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A multi-disciplined approach to tinnitus research
Nottingham Hearing Biomedical Research Unit
Kathryn Fackrell
06/05/2017
A multi-disciplined approach to
tinnitus research
Measuring tinnitus
Functional connectivity
in the tinnitus brain
Validation of measures
of tinnitus
Exploring therapeutic target
Effect of tinnitus on
working memory and
attention
Validation of a new
cognitive model of
tinnitus
Evaluating interventions
Benefit of self-help
programmes
Effectiveness of
audiologist-delivered
counselling
Efficacy of (combination)
hearing aids devices
Efficacy of sound
devices
Efficacy of novel
compounds
Addressing questions that are important to patients and clinicians
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
Manualisation and feasibility of audiologistdelivered counselling for tinnitus
Deb Hall
Mary McMurran
Dawn Marie-Walker
Amanda Casey
David
Stockdale
Manualisation and feasibility of audiologistdelivered 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?
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.
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:
[email protected]
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
Sandra Smith:
• Complete one off survey
[email protected]
A Randomised Placebo Controlled Doubleblind 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 hearingrelated 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
An update on my PhD
VALIDATION OF THE TFI
The importance of questionnaires
How?
Diagnostic tool
Why?
Assess tinnitus severity
Triaging patients
Grade tinnitus severity
Selection criteria
Guiding decisions
To determine treatment candidacy
Identify minimal important change
Inform treatment approaches
Counsel patient
To facilitate clinical audit
To compare new management
Evaluate treatment approaches & interventions
Outcome measure
Hoare & Hall (2011)
Validating a new tinnitus questionnaire:
Tinnitus Functional Index (TFI)
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?
Diagnostic tool & measure of change of tinnitus distress
UK clinical population
250 new tinnitus patients
Final participants
complete this April!
●Nottingham
TFI score distribution
Clinical population
Mean score: 52.6849
Research population
Mean score: 39.3175
Clinic overall scores
N: 252
Aintree
2
QP1 60.78 55.2
QP2 43.83 48.77
3
61.74
56.64
4
50.81
46.07
5
48.16
47.14
6
49.62
46.35
7
42.22
29.64
8
55.28
42.88
9
48.41
43.62
10
57.14
48.80
11
47.68
35.97
12
53.02
46.01
Aintree TFI shows changes over time
Aintree:
60.78
43.83
N: 15
Responsiveness: research population
Floor and ceiling effects: limited detection of individual improvements and
worsening
Responsiveness: clinics population
Floor and ceiling effects: limited detection of individual improvements and
worsening
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?
●Nottingham
Interpretability
•What do the scores mean?
Thank you for listening
Nottingham Hearing Biomedical
Research Unit:
www.hearing.nihr.ac.uk
Sandra Smith: [email protected]
Derek Hoare: [email protected]
Kathryn Fackrell: [email protected]
http://www.autifony.com/autifony-tinnitus-quiet-study.asp