Pilot Study to Evaluate Ecological Momentary Assessment of Tinnitus

Abstract

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.

Ecological Momentary Assessment of Tinnitus Using Smartphone Technology

“…Tinnitus participants in this and previous EMA studies 11, 12 demonstrate high response rates. This suggests that EMA is a feasible tool for the collection of real-time symptoms.…”

Tinnitus and Hearing Survey: A Screening Tool to Differentiate Bothersome Tinnitus From Hearing Difficulties

“…Participants in two separate studies at the Veterans Affairs Portland Health Care System each completed the THS on two occasions, enabling an assessment of its test-retest reliability. Study 1 required that participants were at least "moderately bothered" by their tinnitus (Henry, Galvez, et al, 2012). Study 2 did not require "bothersome" tinnitus but only that the tinnitus perception was chronic and "measurable" using equipment we developed to perform a tinnitus psychoacoustic assessment (Henry et al, 2013).…”

Measuring the Moment-to-Moment Variability of Tinnitus: The TrackYourTinnitus Smart Phone App

“…However recent data demonstrates that tinnitus loudness and annoyance fluctuate significantly from moment to moment (Henry et al, 2012; Wilson et al, 2015). Henry et al (2012) conducted a pilot study in which tinnitus symptoms were measured in 24 participants over 2-weeks at four random time points per day using a personal digital assistant (PDA) device. They presented results, which suggest a large between-days variability of tinnitus distress for some study participants.…”