Sherlock LaGuinn P, Ortiz Candice E, Blasco Georgina P, Brooks Daniel I
Army Hearing Division, Army Public Health Center, Walter Reed National Military Medical Center, Bldg. 19, Fl. 5, 4954 North Palmer Rd., Bethesda, MD.
Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, Bldg. 19, Fl. 5, 4954 North Palmer Rd., Bethesda, MD.
Mil Med. 2019 Oct 1;184(9-10):e468-e473. doi: 10.1093/milmed/usz024.
The number-one service-connected disability is tinnitus. Tinnitus currently has no cure, but the functional impact of tinnitus has been shown to be mitigated by Progressive Tinnitus Management (PTM), a multi-level management approach. The duration of PTM Level 3 skills education (PTM-SE) and the inclusion of mental health providers have been identified as barriers to implementation of PTM-SE in Department of Defense (DOD) medical treatment facilities. The goal of this study was to determine if a version of PTM-SE modified for use in DOD medical treatment facilities resulted in positive changes in tinnitus-related outcomes.
A retrospective study was conducted by examining the medical records of patients who attended modified PTM-SE appointments. The study was approved by the Walter Reed National Military Medical Center Institutional Review Board. The study sample included 130 patients who completed modified PTM-SE between January 2015 and June 2016. Primary outcome measures were tinnitus awareness and tinnitus annoyance; secondary outcome measures were effect on life and self-perceived coping ability. Outcome measures were analyzed with nonparametric statistics and logistic regression.
Modified PTM-SE resulted in clinically significant improvements in the primary outcome measures (awareness, p < 0.0001; annoyance, p < 0.0001). The proportion of patients who indicated an improvement in coping with tinnitus was similar to other published data with similar modifications to PTM-SE.
The evidence supports the assumption that PTM is a flexible program of tinnitus management that even when modified to be suitable for use in a DOD medical treatment facility provides meaningful reductions in tinnitus awareness and annoyance and improves tinnitus coping ability among military beneficiaries. These findings should encourage audiologists to modify PTM to work within their military medical treatment facility.
与服役相关的头号致残疾病是耳鸣。耳鸣目前无法治愈，但渐进性耳鸣管理（PTM）这一多层次管理方法已被证明可减轻耳鸣的功能影响。PTM 3级技能教育（PTM-SE）的时长以及心理健康服务提供者的纳入已被确定为在国防部（DOD）医疗设施中实施PTM-SE的障碍。本研究的目的是确定为在DOD医疗设施中使用而修改的PTM-SE版本是否会使耳鸣相关结果产生积极变化。
通过检查参加修改后的PTM-SE预约的患者病历进行回顾性研究。该研究获得了沃尔特里德国家军事医疗中心机构审查委员会的批准。研究样本包括2015年1月至2016年6月期间完成修改后的PTM-SE的130名患者。主要结局指标是耳鸣知晓度和耳鸣烦恼度；次要结局指标是对生活的影响和自我感知的应对能力。结局指标采用非参数统计和逻辑回归进行分析。
修改后的PTM-SE在主要结局指标上产生了具有临床意义 的改善（知晓度，p<0.0001；烦恼度，p<0.0001）。表示在应对耳鸣方面有所改善的患者比例与其他对PTM-SE进行类似修改的已发表数据相似。
证据支持以下假设，即PTM是一个灵活的耳鸣管理方案，即使经过修改以适用于DOD医疗设施，也能显著降低耳鸣知晓度和烦恼度，并提高军事受益人的耳鸣应对能力。这些发现应鼓励听力学家对PTM进行修改，以便在其军事医疗设施中应用。
