A narrative synthesis of research evidence for tinnitus-related complaints as reported by patients and their significant others

Abstract

Background: There are a large number of assessment tools for tinnitus, with little consensus on what it is important to measure and no preference for a minimum reporting standard. The item content of tinnitus assessment tools should seek to capture relevant impacts of tinnitus on everyday life, but no-one has yet synthesised information about the range of tinnitus complaints. This review is thus the first comprehensive and authoritative collection and synthesis of what adults with tinnitus and their significant others report as problems in their everyday lives caused by tinnitus.

Methods: Electronic searches were conducted in PubMed, Embase, CINAHL, as well as grey literature sources to identify publications from January 1980 to June 2015 in which participants were enrolled because tinnitus was their primary complaint. A manual search of seven relevant journals updated the search to December 2017. Of the 3699 titles identified overall, 84 records (reporting 86 studies) met our inclusion criteria and were taken through to data collection. Coders collated generic and tinnitus-specific complaints reported by people with tinnitus. All relevant data items were then analyzed using an iterative approach to narrative synthesis to form domain groupings representing complaints of tinnitus, which were compared patients and significant others.

Results: From the 86 studies analyzed using data collected from 16,381 patients, 42 discrete complaints were identified spanning physical and psychological health, quality of life and negative attributes of the tinnitus sound. This diversity was not captured by any individual study alone. There was good convergence between complaints collected using open- and closed-format questions, with the exception of general moods and perceptual attributes of tinnitus (location, loudness, pitch and unpleasantness); reported only using closed questions. Just two studies addressed data from the perspective of significant others (n = 79), but there was substantial correspondence with the patient framework, especially regarding relationships and social life.

Conclusions: Our findings contribute fundamental new knowledge and a unique resource that enables investigators to appreciate the broad impacts of tinnitus on an individual. Our findings can also be used to guide questions during diagnostic assessment, to evaluate existing tinnitus-specific HR-QoL questionnaires and develop new ones, where necessary.

Trial registration: PROSPERO registration number: CRD42015020629 . Protocol published in BMJ Open. 2016;6e009171.

Keywords: Adults; Audiology; Otology; People important outcomes; Symptoms.

Fig. 1

Flow diagram of study records. Eighty-four records yielded 86 independent datasets for synthesis. Note that none of the review articles were systematic reviews

Fig. 2

Domain-level grouping created from the responses gathered from patients and significant others. Our domain-level groupings are mapped into the category headings given by the World Health Organization (see headings in capital letters in the top row). Domain-level grouping in the bottom row could not easily be fitted into the WHO nomenclature. Multi-attribute categories are given in bold font; with any denoted with an open bullet point (o) indicating additional multi-attribute domains that have been grouped within the same category. Closed bullet points (●) indicate discrete unidimensional patient-reported domains arising from the data collected. The superscript numbers indicate how many studies in total identified that domain (e.g. ⁿ¹¹). An open square (□) denotes that the domain was identified using an open-question format. A crossed square (⊠) denotes that the domain was identified using a closed-question format

Fig. 3

World map illustrating the distribution of study sites for all included studies, inspired by the World Health Organization (WHO) regional classification, but with Region of the Americas separated into North and South and with Australia and separated from Western Pacific region, because of cultural and language differences. Regions are colour coded in different shades of blue and the values denote the number of studies contributing to the review from that country