New reading Part A TIME LIMIT 15 MINUTES

x Read the following reading material about a study conducted amongst

people in Denmark suffering from Tinnitus

x You only have 15 minutes to scan and fill in the synthesizing exercise (last
page) – so only skim and scan read the reading material – do not spend a lot
of time reading it in depth

x In the exercise on the last page – fill in the missing word (or words) – then
check your answers (last page).

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Reading material No1
Effectiveness of a tinnitus management programme:
a 2-year follow-up study
Claire Gudex, Preben H Skellgaard , Torben West and Jan Sørensen
1
CAST – Centre for Applied Health Services Research and Technology Assessment, University of Southern
2
Denmark, Odense, Denmark; Centre for Help Aids and Communication, Aabenraa, Denmark, BMC Ear, Nose
and Throat Disorders 2009, 9:6doi:10.1186/1472-6815-9-6. The electronic version of this article is the complete
one and can be found online at: http://www.biomedcentral.com/1472-6815/9/6 © 2009 Gudex et al; licensee
BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution,
and reproduction in any medium, provided the original work is properly cited.

Reason for the study

The prevalence of tinnitus in the general population appears to be 8–15% and it is

suggested that 0.5–1% of the population has tinnitus to such a degree that their
possibility of leading a normal life is affected.

While no effective medical or surgical treatment has yet been found for tinnitus,
approaches that offer counselling may be more promising .

An intervention combining counselling and hearing devices is offered to clients

referred to the Centre for Help Aids and Communication (CHC) in southern
Denmark.

The aims of this exploratory study were to examine

i) the characteristics of CHC's clients and their tinnitus,
ii) the effectiveness of the treatment, and
iii) whether particular client groups benefit more than others.

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 Reading material No 2 - Client sample

Between 1st November 2005 and 30th October 2006, 130 clients were referred to CHC for the
treatment of tinnitus. Four clients declined to participate in the study and of the rest, 122
and 102 completed the second and third questionnaires, respectively.

There were no significant differences in socio-demographic or tinnitus variables between

these 100 clients and the 126 clients who completed the first questionnaire (Table 1).

Table 1

Characteristics of participants in the tinnitus study

Completed first Completed both
questionnaire questionnaires
( n = 126) ( n = 100)

% Men/women 67/33 65/35

Mean age (SD) 5 5 ± 1 1 y rs 5 6 ± 1 1 y rs
Range (28–79) (28–79)
Mean duration of tinnitus
≤ 1 yr 19% 20%
2–10 yrs 42% 43%
> 1 0 y rs 39% 36%
Likely aetiology
Noise at work a 69% 64%
Stress 30% 31%
b
Sudden loud noise 25% 23%
Cervical spine problems 14% 15%
c
Other 41% 38%
Sound intolerance
Client self-report 53% 54%
UCL 105–110 bilaterally 19% 14%
UCL 75–100 73% 77%
UCL ≤70 uni/bilaterally 8% 9%

a
Clients included machine workers, plane mechanics, truck drivers, teachers, musicians, bell ringer.
b
E.g. rifle fire, fireworks.
c
Included middle ear disease, whiplash, noise during leisure activities, back/neck/head injury.

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Reading material No 3 - About Table 1.

Characteristics of participants in the tinnitus study.

Most clients (85%) were referrals from ENT specialists and 15% from the regional
audiology clinic.

Half were in active employment;

of the 77 clients under 65 years, 33% were on sickness benefit or had taken early
retirement.

Noise at work was the likely cause of tinnitus for many clients;

33% were employed in the industrial/tradesman sector.

Tinnitus had developed gradually in 73% of clients and had been present for over 10
years in 36%.

One-third of clients reported that tinnitus was a constant problem; the others
experienced most problems when falling asleep or during the night.

Most clients had evidence of sound intolerance and 70% had self-reported hearing
loss in one or both ears.

While only 5% used a hearing aid, many had tried a range of strategies, the most
common being listening to music, going for a walk and other exercise, use of hearing
earmuffs or ear plugs, but also acupuncture, chiropractor, massage and other forms
of naturopathy.

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Reading material No4

Table 2
Main components of CHC's tinnitus management programme (n = 100 clients)
CHC's intervention: advice and devices
Take more care of oneself/lower expectations to oneself 21%
Relaxation strategies 18%
Changes in work or general activity levels 13%
Trial of bedside masker/hearing protector 11%
Trial of hearing aid 94%
1
Other 30%
Clients' own interventions over 1–2 years:
Tried to be less stressed in daily life 48%
Tried to take more care of oneself 52%
A healthier lifestyle 49%
More stress-reducing activities 39%
2
Other 9%

1
E.g. radio as background noise, cognitive therapy, referral to general practitioner for
further investigation, massage, chiropractor, alteration in mode of communication at home,
greater use of the bedside masker that the client already had at home.
2
Extra written comments from clients: e.g. avoidance of noise, use of hearing aid/hearing
protector, weight loss, try to forget the tinnitus.

In Table 2, a range of issues and strategies were discussed during the client
consultations, which had a mean duration of 107 ± 20 minutes (range 60–150
minutes).

Recurring themes were lowering expectations to oneself, relaxation strategies,

greater use of devices such as bedside maskers (which many clients already had at
home) and custom-made hearing protectors.

Nearly all clients (including some without self-reported hearing loss) were offered
either a unilateral hearing aid or bilateral hearing aids to help mask the tinnitus.

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Reading material No 5 - Conclusion

The tinnitus management programme appeared to provide significant benefit to

many of its client at a relatively low cost. It would be useful to conduct a randomised
controlled study comparing the current programme with alternative forms of
combination counselling/sound therapy approaches. The heterogeneity of tinnitus
clients with respect to cause, duration and severity of tinnitus, and presumably
psychological and attitudinal differences, means that careful consideration would
need to be given to sample size and selection and choice of control group.

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Synthesizing exercise

A study on managing Tinnitus was done in _________ 1

2
where it was found that __________ of the population had 1
some degree of Tinnitus. The CHC conducted this study to 2
examine the peculiarities and extent of the Tinnitus in their 3
3
clients, the __________ of treatment and if some client 4
groups ____________ 4 more than others. The client sample 5
included teachers, musicians and even a _______ ________ 5 .
6
7
The majority of participants had been suffering Tinnitus for 2 to 10
8
years: 52 who had completed the first questioninaire and ______ 6
9
who had completed both questionnaires. Referrals to the study
10
from Ear, Nose & Throat specialists accounted for _______ 7 with 11
8
only 15% from the __________ ___________ _________ . The CHC 12
9
study of ________ people found that 94% had trialled a __________ 13
__________ 10
but only 52% had made an effort to take ___________ 14
__________ 11 of themselves. Other approaches taken by sufferers 15
16
in trying to find some answers by themselves were: having less stress
17
in their daily life (48%); adopting a healther lifestyle ( _____ ) 12 and
18
39% got involved in ___________ ____________ ____________ 13
19
activities. Only 9% ticked “other” methods such as avoidance of 20
14 15
____________, weight loss, or simply try to ___________ the 21
tinnitus. 22
The results between the group who completed the first questionnaire
and the group that completed both questionnaires – is surprisingly
similar. ________ at _________16 was felt to be the cause for 69%
cf. 64% of respondents (first and second group respectively), with
other reasons being cited such as stress (30% / 31%); __________
__________ __________ 17 (25% / 23%) such as rifle fire
or___________ 18 and ____________ 19
spine problems (14% / 15%).
The researchers concluded that due to its very nature, future studies
about cause, duration and ____________20 of Tinnitus requires
careful planning with regard to _________21 size and ___________ 22 of
control group.

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ANSWER KEY - A STUDY ON PEOPLE WITH TINNITUS -
SYNTHESIZING EXERCISE

Q1 DENMARK
Q2 8% TO 15%
Q3 EFFECTIVENESS

Q4 BENEFIT

Q5 BELL RINGER

Q6 43
Q7 85%
Q8 REGIONAL AUDIOLOGY CLINIC

Q9 100
Q1 0 HEARING AID

Q1 1 MORE CARE

Q1 2 49%
Q1 3 MORE STRESS REDUCING

Q1 4 NOISE

Q1 5 FORGET

Q1 6 NOISE AT WORK

Q1 7 SUDDEN LOUD NOISE

Q1 8 FIREWORKS

Q1 9 CERVICAL

Q2 0 SEVERITY

Q2 1 SAMPLE

Q2 2 CH O I CE

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