Giriraj Singh Shekhawat

Background: Tinnitus is a prevalent condition affecting approximately 14.4 percent of the global adult population. With growing mobile phone ownership and usage globally, the utilization of smartphone applications (apps) as tinnitus interventions has garnered research and clinical interest. Despite the abundant number of commercially available tinnitus smartphone apps, a majority of them lack validation of their effectiveness. Purpose: The goal of this study was to investigate the feasibility of using a smartphone app (Oto) in tinnitus management as determined by trial acceptability, deliverability, and effectiveness. Research Design: A two-arm controlled trial design was adopted. Study Sample: Sixty-two adults with chronic tinnitus were randomized to either the Oto user group or nonuser (control) group. Intervention: The multimodal Oto smartphone app, which combines patient education, cognitive behavioral therapy, relaxation, mindfulness, and sound therapy, was used by the Oto user group for 3 months. Data Collection and Analysis: Participants completed the Tinnitus Functional Index (TFI) at baseline, 1 month, and 3 months. The Oto user group rated Oto’s ease of use and their satisfaction on a 5-point Likert scale and answered open-ended questions on user experience at 3 months. One-way repeated-measures analysis of variance was performed with Bonferroni correction. Results: Overall retention rate (defined as completion of trial at 3 months) was 87 percent. Among Oto users, 16 percent had a clinically meaningful reduction (≥13 points) in the TFI score from baseline to 3 months, whereas 7 percent of nonusers met the same criterion. The Oto user group showed no significant difference in TFI scores between baseline, 1 month, and 3 months, whereas the nonuser group showed a significant increase in the overall TFI scores from baseline to 1 and 3 months ( F [2, 56] = 7.78, p = 0.001). Oto users found Oto easy to use and appreciated app features such as diversely themed therapy sessions and sound library. Suggestions including adjusting the duration of therapy sessions and a more structured habituation program were also noted for improving Oto. Conclusions: Use of Oto in managing tinnitus was demonstrated to be deliverable and feasible with a high retention rate. A large-scale randomized controlled trial is currently underway to further evaluate Oto’s effectiveness and app usability.

Objective: The goal of this scoping review is to review the scope of features from previous resting-state electroencephalography (EEG) research that have the potential to be objective measures of chronic subjective tinnitus and presence. Methods: Using keywords related to resting-state EEG and tinnitus we retrieved studies from Ovid, PubMed, and CINAHL. Studies were included if they met the following criteria: studies utilized resting-state EEG to assess chronic subjective tinnitus symptoms or compare those with tinnitus to control subjects. Results: We identified and reviewed 81 comparison studies that used resting-state EEG. Spectral power source and electrode analysis were the most common results reported in studies that compared those with chronic subjective tinnitus to controls. Connectivity and network analysis were the third most reported analysis type. Conclusions: Electroencephalography (EEG) has potential to be utilised as an objective measure of chronic subjective tinnitus, independent of subject reports. While no single definitive EEG marker for chronic subjective tinnitus was identified, emerging evidence from comparison studies indicates a strong impact of chronic subjective tinnitus on network measures and connectivity related features. We propose a pathway to establishing objective measures from EEG recordings. Combining spectral band power, network and connectivity as features and validating them with machine learning classification on large, diverse populations, is a proposed pathway to establish objective measures. Significance: Idiopathic chronic subjective tinnitus affects up to a 20% of the population, particularly in the elderly, is associated with hearing loss, and lacks widely accepted treatments. Assessing tinnitus, and symptom changes are challenging due to the lack of objective measures of idiopathic chronic subjective tinnitus. This review focuses on the use of resting-state EEG research to identify candidates that may be developed for use in research and by clinicians.

Background: High prevalence of hearing loss and its physical, mental, and social impacts when unaddressedunderscore a need for early identification. However, in-person hearing assessment may beinaccessible in certain countries and areas. As such, numerous smartphone-based and web-basedapplications (apps) have been developed to perform remote hearing assessment, and yet many ofthem remain unvalidated.Purpose: The purpose of this study was to evaluate the performance, ecological validity, and usabilityof two freely available smartphone-based hearing assessment apps—Hearing Test (Android) and MimiHearing Test (iOS)—alongside a web-based app, MDHearing Aid.Research Design: This is a cross-sectional validation study.Study Sample: This study included 60 adults with hearing thresholds no greater than 20 dB HL or anydegree of sensorineural hearing loss.Data Collection and Analysis: Participants completed standard audiometric testing followed byassessments using three apps in a controlled laboratory setting. The assessments were repeated byparticipants at home the subsequent day. The mHealth App Usability Questionnaire (MAUQ) wasadministered to evaluate the apps’ usability. Performance metrics included sensitivity, specificity, accuracy,and test-retest reliability. Intraclass correlation coefficient (ICC) estimates were calculated tomeasure the apps’ accuracy, test-retest reliability, and ecological validity.Results: All apps had moderate to good sensitivity (0.67–1.00) and specificity (0.72–0.99). The HearingTest app showed poor accuracy at lower frequencies (ICC: 0.24–0.53) and moderate to good accuracy above 1000 Hz (ICC: 0.74–0.83). The Mimi Hearing Test showed poor accuracy at lower frequencies(ICC: 0.27–0.50) and moderate to good accuracy above 2000 Hz (ICC: 0.68–0.85). The web-basedMDHearing Aid test showed moderate to good accuracy across frequencies (ICC: 0.64–0.85). All appshad moderate to excellent test-retest reliability (ICC: 0.66–0.99) and showed poor ecological validity below500 Hz (ICC: 0.20–0.51) and moderate to excellent ecological validity above 1000 Hz (ICC: 0.54–0.95).Usability was rated highly across all apps, with MAUQ scores ranging from 5.4 to 5.9 out of 7.Conclusions: The examined apps exhibit varied accuracy levels and generally reasonable sensitivity,specificity, test-retest reliability, ecological validity, and usability. With additional validation, the HearingTest app may be useful for hearing screening and monitoring in adults. There is a necessity for furtherresearch to unlock the examined apps’ full clinical potential.

Background: Tinnitus is the phantom perception of sound in the ears or head which may result from inflammation of the auditory pathway. A healthy diet consisting of a range of vitamins and minerals may be protective against tinnitus. This study aims to determine the association between intakes of dietary vitamins and minerals and the prevalence and incidence of tinnitus over 10 years. Methods: In this longitudinal cohort study of 2947 participants (aged ≥ 50 years), 935 (32%) cases of tinnitus were identified and included in prevalence analyses. The remaining 2012 participants were followed to establish 10-year incidence of tinnitus. A validated semi-quantitative food frequency questionnaire was used to determine intakes of dietary vitamins and minerals. Results: No significant associations with tinnitus prevalence were found. However, iron and zinc were significantly associated with incident tinnitus. There was a 44% (multivariate-adjusted HR: 1.44, 95% CI: 1.07–1.93) increased risk of developing incident tinnitus over 10 years with lower zinc intakes and a 35% increased risk with lower iron intakes (multivariate-adjusted HR: 1.35, 95% CI: 1.00–1.80). Conclusion: Higher intakes of zinc and iron were significantly associated with lower tinnitus risk. Due to a lack of comparable high-quality data, future research studies should include robust study designs.

(1) Background: Tinnitus involves the conscious awareness of a tonal or composite noise for which there is no identifiable corresponding external acoustic source. For many people, tinnitus is a disorder associated with symptoms of emotional distress, cognitive dysfunction, autonomic arousal, behavioural changes, and functional disability. Many symptoms can be addressed effectively using education or cognitive behavioural therapy. However, there is no treatment that effectively reduces or alters tinnitus-related neurophysiological activity and thus the tinnitus percept. In this systematic review, we evaluated the effectiveness of neuromodulation therapies for tinnitus that explicitly target pathological synchronous neural activity. (2) Methods: Multiple databases were searched for randomised controlled trials of neuromodulation interventions for tinnitus in adults, with 24 trials included. The risk of bias was assessed, and where appropriate, meta-analyses were performed. (3) Results: Few trials used acoustic, vagal nerve, or transcranial alternating current stimulation, or bimodal stimulation techniques, with limited evidence of neuromodulation or clinical effectiveness. Multiple trials of transcranial direct current stimulation (tDCS) were identified, and a synthesis demonstrated a significant improvement in tinnitus symptom severity in favour of tDCS versus control, although heterogeneity was high. (4) Discussion: Neuromodulation for tinnitus is an emerging but promising field. Electrical stimulation techniques are particularly interesting, given recent advances in current flow modelling that can be applied to future studies.