Psychometric evaluation of Visual Analog Scale for the assessment of chronic tinnitus.
From: Am J Audiol. 2012 Jul 30. [Epub ahead of print]
Tinnitus is the perception of sound in the absence of an external auditory stimulus. Tinnitus is a distressing condition that can disturb one’s day-to-day life in a number of ways including distress and annoyance, disruption of sleep, anxiety, and depression. An estimated 16 percent of the American population (50 million people) experience tinnitus to some extent, with up to 16 million seeking medical help and 2 million being unable to lead a normal life.
A variety of conditions and experiences can lead to tinnitus, but its exact physiology is still unknown. As a symptom, it may be associated with a number of conditions—ranging from impacted wax to acoustic tumors—that warrant medical attention. The prevalence of tinnitus increases with age and noise exposure. According to the American Tinnitus Association, noise exposure is the largest attributed cause of tinnitus. People may acquire tinnitus and hearing loss when they are exposed to hazardous levels of industrial, recreational, or military noise. Military personnel are commonly exposed to high levels of noise and, indeed, tinnitus is the most common service-connected disability among U.S. veterans. Traumatic brain injury (concussion) is a common cause of tinnitus in both veterans and nonveterans. Tinnitus can also be a side effect of potentially ototoxic drugs, ranging from aspirin taken to alleviate arthritic pain to aminoglycoside antibiotics and life-saving drugs used to treat cancer. These effects may be temporary, but can be permanent, especially with respect to aminoglycoside antibiotics and cancer chemotherapeutics (in particular cisplatin).
The severity of tinnitus experienced by patients may vary or depend on comorbidities. Tinnitus often co-occurs with hearing loss, and the bothersome effects of tinnitus may be alleviated by the use of hearing aids. Individuals who are dual sensory impaired (deaf and blind) may be confused by tinnitus because visual information does not help them understand that their tinnitus is not an external sound. It is common for tinnitus to aggravate or be aggravated by mental health conditions.
Visual analog scales are well known psychometric measures of subjective attitudes and characteristics. Most commonly, with a Visual analog scale, patients specify their level of agreement to a statement by indicating a position along a continuous line between two end points. The Visual analog scales can be used to assess loudness, pitch, and disturbance of the tinnitus. Tinnitus questionnaires contain a series of questions, and patients select a response to each question from the given choices (usually a graded scale), such as the Tinnitus Handicap Inventory and the Tinnitus Functional Index.
The development of therapeutic interventions for chronic tinnitus requires sensitive and clinically responsive tools to measure treatment induced changes in tinnitus loudness and annoyance. This new study evaluates the psychometric properties of patient-reported Visual analog scales for measuring subjectively perceived tinnitus loudness and annoyance. Data from a single-blind, randomized, placebo-controlled study of acoustic coordinated reset neuromodulation in patients with chronic tinnitus were analyzed to assess the reliability, validity and Minimally Clinically Identifiable Difference of the Visual analog scale loudness and Visual analog scale annoyance. The Visual analog scale loudness and Visual analog scale annoyance were completed at screening, at baseline and at 5 visits during the 16 weeks of the clinical study. Data were analyzed with respect to test-retest reliability, validity and Minimally Clinically Identifiable Difference.
Visual analog scale loudness and Visual analog scale annoyance showed good test-retest reliability of 0.8 and 0.79 respectively. In terms of convergent validity Visual analog scale loudness and Visual analog scale annoyance correlated well with the Tinnitus Questionnaire at all clinical visits. Minimally Clinically Identifiable Difference estimates clustered between 10 and 15 points.
Visual analog scale loudness and Visual analog scale annoyance are valid and effective measurements for capturing reductions in tinnitus severity in patients with chronic tinnitus
Related Sources:
Evaluation and Treatment of Tinnitus: A Comparative Effectiveness Review