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11/05/2015 A multi-disciplined approach to tinnitus research Nottingham Hearing Biomedical Research Unit Kathryn Fackrell.

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Presentation on theme: "11/05/2015 A multi-disciplined approach to tinnitus research Nottingham Hearing Biomedical Research Unit Kathryn Fackrell."— Presentation transcript:

1 11/05/2015 A multi-disciplined approach to tinnitus research Nottingham Hearing Biomedical Research Unit Kathryn Fackrell

2 A multi-disciplined approach to tinnitus research Evaluating interventions Measuring tinnitus Exploring therapeutic target Validation of a new cognitive model of tinnitus Effect of tinnitus on working memory and attention Validation of measures of tinnitus Functional connectivity in the tinnitus brain Efficacy of sound devices Efficacy of novel compounds Benefit of self-help programmes Effectiveness of audiologist-delivered counselling Efficacy of (combination) hearing aids devices 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 Amanda Casey David Stockdale Dawn Marie-Walker

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:

8 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 Evaluating self-help programmes: update Sandra Smith:

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:

10 VALIDATION OF THE TFI An update on my PhD

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

12 Diagnostic tool & measure of change of tinnitus distress Validating a new tinnitus questionnaire: Tinnitus Functional Index (TFI) Does the questionnaire compare to others tinnitus questionnaires? Does the questionnaire reflect what it is measuring? 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 populationResearch population Mean score: Mean score:

15 Clinic overall scores N: 252

16 Aintree: TFI shows changes over time N: Aintree

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: Sandra Smith: Kathryn Fackrell: Derek Hoare:

21 Acoustic CR ® Neuromodulation Specific sound stimulation algorithm developed by the ANM Adaptive Neuromodulation to break up patterns of abnormal synchronous activity in the hearing brain. Two-centre Double blind RESET II trial “The report clearly details the methodology and also the changes in the trial protocol – both approved and also the non-compliances. The End of Study Report did not report a significant difference in the primary outcome measure (global Tinnitus Handicap Questionnaire scores) between the treatment group and the placebo group”. BTA 2014_sourced 04/02/2015


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