Identifying Health-Related Conditions Associated with Tinnitus in Young Adults.

OBJECTIVE: The present study investigated the epidemic of tinnitus in college-aged young adults. Our first objective was to identify health conditions associated with tinnitus in young adults. The second objective was to evaluate the predictive utility of some known risk factors. STUDY DESIGN: A cross-sectional design was used to investigate the prevalence and risk factors for tinnitus. SETTING: A questionnaire was distributed, reaching out to a large college-aged population. A total of 2258 young adults aged 18-30 years were recruited from April 2021 to February 2022. INTERVENTIONS: A questionnaire was administered to investigate the epidemiology of tinnitus in a population of college-aged young adults. RESULTS: About 17.7% of young adults reported bothersome tinnitus perception lasting for ≥5 min in the last 12 months. The prevalence of chronic tinnitus (bothersome tinnitus for ≥1 year) and acute tinnitus (bothersome tinnitus for <1 year) was 10.6% and 7.1%, respectively. About 19% of the study sample reported at least one health condition. Individuals reporting head injury, hypertension, heart disease, scarlet fever, and malaria showed significantly higher odds of reporting chronic tinnitus. Meningitis and self-reported hearing loss showed significant associations with bothersome tinnitus. The prevalence of chronic tinnitus was significantly higher in males reporting high noise exposure, a positive history of reoccurring ear infections, European ethnic background, and a positive health history. Risk modeling showed that noise exposure was the most important risk factor for chronic tinnitus, followed by sex, reoccurring ear infections, and a history of any health condition. A positive history of COVID-19 and self-reported severity showed no association with tinnitus. Individuals reporting reoccurring ear infections showed a significantly higher prevalence of COVID-19. CONCLUSIONS: While young adults with health conditions are at a higher risk of reporting tinnitus, the predictive utility of a positive health history remains relatively low, possibly due to weak associations between health conditions and tinnitus. Noise, male sex, reoccurring ear infections, European ethnicity, and a positive health history revealed higher odds of reporting chronic tinnitus than their counterparts. These risk factors collectively explained about 16% variability in chronic tinnitus, which highlights the need for identifying other risk factors for chronic tinnitus in young adults.

Social Media Use in Hearing Loss, Tinnitus, and Vestibular Disorders: A Systematic Review.

BACKGROUND: People are increasingly using social media outlets for gathering health-related information. There has also been considerable interest from researchers and clinicians in understanding how social media is used by the general public, patients, and health professionals to gather health-related information. Interest in the use of social media for audiovestibular disorders has also received attention, although published evidence synthesis of this use is lacking. The objective of this review article was to synthesize existing research studies related to social media use concerning hearing loss, tinnitus, and vestibular disorders. METHOD: Comprehensive searches were performed in multiple databases between October and November 2020 and again in June 2021 and March 2022, with additional reports identified from article citations and unpublished literature. This review article was presented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: A total of 1,512 articles were identified. Of these, 16 publications met the inclusion criteria. Overall, social media offered people the platform to learn about hearing loss, tinnitus, and vestibular disorders via advice and support seeking, personal experience sharing, general information sharing, and relationship building. Research studies were more common on information and user activities seen on Facebook Pages, Twitter, and YouTube videos. Misinformation was identified across all social media platforms for each of these conditions. CONCLUSIONS: Online discussions about audiovestibular disorders are evident, although inconsistencies in study procedures make it difficult to compare these discussion groups. Misinformation is a concern needing to be addressed during clinical consultations as well as via other public health means. Uniform guidelines are needed for research regarding the use of social media so that outcomes are comparable. Moreover, clinical studies examining how exposure to and engagement with social media information may impact outcomes (e.g., help seeking, rehabilitation uptake, rehabilitation use, and satisfaction) require exploration. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20667672.

Race/Ethnicity, Gender, and Socioeconomic Status Representation in U.S.-Based Randomized Controlled Trials of Tinnitus: A Systematic Review.

PURPOSE: The purpose of this study was to investigate if peer-reviewed randomized controlled trials (RCTs) for the management/treatment of tinnitus conducted in the United States include diverse participants in terms of gender, race/ethnicity, education, occupation, and income. METHOD: We performed a comprehensive and systematic literature search via PubMed, Web of Science, Clinical-Trials.gov, and the Cochrane Central Register of Controlled Trials. Our goal was to identify prospective RCTs of tinnitus intervention conducted in the United States from January 1994 to September 2021 and published in peer-reviewed journals. RESULTS: A total of 2,584 studies were retrieved. Thirty-two peer-reviewed articles met all inclusion criteria. Of the included studies, approximately 96% reported participants' gender. Approximately 15% studies reported race/ethnicity information in alignment with the U.S. Census Bureau. However, an underrepresentation of both females and people of color was evident across studies. Reporting of socioeconomic status information of participants was also scarce, with only 25% studies reporting education and/or occupation of participants and 0% reporting income levels. CONCLUSIONS: This study indicates underrepresentation and underreporting of diverse participant pools in tinnitus research. Reasons for such underrepresentation are explored. Additionally, this systematic review indicates that recent research in tinnitus portrays an optimistic trend in terms of reporting and recruitment of diverse participant groups. Sustainable strategies for including diverse research participants are essential for hearing health care equity. Research and strategies to promote this goal are discussed.

Online Discussions About Tinnitus: What Can We Learn From Natural Language Processing of Reddit Posts?

BACKGROUND: This study was aimed at identifying key topics in online discussions about tinnitus by examining a large data set extracted from Reddit social media using a natural language processing technique. METHOD: A corpus of 113,215 posts about tinnitus was extracted from Reddit's application programming interface. After cleaning the data for duplications and posts without any text information, the sample was reduced to 101,905 posts, which was subjected to cluster analysis using the open-source IRaMuTeQ software to identify main topics based on the co-occurrence of texts. These clusters were named by a panel of tinnitus experts (n = 9) by reading typical text segments within each cluster. RESULTS: The cluster analysis identified 16 unique clusters that belong to two topics, which were named "tinnitus causes and consequences" and "tinnitus management and coping." Based on their characteristics, the clusters were named: tinnitus timeline (10%), tinnitus perception (9.7%), medical triggers and modulators (8.8%), hearing research (8.8%), attention and silence (8.6%), social media posts about tinnitus (7.4%), hearing protection (7.3%), interaction with hearing health care providers (6.7%), mental health and coping (5.8%), music listening (5.7%), hope for a cure (5.6%), interactions with people without tinnitus (5.4%), dietary supplements and alternative therapies (3.2%), sleep (3.9%), dietary effects (1.7%), and writing about tinnitus and being thankful to online community (1.4%). CONCLUSIONS: Despite some limitations, tinnitus posts on Reddit provide rich real-world data to identify various issues and complaints that tinnitus patients and their significant others discuss in online communities. Some of the clusters identified here are novel (e.g., tinnitus timeline, interactions with people without tinnitus) and have not been much discussed in the tinnitus literature. The results suggest that individuals with tinnitus relay on social media for support and highlight the service delivery needs in providing social support through other means (e.g., support groups).

Virtual reality for tinnitus management: a randomized controlled trial.

OBJECTIVE: Sound therapy (ST) and stress reduction regimens have been successfully used to manage tinnitus. Virtual reality (VR) has been used to manage chronic conditions like intractable pain. The aim of the present study was to investigate whether the use of VR in conjunction with ST revealed additional improvements in tinnitus attributes as compared to ST alone. DESIGN: This study was a randomised controlled trial (RCT) with a cross-over design. All participants received two interventions - ST alone (control) and ST with VR stimuli (experimental). ST consisted of fractal tones while VR stimuli comprised of nature videos presented via VR goggles. A multilevel mixed-effects linear regression model was used to estimate the intervention effect. STUDY SAMPLE: Twenty adults with subjective, continuous, chronic tinnitus participated in the study. RESULTS: After adjusting for period and baseline tinnitus loudness, significant improvements were observed in tinnitus loudness and Tinnitus Functional Index scores. Although not statistically significant, mean minimum masking levels were lower after the experimental intervention. CONCLUSIONS: Study participants benefitted from the use of VR in conjunction with ST in a laboratory setting. Additional effectiveness trials and blinded RCTs will be needed before validating the use of VR for tinnitus management in clinical settings.

A Comprehensive Evaluation of Tinnitus Apps.

Purpose The use of mobile phones is on the rise worldwide. Many people who experience tinnitus often turn to the Internet and applications (apps) on their smartphones to acquire information on tinnitus and solutions to "cure" tinnitus. The aim of this study was to evaluate and summarize features offered by tinnitus-related apps on different mobile platforms. Method This study was conducted on 3 mobile platforms-Apple iOS, Google Android, and Windows. The key word tinnitus was searched, and all free and paid apps were downloaded. Relevant apps were reviewed in-depth and then classified into 4 categories based on their functionality-"tinnitus education, awareness, and prevention," "tinnitus assessment and measurement," "tinnitus management," and "misinformation." Results All mobile platforms yielded both free and paid tinnitus apps, allowing individuals to learn more about tinnitus, assess and measure their own tinnitus, gain access to different sounds to help manage their tinnitus, and find strategies to better cope with their tinnitus. The Google Android platform revealed the most number of tinnitus apps. The "tinnitus management" category consistently outperformed the other categories-containing the most number of apps and the most number of features. A small proportion of misinformation apps were detected across platforms. There were no significant differences in the total number of features between free and paid apps (except on the Windows platform). A cost-feature analysis revealed that more expensive apps did not necessarily offer more number of features. Conclusions This study reveals that a variety of tinnitus-related apps-both free and paid-are available on different mobile platforms. Clinicians should be aware that patients with tinnitus often rely on apps for additional help and should be prepared to direct them to valid apps. Implications for end users are discussed as well. Supplemental Material https://doi.org/10.23641/asha.8956775.

A Study of Social Media Utilization by Individuals With Tinnitus.

PURPOSE: As more people experience tinnitus, social awareness of tinnitus has consequently increased, due in part to the Internet. Social media platforms are being used increasingly by patients to seek health-related information for various conditions including tinnitus. These online platforms may be used to seek guidance from and share experiences with individuals suffering from a similar disorder. Some social media platforms can also be used to communicate with health care providers. The aim of this study was to investigate the prevalence of tinnitus-related information on social media platforms. METHOD: The present investigation analyzed the portrayal of tinnitus-related information across 3 social media platforms: Facebook (pages and groups), Twitter, and YouTube. We performed a comprehensive analysis of the platforms using the key words "tinnitus" and "ringing in the ears." The results on each platform were manually examined by 2 reviewers based on social media activity metrics, such as "likes," "followers," and "comments." RESULTS: The different social media platforms yielded diverse results, allowing individuals to learn about tinnitus, seek support, advocate for tinnitus awareness, and connect with medical professionals. The greatest activity was seen on Facebook pages, followed by YouTube videos. Various degrees of misinformation were found across all social media platforms. CONCLUSIONS: The present investigation reveals copious amounts of tinnitus-related information on different social media platforms, which the community with tinnitus may use to learn about and cope with the condition. Audiologists must be aware that tinnitus sufferers often turn to social media for additional help and should understand the current climate of how tinnitus is portrayed. Clinicians should be equipped to steer individuals with tinnitus toward valid information.

fMRI as a Preimplant Objective Tool to Predict Children's Postimplant Auditory and Language Outcomes as Measured by Parental Observations.

BACKGROUND: The trends in cochlear implantation candidacy and benefit have changed rapidly in the last two decades. It is now widely accepted that early implantation leads to better postimplant outcomes. Although some generalizations can be made about postimplant auditory and language performance, neural mechanisms need to be studied to predict individual prognosis. PURPOSE: The aim of this study was to use functional magnetic resonance imaging (fMRI) to identify preimplant neuroimaging biomarkers that predict children's postimplant auditory and language outcomes as measured by parental observation/reports. RESEARCH DESIGN: This is a pre-post correlational measures study. STUDY SAMPLE: Twelve possible cochlear implant candidates with bilateral severe to profound hearing loss were recruited via referrals for a clinical magnetic resonance imaging to ensure structural integrity of the auditory nerve for implantation. INTERVENTION: Participants underwent cochlear implantation at a mean age of 19.4 mo. All children used the advanced combination encoder strategy (ACE, Cochlear Corporation™, Nucleus® Freedom cochlear implants). Three participants received an implant in the right ear; one in the left ear whereas eight participants received bilateral implants. Participants' preimplant neuronal activation in response to two auditory stimuli was studied using an event-related fMRI method. DATA COLLECTION AND ANALYSIS: Blood oxygen level dependent contrast maps were calculated for speech and noise stimuli. The general linear model was used to create z-maps. The Auditory Skills Checklist (ASC) and the SKI-HI Language Development Scale (SKI-HI LDS) were administered to the parents 2 yr after implantation. A nonparametric correlation analysis was implemented between preimplant fMRI activation and postimplant auditory and language outcomes based on ASC and SKI-HI LDS. Statistical Parametric Mapping software was used to create regression maps between fMRI activation and scores on the aforementioned tests. Regression maps were overlaid on the Imaging Research Center infant template and visualized in MRIcro. RESULTS: Regression maps revealed two clusters of brain activation for the speech versus silence contrast and five clusters for the noise versus silence contrast that were significantly correlated with the parental reports. These clusters included auditory and extra-auditory regions such as the middle temporal gyrus, supramarginal gyrus, precuneus, cingulate gyrus, middle frontal gyrus, subgyral, and middle occipital gyrus. Both positive and negative correlations were observed. Correlation values for the different clusters ranged from -0.90 to 0.95 and were significant at a corrected p value of <0.05. Correlations suggest that postimplant performance may be predicted by activation in specific brain regions. CONCLUSIONS: The results of the present study suggest that (1) fMRI can be used to identify neuroimaging biomarkers of auditory and language performance before implantation and (2) activation in certain brain regions may be predictive of postimplant auditory and language performance as measured by parental observation/reports.

The Effectiveness of the Progression of Widex Zen Tinnitus Therapy: A Pilot Study.

PURPOSE: The aim of this study was to measure the progression of benefits to individuals with tinnitus from providing informational counseling, hearing aids, a brief tinnitus activities treatment and Zen therapy. METHOD: Several magnitude estimation scales and tinnitus handicap scales were administered for the duration of the study to 20 participants. RESULTS: Results indicated that all participants benefited from this sequential approach of providing different components of this tinnitus treatment. Large benefits were observed following the tinnitus activities treatment and the Zen treatments. CONCLUSION: We conclude that the progressive approach of treatment demonstrated here should be of benefit to most individuals with tinnitus and that the Widex Zen sound therapy is a worthwhile treatment for many tinnitus sufferers.

fMRI as a Preimplant Objective Tool to Predict Postimplant Oral Language Outcomes in Children with Cochlear Implants.

OBJECTIVES: Despite the positive effects of cochlear implantation, postimplant variability in speech perception and oral language outcomes is still difficult to predict. The aim of this study was to identify neuroimaging biomarkers of postimplant speech perception and oral language performance in children with hearing loss who receive a cochlear implant. The authors hypothesized positive correlations between blood oxygen level-dependent functional magnetic resonance imaging (fMRI) activation in brain regions related to auditory language processing and attention and scores on the Clinical Evaluation of Language Fundamentals-Preschool, Second Edition (CELF-P2) and the Early Speech Perception Test for Profoundly Hearing-Impaired Children (ESP), in children with congenital hearing loss. DESIGN: Eleven children with congenital hearing loss were recruited for the present study based on referral for clinical MRI and other inclusion criteria. All participants were <24 months at fMRI scanning and <36 months at first implantation. A silent background fMRI acquisition method was performed to acquire fMRI during auditory stimulation. A voxel-based analysis technique was utilized to generate z maps showing significant contrast in brain activation between auditory stimulation conditions (spoken narratives and narrow band noise). CELF-P2 and ESP were administered 2 years after implantation. Because most participants reached a ceiling on ESP, a voxel-wise regression analysis was performed between preimplant fMRI activation and postimplant CELF-P2 scores alone. Age at implantation and preimplant hearing thresholds were controlled in this regression analysis. RESULTS: Four brain regions were found to be significantly correlated with CELF-P2 scores. These clusters of positive correlation encompassed the temporo-parieto-occipital junction, areas in the prefrontal cortex and the cingulate gyrus. For the story versus silence contrast, CELF-P2 core language score demonstrated significant positive correlation with activation in the right angular gyrus (r = 0.95), left medial frontal gyrus (r = 0.94), and left cingulate gyrus (r = 0.96). For the narrow band noise versus silence contrast, the CELF-P2 core language score exhibited significant positive correlation with activation in the left angular gyrus (r = 0.89; for all clusters, corrected p < 0.05). CONCLUSIONS: Four brain regions related to language function and attention were identified that correlated with CELF-P2. Children with better oral language performance postimplant displayed greater activation in these regions preimplant. The results suggest that despite auditory deprivation, these regions are more receptive to gains in oral language development performance of children with hearing loss who receive early intervention via cochlear implantation. The present study suggests that oral language outcome following cochlear implant may be predicted by preimplant fMRI with auditory stimulation using natural speech.

A Series of Case Studies of Tinnitus Suppression With Mixed Background Stimuli in a Cochlear Implant.

PURPOSE: Background sounds provided by a wearable sound playback device were mixed with the acoustical input picked up by a cochlear implant speech processor in an attempt to suppress tinnitus. METHOD: First, patients were allowed to listen to several sounds and to select up to 4 sounds that they thought might be effective. These stimuli were programmed to loop continuously in the wearable playback device. Second, subjects were instructed to use 1 background sound each day on the wearable device, and they sequenced the selected background sounds during a 28-day trial. Patients were instructed to go to a website at the end of each day and rate the loudness and annoyance of the tinnitus as well as the acceptability of the background sound. Patients completed the Tinnitus Primary Function Questionnaire (Tyler, Stocking, Secor, & Slattery, 2014) at the beginning of the trial. RESULTS: Results indicated that background sounds were very effective at suppressing tinnitus. There was considerable variability in sounds preferred by the subjects. CONCLUSION: The study shows that a background sound mixed with the microphone input can be effective for suppressing tinnitus during daily use of the sound processor in selected cochlear implant users.

A semi-supervised Support Vector Machine model for predicting the language outcomes following cochlear implantation based on pre-implant brain fMRI imaging.

INTRODUCTION: We developed a machine learning model to predict whether or not a cochlear implant (CI) candidate will develop effective language skills within 2 years after the CI surgery by using the pre-implant brain fMRI data from the candidate. METHODS: The language performance was measured 2 years after the CI surgery by the Clinical Evaluation of Language Fundamentals-Preschool, Second Edition (CELF-P2). Based on the CELF-P2 scores, the CI recipients were designated as either effective or ineffective CI users. For feature extraction from the fMRI data, we constructed contrast maps using the general linear model, and then utilized the Bag-of-Words (BoW) approach that we previously published to convert the contrast maps into feature vectors. We trained both supervised models and semi-supervised models to classify CI users as effective or ineffective. RESULTS: Compared with the conventional feature extraction approach, which used each single voxel as a feature, our BoW approach gave rise to much better performance for the classification of effective versus ineffective CI users. The semi-supervised model with the feature set extracted by the BoW approach from the contrast of speech versus silence achieved a leave-one-out cross-validation AUC as high as 0.97. Recursive feature elimination unexpectedly revealed that two features were sufficient to provide highly accurate classification of effective versus ineffective CI users based on our current dataset. CONCLUSION: We have validated the hypothesis that pre-implant cortical activation patterns revealed by fMRI during infancy correlate with language performance 2 years after cochlear implantation. The two brain regions highlighted by our classifier are potential biomarkers for the prediction of CI outcomes. Our study also demonstrated the superiority of the semi-supervised model over the supervised model. It is always worthwhile to try a semi-supervised model when unlabeled data are available.