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  1. Shabbir M, Akeroyd MA, Hall DA
    Prog Brain Res, 2021;262:209-224.
    PMID: 33931180 DOI: 10.1016/bs.pbr.2021.01.027
    The Core Outcome Measures in Tinnitus (COMiT) initiative has recommended a minimum standard of five outcomes when designing a clinical trial to assess the efficacy of sound-based interventions. These are: ability to ignore, concentration, quality of sleep, sense of control and tinnitus intrusiveness. The next stage is to consider what measurement instruments might be appropriate for assessing these constructs. The current study aimed to systematically gather existing instruments used to assess concentration. A total of 6240 potentially relevant records were identified. Duplicates and non-published works were removed, leaving a total of 3599 records. A procedure was developed to sample a subset of records, in order to identify relevant instruments without exhaustively reading all 3599 texts. Initially 559 records were identified by screening 1000 articles; 500 of which were randomly selected, and 500 were the most recent publications identified from the PubMed database. Using predefined criteria for data saturation, information about measures of concentration was extracted from the 559 full texts. However, data saturation was reached by 240. Thirteen candidate instruments were identified. The next step will be to assess content validity and feasibility of administration for all these candidate instruments. Findings will inform future recommendations for how to measure concentration in clinical trials to ensure results of trials can be easily compared, contrasted, and synthesized.
  2. Biswas R, Lugo A, Genitsaridi E, Trpchevska N, Akeroyd MA, Cederroth CR, et al.
    Prog Brain Res, 2021;263:1-24.
    PMID: 34243884 DOI: 10.1016/bs.pbr.2021.04.005
    INTRODUCTION: Tinnitus is a symptom and not a disease in its own right. A number of medical conditions are known to increase the risk of developing tinnitus. Most known risk factors are otological or neurological, but general health and lifestyle can also precipitate the condition. Understanding these modifiable risk factors can help to identify vulnerable groups and can inform preventive actions to reduce likelihood of developing tinnitus. Smoking, alcohol consumption, body mass index (BMI) and caffeine intake are all lifestyle risk factors hypothesized to be related to tinnitus. Nonetheless, research findings in support of those relationships are somewhat mixed.

    METHODS: A systematic review was conducted to identify all relevant studies on the specific risk factors. Findings were summarized using a narrative synthesis and meta-analysis, where possible.

    RESULTS: Overall 384 studies were included, mostly using cross-sectional designs. Findings indicated significantly increased risk of tinnitus among current (based on 26 studies) and ever smokers (based on 16 studies) and among obese people (based on seven studies), but no effect of alcohol consumption (based on 11 studies). With respect to caffeine intake or coffee drinking, only three studies examined this risk factor and so we were unable to draw conclusions.

    CONCLUSION: Our results contribute to quantifying the relationship between tinnitus and specific lifestyle-related risk factors, and we highlight some of the gaps and inconsistencies across published studies.

  3. Genitsaridi E, Kypraios T, Edvall NK, Trpchevska N, Canlon B, Hoare DJ, et al.
    Prog Brain Res, 2021;263:59-80.
    PMID: 34243891 DOI: 10.1016/bs.pbr.2021.04.006
    The spatial percept of tinnitus is hypothesized as an important variable for tinnitus subtyping. Hearing asymmetry often associates with tinnitus laterality, but not always. One of the methodological limitations for cross-study comparisons is how the variables for hearing asymmetry and tinnitus spatial perception are defined. In this study, data from two independent datasets were combined (n=833 adults, age ranging from 20 to 91 years, 404 males, 429 females) to investigate characteristics of subgroups with different tinnitus spatial perception focusing on hearing asymmetry. Three principle findings emerged. First, a hearing asymmetry variable emphasizing the maximum interaural difference most strongly discriminated unilateral from bilateral tinnitus. Merging lateralized bilateral tinnitus (perceived in both ears but worse in one side) with unilateral tinnitus weakened this relationship. Second, there was an association between unilateral tinnitus and ipsilateral asymmetric hearing. Third, unilateral and bilateral tinnitus were phenotypically distinct, with unilateral tinnitus being characterized by older age, asymmetric hearing, more often wearing one hearing aid, older age at tinnitus onset, shorter tinnitus duration, and higher percentage of time being annoyed by tinnitus. We recommend that careful consideration is given to the definitions of hearing asymmetry and tinnitus spatial perception in order to improve the comparability of findings across studies.
  4. De Ridder D, Schlee W, Vanneste S, Londero A, Weisz N, Kleinjung T, et al.
    Prog Brain Res, 2021;260:1-25.
    PMID: 33637213 DOI: 10.1016/bs.pbr.2020.12.002
    As for hypertension, chronic pain, epilepsy and other disorders with particular symptoms, a commonly accepted and unambiguous definition provides a common ground for researchers and clinicians to study and treat the problem. The WHO's ICD11 definition only mentions tinnitus as a nonspecific symptom of a hearing disorder, but not as a clinical entity in its own right, and the American Psychiatric Association's DSM-V doesn't mention tinnitus at all. Here we propose that the tinnitus without and with associated suffering should be differentiated by distinct terms: "Tinnitus" for the former and "Tinnitus Disorder" for the latter. The proposed definition then becomes "Tinnitus is the conscious awareness of a tonal or composite noise for which there is no identifiable corresponding external acoustic source, which becomes Tinnitus Disorder "when associated with emotional distress, cognitive dysfunction, and/or autonomic arousal, leading to behavioural changes and functional disability.". In other words "Tinnitus" describes the auditory or sensory component, whereas "Tinnitus Disorder" reflects the auditory component and the associated suffering. Whereas acute tinnitus may be a symptom secondary to a trauma or disease, chronic tinnitus may be considered a primary disorder in its own right. If adopted, this will advance the recognition of tinnitus disorder as a primary health condition in its own right. The capacity to measure the incidence, prevalence, and impact will help in identification of human, financial, and educational needs required to address acute tinnitus as a symptom but chronic tinnitus as a disorder.
  5. Hall DA, Hibbert A, Vesala M, Kerr M, Harrison S, Core Outcome Measures in Tinnitus (COMiT)
    Prog Brain Res, 2021;260:205-221.
    PMID: 33637218 DOI: 10.1016/bs.pbr.2020.12.001
    An increasing number of health researchers are recognizing the benefits of crowdsourcing. Web-based discussion forums are well suited for collecting qualitative research data with tinnitus participants and forum posts can be evaluated using thematic analysis. The present study reports an innovative use of such qualitative data contributed by a group of 148 people with tinnitus and tinnitus professionals through the crowdsourcing platform Tinnitus Talk. While the primary research question was focused on defining symptom concepts, discussions were broad-ranging and extended far beyond this topic. Thematic analysis of the discussion conducted by two analysts identified three novel emerging themes and these were not pre-planned according to the moderator's script. These were (i) the lived experience of tinnitus, (ii) perspectives on interventions for tinnitus, and (iii) the experience of participating in a web discussion forum. These unexpected themes contribute to a richer and more in-depth understanding of tinnitus seen through the eyes of those who experience it on a daily basis. Findings are important since spontaneous themes presumably reflect issues that are of personal relevance and importance to the participants. They therefore give insights into future research directions and have implications for patient-centered counseling strategies that could be effective in clinic.
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