Directive Education
MWS, hearing difficulties, tinnitus
PAD, CORTEX, TINNITUS
For the smart-TRT group, 3 different interactive smart pad applications were prepared for the 3 directive education sessions. Each application was a composite of numerous video clips. Two screens were displayed on the smart pad: a big screen that showed illustrations or cartoons and a small screen that showed the face of the speaker (1st session, MWS; 2nd session, MKP; 3rd session, YHK). The 3 smart pad applications were presented to the patients with a 1-month interval between each at the clinic. We did not allow the participants to use these applications at home by themselves, to allow a fair comparison with the control group.The smart pad applications included detailed education on the anatomy and physiology of the ear and auditory pathways, the perception of sound in the auditory cortex, “selective” listening, why tinnitus becomes a problem, the misconception that tinnitus causing hearing difficulties, an explanation of habituation as a goal, subconscious processing of auditory stimuli, “filtering” and “blocking” auditory stimuli from reaching consciousness, how to apply “sound therapy,” the neurophysiological model, and homework for the patient. Although the first session explained every aspect of these points, the second and third sessions reviewed the first session and added some new points with further examples. The smart-TRT was bidirectional: There were 17 multiple choice questions between each lesson for an interim check. The questions were mandatory, and the education session did not proceed if the patient did not respond. After the patient’s response, the correct answer was provided with further explanation why the answer was correct or incorrect. Since the patient’s response to each question was quite variable, the duration of the directive education differed between participants. It took at least 45 minutes for a patient to complete the first education session if the patient answered all the questions correctly and quickly. It took at least 25 minutes for a patient to complete the second and third education sessions. For some patients who had difficulty understanding the directive education, it could take more than 1 hour to complete 1 session.For the conv-TRT group, simplified group (1-4 patients/session) counseling was provided by a single clinician (MWS). The counselor in the conv-TRT group was identical to the first speaker in the smart-TRT group (MWS). The contents and teaching materials for the directive counseling were also identical between the 2 groups. It took about 45 minutes to 60 minutes for a patient to complete the first session. It took about 10 minutes to 20 minutes for a patient to complete the second and third education sessions. The second and third sessions were rather short in the conv-TRT group, because most of the essential information and strategies were already well-covered. It took less time to review the last session and add new knowledge and encourage higher levels of motivation. Other than these points, all the other treatment and follow-up conditions were the same in the 2 groups.