Ecological Momentary Assessment in Hearing Disorders

描述（由申请人提供）：美国中年人最常见的两种听觉障碍是听力损失和耳鸣。大约32%的55岁或以上的人自我报告有听力损失，大约8%的成年人目前报告说他们每天或一直都有耳鸣或嗡嗡声。最近的数据表明，在美国，听力损失和耳鸣的年龄调整患病率可能正在增加。然而，只有相对较小比例的成年人会寻求耳鸣或听力损失的治疗。事实上，目前只有大约25%的成人听力损失患者使用助听器，一些数据显示，只有大约37%的成年人说他们经常耳鸣，他们向医疗保健专业人员报告了这种情况。使用标准问卷调查方法的研究表明，听力损失和耳鸣的患者报告说，他们的问题和痛苦往往是间歇性的和情境性的。几十年的认知心理学研究表明，在人们回忆和报告健康问题和症状的方式中，存在已知和可预测的偏见，特别是那些可能在严重程度上起起落落或在特定情况下更频繁发生的偏见。为了提供与健康问题相关的日常生活经历的更敏感的测量方法，各个领域的临床研究人员转向了一种被称为生态瞬时评估（EMA）的技术。本质上，标准的个人数字助理（PDA）被编程为在预设、随机或参与者选择的时间点用声音或振动警报向患者/参与者发出信号。此警报作为提示，使用PDA手写笔和触摸屏提供一系列评估。通过要求个人提供症状、痛苦和接近发生时间的情况的报告，可以大大减少回忆和报告的偏差，并可以检查症状或痛苦的日变化或其他形式的时间变化。该项目的目标是进行试点研究，检查EMA方法在听力损失和耳鸣中的应用。在研究1中，我们将检查24名研究参与者在接受技术更先进的新型助听器之前和之后的一周内听力困难和痛苦的时间和情境评级。在研究2中，我们将对24名先前报告过严重耳鸣的研究参与者进行为期2周的耳鸣严重程度和痛苦评分的情境和时间变化研究。在这两项研究中，用EMA方法获得的数据将与标准临床评估工具进行比较。这两项研究的发现和方法将指导未来使用EMA技术的临床研究。此外，随着便携式计算设备和听力辅助设备的技术融合，这些试点研究可以作为未来研究项目的基础，将听力测量和基于问卷的数据流整合到现实生活的日常环境中。

DESCRIPTION (provided by applicant): The two most common auditory disorders among middle-aged Americans are hearing loss and tinnitus. Approximately 32% of those 55 years of age or older have self-reported hearing loss and about 8% of all adults currently report that they experience a ringing or buzzing in the ears daily or all of the time. Recent data indicate that the age-adjusted prevalence of both hearing loss and tinnitus may be increasing in the United States. However, only a relatively small proportion of adults with either condition will seek treatment for tinnitus or hearing loss. Indeed, only about 25% of those with adult-onset hearing loss currently use hearing aids and some data have shown that only about 37% of adults who say that they have constant ringing in the ears have reported this condition to a health care professional. Studies utilizing standard questionnaire methods have shown that those suffering from both hearing loss and tinnitus report that their problems and distress are often episodic and situational. Several decades of research in cognitive psychology have shown that there are known and predictable biases in the way people recollect and report health problems and symptoms, particularly those that may wax and wane in severity or occur more frequently in specific situations. In an effort to provide a more sensitive measure of the day-to-day real-life experiences associated with health problems, clinical researchers in a variety of fields have turned to a technique known as ecological momentary assessment or EMA. In essence, a standard Personal Digital Assistant (PDA) is programmed to signal a patient/participant with an audible or vibratory alert at either preset, random, or participant-chosen time points. This alert serves as a prompt to provide a series of assessments using a PDA stylus and touch screen. By asking individuals to provide reports of symptoms, distress, and situations close to the time of occurrence, recall and report biases may be substantially reduced and diurnal or other forms of temporal variation in symptoms or distress may be examined. It is the objective of the project to conduct pilot studies examining the applications of EMA methods to both hearing loss and tinnitus. In Study 1, we will examine temporal and situational ratings of hearing difficulty and distress for a 1-week period before and after 24 research participants have received a new and more technologically advanced hearing aid. In Study 2, we will examine situational and temporal variation in ratings of tinnitus severity and distress for a 2-week period in 24 research participants who have previously reported experiencing severe tinnitus. In both studies, data obtained with EMA methods will be compared to standard clinical assessment tools. The findings and methods developed in these two studies will guide future clinical research using EMA technologies. Further, as the technologies underlying portable computing devices and hearing assistive devices converge, these pilot studies may serve as the foundation for a future program of research integrating both audiometric and questionnaire-based data streams in real-life day-to-day settings. Public Health Relevance Paragraph: Although hearing loss and tinnitus are the two most common hearing problems among middle-aged and older Americans, most of those who experience these disorders do not seek treatment. The objective of this investigation is to use a PDA-based technology to study the effect of hearing loss and tinnitus on people as they go about their daily activities. It is our hope that this pilot project will provide the basis for future clinical research examining the real-time real-world impact of auditory disorders on everyday life.