Why do people with tinnitus use apps?

Addressing priority 1: Independent research complete, supported by NIHR

Currently available tinnitus apps suggest a range of ways in which they might be effective for managing and treating tinnitus, including masking, neuromodulation, relaxation etc. Many allow customisation and personalisation of sounds used. Despite increasing popularity of apps it is unclear what proportion of people use apps for tinnitus management and which apps are the most popular. Also deeper and independent assessment of tinnitus apps that would assess quality of apps (including accuracy of content and usability) and mechanisms of action is lacking. In this ‘horizon scanning’ study, Magdalena Sereda at the NIHR Nottingham Hearing Biomedical Research Unit will identify apps that people use for tinnitus management, evaluate their content, and assess their potential strengths and limitations through an online survey.

Manualisation and feasibility study of audiologist-delivered counselling for tinnitus

Addressing priority 2: NIHR research complete.

In the UK, emphasis is placed on audiologists meeting tinnitus patient needs but few receive the necessary training to provide patient counselling and few audiology departments have counselling-trained audiologists. In this feasibility study, NIHR Nottingham Hearing Biomedical Research Unit staff led by Derek Hoare will develop a manual for audiologists which defines standard care and counselling. Feasibility study objectives include evaluating acceptability of the counselling intervention, compliance, and whether there is sufficient interest and need for a randomised controlled trial.

Cognitive Behaviour Therapy for tinnitus-related insomnia

Addressing priority 3: Independent research complete, supported by NIHRon (now Tinnitus UK).

Sleep disturbance is one of the most common complaints from people with tinnitus affecting between 50-70% of people attending tinnitus clinics. Cognitive Behavioural Therapy (CBT) is a psychological talking therapy which has been shown to help manage insomnia. CBTi is now part of the NICE guidelines for the management of long term insomnia (NICE 2014). This study, led by Dr Laurence McKenna and Dr Liz Marks, University College London, will investigate the effectiveness of CBTi as a treatment of tinnitus-related insomnia. Sleep Hygiene (an approach commonly used in the tinnitus clinics) will be used as a control.

Evaluating the Tinnitus E-Programme, an internet-based self-help programme for tinnitus

Addressing priority 4: NIHR research was funded through the NIHR Nottingham Hearing Biomedical Research Unit PhD studentship.

Until a cure for tinnitus is found, people need support to manage their tinnitus and reduce its impact on their everyday lives. Self-help programmes provide one way of achieving this. A systematic review was published in May 2016 which identified the self-help techniques used in self-help interventions for adults with chronic tinnitus and assessed their effectiveness. From 5 previous studies 15 behaviour change techniques and eight self-management components were identified but confident conclusions could not be drawn regarding efficacy. The PhD project has also evaluated the Tinnitus E-Programme (www.tinnituseprogramme.org), an internet-based self-help programme for people with tinnitus.

Amplification with hearing aids for patients with tinnitus and co-existing hearing loss

Addressing priority 5: A Cochrane Review was published in January 2014. The team reviewed one previous trial to pull together the evidence that already exists about hearing aid interventions for tinnitus and co-existing hearing loss, and to highlight where further research is needed.

The British Tinnitus Association is funding a Head of Research fellowship that addresses priorities 1, 4, 5 and 9. Research is in progress. Dr Magdalena Sereda hopes her funded research will shed new light on the clinical efficacy and cost-effectiveness of NHS contracted sound therapy options for tinnitus including hearing aids and combination hearing aids.

Combined amplification and sound generation devices for tinnitus: towards creating clinical guidance and recommended procedure

Addressing priority 5: Research in progress. Supported by the British Society of Audiology Tinnitus and Hyperacusis Special Interest Group Part-funded by a BSA Applied Research Grant.

Combination hearing aids are devices which amplify sounds in the same way as hearing aids, but also can create sounds such as white noise. They are used to manage tinnitus and are a fairly new addition to use in the UK. Many audiology clinics can offer combination aids. However, there is no standard guide to help audiologists decide on who to offer the devices to or how to fit them to best meet the needs of each patient with hearing loss and tinnitus. Ongoing research led by Dr Magdalena Sereda is conducting a series of surveys to 1) identify where there is and is not clinical consensus on who should be recommended combination hearing aids (candidacy) and how those devices should be fitted; 2) explore expectations and experiences of people with tinnitus who have used combination hearing aids.

Tinnitus in children practice guidance

Addressing priority 6: In March 2015, the Paediatric Audiology Interest Group (PAIG) of the British Society of Audiology published practice guidance – a project that was undertaken by a working party of national specialists in paediatric tinnitus. The guidance offers child-friendly, practical advice for those wanting to develop their skills in the management of children with tinnitus. It is intended for a multidisciplinary audience including audiologists, medical professionals, school nurses, teachers of the deaf, and psychologists. This project was supported by the British Tinnitus Association.

People's experiences with different degrees of hearing loss and tinnitus

Addressing priority 7: People who are deaf or have profound hearing loss are often marginalised by both their tinnitus and hearing loss. The British Tinnitus Association commissioned The Ear Foundation to investigate people's experiences with different degrees of hearing loss and tinnitus (supported by the James Tudor Foundation). The report was launched in September 2015 and presents the views of 1432 participants on the treatment they have received, what helped, what didn't and their hopes for the future.

The QUest In Eliminating Tinnitus (QUIET-1): testing a novel drug for tinnitus

Addressing priority 10: In 2015, Autifony Therapeutics Ltd sponsored a Phase IIa tinnitus clinical trial in the UK, funded by Innovate UK. Professor Jaydip Ray, Consultant Ear, Nose and Throat (ENT) surgeon at Sheffield Teaching Hospitals NHS Foundation Trust and Sheffield Children’s Hospital NHS Foundation Trust was the national Coordinating Investigator and Professor Deborah Hall, University of Nottingham and NIHR Nottingham Hearing Biomedical Research Unit (BRU), was the academic partner. The main aim was to try to demonstrate an improvement in the severity of tinnitus symptoms and impact after 28 days of treatment with the study medicine compared to placebo. Findings from the planned interim analysis of completed participants led to the closure of recruitment due to lack of efficacy. On a statistical basis, it would not be possible to reach the magnitude of change needed to show improvement over the placebo. Nevertheless, the team gained many valuable insights about trial design and patient recruitment.