Pilot study to evaluate ecological momentary assessment of tinnitus

Abstract

Objectives: Because audiometric evaluation, symptom histories, questionnaires, and similar standard assessment tools may not adequately sample the effects of chronic tinnitus on day-to-day activities, there is a need for alternative methodological approaches to study the impact of tinnitus on day-to-day life. An innovative methodological approach that has shown great promise in the study of chronic health problems characterized by reported temporal and/or situational variability in symptoms and distress is known as ecological momentary assessment (EMA). EMA involves the real-time measurement of states, situational factors, and symptoms by individuals as they go about their day-to-day activities. The objective of this pilot investigation was to explore the feasibility of using EMA methods to examine within- and between-day effects of tinnitus.

Design: This study was conducted in three phases: (1) design and development of an EMA methodology that could be used to assess effects of tinnitus; (2) refinement of the methodology through the use of two focus groups; and (3) field-test the methodology with individuals who experienced bothersome tinnitus. For Phase 3, each of the 24 participants wore, throughout their waking hours for 2 weeks, a personal digital assistant that produced alerts four times a day. The alerts prompted participants to respond to 19 questions, including 9 relating to situational and mood factors and 10 comprising the Tinnitus Handicap Inventory-Screening version (THI-S). To evaluate for potential reactive effects of performing the EMA protocol, each participant completed the paper-and-pencil version of the full 25-item THI before and after the 2-week EMA period.

Results: Participants responded to the alerts with a 90% compliance rate, providing a total of 1210 completed surveys. At the time of their response, participants indicated that they were in their house or apartment (67.7%), alone (50.2%), happy (50%), and calm (54.5%). Across most responses, participants could hear their tinnitus (97%), and the loudness of their tinnitus averaged 4.7 on a 7-point increasing-loudness scale. The mean THI-S index score (out of a possible maximum 40 points for greatest tinnitus severity) was 17.0 (moderate self-perceived tinnitus handicap). Repeated THI-S index scores varied considerably both within and between participants. Mean 25-item THI scores were not significantly different before and after the EMA period, suggesting little reactivity of the EMA.

Conclusions: The high compliance rate, positive feedback from participants, lack of reactivity as a result of performing the EMA protocol, and data collected indicate that EMA methodology is feasible with patients who have tinnitus. Outcome data obtained with this methodology cannot be obtained any other way because retrospective questionnaires cannot capture the day-to-day reactions. This methodology has the potential to provide more in-depth and accurate assessments of patients receiving therapy for tinnitus.

Figure 1

Graphical representations of repeated THI-S index scores reflecting three trends across the 2-week EMA sampling period: Improving trend is characterized by an improvement (reduction) in scores. Consistent trend is characterized by little to no directional variation in scores. Worsening trend is characterized by an increase in scores.

Figure 2

Each trace represents the mean daily THI-S scores obtained from participants across 14 days of responding to EMA alerts. Each point for each day indicates the mean TSI-S score derived from four individual TSI-S scores (except days when fewer than four responses were provided). Participants are grouped into quartiles according to their average THI-S score from the first day.

Figure 3

These figures are based on difference scores calculated to reflect the correspondence between paper-and-pencil and PDA formats of obtaining THI-S scores. The height of each bar reflects the number of participants for each range of difference scores. These differences were calculated individually for each of the 24 participants by subtracting the average of the two THI-S scores obtained during the orientation and debriefing sessions from: (a) the average of all of the THI-S scores obtained with the PDA over 14 days of EMA testing; (b) the minimum THI-S score obtained with the PDA; (c) the maximum THI-S score obtained with the PDA.

Figure 3

These figures are based on difference scores calculated to reflect the correspondence between paper-and-pencil and PDA formats of obtaining THI-S scores. The height of each bar reflects the number of participants for each range of difference scores. These differences were calculated individually for each of the 24 participants by subtracting the average of the two THI-S scores obtained during the orientation and debriefing sessions from: (a) the average of all of the THI-S scores obtained with the PDA over 14 days of EMA testing; (b) the minimum THI-S score obtained with the PDA; (c) the maximum THI-S score obtained with the PDA.

Figure 3

These figures are based on difference scores calculated to reflect the correspondence between paper-and-pencil and PDA formats of obtaining THI-S scores. The height of each bar reflects the number of participants for each range of difference scores. These differences were calculated individually for each of the 24 participants by subtracting the average of the two THI-S scores obtained during the orientation and debriefing sessions from: (a) the average of all of the THI-S scores obtained with the PDA over 14 days of EMA testing; (b) the minimum THI-S score obtained with the PDA; (c) the maximum THI-S score obtained with the PDA.