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      Validation of Online Versions of Tinnitus Questionnaires Translated into Swedish


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          Background: Due to the lack of objective measures for assessing tinnitus, its clinical evaluation largely relies on the use of questionnaires and psychoacoustic tests. A global assessment of tinnitus burden would largely benefit from holistic approaches that not only incorporate measures of tinnitus but also take into account associated fears, emotional aspects (stress, anxiety, and depression), and quality of life. In Sweden, only a few instruments are available for assessing tinnitus, and the existing tools lack validation. Therefore, we translated a set of questionnaires into Swedish and evaluated their reliability and validity in a group of tinnitus subjects.

          Methods: We translated the English versions of the Tinnitus Functional Index (TFI), the Fear of Tinnitus Questionnaire (FTQ), the Tinnitus Catastrophizing Scale (TCS), the Perceived Stress Questionnaire (PSQ-30), and the Tinnitus Sample Case History Questionnaire (TSCHQ) into Swedish. These translations were delivered via the internet with the already existing Swedish versions of the Tinnitus Handicap Inventory (THI), the Hospital Anxiety and Depression Scale (HADS), the Hyperacusis Questionnaire (HQ), and the World Health Organization Quality of Life questionnaire (WHOQoL-BREF). Psychometric properties were evaluated by means of internal consistency [Cronbach's alpha (α)] and test–retest reliability across a 9-week interval [Intraclass Correlation Coefficient (ICC), Cohen's kappa] in order to establish construct as well as clinical validity using a sample of 260 subjects from a population-based cohort.

          Results: Internal consistency was acceptable for all questionnaires (α > 0.7) with the exception of the “social relationships” subscale of the WHOQoL-BREF. Test–retest reliability was generally acceptable (ICC > 0.70, Cohens kappa > 0.60) for the tinnitus-related questionnaires, except for the TFI “sense of control” subscale and 15 items of the TSCHQ. Spearmen rank correlations showed that almost all questionnaires on tinnitus are significantly related, indicating that these questionnaires measure different aspects of the same construct. The data supported good clinical validity of the tinnitus-related questionnaires.

          Conclusion: Our results suggest that most Swedish adaptations of the questionnaires are suitable for clinical and research settings and should facilitate the assessment of treatment outcomes using a more holistic approach by including measures of tinnitus fears, emotional burden, and quality of life.

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          Most cited references 37

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          Development of the Tinnitus Handicap Inventory.

          To develop a self-report tinnitus handicap measure that is brief, easy to administer and interpret, broad in scope, and psychometrically robust. A standardization study of a self-report tinnitus handicap measure was conducted to determine its internal consistency reliability and convergent and construct validity. Audiology clinics in tertiary care centers in two sites. In the first investigation, 84 patients reporting tinnitus as their primary complaint or secondary to hearing loss completed the 45-item alpha version of the Tinnitus Handicap Inventory (THI). In the second investigation, 66 subjects also reporting tinnitus completed the 25-item beta version. Convergent validity was assessed using another measure of perceived tinnitus handicap (Tinnitus Handicap Questionnaire). Construct validity was assessed using the Beck Depression Inventory, Modified Somatic Perception Questionnaire, symptom rating scales (annoyance, sleep disruption, depression, and concentration), and perceived tinnitus pitch and loudness judgments. From the alpha version of the THI, we derived a 25-item beta version with the items grouped into functional, emotional, and catastrophic subscales. The total scale yielded excellent internal consistency reliability (Cronbach's alpha = .93). No significant age or gender effects were seen. Weak correlations were observed between the THI and the Beck Depression Inventory, Modified Somatic Perception Questionnaire, and pitch and loudness judgments. Significant correlations were found between the THI and the symptom rating scales. The THI is a self-report measure that can be used in a busy clinical practice to quantify the impact of tinnitus on daily living.
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            Classification and epidemiology of tinnitus.

            One third of all adults report experiencing tinnitus at some time in their lives. Ten percent to 15% have prolonged tinnitus requiring medical evaluation. Classification of tinnitus requires a thorough history and physical examination, supplemented by appropriate diagnostic tests. Tinnitus can be categorized according to its qualities (as described by the patient and matched on the audiometer) and its clinical type (as suggested by probable etiology). Audiologic testing, tinnitus analysis, and occasional radiologic studies assist with classification and direction of treatment planning. The THI is another method of classification that can facilitate the precise monitoring of a patient's progress. By using these tools and standardizing the language, tinnitus studies around the world can become more comparable and patients can be better monitored for treatment response.
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              Consensus for tinnitus patient assessment and treatment outcome measurement: Tinnitus Research Initiative meeting, Regensburg, July 2006.

               A Londero,  I Diges,  H. Flor (2006)
              There is widespread recognition that consistency between research centres in the ways that patients with tinnitus are assessed and outcomes following interventions are measured would facilitate more effective co-operation and more meaningful evaluations and comparisons of outcomes. At the first Tinnitus Research Initiative meeting held in Regensburg in July 2006 an attempt was made through workshops to gain a consensus both for patient assessments and for outcome measurements. It is hoped that this will contribute towards better cooperation between research centres in finding and evaluating treatments for tinnitus by allowing better comparability between studies.

                Author and article information

                Front Aging Neurosci
                Front Aging Neurosci
                Front. Aging Neurosci.
                Frontiers in Aging Neuroscience
                Frontiers Media S.A.
                22 November 2016
                : 8
                1Center for Clinical Studies, University Medical Center Regensburg Regensburg, Germany
                2Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institutet Stockholm, Sweden
                3Hörsel-och Balanskliniken, Karolinska Universitetssjukhuset Stockholm, Sweden
                4Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University Maastricht, Netherlands
                5Center of Expertise in Rehabilitation and Audiology, Adelante Rehabilitation Hoensbroek, Netherlands
                6Stress Research Institute, Stockholm University Stockholm, Sweden
                7Department of Psychiatry and Psychotherapy, University Medical Center Regensburg Regensburg, Germany
                Author notes

                Edited by: Grant Searchfield, University of Auckland, New Zealand

                Reviewed by: Kim Jane Wise, University of Canterbury, New Zealand; Sharon A. Sandridge, Cleveland Clinic, USA

                *Correspondence: Christopher R. Cederroth christopher.cederroth@ 123456ki.se
                Copyright © 2016 Müller, Edvall, Idrizbegovic, Huhn, Cima, Persson, Leineweber, Westerlund, Langguth, Schlee, Canlon and Cederroth.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                Page count
                Figures: 0, Tables: 6, Equations: 0, References: 53, Pages: 15, Words: 10006
                Funded by: Vetenskapsrådet 10.13039/501100004359
                Funded by: Karolinska Institutet 10.13039/501100004047
                Funded by: Stiftelsen Lars Hiertas Minne 10.13039/501100004722
                Funded by: European Cooperation in Science and Technology 10.13039/501100000921
                Original Research


                tinnitus, questionnaires, anxiety, depression, stress, hyperacusis, quality of life, tfi


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