Prognostic Indicators for Positive Treatment Outcome After Multidisciplinary Orofacial Treatment in Patients With Somatosensory Tinnitus

Wal, Annemarie van der; Heyning, Paul Van de; Gilles, Annick; Jacquemin, Laure; Topsakal, Vedat; Rompaey, Vincent Van; Braem, M; Visscher, Corine M.; Truijen, Steven; Michiels, Sarah; Hertogh, Willem De

doi:10.3389/fnins.2020.561038

Cited by 9 publications

(11 citation statements)

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“…The predictive factors identified in this paper do not seem to play an important role in predicting spontaneous improvement of tinnitus, although the published research on this topic mainly focuses on acute rather than chronic tinnitus ( Muhlmeier et al 2016 ; Simoes et al 2021 ). Moreover, high-baseline tinnitus severity has not been found to predict response to other treatments such as orofacial treatment ( van der Wal et al 2020 ), and thus may be a specific predictor for neuromodulation treatment response. To gain more insight into the role of baseline tinnitus severity, but also handedness and depressive symptoms, as predictive factors for treatment response, we strongly recommend the inclusion of a sham control group in future tDCS trials for tinnitus treatment.…”

Section: Discussionmentioning

confidence: 99%

Random Forest Classification to Predict Response to High-Definition Transcranial Direct Current Stimulation for Tinnitus Relief: A Preliminary Feasibility Study

et al. 2022

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Objectives: Transcranial direct current stimulation (tDCS) of the right dorsolateral prefrontal cortex has been hypothesized to reduce tinnitus severity by modifying cortical activity in brain regions associated with the perception of tinnitus. However, individual response to tDCS has proven to be variable. We investigated the feasibility of using random forest classification to predict the response to high-definition (HD) tDCS for tinnitus relief.Design: A retrospective analysis was performed on a dataset consisting of 99 patients with subjective tinnitus receiving six consecutive sessions of HD-tDCS at the Antwerp University Hospital. A baseline assessment consisted of pure-tone audiometry and a set of questionnaires including the Tinnitus Functional Index (TFI), Hospital Anxiety and Depression Scale, and Edinburgh Handedness Inventory. Random forest classification was applied to predict, based on baseline questionnaire scores and hearing levels, whether each individual responded positively to the treatment (defined as a decrease of at least 13 points on the TFI). Further testing of the model was performed on an independent cohort of 32 patients obtained from the tinnitus center at the University of Regensburg.Results: Twenty-four participants responded positively to the HD-tDCS treatment. The random forest classifier predicted treatment response with an accuracy of 85.71% (100% sensitivity, 81.48% specificity), significantly outperforming a more traditional logistic regression approach. Performance of the classifier on an independent cohort was slightly but not significantly above chance level (71.88% accuracy, 66.67% sensitivity, 73.08% specificity). Feature importance analyses revealed that baseline tinnitus severity, co-occurrence of depressive symptoms and handedness were the most important predictors of treatment response. Baseline TFI scores were significantly higher in responders than in nonresponders. Conclusions:The proposed random forest classifier predicted treatment response with a high accuracy, significantly outperforming a more traditional statistical approach. Machine learning methods to predict treatment response might ultimately be used in a clinical setting to guide targeted treatment recommendations for individual tinnitus patients.

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Section: Discussionmentioning

confidence: 99%

Random Forest Classification to Predict Response to High-Definition Transcranial Direct Current Stimulation for Tinnitus Relief: A Preliminary Feasibility Study

et al. 2022

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“…The primary outcome is the change in Tinnitus Functional Index (TFI) score from baseline to 1 month after the treatment. This time point was chosen since previous research indicated that the largest treatment effect on TFI is to be expected 1 month after the last treatment session [ 37 – 40 ]. For the cost-effectiveness analysis, an additional time point, immediately after the last treatment session, is added to be able to link the amount of decrease on TFI to the EuroQoL (EQ)-5D-5L that assesses HRQOL.…”

Section: Methodsmentioning

confidence: 99%

“…The standard care treatment comprises 12 face-to-face individual physiotherapy sessions at a ratio of 1 session of 30 min a week [ 14 , 37 ]. Every patient in the control group will be treated in a tailored manner according to their results on the baseline measurements and will thus receive a personalised 12-week treatment program.…”

Section: Methodsmentioning

confidence: 99%

“…Assuming a standard deviation of 20 points (SD found in international literature [ 67 ] as well as in previous performed own studies [ 14 , 18 ]) and a significance level ( α ) of 0.025, an achieved sample size of 150 patients per group is required to have 80% power to show non-inferiority using a one-sided, independent samples t -test. Considering a possible 10% drop-out, based on previous studies in ST [ 14 , 37 ], 167 patients will be recruited into each group. Hence, a total of 334 patients will be recruited for the study.…”

Section: Methodsmentioning

confidence: 99%

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Cost-effectiveness of a smartphone Application for Tinnitus Treatment (the CATT trial): a study protocol of a randomised controlled trial

Demoen

Jacquemin

Timmermans

et al. 2022

Trials

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Background Tinnitus is a highly prevalent symptom, affecting 10–15% of the adult population. Tinnitus influenced by alterations in somatosensory afference from the neck or jaw is referred to as somatic tinnitus (ST). ST is known to respond positively to physiotherapy treatment; however, it is challenging to motivate patients to systematically perform home exercises correctly, and the necessary tinnitus counselling is often lacking. The aim of this study is twofold, namely to investigate both the effectiveness and cost-effectiveness of a blended physiotherapy program for ST, including a smartphone application designed to increase exercise therapy compliance and provide tinnitus counselling. Methods This study is designed as a single-blind two-arm 1:1 randomised controlled trial (RCT). Adult patients diagnosed with ST, without psychiatric comorbidities and with experience in using a smartphone, will be recruited at the Ear Nose Throat (ENT) department of the Antwerp University Hospital (UZA). Patients will be randomised into two groups. The experimental group will receive the blended physiotherapy program comprising six in-clinic physiotherapy sessions over a period of 12 weeks (1x/2 weeks) and an exercise and counselling program provided by the smartphone application. The control group will receive the standard care program comprising twelve weekly in-clinic physiotherapy sessions. Each physiotherapy session has a duration of 30 min. The primary outcome measure is the change in Tinnitus Functional Index (TFI) score. Additionally, a cost-effectiveness analysis will be performed from a societal perspective considering both direct and indirect costs. There will be follow-up assessments at one and 3 months after the final treatment session. Discussion Our study is the first to combine both tinnitus counselling and neck/jaw treatment provided by a digital application in a blended physiotherapy program. This, in order to empower ST patients to improve and better manage their own health and, possibly, reduce economic costs by alleviating the tinnitus burden that ST patients experience. The strengths of the planned RCT are the high-quality methodological design, the large sample size and the expertise of the involved multidisciplinary research team. Trial registration Clinicaltrials.gov NCT05245318. Registered on 26 January 2022.

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“… 9–12 Meanwhile, subjects with concomitant cervical or temporomandibular dysfunctions can achieve beneficial results with physical therapy such as orofacial treatment. 13 Thus, the large heterogeneity in tinnitus presentation requires a personalized, patient-tailored treatment plan. 14 Overall, existing management strategies more often target accompanying symptoms other than the underlying pathophysiology of the tinnitus percept itself.…”

Section: Introductionmentioning

confidence: 99%

Dual-site transcranial direct current stimulation to treat tinnitus: a randomized controlled trial

Cardon

Jacquemin

Vermeersch

et al. 2022

Brain

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Transcranial direct current stimulation (tDCS) has been proposed as a potential intervention for subjective tinnitus, but supporting evidence remains limited. We aimed to investigate the effect of anodal high-definition tDCS of the left temporal area and right dorsolateral prefrontal cortex on tinnitus severity. This double-blind randomized controlled trial included 77 patients (age range 18–79, 43 male) with chronic subjective tinnitus as their primary complaint. Thirty-eight subjects received six consecutive sessions of dual-site sequential high-definition-tDCS with electrodes positioned over the left temporal area and right dorsolateral prefrontal cortex. Both areas were stimulated for 15 min per session, with total stimulation time amounting to 30 min. Thirty-nine subjects received sham stimulation. The primary outcome measure was the change in tinnitus severity, as evaluated by the Tinnitus Functional Index, from baseline to a follow-up visit at 8 ± 2 weeks after treatment completion. Secondary outcomes included changes in perceived tinnitus loudness, as measured with a visual analogue scale and a tinnitus matching procedure, as well as scores on the Hospital Anxiety and Depression Scale, and the Hyperacusis Questionnaire. No differences in Tinnitus Functional Index change scores were identified between the active treatment and sham control groups (linear regression: P = 0.86). The Tinnitus Functional Index scores decreased significantly over time in both groups (P = 0.0012), indicating the presence of a considerable placebo effect. These change scores were significantly influenced by sex (linear regression: P = 0.037) and baseline symptoms of anxiety (linear regression: P = 0.049) in both groups. In general, Tinnitus Functional Index scores decreased more profoundly in males and in subjects with a higher degree of anxiety at baseline. None of the included secondary measures differed significantly between experimental arms. Our results suggest that dual-site sequential high-definition-tDCS of the left temporal area and right dorsolateral prefrontal cortex does not alleviate tinnitus severity. Interestingly, in our study population, fluctuations in tinnitus severity were influenced by gender and concurrent mental condition. It is therefore important to take these factors into account when conducting or planning randomized controlled trials in tinnitus populations.

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Prognostic Indicators for Positive Treatment Outcome After Multidisciplinary Orofacial Treatment in Patients With Somatosensory Tinnitus

Cited by 9 publications

References 61 publications

Random Forest Classification to Predict Response to High-Definition Transcranial Direct Current Stimulation for Tinnitus Relief: A Preliminary Feasibility Study

Random Forest Classification to Predict Response to High-Definition Transcranial Direct Current Stimulation for Tinnitus Relief: A Preliminary Feasibility Study

Cost-effectiveness of a smartphone Application for Tinnitus Treatment (the CATT trial): a study protocol of a randomised controlled trial

Dual-site transcranial direct current stimulation to treat tinnitus: a randomized controlled trial

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