A multi-disciplined approach to tinnitus research

1. A multi-disciplined approach to tinnitus research Nottingham Hearing Biomedical Research Unit Kathryn Fackrell

2. A multi-disciplined approach to tinnitus research Measuring tinnitus Evaluating interventions Benefit of self-help programmes Functional connectivity in the tinnitus brain Effectiveness of audiologist-delivered counselling Validation of measures of tinnitus Efficacy of (combination) hearing aids devices Effect of tinnitus on working memory and attention Exploring therapeutic target Efficacy of sound devices Validation of a new cognitive model of tinnitus Efficacy of novel compounds Addressing questions that are important to patients and clinicians

3. Effectiveness of audiologist-delivered counselling “‘Talking therapies’ will have an increased role to play in NHS care generally” Cognitive Behaviour Therapy • Offers a practical solution to dealing with current problems Counselling • Aims to empower patients to reach decisions and take actions for themselves Tinnitus Priority Setting Partnership: One of the top 10 unanswered questions

4. Manualisation and feasibility of audiologist-delivered counselling for tinnitus Deb Hall Mary McMurran Dawn Marie-Walker David Stockdale Amanda Casey

5. Manualisation and feasibility of audiologist-delivered counselling for tinnitus Develop a manual for audiologist-delivered talking therapy and test its feasibility • Several interacting components • Target a wide range of possible outcomes • Have a permitted degree of flexibility or tailoring, • What are the essential components of talking therapy for tinnitus that can be delivered by audiologists?

6. Identifying components Step one: Scoping review • Course materials articles, practical guidelines, protocols from relevant clinical trials, commentaries and professional magazine articles Step two: Consultation - Delphi review Develop a consensus on.. • the essential components • associated aims of tinnitus counselling From the shared perspective of the patient and the clinician.

7. Identifying components Step two: Consultation - Delphi review Who do we need? • 20 patients • experienced some form of counselling or CBT for tinnitus complaint • From an audiologist, hearing therapist, or clinical psychologist • 20 audiologists/hearing therapists • received training in counselling or CBT and consult tinnitus patients Derek Hoare: Derek.hoare@nottingham.ac.uk

8. Evaluating self-help programmes: update Study one: Usability of program • Gaining opinion of both the website and program • New users who will • Complete the 6 week program • Complete survey each week • People who have previously used the program • Complete one off survey Sandra Smith: sandra.smith@nottingham.ac.uk

9. A Randomised Placebo Controlled Double-blind trial of AUT00063 drug Investigate the efficacy and safety of AUT00063 drug versus placebo • Reduced activity at certain sites in the brain has been linked to hearing problems, such as tinnitus • voltage-gated potassium channels may be a drug target for hearing-related problems. • an experimental new medicine • improve the action of these specific channels • treat the brain component of these hearing problems • early-onset subjective tinnitus Please follow the link for more information: http://www.autifony.com/autifony-tinnitus-quiet-study.asp

10. An update on my PhD Validation of the TFI

11. The importance of questionnaires Why? Diagnostic tool How? Why? Assess tinnitus severity • Triaging patients • Grade tinnitus severity • Selection criteria • Guiding decisions • To determine treatment candidacy • Identify minimal important change • To facilitate clinical audit • Inform treatment approaches To compare new management • Counsel patient • Evaluate treatment approaches & interventions Outcome measure Hoare & Hall (2011)

12. Validating a new tinnitus questionnaire: Tinnitus Functional Index (TFI) Diagnostic tool & measure of change of tinnitus distress Does the questionnaire reflect what it is measuring? Does the questionnaire compare to others tinnitus questionnaires? Does the questionnaire reliably show changes that occur over time? Is there a grading system?

13. UK clinical population 250 new tinnitus patients Final participants complete this April!

14. TFI score distribution Clinical population Research population Mean score: 52.6849 Mean score: 39.3175

15. Clinic overall scores N: 252

16. Aintree Aintree: TFI shows changes over time 60.78 43.83 N: 15

17. Responsiveness: research population Floor and ceiling effects: limited detection of individual improvements and worsening

18. Responsiveness: clinics population Floor and ceiling effects: limited detection of individual improvements and worsening

19. UK clinical population 250 new tinnitus patients Factorial structure • Any identified domains/subscales • Is the structure reliable? Reproducibility • Can it reliably distinguish between people? Responsiveness • Does it reliably show small changes that occur over time? • Is there a minimal important change score? Interpretability • What do the scores mean?

20. Thank you for listening Nottingham Hearing Biomedical Research Unit: www.hearing.nihr.ac.uk Sandra Smith: sandra.smith@nottingham.ac.uk Derek Hoare: derek.hoare@nottingham.ac.uk Kathryn Fackrell: msxklf@nottingham.ac.uk http://www.autifony.com/autifony-tinnitus-quiet-study.asp