Emerging Topics in the Behavioral Neuroscience of Tinnitus

Short- and Long-Term Outcomes of e-Health and Internet-Based Psychological Interventions for Chronic Tinnitus: A Systematic Review and Meta-Analysis

Objective: e-Health or web-based systems in the field of tinnitus have gained increasing interest. Cognitive behavioral therapy (CBT) delivered via the internet is currently witnessing a surge in both attention and offerings. This systematic review analyzed the efficacy and sustainability of internet-based therapies aimed at reducing tinnitus distress and comorbidities such as anxiety, depression, and sleep disorders. The review exclusively considered randomized controlled trials (RCTs) in which trained personnel were actively involved during intervention. Methods: Utilizing search terms such as tinnitus, internet-based therapy, and e-Health therapy, we identified 155 studies, from which 37 RCTs were carefully examined for data availability. Primary outcome measures included treatment effects for tinnitus distress (Tinnitus Questionnaire and other questionnaires) and handicap (Tinnitus Handicap Inventory), while secondary outcomes encompassed depression, anxiety, and sleep problems. Meta-analyses were conducted employing random-effect models. A study effect model was applied, yielding a singular effect size for each sample. The effect sizes were examined for influences of various moderators. Results: We found a statistically significant large effect size for improvement in tinnitus distress (d = 0.83; [confidence interval 0.61-1.06] with total n = 450 for the experimental group and total n = 504 or the controls), while the reduction of tinnitus handicap was smaller (moderate effect size d = 0.59; [0.44-0.73]). Less strong but still significant effects resulted for depression, anxiety, and insomnia. Most of the long-term outcomes remained stable. As moderators, the risk of bias (RoB) and the severity of tinnitus manifestations were identified. Conclusions: Internet-based therapy provides a valuable avenue for initial therapeutic contact, as supporting component in tinnitus treatment if accompanied by therapists. The heterogeneous quality with high drop-out rates or partly high RoB and the wide range of interventions (counseling, eCBT, mindfulness) might be considered as a limiting factor for a first-line management in tinnitus. So far, the use of e-Health is dependent on availability or user preferences.

A Review of Auditory Rehabilitation Uses in Hearing Aid-Based Therapy for Tinnitus (2013-2024)

The weight of evidence supports hearing aids playing an important role in tinnitus management. Less information is available about the role of auditory rehabilitation (AR) in the hearing aid therapy process. The research question was "what role has amplification and AR played in the management of tinnitus." To identify relevant studies, database searches of Scopus (keywords), Embase (keywords), and PubMed (title and abstract) were carried out in April/May 2024 using the following search terms [tinnitus] and [amplification] or [hearing aids]. Articles were excluded if not written in English or unavailable in full text. Reviews and protocols were excluded. Once duplicates were removed, 495 articles were screened with 58 articles being included in the review. After cataloguing, articles were divided into those that described use of AR in their methods and those that did not. AR was subcategorized into four categories and described as (1) instruction, (2) counseling, (3) sensory management, (4) perceptual training. Articles published in the last 12 years support the use of hearing aids. The use of AR in addition to amplification was common but its content, application, and contribution to outcomes were ambiguous. Augmentation of amplification benefits for tinnitus through AR presents an opportunity for future research. In future research, each AR component needs to be described in greater detail and the relative merits of different types of AR and their role in personalized therapy needs to be ascertained.

A scoping review of tinnitus research undertaken by New Zealand researchers: Aotearoa-an international hotspot for tinnitus innovation and collaboration

Tinnitus is a very common oto-neurological disorder of the perception of sound when no sound is present. To improve understanding of the scope, strengths and weaknesses of New Zealand tinnitus research, a critical scoping review was undertaken. The aim was to help develop priorities for future research. A review of the literature was undertaken using a 6-stage scoping review framework of Scopus and Pub Med were searched in May 2023 with the combination of following key word [Tinnitus] and country of affiliation [New Zealand]. The search of PubMed resulted in 198 articles and that of Scopus 337 articles. After initial consideration of title relevance to the study (165 from PubMed and 196 from Scopus) removal of duplicates and after reading the articles and adding from references, 208 studies were chosen for charting of data. Nine themes were identified and described: A. Epidemiology; B. Models; C. Studies in animals; D. Mechanisms; E. Assessment and prognosis; F. Pharmacotherapy; G. Neuromodulation; H. Sensory therapies; I. Clinical practice. An urgent priority for future tinnitus research in NZ must be to address the absence of cultural and ethnic diversity in participants and consideration of traditional knowledge.

A State-of-Art Review of Digital Technologies for the Next Generation of Tinnitus Therapeutics

Background: Digital processing has enabled the development of several generations of technology for tinnitus therapy. The first digital generation was comprised of digital Hearing Aids (HAs) and personal digital music players implementing already established sound-based therapies, as well as text based information on the internet. In the second generation Smart-phone applications (apps) alone or in conjunction with HAs resulted in more therapy options for users to select from. The 3rd generation of digital tinnitus technologies began with the emergence of many novel, largely neurophysiologically-inspired, treatment theories that drove development of processing; enabled through HAs, apps, the internet and stand-alone devices. We are now of the cusp of a 4th generation that will incorporate physiological sensors, multiple transducers and AI to personalize therapies. Aim: To review technologies that will enable the next generations of digital therapies for tinnitus. Methods: A "state-of-the-art" review was undertaken to answer the question: what digital technology could be applied to tinnitus therapy in the next 10 years? Google Scholar and PubMed were searched for the 10-year period 2011-2021. The search strategy used the following key words: "tinnitus" and ["HA," "personalized therapy," "AI" (and "methods" or "applications"), "Virtual reality," "Games," "Sensors" and "Transducers"], and "Hearables." Snowballing was used to expand the search from the identified papers. The results of the review were cataloged and organized into themes. Results: This paper identified digital technologies and research on the development of smart therapies for tinnitus. AI methods that could have tinnitus applications are identified and discussed. The potential of personalized treatments and the benefits of being able to gather data in ecologically valid settings are outlined. Conclusions: There is a huge scope for the application of digital technology to tinnitus therapy, but the uncertain mechanisms underpinning tinnitus present a challenge and many posited therapeutic approaches may not be successful. Personalized AI modeling based on biometric measures obtained through various sensor types, and assessments of individual psychology and lifestyles should result in the development of smart therapy platforms for tinnitus.