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Does Evidence Support Audiological Internet-based Interventions?

Beukes, EldréVinaya PhD; Manchaiah, Vinaya PhD

doi: 10.1097/01.HJ.0000602920.83942.c5
Audiology Treatment
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Dr. Beukes, left, is a post-doctoral researcher in the department of speech and hearing sciences at Lamar University in Beaumont, TX, where Dr. Manchaiah is the Jo Mayo Endowed Professor of Speech and Hearing Sciences.

Hearing loss, the second most common impairment in the world, often occurs with other distressing auditory conditions such as tinnitus and loss of vestibular function.1,2 The incidence of these conditions increases with age,3-5 which is of concern due to the rising proportion of elderly people.6 As these are chronic, long-term conditions, ongoing management is required, adding to society's health care and economic burden. For hearing loss alone, the resulting annual global costs are $750 billion. Although interventions to address hearing loss, tinnitus, and vestibular disorders are cost-effective, provision of such services is hampered by factors such as lack of resources,7 lack of evidence-based treatments, and limited hearing health care professionals.8 Uptake of interventions is further complicated by multiple factors surrounding accessibility (in terms of location and time), costs, and barriers to engagement and compliance.9

Figure 1.

Figure 1.

Table 1

Table 1

Internet-based interventions (IBIs) have emerged as an approach to address these barriers by offering accessible and affordable audiology services10 that encourage self-management and engagement.11 They provide great flexibility as either a replacement for or supplement to routine care. IBIs can be provided with or without guidance (i.e., professional support). Perhaps the most attractive aspect is that IBIs can be used as a shared global resource, being based online and not in a specific geographic location. Despite these advantages, emphasis needs to be placed on the evidence base of these interventions.

Beukes, et al.,12 undertook a systematic review to summarize the evidence base for hearing-related IBI (for hearing loss, tinnitus, and vestibular difficulties), with a focus on identifying the primary, secondary, and long-term effects of these interventions. The review included 15 studies from Sweden, the United Kingdom, and Germany, with data from 1,811 participants. To improve the quality of the evidence, only randomized controlled trials were included. The majoity (12 studies) were efficacy trials (i.e., tested IBI in controlled conditions) and three were effectiveness studies (i.e., tested IBI in “real” world conditions). All Internet intervention arms provided guidance except for that of vestibular rehabilitation. There was little overlap in the range of interventions (Fig. 1) and comparators used (see Fig. 2 online: bit.ly/31wHHqV), except in the consistent use of cognitive behavioral therapy (CBT) for tinnitus. Comparison of the main findings for each type of IBI is summarized in Table 1.

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EVIDENCE FOR HEARING LOSS?

Results indicated that IBI for hearing loss can be of great value, although further high-quality studies are required to improve the evidence base. The optimal IBI model for hearing loss needs consideration. This may be a blended approach, where hearing aids are fitted (face-to-face, remotely, or over the counter) and IBI is provided to address the extensive auditory rehabilitation required. Another consideration is how to address different rehabilitation needs for each stage of the hearing rehabilitation pathway, including pre-intervention counselling, post-fitting rehabilitation, and management of emotional and functional effects. Finding the time or expertise to address the psychological distress associated with hearing problems is usually a challenge. IBIs are very viable options for such help. Further development of these interventions may also help improve the impact they have on improving patients’ quality of life.

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EVIDENCE FOR TINNITUS?

The tinnitus IBI stood apart from the other interventions since a more unified approach was followed using the theoretical principles of CBT. Despite the proved effectiveness of CBT for tinnitus,28,29 its provision is often hampered because not many qualified professionals can offer this support.30 The present review found that internet-based CBT for tinnitus indicated a clear potential to improve access to evidence-based interventions. These interventions also contributed to reducing the impact of various comorbidities, such as insomnia, anxiety, and depression, and improving patients’ quality of life. The evidence base is further enhanced as results were maintained long-term (i.e., measured up to one year post-intervention). Future research should identify which aspects of IBIs should be modified to further improve their clinically significant impact.

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EVIDENCE FOR VESTIBULAR DISORDERS?

Only one study included in the review examined the efficacy of IBI for vestibular disorders, which suggests an immediate need to develop IBI for various types of vestibular disorders. The study in this review addressed motion-provoked dizziness. Another IBI for Ménière's disease31 was identified but did not meet the inclusion criteria. Considering the high prevalence of vestibular problems, IBI could significantly help address these difficulties. Many vestibular disorders require long-term intervention, which is not always possible due to inadequate clinical and/or financial resources—burdens that IBI could potentially relieve.

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IMPLICATIONS FOR HEARING CARE

Perhaps the greatest challenge is getting these interventions implemented in clinical practice. Hearing care providers are uniquely positioned to advocate for the increased provision of quality audiology care across the globe, so they can play a central role in advocating for the inclusion of IBIs.32 To date, IBI development has focused largely in Europe, but these interventions should be developed and adapted for use in different populations, cultures, and areas where audiology services are particularly limited.

IBIs can contribute to the provision of comprehensive rehabilitation, which has been shown to improve treatment outcomes and patients’ quality of life.33 These interventions also provide numerous opportunities that promote self-management among individuals with hearing-related conditions and promote public-patient involvement, which could further unite and strengthen audiology service provision.

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REFERENCES

1. Olusanya BO, Neumann KJ, Saunders JE The global burden of disabling hearing impairment: A call to action Bull World Health Organ 2014 92 367–373
2. Vos T, Allen C, Arora M, et al Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: A systematic analysis for the global burden of disease study 2015 The Lancet 2016 388 10053 1545–1602
3. McCormack A, Edmondson-Jones M, Somerset S, Hall D A systematic review of the reporting of tinnitus prevalence and severity Hear Res 2016 337 70–79
4. Jönsson R, Sixt E, Landahl S, Rosenhall U Prevalence of dizziness and vertigo in an urban elderly population Journal of vestibular research 2004 14 1 47–52
5. Bainbridge KE, Wallhagen MI Hearing loss in an aging american population: Extent, impact, and management Annu Rev Public Health 2014 35 139–152
6. World Health Organization. World report on ageing and health. World Health Organization; 2015.
7. World Health Organization. Multi-country assessment of national capacity to provide hearing care, 2013.
8. Hignett S, Lang A, Pickup L, et al More holes than cheese what prevents the delivery of effective, high quality and safe health care in england? Ergonomics 2018 61 1 5–14
9. Barnett M, Hixon B, Okwiri N, et al Factors involved in access and utilization of adult hearing healthcare: A systematic review Laryngoscope 2017 127 5 1187–1194
10. Donahue A, Dubno JR, Beck L Guest editorial: Accessible and affordable hearing health care for adults with mild to moderate hearing loss Ear Hear 2010 31 1 2–6
11. Yardley L, Spring BJ, Riper H, et al Understanding and promoting effective engagement with digital behavior change interventions Am J Prev Med 2016 51 5 833–842
12. Beukes EW, Manchaiah V, Allen PM, Baguley DM, Andersson G Internet-based interventions for adults with hearing loss, tinnitus, and vestibular disorders: A systematic review and meta-analysis Trends in hearing 2019 23 2331216519851749
13. Malmberg M, Lunner T, Kahari K, Andersson G Evaluating the short-term and long-term effects of an internet-based aural rehabilitation programme for hearing aid users in general clinical practice: A randomised controlled trial. BMJ Open. 2017;7(5):e013047-2016-013047.
    14. Manchaiah V, Rönnberg J, Andersson G, Lunner T Use of the ‘patient journey'model in the internet-based pre-fitting counseling of a person with hearing disability: Lessons from a failed clinical trial. BMC Ear,Nose and Throat Disorders 2014 14 1 3
      15. Molander P, Hesser H, Weineland S, et al Internet-based acceptance and commitment therapy for psychological distress experienced by people with hearing problems: A pilot randomized controlled trial Cognitive behaviour therapy 2018 47 2 169–184
        16. Thorén E, Svensson M, Törnqvist A, Carlbring P, Lunner T Rehabilitative online education versus internet discussion group for hearing aid users: A randomized controlled trial J Am Acad Audiol 2011 22 5 274–285
          17. Thorén ES, Öberg M, Wänström G, Andersson G, Lunner T A randomized controlled trial evaluating the effects of online rehabilitative intervention for adult hearing-aid users International Journal of Audiology 2014 53 7 452–461
            18. Beukes EW, Baguley DM, Allen PM, Manchaiah V, Andersson G Audiologist-guided internet-based cognitive behavior therapy for adults with tinnitus in the united kingdom: A randomized controlled trial Ear Hear 2018 39 3 423–433
              19. Hesser H, Gustafsson T, Lunden C, et al A randomized controlled trial of internet-delivered cognitive behavior therapy and acceptance and commitment therapy in the treatment of tinnitus J Consult Clin Psychol 2012 80 4 649–661
                20. Jasper K, Weise C, Conrad I, Andersson G, Hiller W, Kleinstaeuber M Internet- based guided self-help versus group cognitive behavioral therapy for chronic tinnitus: A randomized controlled trial Psychother Psychosom 2014 83 4 234–246
                  21. Nyenhuis N, Kröner-Herwig B, Zastrutzki S, Jäger B An internet- based cognitive- behavioural training for acute tinnitus: Secondary analysis of acceptance in terms of satisfaction, trial attrition and non-usage attrition Cognitive Behaviour Therapy 2013 42 2 139–145
                    22. Weise C, Kleinstauber M, Andersson G Internet-delivered cognitive-behavior therapy for tinnitus: A randomized controlled trial Psychosom Med 2016 78 4 501–510
                      23. Beukes, E.W., Andersson, G., Allen, P.M. Manchaiah, V. and Baguley, D.M. Effectiveness of guided internet-based cognitive behavioural therapy vs face-to-face clinical care for treatment of tinnitus. A randomized clinical trial JAMA Otolaryngology–Head & Neck Surgery 2018 144 12 1126–1133
                        24. Kaldo V, Levin S, Widarsson J, Buhrman M, Larsen H, Andersson G Internet versus group cognitive-behavioral treatment of distress associated with tinnitus: A randomized controlled trial Behavior Therapy 2008 39 4 348–359
                          25. Beukes EW, Allen PM, Baguley DM, Manchaiah V, Andersson G Long-term efficacy of audiologist-guided internet-based cognitive behavior therapy for tinnitus Am J Audiol 2018 27 3S 431–447
                            26. Andersson G, Stromgren T, Strom L, Lyttkens L Randomized controlled trial of internet-based cognitive behavior therapy for distress associated with tinnitus Psychosom Med 2002 64 5 810–816
                              27. Geraghty AWA, Essery R, Kirby S, et al Internet-based vestibular rehabilitation for older adults with chronic dizziness: A randomized controlled trial in primary care Ann Fam Med 2017 15 3 209–216
                                28. Hoare DJ, Kowalkowski VL, Kang S, Hall DA Systematic review and meta-analyses of randomized controlled trials examining tinnitus management Laryngoscope 2011 121 7 1555–1564
                                29. Martinez-Devesa P, Perera R, Theodoulou M, Waddell A Cognitive behavioural therapy for tinnitus. The Cochrane Library. 2010.
                                30. Schmidt CJ, Kaelin C, Henselman L, Henry JA Need for mental health providers in progressive tinnitus management: A gap in clinical care. Federal Practitioner 2017 34 5 6
                                31. Pyykko I, Manchaiah V, Kentala E, Levo H, Juhola M Internet-based self-help for ménière's disease: Details and outcome of a single-group open trial Am J Audiol 2017 26 4 496–506
                                32. Brodie A, Smith B, Ray J The impact of rehabilitation on quality of life after hearing loss: A systematic review European Archives of Oto-Rhino-Laryngology 2018 275 10 2435–2440
                                33. O'Donoghue GM, Tucci DL, Wilson BS The mounting burden of hearing loss worldwide: Gearing up global collaboration ENT & Audiology News 2017 26 65–66
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