FS303 - James Jerger Career Award Honoree: Tinnitus, Hyperacusis, Misophonia: Where Are We Now?

Abstract: Since the 1970s research and treatment of tinnitus and Decreased Sound Tolerance (DST, i.e., hyperacusis and misophonia) have improved significantly. Nevertheless, a number of issues hinder future progress. There is no generally agreed-upon standard for evaluation and management of tinnitus and DST in clinical practice. Despite numerous proposed therapies, clinical trials for tinnitus and DST lag behind those for other chronic conditions.
Even with the consensus of tinnitus as a phantom auditory perception, there are still differences in opinion regarding its definition, and even larger differences regarding definition of DST, particularly misophonia.
Despite the well-recognized frequent co-occurrence of tinnitus, DST, and hearing loss, the interrelationship and mutual influence of these conditions are typically not accounted for in studies investigating the mechanisms of tinnitus and DST and in clinical trials. In clinical studies there is a lack of consensus regarding the recruiting and inclusion / exclusion criteria of subjects’ selection.
The lack of consensus on which profession is best equipped to treat tinnitus, and DST often results in the recommendation of a multi-disciplinary "umbrella approach" for evaluation and treatment. This presentation will argue why this strategy may not be optimal in real-world clinical settings, and why audiologists are the professionals best suited for the diagnosis and management of tinnitus and DST.

Summary: Since 1970s research and treatment of tinnitus and Decreased Sound Tolerance (DST, i.e., hyperacusis and misophonia) have improved significantly. The number of papers has increased dramatically, and more stringent criteria are used in publications. Notably, organizations devoted to promoting knowledge about tinnitus and DST for general population and professionals have been created and made significant impact on the field. Last but not least financial support for basic and clinical research promoting development of clinical innovations has increased substantially.

Nevertheless, a number of issues hinder future progress causing that tinnitus is still a significant problem negatively interfering with the daily lives of a considerable proportion of the general population. Situation is even less satisfying for DST. There is no generally agreed-upon standard for methods used for evaluation and for management of tinnitus and DST in clinical practice. Even though there is a proliferation of various approaches, the number of clinical trials for tinnitus is well behind that of other chronic conditions, hindering progress in development of effective treatment methods and creating uncertainty which of many promoted procedures is indeed effective.

Even with the consensus of tinnitus as a phantom auditory perception, there are differences in opinion regarding its definition and there are considerable differences regarding definitions of DST, particularly misophonia. There is no agreement about how neuronal activity perceived as tinnitus looks like, and how to unequivocally determine tinnitus severity. While other auditory problems (hyperacusis, misophonia, hearing loss, tensor tympani syndrome), which frequently coexist with tinnitus are fully recognized, however there is a lack of agreement on how to eliminate impact of these problems in studies on the mechanisms of tinnitus and DST. In clinical studies there is a lack of consensus regarding the inclusion / exclusion criteria of subjects. In basic research, there are animal models allowing evaluation of tinnitus perception but not assessing tinnitus severity.

Artificial Intelligence (AI) has just started to be utilized in the tinnitus and DST fields, but its potential is not fully explored. The Oregon Tinnitus Data Archive, published in 2016, was the first starting point, and now Tinnitus Research Initiative (TRI), has created a platform for the international collaboration of and the basis for vigorous use of AI to investigate a variety of topics in the tinnitus and DST fields.

The lack of agreement on which profession is best equipped to treat patients with tinnitus and DST often results in the recommendation of a multi-disciplinary "umbrella approach" for evaluation and treatment. This presentation will argue why this team-based strategy may not be optimal in real-world clinical settings, and why audiologists are the professionals best suited for the diagnosis and management of tinnitus and DST.

All these issues significantly impact on tinnitus and DST research, and clinical management will be briefly addressed in this presentation.

Assumptions: Basic knowledge about tinnitus, hyperacusis, misophonia

Brief Summary of Clinical Takeaways: Knowing the current status in treatments of tinnitus and DST, as well as areas of limitations requiring attention and future improvement.