Goldberg Rachel L, Piccirillo Marilyn L, Nicklaus Joyce, Skillington Andrew, Lenze Eric, Rodebaugh Thomas L, Kallogjeri Dorina, Piccirillo Jay F
Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri.
Department of Psychology, Washington University in St Louis, St Louis, Missouri.
JAMA Otolaryngol Head Neck Surg. 2017 Jul 1;143(7):700-706. doi: 10.1001/jamaoto.2017.0020.
Existing patient-reported outcome measures of tinnitus assess the severity and disability retrospectively, which may result in adequate reliability, but cannot capture the fluctuating and individualized nature of tinnitus. Experience sampling may provide an alternative.
To use an ecological momentary assessment (EMA) to measure tinnitus disability and associated constructs.
DESIGN, SETTING, AND PARTICIPANTS: Forty adults with tinnitus provided self-report of their tinnitus bother using 5 questions measured by EMA, as well as standard retrospective outcome measures. In this 6-week longitudinal observational study conducted from July 15 to December 22, 2014, participants provided EMA data for 2 weeks (part 1); then after a 2-week break, they provided EMA data for an additional 2 weeks (part 2). A text message with a link to the EMA survey was sent for a total of 56 assessments during each 2-week assessment period. Ecological momentary assessment responses were evaluated using multilevel confirmatory factor analysis to assess the fluctuating nature of bothersome tinnitus across the group and within the pool of individuals over time.
Ecological momentary assessment questions measured tinnitus disability and associated constructs. Compliance in each study part was assessed based on response rates. The Tinnitus Functional Index and the Overall Global Rating of Bother Scale were assessed at the beginning and end of each 2-week assessment period to explore the effect of the frequent EMAs on the perceived level of bother from tinnitus.
Of the 40 participants in the study (10 women and 30 men; mean [SD] age, 60.0 [10.5] years), the median survey response rate was high (49 responses to 56 surveys sent [88%] for part 1 and 47 responses of 56 surveys sent [84%] for part 2). The latent factor identified by the 2-level confirmatory factor analysis models demonstrates that within-individual tinnitus bother, loudness, and stress vary together over time. In addition, tinnitus bother, feeling, and stress symptoms all vary together across individuals, which means that bother and stress covary strongly both across time and across individuals.
Ecological momentary assessment evaluates the moment-to-moment perception of tinnitus and the effect of emotional and environmental factors, which suggests that it is a superior tool to measure tinnitus outcomes compared with standard retrospective self-reports. Taken together, information from emotional and environmental factors can be summarized in an underlying (latent) factor that represents a vulnerability to bothersome tinnitus and that can be used to comprehensively describe the tinnitus experience. Momentary variability in tinnitus bother is strongly associated with levels of perceived stress.
现有的耳鸣患者报告结局测量方法是回顾性评估严重程度和残疾情况，这可能具有足够的可靠性，但无法捕捉耳鸣的波动和个体化特征。经验抽样可能提供一种替代方法。
使用生态瞬时评估（EMA）来测量耳鸣残疾及相关指标。
设计、设置和参与者：40名患有耳鸣的成年人通过EMA测量的5个问题以及标准回顾性结局测量方法，提供了关于耳鸣困扰的自我报告。在这项于2014年7月15日至12月22日进行的为期6周的纵向观察性研究中，参与者在2周内（第1部分）提供EMA数据；然后在休息2周后，他们又提供了另外2周的EMA数据（第2部分）。在每个2周评估期内，共发送56条带有EMA调查链接的短信。使用多水平验证性因素分析评估生态瞬时评估的回答，以评估耳鸣困扰在群体中以及个体群体随时间的波动性质。
生态瞬时评估问题测量耳鸣残疾及相关指标。根据回答率评估每个研究部分的依从性。在每个2周评估期开始和结束时，评估耳鸣功能指数和总体困扰总体评分，以探讨频繁的EMA对耳鸣感知困扰水平的影响。
在该研究的40名参与者中（10名女性和30名男性；平均[标准差]年龄为60.0[10.5]岁），调查回答率中位数较高（第1部分发送的56份调查问卷中有49份回复[88%]，第2部分发送的56份调查问卷中有47份回复[84%]）。二级验证性因素分析模型确定的潜在因素表明，个体内耳鸣困扰、响度和压力随时间共同变化。此外，耳鸣困扰、感觉和压力症状在个体间也共同变化，这意味着困扰和压力在时间和个体间都有很强的共变关系。
生态瞬时评估评估了对耳鸣的即时感知以及情绪和环境因素的影响，这表明与标准回顾性自我报告相比，它是测量耳鸣结局的更优工具。综合来看，来自情绪和环境因素的信息可以汇总在一个潜在因素中，该因素代表了对困扰性耳鸣的易感性，可用于全面描述耳鸣体验。耳鸣困扰的瞬时变异性与感知压力水平密切相关。
