British Academy of Audiology (BAA) — 2018 Conference

Photos are from David's twitter account.

New European tinnitus guidelines funded by a @COSTprogramme (on twitter) grant soon to be published


Top 10 Hyperacusis Research Priorities (what a joke)

Tinnitus Care Options (by the BTA)


Hyperacusis Management in Children




"Cognitive Therapy - Main Finding: Improvement in mood but not quality of life" (at the bottom of the last photo, found that quite interesting)

 

"There's UK #tinnitus guidance soon to be published by @BSAudiology1 what are they likely to include? @Derek_J_Hoare tells us #BAAConf"

 

@David did you get a chance to talk to people at the Neuromod stand?

And thanks @Autumnly for opening the thread

 

Why are they against Neuromodulation and Vagus Nerve stimulation, or even sound therapy? They only advocate CBT?

Are they finally going to classify different types of hyperacusis?

 

Because CBT is the cure all method for everything! They just need to put into a syringe and inject it into the ear drum.

I am curious if Neuromod had anything there though?

 

Suicide.

 

Wonder what she had to say at the booth. Guess not much since we haven´t seen a paper yet. I am not keeping my hopes up for Neuromod though... Although I would most probably get a unit asap either way. Depending on the published results.

 

They forgot to mention TRT, CBT, BTA, ATA... = Bullshit.

 

Yep. Nothing new to what was discussed at the BTA Conference. Looking at a January launch in Ireland. Rolling out to the UK after that. Applying for FDA approval for the US.

 

Not sure. There is a move for a consensus definition of hyperacusis.

 

Wait, January launch in Ireland? That means for the super desperate (and rich?) among us we could fly to Ireland in three months and get a MuteButton device??
Guys, is this right??

(Of course we're still waiting for publishing of serious evidence of efficacy!)
@RCP1

 

Torture.

 

Why are they against supplementation?

I am by no means saying it will cure tinnitus, but many people have reduced their tinnitus when they fix a mineral or vitamin imbalances. There have also been studies done showing the beneficial effect that certain supplements have on the auditory system when exposed to loud noises or ototoxic medication.

 

Just a complete stab in the dark here, but maybe they think deficiencies are best corrected in our diet maybe?

For example, get your magnesium from spinach or kale.

I know a lot of studies are against some supplements in pill form because they don’t show much effect. However, this really does depend upon what the supplement is and what you are taking it for.

By the way, I take supplements.

 

I do as well and noticed improvements in others areas of my health once I started.

 

A launch of MuteButton in January?

Who is going to pay for that before the peer review is published?

I was just looking at some of the previous threads, and I’m a layman in this, but they can’t release it before if I’m correct? You know just like ACRN by Desyncra, how many real success stories did you see related to that and it’s on sale in the U.K. for £4,500. Nah you’re okay.

I’ll wait until the evidence base builds up - even in the first study that showed positive results had conflicting interests - where the people that made it had financial interest in it. Also, they can manipulate the outcome by study designs etc.

I will wait, but my wallet will be empty if it really works as good as is speculated.

 

As this strand is here and there seems to be some interest, thought I'd add my thoughts on the BAA conference and the relevant presentations. Remember - this conference is for audiologists, it isn't the place for basic science or trials to be reported that don't inform clinical practice, so what you tend to see presented is research that's clinically relevant and projects that can change what's happening on the front line. So all presentations had to include a slide with 'How can I use this information on Monday?'


So some thoughts;

• Hyperacusis - was good to see 2 talks on the main stage about hyperacusis. 1st time I've noticed it having this level of interest. Both talks were well attended. The hyperacusis research uncertainties have been accepted as a letter to The Lancet, so will get big exposure to hyperacusis and the need for research. The nature of JLA's often mean the top 10 are fairly generic questions (but it gets media exposure), my interest is always in the long list of questions that are produced and turned into PICO research questions. So will be worth looking out for that when it is published. The second talk looking at managing hyperacusis in children was excellent and could be used as the basis for practice guidance - I was really excited about this. As we know little about what standard practice currently looks like.
  
  
• Practice guidance talk - Derek Hoare's talk was similar to the one at the BTA conference (@Hazel took a lot of notes, so hopefully will write up?!) but he did add some new slides looking at forest plots that will be included in Cochrane Reviews which will be published over the next few months. I tweeted one of these looking at neuromodulation. This will be the tinnitus research to look out for over the next month or so. There's a real rush to publish systematic reviews, as NICE will include these when writing the tinnitus practice guidance but have a deadline of December for anything to be published to be taken into consideration - and systematic reviews are considered as the highest level of evidence. They will all be published free to access here; https://www.cochranelibrary.com.
  
  
• Helen Pryce gave a nice talk that balanced well with the above on the importance of patient centred care, promoting the tinnitus decision making aid https://www.tinnitus.org.uk/decision-aid there's also a series of YouTube videos out there linked to this, this had been presented at the BTA conference in 2017, but now has papers published on the project.
  
  
• Tony Kay/Dominic Bray presented their tinnitus pathway from Aintree. Has been presented at the BTA conference before but is a comprehensive service with support from psychology. Tony and Dominic talk at a lot of BTA Information Days and will be at our next one in Liverpool later this month if anyone is going from here?
  
  
• I did a workshop with BAA Past President, Michelle Booth (well attended, standing room only) on a new free to access basic training package we're putting together to inform every audiologist what they should know about tinnitus, so they can better support people living with tinnitus and triage more effectively and not just rely on the tinnitus service within their departments. It is levered from a piece of work we undertook a while ago which found many people with significant hearing loss often disclosed their tinnitus in appointments but it was overlooked by the audiologist. Full report here; https://www.tinnitus.org.uk/conspiring-together-tinnitus-and-hearing-loss if this approach works we're hoping to do something similar for ENTs next.
  
  
• Really interesting innovation in pathways presented by North Wales Audiology Service, where Audiologists are available and run clinics in primary care, so rather than seeing a GP, you're referred to see the Audiologist if you ask for a GP appointment for an ear complaint. 98% patient satisfaction and 13% of the patients using the service were doing so for tinnitus. Keen to find out more about that. I tweeted some of the slides yesterday.
  
  
• Kevin Munro presented the new NICE guidance on hearing loss in adults https://www.nice.org.uk/guidance/ng98 was interesting to see how many answers found no research evidence (quite a lot!) and how many others only found evidence rated as 'very low' or 'low.' BUT the positive was that it raises the profile of hearing loss and there is now NICE practice guidance that will be updated in the future and there is a very useful case for further research that funders will take more seriously, as it has been identified by NICE. Worth bearing in mind for the tinnitus practice guidance, due to be published in March 2020.
  
  
• Posters- there were only 5 tinnitus posters which was disappointing. Good from the BTA perspective, as 2 were from the BTA and we funded or participated in the other 3 but the posters aren't a big part of the conference really.
  
  
• Neuromod - had a low profile, didn't present, were just talking and showing people the device on their stand. I did spend a long time talking with them and their plans and some BTA future projects I was keen to understand their perspectives on. There seems to be quite a bit they still need to do for January launch!

Will answer the other questions people have raised on practice guidance next week, need to dig out a few references first though.


Apologies for all the typos!

 

Pardon if I didn’t understand this correctly, but from the looks of it, they are disregarding and/or discouraging therapies or attempts at actually curing or treating the condition in a way that results in a decrease in tinnitus volume.

It’s good that these conferences are organized and more awareness is being raised, I just wish the proposed solutions went beyond CBT and the like.

 

I know we are still away from addressing and repairing the underlying faulty mechanisms in the brain or inner ear that play a role in hyperacusis and tinnitus, but can we at least try to raise awareness so ENT's acknowledge hidden hearing loss, acoustic trauma patients like me are told no hearing loss when I have muffled hearing in my right ear, hyperacusis for about 9 months and zapping mechanical tinnitus noises in my head.

The 250 Hz - 8 kHz tonal audiogram is inaccurate and still runs the show.

Hyperacusis described as painful in the ear, face, i.e. burning pain, tingling, tightness, numbness seems to resemble neuropathic/chronic pain elsewhere in the body. That's what some researchers have said.

Whereas loudness sensitivity/amplification seems to be a separate issue found in auditory/sensory processing disorders such as Autism, as if the brain is amplifying damaged frequencies or peripheral hypothesis that hair cells that work as amplifiers make up for other damaged hair cells.

Many things can cause pain, so that's the biggest issue, but it just upsets me that the word "hyperacusis" is an extremely generic term for likely several separate issues makes sufferers feel hopeless knowing that the medical community is in the dark or ENT's won't push for research and just basically shill for sound therapies not understanding the controversy.

99% of my hyperacusis is gone but I still get tightness in my face and nose around high pitch noises and around 1 kHz I notice an abnormal amplification of noise. It's just that so many people I notice are suffering and get disregarded by the medical community.

My friends and I are speculating about the pathologies of hearing loss, tinnitus and hyperacusis. I am not in a lab where I can test anything, I'm not qualified, just a wannabe, I just hope actual researchers are investigating these conditions.

I hope 5 years from now the pathologies of tinnitus, and hyperacusis are understood and classified correctly and maybe even some treatments to correct mild/moderate forms of hearing loss and tinnitus, Meniere's disease, sudden hearing loss etc...

I'd hate to fast forward 5 years in the future and see the medical community playing dumb about hidden hearing loss and ignoring biomedical research for otological disorders, with the tonal audiogram being the ultimate authority + pallative hearing aids, sound therapy, disability for tinnitus/hearing loss prices skyrocketing.

 

Why do you think they are discouraging it? Perhaps their aim is see what people can do about their tinnitus TODAY and not in the future...?

Like managing techniques, not everybody who rings associations want to be told that there may be a cure in the future because at this point - nobody knows.

At this moment in time, the key to recovering from tinnitus is accepting it and learning to live with the noise. Not what people want to hear, but go back years ago when it first started, I was mad on finding the cure.

 

I said I'd try and answer some of the questions on here relating to the guidelines. As well as the guidelines (not yet published) highlighted above, other countries do have guidelines already in place, the US ones are the most referenced; https://journals.sagepub.com/doi/full/10.1177/0194599814545325?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed

Guidelines should be evidence based. Meaning they make recommendations, and the strength of the recommendation should be based on the weight of evidence available. Some guidelines will be more liberal with that interpretation then others. NICE will be very restrictive, whereas the BSA guidelines will be a little more flexible, but will still need to prove the statements with evidence. So with that in mind;

The guidelines are not against Neuromodulation, VNS or sound therapy. They make no recommendation because there is not a sufficient evidence base that they either Do or Do Not work. So currently see the white box as areas that require more evidence to be recommended within practice guidelines. The reason the therapies in the 'No Recommendation,' box appear is because they were highlighted as currently available or emerging treatments/therapies that were worth of consideration within the guideline. Others will have different lists, depending on when the guidelines were produced or what is available locally.

Because there is evidence (and quite a lot of it) they do not work for tinnitus. If you have a deficiency then treating this may be sensible BUT you are treating the deficiency, not the tinnitus. Zinc and B12 are the ones most commonly referenced here. The guidelines are for treating tinnitus, not for treating a vitamin (or other deficiency), in the same way they are not a guideline for hearing loss (which may also cause tinnitus). So the guideline is against taking a supplement solely for tinnitus (as are the US guidelines), based on current evidence.

Practice guidelines are (and should) be based on evidence and at the moment this is where the evidence leads such a document. All of the practice guidelines are 'live' documents, they will be updated to account for future evidence, so they will change as new practice and research emerges. BUT they can only make recommendations for and against based on the current evidence, and often will only consider high quality RCT's and systematic reviews - so the highest level of evidence.

So...

There is a valid point in some of the comments on supplements. Guidelines are developed for what makes a difference on a population wide level, due to them being developed based on RCTs, etc. This doesn't account for what works for some individuals, as they get lost in the numbers often. Nor do they take account of patient preference. So things that work for some or may be reported in the forum as useful may be missed due to the data that is used to write these. There are similar frustrations often for clinician who believe important elements of care get overlooked in the need for high level evidence.

But...

They are useful. They promote the need for tinnitus care and management to be taken seriously. They provide a blueprint for services to follow. They raise the profile of tinnitus - by having the guidelines it raises the bar and gives people with tinnitus some sort of comparator to see if the care received meets the local guideline. It also raises awareness of the research gaps where more research is needed into current treatments to prove efficacy (the No Recommendation box in this case). They are a live document and will be updated in the future based on new evidence, so are overall helpful to have in place.

Please don't shoot the messenger! Just trying to give some context I thought may be useful.

 

Setting down a paper cup = gunshot.