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Pilot Study to Evaluate Ecological Momentary Assessment of Tinnitus

Henry, James A.1,2; Galvez, Gino1; Turbin, Mitchel B.1; Thielman, Emily J.1; McMillan, Garnett P.1; Istvan, Joseph A.1

doi: 10.1097/AUD.0b013e31822f6740
Research Articles

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.

Supplemental Digital Content is available in the text.

1VA RR&D National Center for Rehabilitative Auditory Research, VA, Medical Center

2Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University (OHSU), Portland, Oregon

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal’s Web site (

The authors thank Erin Conner for her work as a research assistant during the first half of this project.

This work was supported by a Research Grant from the National Institute on Deafness and Other Communications Disorders (1R03DC009012-01A1) and Research Career Scientist Award from VA Rehabilitation Research and Development Service (F7070S) to J.A.H. Administrative support and facilities were provided by the VA National Center for Rehabilitative Auditory Research, Portland, Oregon; and Oregon Health & Science University, Portland, Oregan.

The contents of this report do not represent the views of the Department of Veterans Affairs or the U.S. Government.

Address for correspondence: James A. Henry, PhD, VA Medical Center National Center for Rehabilitative Auditory Research, PO Box 1034, Portland, OR 97207, USA. E-mail:

Received February 26, 2011

Accepted July 19, 2011

© 2012 Lippincott Williams & Wilkins, Inc.