Tinnitus & Hyperacusis Therapy Masterclass
tinnitustherapy.org.uk

 

 

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hashir.aazh@tinnitustherapy.org.uk

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Specialist course for management of tinnitus and hyperacusis in children and adults

 







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Dates: 25-27 July 2018
Venue: Birkbeck, University of London, London, United Kingdom   

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Research updates on clinical matters related to 

tinnitus and hyperacusis rehabilitation  

1. Am J Audiol. 2017 Sep 18;26(3):226-232. doi: 10.1044/2017_AJA-17-0011.

Incidence of Discomfort During Pure-Tone Audiometry and Measurement of
Uncomfortable Loudness Levels Among People Seeking Help for Tinnitus and/or
Hyperacusis.

Aazh H(1), Moore BCJ(2). Author information: (1)Audiology Department, Royal Surrey County Hospital NHS Foundation Trust, Guildford, United Kingdom. (2)Department of Psychology, University of Cambridge, United Kingdom. Purpose: The aim of this study was to assess the proportion of patients seen in a tinnitus and hyperacusis therapy clinic for whom presentation levels based on the British Society of Audiology (BSA)-recommended procedures for pure-tone audiometry and determination of uncomfortable loudness levels (ULLs) exceed ULLs, leading to discomfort during administration of these procedures. Method: This was a retrospective cross-sectional study of 362 consecutive patients who attended a National Health Service audiology clinic for tinnitus and/or hyperacusis rehabilitation. Results: For 21% of the patients, presentation levels based on the BSA procedure for pure-tone audiometry exceeded the ULL for at least 1 of the measured frequencies (excluding the first frequency tested, 1 kHz): 0.25, 0.5, 2, 3, 4, 6, and 8 kHz. For 24% of patients, the starting presentation level of 60 dB hearing level recommended for determination of ULLs exceeded the ULL for at least 1 frequency. Conclusion: The starting presentation levels used for pure-tone audiometry and measurement of ULLs should be lower than those recommended by the BSA for people with tinnitus and hyperacusis. DOI: 10.1044/2017_AJA-17-0011 PMID: 28810267 2. Int J Audiol. 2017 Sep;56(9):677-684. doi: 10.1080/14992027.2017.1335887. Epub 2017 Jun 18.

Factors related to tinnitus and hyperacusis handicap in older people.

Aazh H(1), Lammaing K(1), Moore BCJ(2). Author information: (1)a Audiology Department , Royal Surrey County Hospital NHS Foundation Trust , Guildford , UK and. (2)b Department of Experimental Psychology , University of Cambridge , Cambridge , UK. OBJECTIVE: The aim was to assess factors related to tinnitus and hyperacusis handicap in older people. DESIGN: Retrospective cross-sectional. STUDY SAMPLE: Data were gathered for 184 patients with an average age of 69 years. RESULTS: Tinnitus handicap as measured via the Tinnitus Handicap Inventory (THI) was significantly predicted by tinnitus annoyance as measured via the visual analogue scale (VAS) (regression coefficient, b = 2.9, p < 0.001) and the effect of tinnitus on the patient's life as measured via the VAS (b = 3.9, p < 0.001). Hyperacusis handicap as measured via the Hyperacusis Questionnaire (HQ) was significantly predicted by the score on the depression subscale of the Hospital Anxiety and Depression Scale (HADS) (b = 0.8, p < 0.001) and to a small extent by the THI score (b = 0.07, p = 0.048). Insomnia scores as measured via the Insomnia Severity Index (ISI) were significantly predicted by scores on the depression subscale of the HADS (b = 0.46, p = 0.007). CONCLUSIONS: Since tinnitus annoyance significantly predicts tinnitus handicap, it is important to explore factors associated with annoyance that may be useful in designing appropriate rehabilitative interventions aimed at reducing tinnitus handicap in older people. Future studies should explore whether hyperacusis and insomnia in older people with tinnitus need to be managed in conjunction with treatment for depression. DOI: 10.1080/14992027.2017.1335887 PMID: 28625091 3. Int J Audiol. 2017 Oct;56(10):793-800. doi: 10.1080/14992027.2017.1335888. Epub 2017 Jun 16.

Factors related to uncomfortable loudness levels for patients seen in a tinnitus
and hyperacusis clinic.

Aazh H(1), Moore BCJ(2). Author information: (1)a Audiology Department , Royal Surrey County Hospital NHS Foundation Trust , Guildford , UK and. (2)b Department of Experimental Psychology , University of Cambridge , Cambridge , UK. OBJECTIVES: The aims were as follows: (1) to explore patterns of uncomfortable loudness levels (ULLs) across frequency and their associated factors for patients with tinnitus and hyperacusis, and (2) to re-evaluate the criteria for diagnosing hyperacusis based on ULLs and scores for the Hyperacusis Questionnaire (HQ). DESIGN: This was a retrospective cross-sectional study. STUDY SAMPLE: 573 consecutive patients for whom ULLs had been measured were included. RESULTS: A good correspondence between the diagnosis of hyperacusis based on the across-frequency average ULL for the ear with the lowest ULLs (ULLmin) and hyperacusis handicap based on HQ scores was obtained with cut-off values of ULLmin ≤77 dB HL and HQ score ≥ 22. A regression model showed significant relationships between ULLmin and the score on the HQ and age. The mean HQ score for patients with a large interaural asymmetry in ULLs was significantly higher than for the remainder. Hyperacusis handicap was associated with strong across-frequency variations in ULLs. CONCLUSIONS: Appropriate cut-off values for diagnosing hyperacusis are ULLmin ≤77 dB HL and HQ score ≥22. Large interaural asymmetry and large across-frequency variations in ULLs are associated with higher HQ scores. DOI: 10.1080/14992027.2017.1335888 PMID: 28622055 4. Int J Audiol. 2017 Jul;56(7):489-498. doi: 10.1080/14992027.2017.1298850. Epub 2017 Mar 9.

Usefulness of self-report questionnaires for psychological assessment of patients
with tinnitus and hyperacusis and patients' views of the questionnaires.

Aazh H(1), Moore BCJ(2). Author information: (1)a Audiology Department , Royal Surrey County Hospital NHS Foundation Trust , Guildford , UK and. (2)b Department of Experimental Psychology , University of Cambridge , Cambridge , UK. OBJECTIVE: The objective was to determine the relevance and applicability of psychological questionnaires to patients seeking help for tinnitus and/or hyperacusis. DESIGN: This was a questionnaire-based survey. The following questionnaires were administered: Generalised Anxiety Disorder (GAD-7), Short Health Anxiety Inventory (SHAI), Mini-Social Phobia Inventory (Mini-SPIN), Obsessive Compulsive Inventory-Revised (OCI-R), Panic Disorder Severity Scale-Self Report (PDSS-SR), Patient Health Questionnaire (PHQ-9) and Penn State Worry Questionnaire-Abbreviated version (PSWQ-A). In addition, a patient feedback questionnaire was completed asking about the extent to which each questionnaire was relevant to them and how strongly they would recommend its use in the assessment of patients with tinnitus and hyperacusis. STUDY SAMPLE: A total of 150/402 consecutive patients seen in a one-year period completed the questionnaires. RESULTS: 65% of patients had abnormal scores for one or more of the questionnaires. All questionnaires except the PDSS-SR were rated as relevant and recommended for use. CONCLUSIONS: The GAD-7, SHAI, Mini-SPIN, OCI-R, PSWQ-A and PHQ-9 are recommended for evaluation of psychological problems for patients seeking help for tinnitus and/or hyperacusis. Abnormal results on these questionnaires may indicate the need for referral for possible treatment of psychological problems. DOI: 10.1080/14992027.2017.1298850 PMID: 28277857 5. J Am Acad Audiol. 2017 Mar;28(3):248-260. doi: 10.3766/jaaa.16035.

Audiological Rehabilitation for Facilitating Hearing Aid Use: A Review.

Aazh H(1)(2), Moore BC(3). Author information: (1)Audiology Department, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK. (2)London School of Hygiene & Tropical Medicine, University of London, London, UK. (3)Department of Psychology, University of Cambridge, Cambridge, UK. PURPOSE: This article reviews and critically analyzes the design of studies on the effect of audiological rehabilitation (AR) programs on hearing aid (HA) outcomes, in order to guide future research. RESEARCH DESIGN: The design of this study was a narrative review. Studies were included in the review if they were randomized controlled trials that investigated the effects of AR on HA use and outcome between 2000 and 2016. RESULTS: Seven articles that met the inclusion criteria were included in the review. Most used educational rather than counseling approaches. Although educational AR programs seem to be useful in enhancing the use of communication strategies, there is limited evidence for their effect on HA use and self-perceived hearing handicap. CONCLUSIONS: More research is needed in this field. Future studies should (1) investigate the efficacy of AR interventions based on counseling and empathetic listening as opposed to or in addition to educational interventions, (2) use stricter criteria to include only a subpopulation of patients who do not get on well with their HAs, (3) measure the amount of HA use via data-logging and self-report questionnaires, and (4) use a matching comparison intervention for patients in the control group. DOI: 10.3766/jaaa.16035 PMID: 28277215 6. Int J Audiol. 2016 Sep;55(9):514-22. doi: 10.1080/14992027.2016.1178400. Epub 2016 May 19.

Tinnitus and hyperacusis therapy in a UK National Health Service audiology
department: Patients' evaluations of the effectiveness of treatments.

Aazh H(1), Moore BC(2), Lammaing K(1), Cropley M(3). Author information: (1)a Audiology Department , Royal Surrey County Hospital NHS Foundation Trust , Guildford , UK . (2)b Department of Experimental Psychology , University of Cambridge , UK , and. (3)c School of Psychology , University of Surrey , Guildford , UK. OBJECTIVE: To assess patients' judgements of the effectiveness of the tinnitus and hyperacusis therapies offered in a specialist UK National Health Service audiology department. DESIGN: Cross-sectional service evaluation questionnaire survey. Patients were asked to rank the effectiveness of the treatment they received on a scale from 1 to 5 (1 = no effect, 5 = very effective). STUDY SAMPLE: The questionnaire was sent to all patients who received treatment between January and March 2014 (n = 200) and 92 questionnaires were returned. RESULTS: The mean score was greatest for counselling (Mean = 4.7, SD = 0.6), followed by education (Mean = 4.5, SD = 0.8), cognitive behavioural therapy - CBT (Mean = 4.4, SD = 0.7), and hearing tests (Mean = 4.4, SD = 0.9). Only 6% of responders rated counselling as 3 or below. In contrast, bedside sound generators, hearing aids, and wideband noise generators were rated as 3 or below by 25%, 36%, and 47% of participants, respectively. CONCLUSION: The most effective components of the tinnitus and hyperacusis therapy interventions were judged by the patients to be counselling, education, and CBT. DOI: 10.1080/14992027.2016.1178400 PMCID: PMC4950421 PMID: 27195947 7. Int J Audiol. 2016;55(3):149-56. doi: 10.3109/14992027.2015.1074733. Epub 2015 Sep 2.

Feasibility of conducting a randomized controlled trial to evaluate the effect of
motivational interviewing on hearing-aid use.

Aazh H(1). Author information: (1)a Audiology Department , Royal Surrey County Hospital , Guildford , UK. OBJECTIVES: The aim of this study was to evaluate the feasibility of conducting a randomized controlled trial (RCT) on the effect of motivational interviewing (MI) on hearing-aid use. DESIGN: This was a pilot single-blind, randomized parallel-group study conducted in the UK. STUDY SAMPLE: Thirty-seven adult patients who reported using their hearing aid(s) less than four hours per day were randomized to MI combined with Standard Care (MISC) (n = 20), and Standard Care only (SC) (n = 17). RESULTS: Of 220 patients invited, 37 were enrolled giving the recruitment rate of 17%. One participant withdrew giving the retention rate of 97%. It was feasible to combine MI with SC for facilitating hearing-aid use and deliver the intervention with high fidelity in an audiology setting. The measure on hearing-aid use (data logging) one month after interventions favoured the MISC group. CONCLUSIONS: This pilot study suggests that conducting an RCT on using MI for facilitating hearing-aid use in people who do not use their hearing aids is feasible, and that MI combined with SC may have more positive effects on hearing-aid use compared to SC only. DOI: 10.3109/14992027.2015.1074733 PMID: 26328620 [Indexed for MEDLINE] 8. Int J Audiol. 2015 Mar;54(3):152-61. doi: 10.3109/14992027.2014.967367. Epub 2014 Nov 14.

Hearing-aid use and its determinants in the UK National Health Service: a
cross-sectional study at the Royal Surrey County Hospital.

Aazh H(1), Prasher D, Nanchahal K, Moore BC. Author information: (1)* Audiology Department, Royal Surrey County Hospital NHS Foundation Trust , Guildford , UK. OBJECTIVES: The aim of this study was to investigate the rate of and factors contributing to non-adherence to hearing-aid use in the UK National Health Service. DESIGN: A cross-sectional postal questionnaire survey. STUDY SAMPLE: A questionnaire, including the International Outcome Inventory for Hearing Aids, was sent to all patients fitted with hearing aids at the Royal Surrey County Hospital between 2011 and 2012 (N = 1874). A total of 1023 questionnaires were completed and returned (response rate of 55%). RESULTS: A total of 29% of responders did not use their hearing aids on a regular basis (i.e. used them less than four hours per day). Non-regular use was more prevalent in new (40%) than in existing patients (11%). Factors that reduced the risk of non-regular use included bilateral versus unilateral amplification, and moderate or severe hearing loss in the better ear. 16% of responders fitted with bilateral amplification used only one of their hearing aids. CONCLUSIONS: The level of non-regular use of hearing aids in NHS found in this study was comparable to those for other countries. Additional support might be needed for patients at a higher risk of non-regular use. DOI: 10.3109/14992027.2014.967367 PMID: 25395258 [Indexed for MEDLINE] 9. Noise Health. 2014 Mar-Apr;16(69):123-6. doi: 10.4103/1463-1741.132100.

Insights from the First International Conference on Hyperacusis: causes,
evaluation, diagnosis and treatment.

Aazh H(1), McFerran D, Salvi R, Prasher D, Jastreboff M, Jastreboff P. Author information: (1)Department of Audiology, Royal Surrey County Hospital, Guildford; Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, United Kingdom. The First International Conference on Hyperacusis gathered over 100 scientists and health care professionals in London, UK. Key conclusions from the conference included: (1) Hyperacusis is characterized by reduced tolerance of sound that has perceptual, psychological and social dimensions; (2) there is a growing awareness that children as well as adults experience symptoms of hyperacusis or misophonia; (3) the exact mechanisms that give rise to hyperacusis are not clear, but the available evidence suggests that functional changes within the central nervous system are important and in particular, hyperacusis may be related to increased gain in the central auditory pathways and to increased anxiety or emotional response to sound; (4) various counseling and sound therapy approaches seem beneficial in the management of hyperacusis, but the evidence base for these remains poor. DOI: 10.4103/1463-1741.132100 PMID: 24804717 [Indexed for MEDLINE]

Auditory and Vestibular Research 2016. 25(1):14-23. 


A comparison between tinnitus retraining therapy and a simplified version in treatment of tinnitus in adults
Hashir Aazh, Brian C. J. Moore


ABSTRACT


Background and Aim: Tinnitus retraining therapy (TRT) comprises comprehensive edu­cational counseling and sound therapy. The aim of this study was to compare the eff­ectiveness of TRT relative to a simplified version of TRT (sTRT). Simplified TRT is different from TRT in the duration and type of the educational counseling (shorter) but is similar to TRT in the application of sound therapy.
Methods: This was a retrospective service eva­luation survey and the data were collected from 12 consecutive patients who received TRT and 12 patients who received sTRT. The average duration of tinnitus was six years (SD=7.9) with a range between one month and 30 years. All patients received between three and six months of treatment, which typically involved three to four appointments.
Results: The results showed that scores on the Tinnitus Handicap Inventory (THI) and the visual analog scale of tinnitus loudness, annoyance and effect on life declined sig­nificantly (improved) for both TRT and sTRT groups (p<0.05). 75% of the patients receiving TRT and 83% of patients receiving sTRT exhibited a decline of 25 or more in THI score. The mean decline in the THI scores was 34 (SD=14) for the TRT group, and 41 (SD=21) for the sTRT group, and the difference in means was not statistically significant (p=0.34).
Conclusion: The results suggest that the dura­tion and type of counseling does not play a critical role in treatment outcome and sTRT may be used when time constraints do not allow the full treatment.


Auditory and Vestibular Research 2016. 25(2):63-74. 


Cognitive behavioural therapy in management of hyperacusis: a narrative review and clinical implementation
Hashir Aazh, Rory Allott


ABSTRACT


Background and Aim: The aim of this article was to critically discuss the clinical application of a cognitive behaviour therapy (CBT) protocol for the treatment of hyperacusis and its asso­ciated distress.
Methods: Narrative review
Recent Findings: Reviewing the research lit­erature suggests that hyperacusis, anxiety and safety seeking behaviours may be linked. Therefore, it seems reasonable to suggest that clinical management of hyperacusis should also include addressing co-existing anxiety and avoidance behaviour. Although, there is strong evidence supporting the effectiveness of CBT in treating anxiety, the studies directly assessing the effect of CBT on hyperacusis are limited. In this paper, the clinical implementation of a CBT protocol for hyperacusis rehabilitation is discussed.
Conclusion: Although a causal relationship bet­ween anxiety and hyperacusis is not clear, there is a growing body of evidence suggesting a pos­sible link between them. In the absence of a cure for hyperacusis, treatment of the anxiety component of the condition could be beneficial.