Tinnitus in Patients with Sensorineural Hearing Loss – Management, Quality of Life and Treatment Strategies

.............................................................................................................................. 7 LIST OF ORIGINAL PAPERS ................................................................................................. 9 ABBREVIATIONS .................................................................................................................. 10 INTRODUCTION .................................................................................................................... 11 BACKGROUND ...................................................................................................................... 13 Tinnitus ............................................................................................................................... 13 A historical description ................................................................................................ 13 Epidemiology ............................................................................................................... 13 Theories ............................................................................................................................... 15 Non-cochlear models ................................................................................................... 15 Cochlear models .......................................................................................................... 15 Phantom perception ..................................................................................................... 16 Measurement of tinnitus ..................................................................................................... 16 Treatment models ................................................................................................................ 17 Tinnitus Retraining Therapy (TRT) ............................................................................. 18 Cognitive Behavioral Therapy (CBT) .......................................................................... 19 Stepped Care model ..................................................................................................... 19 Hearing Aids Fitting .................................................................................................... 20 Hearing impairment ............................................................................................................ 21 Working memory ................................................................................................................ 22 Component model ........................................................................................................ 23 Working memory and tinnitus ...................................................................................... 24 Audiological rehabilitation ................................................................................................. 24 Conventional audiological rehabilitation .................................................................... 25 Patient-centered rehabilitation .................................................................................... 25 Motivational Interviewing (MI) .......................................................................................... 26 Theories ........................................................................................................................ 27 The spirit of MI ............................................................................................................ 27 The principles of MI ..................................................................................................... 28 AIMS ........................................................................................................................................ 31 MATERIALS AND METHODS ............................................................................................. 33 Measures ............................................................................................................................. 34 Audiometry ................................................................................................................... 34 Self-assessment Instruments ......................................................................................... 35 EuroQoL (EQ-5D) ....................................................................................................... 35 Tinnitus Handicap Inventory (THI) ............................................................................. 35 Hospital Anxiety and Depression Scale (HADS) ......................................................... 36 Questionnaire about life quality .................................................................................. 36 Pittsburgh Sleep Quality Index (PSQI) ........................................................................ 37 Hearing Handicap Inventory for the Elderly (HHIE) .................................................. 37 The International Outcome Inventory for Hearing Aids (IOI-HA) .............................. 37 Reading span ................................................................................................................ 38 Hearing in Noise Test (HINT) ...................................................................................... 38 STATISTICAL METHODS .................................................................................................... 39 ETHICAL CONSIDERATIONS ............................................................................................. 39 RESULTS ................................................................................................................................. 41 Study I ................................................................................................................................. 41 Examinations ................................................................................................................ 41 Treatments .................................................................................................................... 41 Study II ................................................................................................................................ 41 THI ............................................................................................................................... 41 EQ-5D .......................................................................................................................... 41 Questions about patients’ general health .................................................................... 42 Open questions ............................................................................................................. 42 Study III .............................................................................................................................. 43 Analysis of the clinical material (n=92) ...................................................................... 43 Analysis of the age-matched subgroups (n=60) .......................................................... 43 Study IV .............................................................................................................................. 44 Differences between the MI and SP groups at baseline and follow-up ....................... 44 Study V ............................................................................................................................... 44 DISCUSSION .......................................................................................................................... 45 Methods discussion ............................................................................................................. 46 Results discussion ............................................................................................................... 47 Examinations at the ENT clinics .................................................................................. 47 The offered treatments ................................................................................................. 47 Measurement outcomes ................................................................................................ 49 Future directions ................................................................................................................. 52 CONCLUSIONS ...................................................................................................................... 54 ACKNOWLEDGEMENTS ..................................................................................................... 55 SVENSK SAMMANFATTNING ........................................................................................... 57 REFERENCES ......................................................................................................................... 60