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: 10684763
• 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/10684763
• 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; Compensation; Data; Development; Diagnosis; Diagnostic tests; Discipline; Disease; Distress; Effectiveness; Evaluation; Eye Movements; Flexor; Future; Goals; Guidelines; Head; Head and neck structure; Health Personnel; Healthcare Systems; Hearing; Injury; Jaw; Knowledge; Learning; 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 Care; Procedures; Protocols documentation; Recording of previous events; Rehabilitation therapy; Reporting; Research; Screening procedure; Sensitivity and Specificity; Sensorineural Hearing Loss; Series; Services; Standardization; Stimulus; Techniques; Temporomandibular Joint Dysfunction Syndrome; Testing; Tinnitus; Traction; Treatment Effectiveness; Uncertainty; Veterans; Work; arm; associated symptom; 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; randomized, clinical trials; 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.

当感知特征（如音调和响度）发生变化时，怀疑是体感耳鸣