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Purpose: Individuals complaining of tinnitus often attribute hearing problems to the tinnitus. In such cases some (or all) of their reported "tinnitus distress" may in fact be caused by trouble communicating due to hearing problems. We developed the Tinnitus and Hearing Survey (THS) as a tool to rapidly differentiate hearing problems from tinnitus problems. Method: For 2 of our research studies, we administered the THS twice (mean of 16.5 days between tests) to 67 participants who did not receive intervention. These data allow for measures of statistical validation of the THS. Results: Reliability of the THS was good to excellent regarding internal consistency (a = .86-.94), test-retest reliability (r = .76-.83), and convergent validity between the Tinnitus Handicap Inventory (Newman, Jacobson, & Spitzer, 1996;Newman, Sandridge, & Jacobson, 1998) and the A (Tinnitus) subscale of the THS (r = .78). Factor analysis confirmed that the 2 subscales, A (Tinnitus) and B (Hearing), have strong internal structure, explaining 71.7% of the total variance, and low correlation with each other (r = .46), resulting in a small amount of shared variance (21%). Conclusion: These results provide evidence that the THS is statistically validated and reliable for use in assisting patients and clinicians in quickly (and collaboratively) determining whether intervention for tinnitus is appropriate.T innitus has been defined as head or ear noise lasting at least 5 min and occurring more than once a week (Dauman & Tyler, 1992). For most people who have tinnitus, the sound is constant or near-constant. Epidemiologic studies reveal that tinnitus is experienced by 10%-15% of the adult populations in different countries (Heller, 2003;Hoffman & Reed, 2004;Shargorodsky, Curhan, & Farwell, 2010). It is often reported that for about 80% of those who experience tinnitus, the tinnitus is not particularly bothersome, and clinical intervention for the tinnitus is not required (Cima, Vlaeyen, Maes, Joore, & Anteunis, 2011; Davis & Refaie, 2000;Jastreboff & Hazell, 1998;Krog, Engdahl, & Tambs, 2010). When intervention for tinnitus is desired by, and appropriate for, a given patient, the amount of intervention provided should depend on the individual's specific needs Tyler & Baker, 1983).Dobie's (2004) multilevel pyramid analogy is helpful in conceptualizing how tinnitus affects people differently (see Figure 1). The base of the pyramid contains those who have tinnitus but are not bothered by it. The next higher level contains people whose tinnitus is "bothersome," ranging from "mild" to "moderate" to "severe." The tip of the pyramid contains those relatively few individuals who are "debilitated" by their tinnitus. This pyramid analogy highlights the fact that most people who experience tinnitus do not need clinical intervention specific to the tinnitus. Those who do differ widely with respect to their clinical needs, ranging from answering a few questions (e.g., they want assurance that their tinnitus does not reflect some serious disease) to providin...

Objectives Because audiometric evaluation, symptom histories, questionnaires, and similar standard assessment tools may not adequately sample the effects of chronic tinnitus on day-to-day activities, there is a need for alternative methodological approaches to study the impact of tinnitus on day-to-day life. An innovative methodological approach that has shown great promise in the study of chronic health problems characterized by reported temporal and/or situational variability in symptoms and distress is known as ecological momentary assessment (EMA). EMA involves the real time measurement of states, situational factors, and symptoms by individuals as they go about their day-to-day activities. The objective of this pilot investigation was to explore the feasibility of using EMA methods to examine within- and between-day effects of tinnitus. Design This study was conducted in three phases: (1) design and development of an EMA methodology that could be used to assess effects of tinnitus; (2) refinement of the methodology through the use of two focus groups; and (3) field-test the methodology with individuals who experienced bothersome tinnitus. For Phase 3, each of the 24 participants wore, throughout their waking hours for two weeks, a personal digital assistant that produced alerts four times a day. The alerts prompted participants to respond to 19 questions, including nine relating to situational and mood factors, and 10 comprising the Tinnitus Handicap Inventory - Screening version (THI-S). To evaluate for potential reactive effects of performing the EMA protocol, each participant completed the paper-and-pencil version of the full 25-item THI before and after the 2-week EMA period. Results Participants responded to the alerts with a 90% compliance rate, providing a total of 1210 completed surveys. At the time of their response, participants indicated they were in their house or apartment (67.7%), alone (50.2%), happy (50%), and calm (54.5%). Across most responses, participants could hear their tinnitus (97%), and the loudness of their tinnitus averaged 4.7 on a 7-point increasing-loudness scale. The mean THI-S index score (out of a possible maximum 40 points for greatest tinnitus severity) was 17.0 (moderate self-perceived tinnitus handicap). Repeated THI-S index scores varied considerably both within and between participants. Mean 25-item THI scores were not significantly different before and after the EMA period, suggesting little reactivity of the EMA. Conclusions The high compliance rate, positive feedback from participants, lack of reactivity as a result of performing the EMA protocol, and data collected indicate that EMA methodology is feasible with patients who have tinnitus. Outcome data obtained with this methodology cannot be obtained any other way because retrospective questionnaires cannot capture the day-to-day reactions. This methodology has the potential to provide more in-depth and accurate assessments of patients receiving therapy for tinnitus.

Objectives Measurement of outcomes has become increasingly important to assess the benefit of audiologic rehabilitation, including hearing aids, in adults. Data from questionnaires, however, are based on retrospective recall of events and experiences, and often can be inaccurate. Questionnaires also do not capture the daily variation that typically occurs in relevant events and experiences. Clinical researchers in a variety of fields have turned to a methodology known as ecological momentary assessment (EMA) to assess quotidian experiences associated with health problems. The objective of this study was to determine the feasibility of using EMA to obtain real-time responses from hearing aid users describing their experiences with challenging hearing situations. Design This study required three phases: (1) develop EMA methodology to assess hearing difficulties experienced by hearing aid users; (2) utilize focus groups to refine the methodology; and (3) test the methodology with 24 hearing aid users. Phase 3 participants carried a personal digital assistant (PDA) 12 hr per day for 2 wk. The PDA alerted participants to respond to questions four times a day. Each assessment started with a question to determine if a hearing problem was experienced since the last alert. If “yes,” then up to 23 questions (depending on contingent response branching) obtained details about the situation. If “no,” then up to 11 questions obtained information that would help to explain why hearing was not a problem. Each participant completed the Hearing Handicap Inventory for the Elderly (HHIE) both before and after the 2-wk EMA testing period to evaluate for “reactivity” (exacerbation of self-perceived hearing problems that could result from the repeated assessments). Results Participants responded to the alerts with a 77% compliance rate, providing a total of 991 completed momentary assessments (mean = 43.1 per participant). A substantial amount of data was obtained with the methodology. Notably, participants reported a “hearing problem situation since the last alert” 37.6% of the time (372 responses). The most common problem situation involved “face-to-face conversation” (53.8% of the time). The next most common problem situation was “telephone conversation” (17.2%) followed by “TV, radio, iPod, etc.” (15.3%), “environmental sounds” (9.7%), and “movies, lecture, etc.” (4.0%). Comparison of pre- and post-EMA mean HHIE scores revealed no significant difference (p>.05), indicating that reactivity did not occur for this group. It should be noted, however, that 37.5% of participants reported a greater sense of awareness regarding their hearing loss and use of hearing aids. Conclusions Results showed participants were compliant, gave positive feedback, and did not demonstrate reactivity based on pre- and post-HHIE scores. We conclude that EMA methodology is feasible with patients who use hearing aids and could potentially inform hearing healthcare (HHC) services. The next step is to develop and evaluate EMA protocols that provide deta...

Background. Many people with MS fall, but the best method for identifying those at increased fall risk is not known. Objective. To compare how accurately fall history, questionnaires, and physical tests predict future falls and injurious falls in people with MS. Methods. 52 people with MS were asked if they had fallen in the past 2 months and the past year. Subjects were also assessed with the Activities-specific Balance Confidence, Falls Efficacy Scale-International, and Multiple Sclerosis Walking Scale-12 questionnaires, the Expanded Disability Status Scale, Timed 25-Foot Walk, and computerized dynamic posturography and recorded their falls daily for the following 6 months with calendars. The ability of baseline assessments to predict future falls was compared using receiver operator curves and logistic regression. Results. All tests individually provided similar fall prediction (area under the curve (AUC) 0.60–0.75). A fall in the past year was the best predictor of falls (AUC 0.75, sensitivity 0.89, specificity 0.56) or injurious falls (AUC 0.69, sensitivity 0.96, specificity 0.41) in the following 6 months. Conclusion. Simply asking people with MS if they have fallen in the past year predicts future falls and injurious falls as well as more complex, expensive, or time-consuming approaches.