Teleaudiology has been widely used across the services and in the management of people with tinnitus.1-4 Amid the COVID-19 pandemic, telehealth services have seen a sharp increase across health professions as a way of minimizing the risk of infection.5-7 Audiologist-delivered cognitive-behavioral therapy (CBT) is a key intervention for patients with tinnitus.8-12 A recent study shows that although CBT delivered via telehealth is found to be acceptable to most patients, one in five patients prefers face-to-face appointments.13 Research has shown that patients who declined the telehealth option tended to have worse hearing in their better ear,13 probably because understanding speech over the internet can be considerably difficult for people with hearing loss. The use of complementary internet-based programs, which may include educational videos or other visual aids, can provide a greater incentive for patients with tinnitus to utilize telehealth options.3,4
The internet-based cognitive behavioral therapy for tinnitus (iCBT for Tinnitus; www.icbt4tinnitus.com) is designed to help those with bothersome tinnitus manage tinnitus-related distress using CBT techniques.14 Composed of seven online modules (Table 1), iCBT for Tinnitus can be offered by audiologists as a complementary intervention to their services for tinnitus patients or as a standalone treatment if no other intervention is needed. In this study, we evaluate the views of health care professionals on the clinical implementation of iCBT for tinnitus.
Forty-one health care professionals who attended a workshop about iCBT for Tinnitus were asked to take part in a survey study. Seventy percent of participants were audiologists, 10 percent were otolaryngologists, seven percent were mental health professionals, and the remaining 13 percent were other health care professionals. The survey consisted of two questions:
- How likely are you to use this iCBT for Tinnitus program as a complementary intervention to the services you provide for tinnitus patients?
- How likely are you to use this iCBT for Tinnitus program as a standalone intervention for your tinnitus patients?
The response choices for both questions were “Extremely likely,” “Likely,” “Neither likely nor unlikely,” “Unlikely,” “Extremely unlikely,” and “I don't know.”
To calculate a score for each question, the response choices were given points from 5 points for “Extremely likely” to 1 point for “Extremely unlikely.” Participants who chose “I don't know” were not included in the analysis. The data were anonymous. Descriptive statistics, medians of the scores for each question, and SDs are reported in the results section. Wilcoxon matched-pairs signed-ranks tests were used to compare participants’ responses between the two questions. The p-value required for statistical significance was set at p <0.05. The Stata program (version 13) was used for statistical analyses.
RESULTS AND DISCUSSIONS
For the question “How likely are you to use this iCBT for Tinnitus program as a complementary intervention to the services you provide for tinnitus patients?” the median response was 5/5 (SD = 0.75), and 87 percent of respondents chose “Extremely likely” or “Likely.” For the question “How likely are you to use this iCBT for Tinnitus program as a standalone intervention for your tinnitus patients?” the median response was 4/5 (SD = 1.3), and only 56.4 percent of respondents chose “Extremely likely” or “Likely.” The difference in the participants’ responses between questions 1 and 2 was statistically significant (p = 0.004). In other words, the healthcare professionals who took part in this survey were more likely to use iCBT as a complementary intervention than as a standalone intervention. Spearman correlations did not show any significant relationship between the participants’ responses and their profession (i.e., audiologist, otolaryngologist, mental health professionals, others), p > 0.05.
To sum up, 87 percent of health care professionals who took part in this survey said that it is “Extremely likely” or “Likely” to use iCBT in addition to other services that they provide for tinnitus patients, and 56 percent said that it is “Extremely likely” or “Likely” to suggest iCBT to their patients as a standalone treatment.