Developing Tools and a Care Path for Somatosensory Tinnitus

开发体感耳鸣的工具和护理路径

• 批准号: 10538961
• 负责人: Sarah Theodoroff
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-10-01 至 2026-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10538961
• 关键词: Address; American Physical Therapy Association; Area; Articular Range of Motion; Attention; Audiology; Auditory Perception; Awareness; Belief; Biomechanics; Caring; Cervical; Cervical spine; Characteristics; Clinic; Clinical; Clinical Practice Guideline; Clinical Trials; Communication; Data; Development; Diagnosis; Diagnostic tests; Discipline; Disease; Distress; Effectiveness; Evaluation; Eye Movements; Financial compensation; Flexor; Future; Goals; Gold; Guidelines; Head and neck structure; Health Personnel; Healthcare Systems; Hearing; Injury; Jaw; Knowledge; Location; Loudness; Movement; Muscle; Muscle Contraction; Musculoskeletal; Neck; Outcomes Research; Pathway interactions; Patient Care; Patient Self-Report; Patients; Perception; Phase; Physical therapy; Pilot Projects; Prevalence; Primary Health Care; Procedures; Protocols documentation; Randomized Clinical Trials; Recording of previous events; Rehabilitation therapy; Reporting; Research; Screening procedure; Sensitivity and Specificity; Sensorineural Hearing Loss; Series; Services; Standardization; Stimulus; Suggestion; Techniques; Temporomandibular Joint Dysfunction Syndrome; Testing; Tinnitus; Traction; Treatment Effectiveness; Uncertainty; Veterans; Work; arm; associated symptom; base; clinical care; clinical decision-making; clinical examination; clinical practice; comorbidity; diagnostic accuracy; diagnostic screening; disability; efficacy evaluation; evidence base; individualized medicine; instrument; jaw movement; military veteran; patient oriented; physical therapist; programs; response; screening; somatosensory; standard of care; tool; trial comparing

Somatosensory tinnitus is suspected when perceptual characteristics (e.g., pitch and loudness) change immediately following head and neck maneuvers, forceful muscle contractions, or eye or jaw movements. Prevalence estimates vary, with reports as high as 80% of tinnitus patients being able to modulate their tinnitus by manipulating somatic regions of the head, neck, and jaw (Ralli et al, 2017), suggesting somatosensory tinnitus to be common, yet research related to this type of tinnitus in Veterans has received minimal attention. Veterans whose tinnitus is influenced by somatic movements suggests the possibility of an underlying biomechanical deficit that is being overlooked, which if treated, has the potential to alleviate the tinnitus symptoms associated with the musculoskeletal problem and help them regain normal functioning. The proposed research is taking the next step in achieving our long-term goal to develop a framework that can diagnose, assess, and treat Veterans with somatosensory tinnitus. The plan for this avenue of research is to build-on the important knowledge gained from the pilot phase of this work and accomplish the following objectives: (1) create a diagnostic screening test with good sensitivity and specificity to identify ST; (2) develop evidence-based clinical procedures for physical therapists to assess and treat ST; and (3) perform a randomized clinical trial comparing the newly developed treatment for ST with audiology-based standard of care. The first year of the project will focus on creating two “short forms” (i.e., diagnostic tests) that will be compared with the clinical exam currently used to diagnose somatosensory tinnitus to develop a test instrument with good sensitivity and specificity, i.e., good diagnostic accuracy, to identify somatosensory tinnitus. Additionally, work to be done during Year 1 involves adapting the standardized biomechanical physical evaluation consistent with the American Physical Therapy Association clinical practice guidelines to include procedures that capture changes in tinnitus perception and develop an 8-week individualized physiotherapy program that will be used in the clinical trial portion of this research. In Years 2-4, we will conduct a longitudinal three-parallel arm randomized clinical trial on 72 subjects to evaluate the relative efficacy of individualized physiotherapy and audiology-based standard of care, alone, or in combination, for reducing tinnitus loudness and distress. This avenue of research is taking the necessary steps to provide an evidence-based approach to direct clinical decision-making for Veterans with tinnitus. Knowledge learned will be disseminated to healthcare providers in multiple disciplines (e.g., audiology, physical therapy, primary care, etc.) to dispel the belief that “nothing can be done” and raise awareness regarding how best to assess and treat Veterans with tinnitus, ultimately enhancing the delivery and effectiveness of patient care. The long-term goal of this avenue of research is to apply principles of individualized medicine to develop a Veteran-centric care pathway integrating audiology and physical therapy in the assessment and treatment of somatosensory tinnitus. Outcomes of this research will guide the development of a clinical care pathway to meet the rehabilitative needs of Veterans in a way that currently is unmet and provide clinicians patient-centered tools along with a viable treatment option for somatosensory tinnitus.

当知觉特征（例如音调和响度）发生变化时，应怀疑体感耳鸣 头部和颈部动作、肌肉强力收缩或眼睛或下巴运动后立即进行。 患病率估计各不相同，据报道高达 80% 的耳鸣患者能够调节耳鸣 通过操纵头部、颈部和下巴的躯体区域（Ralli et al, 2017），表明体感 耳鸣很常见，但与退伍军人中此类耳鸣相关的研究却很少受到关注。 耳鸣受躯体运动影响的退伍军人表明，可能存在潜在的潜在问题 被忽视的生物力学缺陷，如果得到治疗，有可能减轻耳鸣 与肌肉骨骼问题相关的症状并帮助他们恢复正常功能。 拟议的研究正在朝着实现我们的长期目标迈出下一步，即开发一个框架，该框架可以 诊断、评估和治疗患有体感耳鸣的退伍军人。这一研究途径的计划是 以从这项工作的试点阶段获得的重要知识为基础，并完成以下任务 目标：（1）创建一种具有良好敏感性和特异性的诊断筛查测试来识别 ST； (2) 开发 物理治疗师评估和治疗 ST 的循证临床程序； (3) 执行 随机临床试验将新开发的 ST 治疗方法与基于听力学的标准进行比较 关心。 该项目的第一年将重点创建两种“简短形式”（即诊断测试），以进行比较 针对目前用于诊断体感耳鸣的临床检查，开发出具有良好效果的测试仪器 识别体感耳鸣的敏感性和特异性，即良好的诊断准确性。另外，工作 第一年要做的工作包括调整标准化生物力学物理评估，使其与 美国物理治疗协会临床实践指南包括以下程序： 耳鸣感知的变化并制定将使用的为期 8 周的个性化物理治疗计划 在本研究的临床试验部分。在第2-4年，我们将进行纵向三平行臂 对 72 名受试者进行的随机临床试验，评估个体化物理治疗和治疗的相对疗效 基于听力学的护理标准，单独或组合，用于减少耳鸣响度和痛苦。 这一研究途径正在采取必要的步骤来提供基于证据的方法来指导临床 患有耳鸣的退伍军人的决策。所学到的知识将传播给以下地区的医疗保健提供者 多学科（例如听力学、物理治疗、初级保健等）来消除“没有什么可以 完成”并提高人们对如何最好地评估和治疗耳鸣退伍军人的认识 提高患者护理的提供和有效性。这一研究途径的长期目标是 应用个体化医学原则，开发以退伍军人为中心的护理途径，将听力学和 物理疗法在体感耳鸣的评估和治疗中的应用。这项研究的成果将 指导临床护理途径的发展，以满足退伍军人的康复需求 目前尚未得到满足，并为临床医生提供以患者为中心的工具以及可行的治疗选择 体感耳鸣。