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Motivational Interviewing as an Adjunct to Hearing Rehabilitation for Patients with Tinnitus: A Randomized Controlled Pilot Trial.
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
Region Östergötland, Center for Health and Developmental Care, Center for Public Health.
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Department of Clinical Neuroscience, Karolinska Institute, Sweden.. (Internet, health and clinical psychology research group)ORCID iD: 0000-0003-4753-6745
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
2016 (English)In: Journal of the American Academy of Audiology, ISSN 2157-3107, Vol. 27, no 8, 669--676 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To test the effects of a brief motivational interviewing (MI) program as an adjunct to hearing aid rehabilitation for patients with tinnitus and sensorineural hearing loss.

RESEARCH DESIGN: This was a pilot randomized controlled trial.

STUDY SAMPLE: The sample consisted of 50 patients aged between 40 and 82 yr with both tinnitus and sensorineural hearing loss and a pure-tone average (0.5, 1, 2, and 4 kHz) < 70 dB HL. All patients were first-time hearing aid users.

INTERVENTION: A brief MI program was used during hearing aid fitting in 25 patients, whereas the remainder received standard practice (SP), with conventional hearing rehabilitation.

DATA COLLECTION AND ANALYSIS: A total of 46 patients (N = 23 + 23) with tinnitus were included for further analysis. The Tinnitus Handicap Inventory (THI) and the International Outcome Inventory for Hearing Aids (IOI-HA) were administered before and after rehabilitation. THI was used to investigate changes in tinnitus annoyance, and the IOI-HA was used to determine the effect of hearing aid treatment.

RESULTS: Self-reported tinnitus disability (THI) decreased significantly in the MI group (p < 0.001) and in the SP group (p < 0.006). However, there was greater improvement in the MI group (p < 0.013). Furthermore, the findings showed a significant improvement in patients' satisfaction concerning the hearing aids (IOI-HA, within both groups; MI group, p < 0.038; and SP group, p < 0.026), with no difference between the groups (p < 0.99).

CONCLUSION: Tinnitus handicap scores decrease to a greater extent following brief MI than following SP. Future research on the value of incorporating MI into audiological rehabilitation using randomized controlled designs is required.

Place, publisher, year, edition, pages
Reston: American Academy of Audiology , 2016. Vol. 27, no 8, 669--676 p.
National Category
Other Medical Sciences
Identifiers
URN: urn:nbn:se:liu:diva-131111DOI: 10.3766/jaaa.15126ISI: 000381957200006PubMedID: 27564444OAI: oai:DiVA.org:liu-131111DiVA: diva2:967754
Available from: 2016-09-09 Created: 2016-09-09 Last updated: 2017-05-03Bibliographically approved
In thesis
1. Tinnitus in Patients with Sensorineural Hearing Loss: Management, Quality of Life and Treatment Strategies
Open this publication in new window or tab >>Tinnitus in Patients with Sensorineural Hearing Loss: Management, Quality of Life and Treatment Strategies
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Approximately 15% of Swedish people experience tinnitus, but only 2.4% experience severe problems. Treatment modalities for tinnitus vary, but the most common treatment is counseling. The majority of patients with tinnitus report some degree of hearing loss, and hearing aids have been used for many years in patients who suffer from both tinnitus and hearing impairment. The aim of the present thesis was to investigate disease management, determine quality of life and identify treatment strategies for patients with tinnitus and sensorineural hearing loss.

The first two studies described here are retrospective, descriptive studies of patients who sought care for tinnitus and hearing loss at two Ear-Nose-Throat (ENT) clinics in Östergötland County, Sweden, during the years 2004 - 2007. Study I showed that 70% of the cohort had tinnitus; however, many did not initially receive a diagnosis of tinnitus. Information about vertigo, heredity for hearing loss and tinnitus, diabetes history, cardiovascular disease history and other factors related to health was often missing from the patients’ medical records. The results could show that the overall scores using the Tinnitus Handicap Inventory (THI) were higher in female patients than in male patients. Although it is likely that hearing aids would be beneficial for the majority of these patients, 314 (44%) of the 714 total patients had hearing aids. Furthermore, the outcomes from study II demonstrated that a majority of the patients (61%) who were dissatisfied with the care they had obtained had no hearing aids. This finding may indicate that the fitting of hearing aids is an important treatment for patients with both tinnitus and hearing loss.

Studies III and IV were prospective studies. Data collection was based on patients who sought care for tinnitus and/or hearing loss at the ENT clinic in Linköping during 2012-2013. In study III, 92 patients were divided into two groups: one group contained individuals with both tinnitus and hearing loss, and the other group contained patients with only hearing loss. The patients were assessed using the Reading Span test, the Hearing in Noise Test (HINT) and three questionnaires (the THI, the Hearing Handicap Inventory for Elderly and the Pittsburg Sleep Quality Index) at baseline and follow-up. The results from the age-matched subgroups (n=30+30) generated from the full clinical groups (46+46) showed significantly improved Reading Span test performance and sleep quality in patients with both tinnitus and hearing loss. Similar results were observed in our full clinical population (n=46+46). However, the interpretation of this finding is difficult due to age differences between the groups. In conclusion, hearing aid fitting had a significantly positive impact on working memory capacity and sleep quality in patients with both tinnitus and hearing loss compared with patients with only hearing loss.

In study IV, a brief Motivational Interviewing (MI) guide was integrated into the hearing rehabilitation process for 23 patients with both tinnitus and hearing loss, and they were compared against a control group (n=23) of patients with both tinnitus and hearing loss who underwent traditional hearing rehabilitation. The results showed that the patients who received the brief MI guide required fewer visits to complete their hearing rehabilitation compared with the patients in the control group. In addition, there was a significant difference in THI scores between the groups, which indicated that the intervention reduced tinnitus annoyance more in the MI group. Furthermore, both groups showed higher scores at follow-up compared with baseline on the International Outcome Inventory for Hearing Aids (IOI-HA) scale, which indicated that both approaches showed a positive effect on hearing aid satisfaction.

Study V was a retrospective, descriptive study that focused on a part of a Stepped Care model and included patients who participated in half-day tinnitus information meetings from 2004 to 2011 in the audiology clinic at Linköping University Hospital. A total of 426 tinnitus patients with complete questionnaires (the THI and the Hospital Anxiety and Depression Scale, HADS) were included in the study. The results showed significant decreases in scores on the THI and the anxiety module of the HADS before and after the information session. However, there were no statistically significant changes in the depression module of the HADS.

In conclusion, this thesis underscores the importance of hearing impairment, cognitive variables and motivational procedures in the management of tinnitus. Multidisciplinary group information needs to be further validated.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. 73 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1536
National Category
Otorhinolaryngology Neurology Public Health, Global Health, Social Medicine and Epidemiology Psychology
Identifiers
urn:nbn:se:liu:diva-132163 (URN)10.3384/diss.diva-132163 (DOI)9789176856970 (ISBN)
Public defence
2016-11-17, Graniten, Campus US, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2016-10-19 Created: 2016-10-19 Last updated: 2016-10-19Bibliographically approved

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