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Clinical management of tinnitus remains challenging due to unclear etiology and diverse phenotypic manifestations. To quantify its associated burden, a variety of patient-reported outcome measures (PROMs) are used. This study aims to comprehensively evaluate the content overlap of items between eight PROMs commonly used in tinnitus research. A two-stage, blinded multi-rater process was used to analyze the content of all 199 items from the International Tinnitus Inventory (ITI), Subjective Tinnitus Severity Scale (STSS), Tinnitus Functional Index (TFI), Tinnitus Handicap Inventory (THI), Tinnitus Handicap Questionnaire (THQ), Tinnitus Primary Function Questionnaire (TPFQ), Tinnitus Questionnaire (TQ), and Tinnitus Reaction Questionnaire (TRQ). The Jaccard Index was used to measure pairwise content overlap between scales. The analysis revealed 83 distinct symptoms. \"Concentration\" was the most frequently captured symptom (in seven scales), whereas 41 symptoms (49.4%) were unique to one scale. The TQ exhibited the highest number of unique symptoms (52.5%), while the THI had the least (4%). The Jaccard Index identified very weak/weak scale overlap between the PROMs. The highest overlap was observed between TFI and THI (0.35). The TFI had the highest mean overlap (0.26), coming closest to the content measured by all other PROMs. The results demonstrate high heterogeneity and limited content overlap among tinnitus burden PROMs, similar to other conditions. The findings suggest that tinnitus burden is not measured as a unified construct across questionnaires, thus, researchers and clinicians should carefully consider the specific symptoms measured when selecting instruments for treatment evaluation and comparison.

Over the past few years extensive body of research was produced investigating the effects of repetitive transcranial magnetic stimulation (rTMS) for the treatment of chronic tinnitus with heterogeneous results. This heterogeneity is exemplified by two recently published large-scale clinical trials reporting different outcomes. Technical aspects of rTMS were suspected as a potential source for this incongruency. The aim of this systematic review is to examine the overall efficacy as well as to identify possible technical factors relevant for the effectiveness of rTMS tinnitus trials. Via a literature search appropriate original research papers were identified and rTMS parameters were extracted from each study arm for subsequent statistical analysis with respect to observed effects (significant vs. not significant pre-post rTMS effects). Our findings indicate that verum rTMS is superior to sham rTMS as demonstrated by the proportion of significant pre-post contrasts. Some relevant rTMS parameters (e.g., pulse waveform) are not reported. Lower rTMS stimulation intensity was associated with significant effects in verum rTMS arms. An additional stimulation of the DLPFC to the temporal cortex was not found to promote efficacy. Future research should consider differential effects of rTMS induced by technical parameters and strive for an exhaustive reporting of relevant rTMS parameters.

Optimization of dietary intake is an essential component in the multidimensional effort to prevent and manage chronic disease. Recently, demand has increased for nutrition-focused management strategies for chronic tinnitus. The primary aim of this study was to evaluate 10 dietary items for their association with changes in subjective tinnitus severity. A secondary aim was to develop an algorithm to better identify those individuals who might benefit from dietary modification strategies. A total of 5017 anonymous users of the TinnitusTalk forum completed an online survey regarding how various dietary items affected the severity of their tinnitus. Results suggest that, while intake of caffeine [positive effect (PE): 0.4%; negative effect (NE): 16.2%], alcohol (PE: 2.7%; NE: 13.3%, and salt (PE: 0.1%; NE: 9.9%) was most likely to influence tinnitus severity, it did so only for a small proportion of participants and reported effects were most commonly mild. Further, though a classification algorithm was able to leverage participant demographic, comorbidity, and tinnitus characteristics to identify those individuals most likely to benefit from dietary modification above chance levels, further efforts are required to achieve significant clinical utility. Taken together, these results do not support dietary modification as a primary treatment strategy for chronic tinnitus in the general population, though clinically meaningful effects might be observable in certain individuals.

The influence of naps on tinnitus was systematically assessed by exploring the frequency, clinical and demographic characteristics of this phenomenon. 9,724 data from two different tinnitus databases (Tinnitus Hub: n = 6115; Tinnitus Research Initiative (TRI): n = 3627) were included. After separate analysis of the databases, these results were then compared with each other. In the Tinnitus Hub survey database, a total of 31.1% reported an influence on tinnitus by taking a nap (26.9% in the TRI database), with much more frequent worsening after a nap than improvement (23.0% a little or a lot worse; TRI: 17.7% worse; 8.1% a little or a lot better; TRI: 9.2% better). The influence of napping on tinnitus was associated in both databases with other clinical features, such as the dependence of tinnitus on night quality, stress and somatosensory maneuvers. The present study confirms the clinical observation that more tinnitus sufferers report worsening after a nap than tinnitus sufferers reporting an improvement. It was consistently shown that tinnitus sufferers reporting nap-induced modulation of tinnitus also report more frequently an influence of night sleep on their tinnitus. Further clinical and polysomnographic research is warranted to better understand the interaction between sleep and tinnitus.

Education 4.0 is a new educational paradigm that intends to address the needs and potentialities of the fourth industrial revolution. Education 4.0 builds on the concept of learning by doing, in which students are encouraged to learn and discover different things in singular ways based on experimentation. This study intends to analyze the role of emerging technologies like serious games and industry 4.0 in the transformation of education 4.0 in higher education. A qualitative methodology was employed based on 25 case studies of innovative projects in Portuguese higher education institutions. The results indicate a residual adoption of serious games and gamification approaches only appear in less than 20% of the projects. It was also possible to identify that most projects involve several stakeholders such as teachers, students and university managers, and typically involve multidisciplinary competencies fields. The main benefits brought to the education context include greater involvement of students in projects, development of their skills and its application in a real context. On the other hand, the main challenges are the simplification of the real world made by these applications, the difficulties inherent to their inclusion in the didactical system and the limited capacities to offer greater interactivity without predefined external stimuli.

The recording of Ecological Momentary Assessments (EMA) can assist people with chronic diseases in monitoring their health state. However, many users quickly lose interest in their respective EMA platforms. Therefore, we studied the adherence of users of the mHealth app T rack Y our T innitus (TYT). The app is used to record EMA in people with tinnitus. 1292 users, who interacted with the app between April 2014 and February 2017, were analyzed in this work. We defined “adherence” based on the dimensions of interaction duration and interaction continuity. We propose methods that are able to predict the (dis)continuation of interaction with the app and identify user segments that are characterized by similar patterns of adherence. For the prediction task we used the data of the questionnaires MiniTF and TSCHQ, which are filled in when the users enter TYT for the first time. Additionally, time series of the eight items of the daily EMA questionnaire were used. The distribution of user activity pertaining to the adherence dimension of interaction duration revealed a very skewed distribution, with most users giving up after only 1 day of interaction. However, many users returned after interrupting for some time. Some of the MiniTF items indicated that the worries of users might have lead to an increased likelihood of returning back to the app. The MiniTF score itself was not predictive, though. The answers to the TSCHQ items, in turn, pointed to user strata (more than 65 years of age at registration), which tended towards higher interaction continuity. As the registration questionnaires predicted adherence only to a limited extent, it is promising to study the activities of the users in the very first days of interaction more deeply. It turned out in this context that the effects of interaction stimulants like personalized and non-personalized tips, pointers to information sources, and mechanisms used in online treatments for tinnitus (e.g., in iCBT) should be further investigated.

Background: Chronic bothersome tinnitus is a prevalent tinnitus subtype placing a high burden on affected individuals, economies, and healthcare systems. Patient and professional perspectives seem to be partly misaligned on how to improve tinnitus research and treatments in the future. This qualitative interview study was aimed at exploring, comparing, and stipulating the perspectives of different tinnitus stakeholder groups on ways of redirecting research and treatments to reduce patients’ suffering while accounting for challenges within these practices. Methods: This study used the participatory action research approach to facilitate the stakeholder involvement. Semi-structured online interviews including five participants (two tinnitus patients, two tinnitus researchers and medical specialists, one general practitioner) were conducted. Inductive grounded theory and the constant comparative method were used for data analysis. Results: Four categories for suggested research adaptations ((I) ethical patient involvement; (II) prioritising cure versus coping research; (III) funding; (IV) ethical publication) and six categories for suggested treatment adaptations ((I) ethical professional support; (II) patient involvement; (III) interdisciplinarity; (IV) professional tinnitus education; (V) clinical treatment guidelines; (VI) psychological treatment) were identified. Participants held partly similar priorities such as increasing pathophysiological and cure research. Differences between participants included, for instance, patients aiming for increasing patient involvement in tinnitus research and treatments compared to professionals arguing that the excessive focus on patients’ conditions might reduce the patients’ chances of habituating to their symptoms. Conclusions: Four action redirections for improving tinnitus research and treatment practices were defined: (I) facilitating communication between and within stakeholder groups, (II) increasing the reflective use of patient involvement, (III) increasing interdisciplinarity, and (IV) reducing barriers to receiving psychological treatment.

PurposeWith the growing importance of performance measurement and management, this exploratory study intends to examine the practices of maintenance managers with regards to maintenance measures, as used in their organizations. In this process, the study attempts to uncover the relevant maintenance performance dimensions from the perspectives of the surveyed managers. In addition, the mediating effect of information availability on the main performance measures utilization is studied.Design/methodology/approachThe research at hand is survey-based. It utilizes the responses of a sample of ninety-five (95) experienced maintenance managers to identify the most relevant maintenance performance measures. Factor analysis is then utilized to uncover the important dimensions of performance, as seen by the respondents. Additionally, using the Partial Least Squares method, several models were studied.FindingsThe findings of this exploratory research appear to suggest that maintenance managers are beginning to broaden their perspective with regard to performance management. While machine and plant-related performance measures are still emphasized, maintenance managers are slowly moving toward a wider organizational orientation. While the manufacturing organizations are becoming more and more customer-oriented open systems, the maintenance function of these organizations is still, for the most part, operating under the semi-open system orientation. Overall, it appears that an emerging maintenance strategy is slowly taking shape.Research limitations/implicationsFor the most part, performance measures and measurement related to maintenance have not received enough attention from researchers. Therefore, the literature dealing with the different facets of performance in maintenance has not been forthcoming. The study attempts to fill this apparent gap in the literature. This is important, as maintenance managers are being asked to contribute to the achievement of the competitive strategies of their organizations. Therefore, they must quickly learn how to view maintenance from a coherent strategic organizational perspective. Such a perspective should help in integrating the maintenance, resources, capabilities, and technical know-how in order to serve the strategic goal of their organization. The research at hand is limited to a sample from Portugal. Therefore, the results and conclusions must be interpreted accordingly.Practical implicationsAs maintenance managers struggle to move from a machine-orientation to a more organizational-wide strategic orientation, they are often left with many questions and few answers. This study attempts to bring this problem to the spotlight so that it can receive more systematic empirical and practical research. In this context, the role of maintenance managers in the process of organizational strategy formulation should be examined.Originality/valueThe study presented in this article has practical, as well as theoretical contributions. It deals with an area of performance measurement, which so far has been relatively ignored. It uses a system orientation (closed vs open), in addition to the strategic orientation (single vs multi-faceted strategy) in order to shed some light on the need to have consistency between the nature of the system and its strategic objective.

Background: Tinnitus is a heterogeneous condition which may be associated with moderate to severe disability, but the reasons why only a subset of individuals is burdened by the condition are not fully clear. Ecological momentary assessment (EMA) allows a better understanding of tinnitus by capturing the fluctuations of tinnitus symptoms, such as distress and loudness, and psychological processes, such as emotional arousal, overall stress, mood, and concentration and how these variables interact over time. Whether any of those variables have an influence over the next day, that is, whether any of these variables are auto- or cross-correlated, is still unanswered. Objectives: Assess whether behavioral and symptom-related data from tinnitus users from the TrackYourTinnitus (TYT) mobile app have an impact on tinnitus loudness and distress on subsequent days Methods: Anonymized data was collected from 278 users of the iOS or Android TYT apps between 2014 and 2020. Tinnitus-related distress, tinnitus loudness, concentration level, mood, emotional arousal, and overall stress level were assessed using either a slider or the Wong-Baker Pain FACES scale via a daily survey. Three modelling strategies were used to investigate whether tinnitus loudness and distress are affected by previous days symptoms or psychological processes: auto- and cross correlations, regressions with elastic net regularization, and subgrouping within group iterative multiple model estimation (S-GIMME). Results: No autocorrelation or cross-correlation was observed at the group level between the variables assessed. However, application of the regression models with elastic net regularization identified individualized predictors of tinnitus loudness and distress for most participants, with the models including contemporaneous and lagged information from the previous day. S-GIMME corroborated these findings by identifying individualized predictors of tinnitus loudness and distress from the previous day. Discussion: We showed that tinnitus loudness and tinnitus distress are affected by the contemporaneous and lagged dynamics of behavioral and emotional processes measured through EMA. These effects were seen at the group, and individual levels. The relevance EMA and the implications of the insights derived from it for tinnitus care are discussed, especially considering current trends towards the individualization of tinnitus care.

In most tinnitus patients, tinnitus can be masked by external sounds. However, evidence for the efficacy of sound-based treatments is scarce. To elucidate the effect of sounds on tinnitus under real-world conditions, we collected data through the TrackYourTinnitus mobile platform over a ten-year period using Ecological Momentary Assessment and Mobile Crowdsensing. Using this dataset, we analyzed 67,442 samples from 572 users. Depending on the effect of environmental sounds on tinnitus, we identified three groups (T-, T+, T0) using Growth Mixture Modeling (GMM). Moreover, we compared these groups with respect to demographic, clinical, and user characteristics. We found that external sound reduces tinnitus (T-) in about 20% of users, increases tinnitus (T+) in about 5%, and leaves tinnitus unaffected (T0) in about 75%. The three groups differed significantly with respect to age and hearing problems, suggesting that the effect of sound on tinnitus is a relevant criterion for clinical subtyping.