{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T09:37:41Z","timestamp":1779269861182,"version":"3.51.4"},"reference-count":31,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T00:00:00Z","timestamp":1648166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Sivantos GmbH","award":["no number"],"award-info":[{"award-number":["no number"]}]},{"name":"European Union\u2019s Horizon 2020 Research and Innovation Programme","award":["848261"],"award-info":[{"award-number":["848261"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Tinnitus is an auditory phantom perception in the ears or head in the absence of a corresponding external stimulus. There is currently no effective treatment available that reliably reduces tinnitus. Educational counseling is a treatment approach that aims to educate patients and inform them about possible coping strategies. For this feasibility study, we implemented educational material and self-help advice in a smartphone app. Participants used the educational smartphone app unsupervised during their daily routine over a period of four months. Comparing the tinnitus outcome measures before and after smartphone-guided treatment, we measured changes in tinnitus-related distress, but not in tinnitus loudness. Improvements on the Tinnitus Severity numeric rating scale reached an effect size of 0.408, while the improvements on the Tinnitus Handicap Inventory (THI) were much smaller with an effect size of 0.168. An analysis of user behavior showed that frequent and intensive use of the app is a crucial factor for treatment success: participants that used the app more often and interacted with the app intensively reported a stronger improvement in the tinnitus. Between study allocation and final assessment, 26 of 52 participants dropped out of the study. Reasons for the dropouts and lessons for future studies are discussed in this paper.<\/jats:p>","DOI":"10.3390\/jcm11071825","type":"journal-article","created":{"date-parts":[[2022,3,27]],"date-time":"2022-03-27T21:27:51Z","timestamp":1648416471000},"page":"1825","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Smartphone-Guided Educational Counseling and Self-Help for Chronic Tinnitus"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7942-1788","authenticated-orcid":false,"given":"Winfried","family":"Schlee","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3174-4910","authenticated-orcid":false,"given":"Patrick","family":"Neff","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany"},{"name":"URPP (University Research Priority Program) \u201cDynamics of Healthy Ageing\u201d, University of Z\u00fcrich, 8006 Z\u00fcrich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Simoes","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Berthold","family":"Langguth","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3633-999X","authenticated-orcid":false,"given":"Stefan","family":"Schoisswohl","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heidi","family":"Steinberger","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6232-7189","authenticated-orcid":false,"given":"Marie","family":"Norman","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1828-5759","authenticated-orcid":false,"given":"Myra","family":"Spiliopoulou","sequence":"additional","affiliation":[{"name":"Knowledge Management and Discovery Lab, Otto-von-Guericke University, 39106 Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6874-9478","authenticated-orcid":false,"given":"Johannes","family":"Schobel","sequence":"additional","affiliation":[{"name":"DigiHealth Institute, Neu-Ulm University of Applied Sciences, 89231 Neu-Ulm, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9651-0966","authenticated-orcid":false,"given":"Ronny","family":"Hannemann","sequence":"additional","affiliation":[{"name":"WSAudiology, Sivantos GmbH, 91058 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1522-785X","authenticated-orcid":false,"given":"R\u00fcdiger","family":"Pryss","sequence":"additional","affiliation":[{"name":"Institute of Clinical Epidemiology and Biometry, University of W\u00fcrzburg, 97080 W\u00fcrzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"M\u00f8ller, A.R. (2011). Similarities between tinnitus and pain. Textbook of Tinnitus, Springer.","DOI":"10.1007\/978-1-60761-145-5"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"De Ridder, D., Schlee, W., Vanneste, S., Londero, A., Weisz, N., Kleinjung, T., Shekhawat, G.S., Elgoyhen, A.B., Song, J.-J., and Andersson, G. (2021). Tinnitus and tinnitus disorder: Theoretical and operational definitions (an international multidisciplinary proposal). Progress in Brain Research, Elsevier.","DOI":"10.1016\/bs.pbr.2020.12.002"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"100250","DOI":"10.1016\/j.lanepe.2021.100250","article-title":"Tinnitus prevalence in Europe: A multi-country cross-sectional population study","volume":"12","author":"Biswas","year":"2021","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.heares.2016.05.009","article-title":"A systematic review of the reporting of tinnitus prevalence and severity","volume":"337","author":"McCormack","year":"2016","journal-title":"Hear. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1159\/000431376","article-title":"Prevalence and Determinants of Tinnitus in the Italian Adult Population","volume":"45","author":"Gallus","year":"2015","journal-title":"Neuroepidemiology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1016\/S0140-6736(13)60142-7","article-title":"Tinnitus","volume":"382","author":"Baguley","year":"2013","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Landgrebe, M., Zeman, F., Koller, M., Eberl, Y., Mohr, M., Reiter, J., Staudinger, S., Hajak, G., and Langguth, B. (2010). The Tinnitus Research Initiative (TRI) database: A new approach for delineation of tinnitus subtypes and generation of predictors for treatment outcome. BMC Med. Inform. Decis. Mak., 10.","DOI":"10.1186\/1472-6947-10-42"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1038\/nrn4003","article-title":"Tinnitus: Perspectives from human neuroimaging","volume":"16","author":"Elgoyhen","year":"2015","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"53","DOI":"10.3389\/fnagi.2019.00053","article-title":"Editorial: Towards an Understanding of Tinnitus Heterogeneity","volume":"11","author":"Cederroth","year":"2019","journal-title":"Front. Aging Neurosci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"802","DOI":"10.3389\/fnins.2019.00802","article-title":"Why Is There No Cure for Tinnitus?","volume":"13","author":"McFerran","year":"2019","journal-title":"Front. Neurosci."},{"key":"ref_11","first-page":"CD012614","article-title":"Cognitive behavioural therapy for tinnitus","volume":"2020","author":"Fuller","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13063-021-05835-z","article-title":"Unification of Treatments and Interventions for Tinnitus Patients (UNITI): A study protocol for a multi-center randomized clinical trial","volume":"22","author":"Schoisswohl","year":"2021","journal-title":"Trials"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e346","DOI":"10.1097\/AUD.0000000000000330","article-title":"Multisite Randomized Controlled Trial to Compare Two Methods of Tinnitus Intervention to Two Control Conditions","volume":"37","author":"Henry","year":"2016","journal-title":"Ear Hear."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.pec.2019.07.031","article-title":"Effect of educational counseling alone on people with tinnitus: Meta-analysis of randomized controlled trials","volume":"103","author":"Xiang","year":"2020","journal-title":"Patient Educ. Couns."},{"key":"ref_15","first-page":"S1","article-title":"Clinical Practice Guideline","volume":"151","author":"Tunkel","year":"2014","journal-title":"Otolaryngol. Neck Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s00106-019-0633-7","article-title":"A multidisciplinary European guideline for tinnitus: Diagnostics, assessment, and treatment","volume":"67","author":"Cima","year":"2019","journal-title":"HNO"},{"key":"ref_17","unstructured":"Biesinger, E. (2012). Tinnitus\u2014Endlich Ruhe im Ohr, Goldmann Taschenbuch Verlag. Ursachen Erkennen und Ausschalten."},{"key":"ref_18","unstructured":"Hallam, R. (1994). Leben mit Tinnitus, Quintessenz. Wie Ohrger\u00e4usche Ertr\u00e4glicher Werden."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Hesse, G. (2016). Therapie bei Chronischem Tinnitus, Thieme. Habituationstherapien.","DOI":"10.1055\/b-0035-127618"},{"key":"ref_20","unstructured":"Kellerhals, B., and Zogg, R. (2004). Tinnitus-Hilfe: Ein Arbeitsbuch f\u00fcr Patienten und Ihre \u00c4rztlichen und Nicht\u00e4rztlichen Helfer, Karger."},{"key":"ref_21","unstructured":"Ross, U.H. (2009). Tinnitus: So Finden sie Wieder Ruhe, Gr\u00e4fe und Unzer."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"294","DOI":"10.3389\/fnagi.2016.00294","article-title":"Measuring the Moment-to-Moment Variability of Tinnitus: The TrackYourTinnitus Smart Phone App","volume":"8","author":"Schlee","year":"2016","journal-title":"Front. Aging Neurosci."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Unnikrishnan, V., Schleicher, M., Shah, Y., Jamaludeen, N., Pryss, R., Schobel, J., Kraft, R., Schlee, W., and Spiliopoulou, M. (2020). The Effect of Non-Personalised Tips on the Continued Use of Self-Monitoring mHealth Applications. Brain Sci., 10.","DOI":"10.3390\/brainsci10120924"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1001\/archotol.1996.01890140029007","article-title":"Development of the Tinnitus Handicap Inventory","volume":"122","author":"Newman","year":"1996","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.heares.2019.02.017","article-title":"Standardised profiling for tinnitus research: The European School for Interdisciplinary Tinnitus Research Screening Questionnaire (ESIT-SQ)","volume":"377","author":"Genitsaridi","year":"2019","journal-title":"Hear. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1590\/S1516-31802007000200006","article-title":"Self-efficacy scale for Brazilians with type 1 diabetes","volume":"125","author":"Gastal","year":"2007","journal-title":"Sao Paulo Med. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1684\/ejd.2010.0893","article-title":"Measuring empowerment in patients with psoriasis: The psoriasis empowerment enquiry in the routine practice (PEER) questionnaire","volume":"20","author":"Pagliarello","year":"2010","journal-title":"Eur. J. Dermatol."},{"key":"ref_28","unstructured":"R Core Team (2019). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1080\/14992027.2021.1915509","article-title":"Understanding patient empowerment along the hearing health journey","volume":"61","author":"Gotowiec","year":"2021","journal-title":"Int. J. Audiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"157","DOI":"10.3389\/fpubh.2019.00157","article-title":"Toward Personalized Tinnitus Treatment: An Exploratory Study Based on Internet Crowdsensing","volume":"7","author":"Simoes","year":"2019","journal-title":"Front. Public Health"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Schlee, W., Schoisswohl, S., Staudinger, S., Schiller, A., Astrid, L., Berthold, L., Martin, S., Jorge, S., Patrick, N., and Dimitris, K. (2021). Towards a Unification of Treatments and Interventions for Tinnitus Patients: The EU Research and Innovation Action UNITI. Progress in Brain Research, Elsevier.","DOI":"10.1016\/bs.pbr.2020.12.005"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/7\/1825\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:43:15Z","timestamp":1760136195000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/7\/1825"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,25]]},"references-count":31,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["jcm11071825"],"URL":"https:\/\/doi.org\/10.3390\/jcm11071825","relation":{"has-preprint":[{"id-type":"doi","id":"10.20944\/preprints202201.0469.v1","asserted-by":"object"}]},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,25]]}}}