Research Paper Example on Tinnitus
Subjective tinnitus, or the phantom perception of sound with no identifiable sound source (Johnson, 2014), is a major problem for many individuals. Affecting roughly 15% of the global population (“Understanding the Facts”, 2020), tinnitus can greatly affect an individual’s quality of life. Many patients with tinnitus experience difficulty sleeping and concentrating and, over time, the negative effects of tinnitus on cognition can cause anxiety, depression, and anger (Johnson, 2014). While there is no one known cause of tinnitus, many individuals with tinnitus (about 80%) experience tinnitus as a symptom of sensorineural hearing loss. It is thought that pathology of the cochlea deprives the brain of normal auditory input, leading to neural changes that cause tinnitus (Henry et al., 2014). Previous research has shown that, for this population, hearing aids can provide significant relief from tinnitus. One study on this topic found that 100% of participants had a significant reduction in tinnitus when using hearing aids that totally masked their tinnitus (McNeill et al., 2012).
With the recent popularization of extended-wear hearing aids (EWHA; hearing aids that sit invisibly in the ear canal and can be worn 24/7 for two to three months at a time), researchers have begun to explore the efficacy of these hearing aids in treating tinnitus. Based on previous research, it is known that hearing aids are a viable treatment for those with tinnitus and concomitant sensorineural hearing loss. However, researchers are now assessing the efficacy of the unique characteristics of EWHAs in treating tinnitus. EWHAs can be worn 24/7, allowing the user access to sound when they are asleep, showering, or exercising. This continuous stimulation of the auditory system, not offered with conventional hearing aids, has the potential to greatly diminish the sensation of, and negative effects associated with tinnitus. This paper will delve into three recent studies conducted on the use of EWHAs in treating tinnitus, offer recommendations for future research, and conclude with clinical recommendations based on the results of the presented studies.
The first of the three studies to be presented was conducted in 2019 at The University of Melbourne. Dowell, Power, and Tomlin’s “Reducing Tinnitus with Hearing Aids: Does the Lyric Offer a More Effective Option?” sought to explore the efficacy of the Lyric hearing aid (an EWHA) in reducing tinnitus versus a traditional hearing aid. The study included thirty-three participants with at least a mild hearing loss and bothersome tinnitus (self-reported, TFI score of 20 or greater). Prior to the administration of treatment, participants were asked to complete the Tinnitus Functional Index (TFI) assessment, which would be used as a measure to assess tinnitus reduction (Power et al., 2019). The TFI is a validated instrument that uses eight subscales (intrusive, sense of control, cognitive, sleep, auditory, relaxation, quality of life, and emotional) to determine the overall severity of tinnitus and its negative impacts on an individual’s life (Johnson, 2014).
Participants were evenly split into three test groups: Lyric group, Traditional hearing aid group (Phonak Audéo B90 312), and Masker group (Phonak Audéo B90 312 + Masker). Each participant was readministered the TFI assessment at 1 month and 3 months post hearing aid fitting. Results of the study showed that participants in the Lyric group reached a clinically significant reduction of TFI score (-13 points) both faster than, and at a greater magnitude, than did the Traditional hearing aid group or the Masker group. 80% of the Lyric group reached a clinically significant reduction in TFI score compared to 63% of the Traditional hearing aid group and only 45% of the Masker group. These results suggest that EWHAs offer a better chance at greater and quicker tinnitus reduction than do traditional hearing aids. (Power et al., 2019)
A similar study, published by ENT and Audiology News in 2014, also sought to examine the use of EWHAs in treating tinnitus for individuals with concomitant mild to moderate hearing loss. Jacob Johnson’s “Lyric 24/7 hearing: could it help those with tinnitus?” describes a study in which 15 participants with both hearing loss and tinnitus were fit with Lyric hearing aids. In order to qualify for the study, participants needed an initial TFI score of 25 or greater and could have no previous experience with the Lyric hearing aid. While, like the previous study, the TFI was used as the primary measure, this study also utilized two other measures over the course of the study, the PSS and the PHQ-9. The Perceived Stress Scale (PSS) measures perceived stress and an individual’s perceived ability to cope with their demands, while the Patient Health Questionnaire-9 (PHQ-9) is a screener for depression. Participants were fit binaurally with Lyric hearing aids and were readministered the TFI assessment at two weeks, one month, and three months. (Johnson, 2014)
Analysis of the acquired data showed that participants experienced a decrease in tinnitus impact in all eight of the TFI subscales at each administration of the assessment. Particularly large changes were noted in the auditory, intrusive, sleep, and quality of life subscales. While none of the subscales saw a truly statistically significant difference, each participant noted an overall improvement in tinnitus reduction through the use of the Lyric hearing aid (Johnson, 2014). One limitation of this study design is that it did not include a control or alternate treatment group which limits the applicability of its findings in comparing the efficacy of EWHAs in treating tinnitus versus traditional hearing aids.
The final study that will be discussed in this paper was conducted by Henry et al. (2017) and published in the Journal of The American Academy of Audiology. The purpose of this study was to compare the efficacy of traditional hearing aids, traditional hearing aids with a sound generator, and EWHAs in providing relief from tinnitus. This study also utilized the TFI as its primary measure for the reduction of tinnitus and other secondary measurements to examine hearing aid satisfaction and performance (QuickSIN, HHIE/HHIA, SSQ12, and IOI-HA). Participants for this study included 55 individuals with a TFI score of 25 or greater and a mild to moderately-severe hearing loss who were sorted into three groups: Hearing Aid (18 participants), Hearing Aid + Sound Generator (19 participants), and EWHA (18 participants). (Henry et al., 2017)
According to the analysis of the TFI score data, over the course of the 4-month study, nearly every participant experienced a reduction in tinnitus symptoms. The average change in TFI score from the baseline assessment to the final assessment was -21 points in the Hearing Aid group, -33 points in the Hearing Aid+Sound Generator group, and -31 points in the EWHA group. By group, 67% of the Hearing Aid group participants had a clinically significant improvement in tinnitus symptoms, 79% of those in the Hearing Aid+Sound Generator group, and 82% of participants in the EWHA group. While the EWHA group average TFI reduction was not clinically significant, the removal of one participant from this group whose data were an outlier did result in a clinically significant average TFI score reduction (-14.5 points). Importantly, participants in the EWHA group showed three times as much improvement on the sleep subscale of the TFI than did the other test groups. This study suggests that while traditional hearing aids, whether paired with a sound generator or not, can offer a significant reduction in tinnitus symptoms for patients, EWHAs may offer a greater reduction in tinnitus symptoms, specifically in the sleep domain. (Henry et al., 2017)
A few recommendations for future research in this area include ensuring the use of a control group or an alternate treatment group. This would allow for better comparison between the efficacy of each treatment (or no treatment) and could inform clinical practice more comprehensively. Another recommendation would be to explore the combination of EWHAs and tinnitus counseling as a more effective approach to tinnitus reduction than is the EWHA by itself.
Based on the above research, the use of EWHAs as a treatment for tinnitus is not only valid but might actually outperform traditional hearing aids. EWHAs were found to consistently provide greater tinnitus reduction in the sleep subscale and produced equal to or greater overall TFI score reduction for users than did traditional hearing aids. While some barriers exist to the accessibility of EWHAs (candidacy, monetary, and provider-based), when possible, for patients with a mild to moderately-severe hearing loss and bothersome tinnitus, the prescription of EWHAs may offer significant benefits and reduction of tinnitus sensation and symptoms.
