Tinnitus Sound Therapy Effectiveness: A Critical Appraisal of 4 Studies - Essay Sample

Introduction

This part of the study entails the study analysis and critical appraisal of four different studies that are related to the topic of study. The study entails research on the effectiveness of tinnitus sound therapy for tinnitus patients with normal hearing thresholds. Paglialonga et al. (2011, 796) have written an article on the "Influence of tinnitus sound therapy signals on the intelligibility of speech." The methodology of the study entails the use of normal hearing subjects to test the speech intelligibility while in the presence of three different signals of sound therapy. These include a recording of water in motion, wide-band noise, and a grouping of tones.

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The sample group used in the research consisted of 10 young adults with a normal hearing. The young adults ranged between the ages of 22 and 32, and their mean age was 24 years. The distribution of gender in the group was seven women and three men. There was a need for all the members of the sample group to have a tone threshold of less than 20 dB HL, for every audiometric frequency. The frequency used for the study was between 125 and 8000 Hz (Duraj and Searchfield, 2017, 44). For all the ten subjects, their mean pure tone threshold was less than 10 dB HL for all the tested frequencies.

The results observed from the study were that for a certain level of stimulation, speech intelligibility worsened when in the presence of wide-band noises, that is, when a comparison was made with other signals of sound therapy. Speech intelligibility deteriorated more, with an increase in the three different sound therapy signals. A combination of tones showed a minimum impact on sound intelligibility.

Randomization bias occurs when random selection involves people who would not participate in the program, under normal circumstances. The randomization process of the study is of high quality because it does not entail a randomization bias. In order to get the best results for the effectiveness of tinnitus sound therapy on patients with normal hearing, the sample population should entail young people (Hosbon et al., 2012, 11). People between the age of 22 and 32 have the best immunity, and that age bracket is considered the healthiest.

Selection bias is observed in the study because the number of male participants is extremely higher than that of the women participants. To avoid selection bias, the researchers should have ensured a balance between both genders. The results obtained from the study lack accuracy because there is no fair distribution of gender amongst the participants. The results tend to lean more on the male side because they make up the majority of the participants.

The study does not entail any detection bias because the ten participants were treated as one group. The researchers were looking for a sample group of young and healthy patients. Other characteristics and qualities of the participants were not put into consideration. Detection bias occurs when there is a difference between how outcomes are determined for the different members of the group (Argstatter and Grapp, 2016, 2). For the study, the same method of determining outcomes were used. All the ten participants took the same test, which was using a touch-sensitive screen to choose a consonant from the three alternatives. The use of similar procedures for determining the outcomes is an indication of the absence of determination bias.

Attrition bias is not seen in the study. Attrition bias occurs when there is a loss of one or several participants who had been chosen in a randomized control trial. This affects the results of the study. None of the participants left during the study, and this rules out the attrition bias. All ten participants were present until the end of the study. Reporting bias is whereby certain information from a study is withheld by the participants. The study might have entailed a reporting bias because the participants needed to provide information on their health status. Paglialonga et al. (2011) have not provided information on the medical background of the participants, which makes the study less reliable. A participant's medical history affects the outcomes of the study.

According to the grading stated in the methodology section, the study by Paglialonga et al. (2011) is a grade C. This is because there is a medium risk of bias in more than one parameter. Data collection of the study entails selection bias and reporting bias. The risk in both parameters is medium because their impact on the outcomes is not great.

The second study that correlates with the topic of study is "The Long-term Effectiveness of Tinnitus Multivariate Integrated Sound Therapy (T-MIST) in 148 tinnitus patients with normal hearing thresholds." Zhao et al. (2019) conducted this study on 148 patients who had a normal hearing threshold. The recruiting process began in January 2015 and ended in March 2017. The patients were recruited from the hospital of First People in Guangdong, China. The hearing thresholds of the patients were measured audio metrically. The normal thresholds portrayed a 20 dB HL for each octave frequency between 500 and 4000 Hz (Henry et al., 2006, 119). For all the participants involved in the study, no hearing threshold exceeded 30dB HL within a frequency of 250 and 8000Hz. Their age ranged between 18 and 64 years, and the average age was 32 years. The sample group consisted of 76 women and 72 men.

The results of the study indicated that 52 patients portrayed a partially or fully positive RIT response. Out of the 52 patients, 12 of them had tinnitus on their left ear, 12 of them had tinnitus on their right ear, while 28 of them had bilateral tinnitus. Sixty-two patients who had participated in the study portrayed a rebound or negative RIT response (Argstatter and Grapp, 2016, 6). Results of the immediate response indicated that the loudness of the tinnitus was almost similar in the groups, and they all had different RIT responses, according to the Kruskal-Walls test. The effectiveness of T-MIST based on a long-term follow up indicated a reduction in the THI scores of the before and after sound interventions of T-MIST. Different follow-up stages indicated quite similar THI scores.

The randomization process and allocation concealment of the study does not indicate a randomization bias. The best place to find tinnitus patients was in a hospital, and the researchers used patients from the First People's Hospital of Foshan, Guangdong, China, as their participants for the study. Zhao et al. (2019) would have used the same kind of participants if the study was conducted in a different circumstance. This means that the researchers used the right category of participants to prevent a randomization bias.

Seventy-two men and 76 women were used for the study. There is a fair gender distribution, and the researchers did well in preventing a selection bias. The age distribution is also fair because the study involved participants aged between 18 and 64. The average age of the participants was 32 years. Both the young and old people were represented in the study, and this increases the accuracy of the results. A study should aim at capturing all the population dynamics to increase the accuracy of the results. Zhao et al. (2019) study are accurate and reliable because it does indicate any type of selection bias.

The study entailed different categories of people, but researchers did not portray any type of detection bias. All the participants were treated equally, despite that some of them were older. Detection bias would have occurred if assumptions had been made based on the age of the patients. For example, if older people were subjected to different sound therapy signals than those used for the young participants. In this study, however, all participants underwent the same procedures. All of them followed a clinical protocol, which entailed an examination of otoscope, tests of admittance, audiometry of pure tone, and tests to match tinnitus. They were then assigned three sound therapy programs based on the patients' preferences. The procedure treated the participants as one group, and this ruled out the possibility of detection bias.

Attrition bias is seen in the study. The researchers had included a total of 148 patients in their study. At the end of the study, the researchers only provided the results of 127 patients. This means that there was a loss of some participants. Twenty-one patients were not present until the end of the study. The loss of some participants has an effect on the outcome of the study. This is because the researchers had selected a group of 148 participants because, according to them, that number would give them accurate results. However, in most studies, researchers usually leave an allowance in case something happens during the data collection process. One of such an allowance is the recruitment of more participants, in case some of them did not complete the process. Therefore, attrition bias is a low risk in this study.

The study does not portray any reporting bias. This is because all the participants followed a clinical protocol before any sound therapy was conducted in them. All the tests conducted on them indicated whether they had normal hearing thresholds. Reporting bias would have occurred if the patients were asked to state the nature of their hearing thresholds. The researchers involved medical practitioners to ensure that reporting bias was not present in the study. A reporting bias would have affected the outcomes of the study.

According to the grading criteria stated in the methodology section, the study is a grade A. This is because there is a low risk in the attrition bias. The loss of some participants poses a risk to the study. The 21 patients who were not present until the end of the study may or may not have affected the results of the research. The study did not entail a risk in any of the other parameters.

The third study that connects to the topic of study is "Benefit of Hearing Aids on Treatment Outcome in Neuro-Music Therapy for Chronic Tinnitus." The study has been done by Argstatter and Grapp (2016). In the methodology section, the researchers conducted a retrospective analysis of patients who used to attend a therapy of neuro-music. The eligible participants in the study were patients who suffered from tonal and chronic tinnitus. The participants were divided into three groups. The first group, A, consisted of people with a hearing loss but have been compensated with a suitable hearing loss. Group B consisted of patients with hearing loss but had not been compensated with a suitable hearing loss. The last group, C, consisted of participants who had a normal hearing threshold. The total number of participants was 120 patients, 40 patients in each of the groups.

The stratification of the three groups was done according to the tinnitus handicap variables. These are the gender of the participants and their TQ-score. Hearing loss in the tinnitus pitch was one of the considerations of groups A and B. The results of the study entailed a notable improvement in the total scores of the tinnitus questionnaires. Results were obtained from a comparison of the time of admission and the end of treatment. For groups A and C, 8 out of 10 patients made an accomplishment of a reliable decrease in the scores of TQ. In group B, only 3 out of 10 patients recorded a reduction in TQ scores.

The study does not include a randomization bias in the methodology section. The researchers had aimed at investigating the benefits of hearing aids on the treatment outcome...