sample has identified six common personal treatment goals. The purpose of this study is to determine whether the preliminary identified goals are confirmed by a heterogeneous sample of people with bothersome tinnitus and to identify any other common personal goals with the intention to construct a closed-end Goal Attainment Scale for tinnitus for use in research of effectiveness of (new) tinnitus treatments. METHODS: Two consecutive polls were plotted in an online peer support group form a heterogeneous sample. First, members were asked to vote for preliminary identified goals and asked to formulate additional personal goals. Corresponding goals were grouped together. Goals that were acknowledged by at least 10% of respondents were used in the second poll in which respondents could vote for statements that they recognized themselves in. RESULTS: The first poll (N = 180) resulted in 15 personal treatment goals. Comparison resulted in five common goals, which were confirmed in the second poll (N = 238): to gain control, to improve well-being and sleep, to reduce effects on hearing and to understand tinnitus. CONCLUSIONS: We expect that if a patient achieves personal goals, he will be likely to reduce healthcare consumption. Based on common personal goals, validity of treatment evaluations is increased. We present a closed-end Goal Attainment Scale in tinnitus.

Preliminary longitudinal results of neuropsychological education as first and sole intervention for new tinnitus patients.

INTRODUCTION: Tinnitus is a potentially aggravating symptom without curative treatment. Cognitive Behavioral Therapy has been proved effective. It aims to learn to cope with tinnitus by reducing fearfull appraisal of tinnitus. Education is an important part of that therapy. Neuropsychological education alone in an early stage of the symptom might reduce the need for extensive therapy. OBJECTIVE: To evaluate change of tinnitus related handicaps after neuropsychological education. MATERIALS AND METHODS: One hundred and six new tinnitus patients without otological ilnesses were educated in a neurophysiological model of tinnitus after otological inspection and audiometry. This was organized as a monthly standard session. Primary outcome was the Tinnitus Handicap Inventory (THI) score and subscores before intervention and 6 weeks after with follow up after 12 months. Seventy four participants were included for analysis. RESULTS: Six weeks post intervention a trend was seen in reduction of catastrophic reactions. After 12 months a significant decrease in THI scores was observed (all p values ≤ 0.01). The majority received no other treatment after the education. There were no significant differences between participants evaluating the workshop positively or negatively with respect to THI scores or tinnitus severity. CONCLUSION: Neuropsychological education may be a sufficient intervention for new tinnitus sufferers.

Factors associated with Self Rated Health in persons with tinnitus from the general population.

OBJECTIVES: Tinnitus, the perception of a sound without a corresponding external source, may be associated with decreased Self-Rated Health (SRH). Most research on tinnitus has been done in clinical populations. We aimed to study factors associated with SRH in individuals reporting tinnitus from the general population. METHODS: In this cross-sectional study, we used data of participants of the Lifelines population-based cohort who answered the question: "Do you hear soughing or whistling in your ear or ears?" (N=124,490). SRH was assessed using the RAND-36 item on SRH. Linear regression was used to study associations between SRH and impairment of hearing, physical and mental health, lifestyle, personality, and demographic features, in the group reporting always tinnitus (N=8,011). Models were also run in the entire study cohort, to test whether tinnitus was associated with SRH after adjustment for these variables. RESULTS: Of all participants, 6.4% reported always hearing tinnitus, with 83.7% of these reporting good to excellent SRH. The strongest positive associations with SRH in the group reporting always tinnitus were found for younger age, higher education levels, good sleep quality, more social contacts, absence of irritable bowel syndrome and fibromyalgia, high competence, and low impulsivity. In the total population, tinnitus was negatively associated with SRH, while adjusting for demographic features, physical and mental health history, lifestyle, and personality. CONCLUSION: Our findings contribute to increased understanding of resilience towards the negative consequences of tinnitus. In their early encounters with tinnitus patients, clinicians could focus on self-help regarding sleep hygiene and stimulate social activities.

A cognitive model of tinnitus and hyperacusis; a clinical tool for patient information, appeasement and assessment.

Tinnitus and hyperacusis are both aggravating audiological symptoms. Their underlying mechanisms are not fully understood, but the pathophysiology involves a central mechanism rather than a peripheral one. There is no curative treatment. A review of the available research on tinnitus and auditory processing was conducted to connect insights gained from different approaches to the subject; this resulted in the development of a holistic view of both conditions. In this view, the chronic course of the symptoms is pathological and attributed to a stress-related lack of habituation. This article adds to the literature on tinnitus and hyperacusis by presenting a schematic model of the cognitive mechanisms which can be used clinically in patient information sessions which are geared towards provide reassurance and encouraging the development of coping skills. In cooperation with the patient, the model can also help in the identification of underlying pathology. Future aims of study are suggested, elaborating on the role of tinnitus and hyperacusis in normal auditory processing and on the value of insight. Finally, parallels are drawn between tinnitus and positive symptom syndromes in neuropsychiatry and some of its modern visions on their treatment.