RR&D Research Career Scientist Award Application

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Primary (sensorineural) tinnitus of at least 6 months duration is usually a permanent condition with no cure available. Veterans whose tinnitus is bothersome must rely on methods designed to reduce emotional and functional reactions to tinnitus. Dr. Henry's research activities are focused on producing evidence-based research supporting such methods, and disseminating these methods throughout VA as well as to non-VA national and international audiences. Over his 30-year VA research career, including 20 VA research grants, Dr. Henry has led a research team that has developed Progressive Tinnitus Management (PTM), a multi- disciplinary stepped-care method designed to be efficiently implemented in busy VA clinics. The five levels of care include Level 1 Referral, Level 2 Audiologic Evaluation, Level 3 Skills Education, Level 4 Interdisciplinary Evaluation, and Level 5 Individualized Support. Level 1 consists of referral guidelines for any provider encountering patients who complain of tinnitus. Level 2 involves audiologic testing, brief tinnitus assessment, hearing aids if needed, and brief tinnitus counseling. Dr. Henry's team has completed two randomized controlled trials (RCTs) to evaluate the use of hearing aids and combination instruments (hearing aid with built- in sound generator) for tinnitus management. These RCTs validated both types of ear-level devices as efficacious for tinnitus management—findings that were consistent with the only other comparable RCT and supporting PTM Level 2 Audiologic Evaluation as the gateway of any PTM program. Patients requiring tinnitus services beyond Level 2 are advised to attend Level 3 Skills Education, involving five sessions (individual or group) of educational counseling to learn self-care skills for bothersome tinnitus. Two of the sessions are conducted by an audiologist who teaches the principles of sound-based therapy, and three are taught by a mental health provider who administers components of Cognitive-Behavioral Therapy (CBT). In his recent VA- funded projects, Dr. Henry led a “clinically embedded” RCT at two VA medical centers—Memphis, Tennessee, and West Haven, Connecticut—revealing efficacy of PTM Level 3 Skills Education. He then led a second RCT, evaluating a telephone-administered version of Level 3 Skills Education (“Tele-PTM”), which demonstrated the efficacy of remote counseling for bothersome tinnitus. Combined, these four RCTs have provided an evidence base for providing effective clinical services for tinnitus, either in the clinic or via telehealth, which address the tinnitus needs for the great majority of Veterans suffering from this invisible condition. A very small number of patients require Level 4 and Level 5 services. Since 2009, the VA National Audiology and Speech Pathology (ASP) Service has endorsed PTM as the VA standard of care for tinnitus and, since this time, Dr. Henry and his team have conducted numerous trainings and provided individual consultation to hundreds of clinicians providing tinnitus services to Veterans. Dr. Henry is also leading a longitudinal epidemiology study This multi- site study includes the NCRAR (main site) and the DoD Hearing Center of Excellence in San Antonio, TX. To date, almost 500 Veterans and active Service Members have been enrolled. In addition to his research activities, Dr. Henry has been committed to the development of the next generation of tinnitus and rehabilitation researchers, supporting the training of pre- and postdoctoral fellows, VA career development award grantees, and clinician researchers as they develop independent lines of rehabilitation research. This mentorship has resulted in numerous co-authored scientific manuscripts and collaborative research grants among his trainees. Dr. Henry is recognized as an international expert in tinnitus rehabilitation research and development, whose expertise is sought for VA and NIH scientific review panels, national and international research collaborations and consultations, and training of the next generation of tinnitus clinicians and researchers. Most importantly, his ongoing contributions to the clinical management of tinnitus will continue to make a difference in Veterans' health and functioning for decades to come.