Citation
(2013), "Internet review", Health Education, Vol. 113 No. 1. https://doi.org/10.1108/he.2013.142113aaa.001
Publisher
:Emerald Group Publishing Limited
Copyright © 2012, Emerald Group Publishing Limited
Internet review
Internet review
Article Type: Internet review From: Health Education, Volume 113, Issue 1.
Tinnitus
Although not categorised as a disease, tinnitus can be a very distressing condition that can have a major impact on a person's well-being. It is also more common that might be assumed; 20 per cent in 55-65-year-olds when assessed on a general health questionnaire. Tinnitus is very much a subjective condition and it is therefore difficult to assess objectively. This subjective nature means that the symptoms can also vary considerably from buzzing in the ear, ringing or rushing sounds even clicking noises. Most typically, the symptoms could be described as an unwanted auditory stimulus, that no one else can hear. As might be expected with such a wide range of symptoms there is no single cause of tinnitus. The causes of tinnitus may be simple, for example a build up of earwax or there may be a more complex underlying neurological problem. With the symptoms being so varied it is not surprising that there are a wide range of treatments available including some that are delivered online via the internet.
The purpose of this review is to examine what the internet can contribute to the mitigation of this distressing condition.
Beacon
http://beacon.anu.edu.au/websites/view/93/17
This Australian web site is interesting in that it provides reviews for online physical and mental health programmes. The programmes that have been reviewed range from alcohol dependence to panic disorder, and of course tinnitus. Each review provides a brief paragraph describing the web site and a five star smiley system for rating that web site. In addition details of how to access the web site is provided, plus any costs involved, as well as any research evidence supporting the web site. A reference section also provides details of relevant research papers.
As far as help with tinnitus is concerned, the web site provides access to a limited research project that has used online CBT to help people deal with the symptoms of the condition. The brief report concludes that the programme as described is effective in mitigating the symptoms when compared with a control group who do not receive the online CBT. The report is not yet finalised but preliminary findings do suggest that online therapies for tinnitus look promising.
American Tinnitus Association (ATA)
This is the web site of the ATA, a charity based in North America that is dedicated to funding research into tinnitus. They are obviously quite successful in that they have funded over 100 research studies since 1980 and much of this research is available through the web site. The web site has some interesting banner advertising and information snippets giving users a quick overview of the problem. For example, we are told that over 50 million Americans experience the condition and that it is the number one disability found in military veterans.
The web site is divided into six main sections, three of which provide advice and guidance on how to manage the condition and the remaining three are devoted to fund raising, research and awareness raising. The advice and guidance sections start by providing the user with access to “20 tips for managing your tinnitus”. Within these there is basic guidance on what tinnitus is and how to self-diagnose. Great emphasis is placed on self-help and remaining positive. The content acknowledges that there is no cure for tinnitus but it does suggest that people with the condition examine their own diet, lifestyle and medications for clues to what might be responsible or may be aggravating the condition. As part of the self-help process users are encouraged to educate themselves, join local support groups and of course seek advice from web sites such as ATA.
The section that provides information for “patients, family and friends” is not extensive but it does answer the basic questions that people might ask. For example what is tinnitus, how is it caused, is there a cure, what treatments or support are available? This section also poses questions for users, including how they might contribute either by making a donation to fund research, or by lobbying politicians to make it more of a priority. This section is well written and informative and also includes links to other resources including YouTube videos of sufferers discussing their problems. There is also a useful guide that can be downloaded to help users find a health professional who might be able to help. Even though this guide has been produced primarily for a North American audience, the questions posed and points made are generally applicable to other parts of the world.
The ATA has been involved in this work for many years and the quality of this web site reflects the high degree of professionalism that might be expected.
eMedicine Health
www.emedicinehealth.com/tinnitus/article_em.htm
This is another offering from North America but it is very different from the ATA web site. This web site offers information on a variety of health topics as well as tinnitus. The most obvious thing users will notice about this web site is the profusion of distractions, some relevant to tinnitus, many that are not. Unfortunately advertisements are a necessary part of this type of web site and it is what provides the financial support that allows it to be maintained. However irrelevant advertisements, for example dealing with skin conditions, when the user is interested in tinnitus, are simply an unnecessary distraction. With web technology available today it should be possible for this type of web site to tailor the advertisements they offer to reflect the search terms submitted by users.
The content that is provided is simple and, with the exception of a diagram of a cross-section of an ear, almost wholly text based. There is a slide show but that seems to show very little apart from people in noisy environments, which may or may not be relevant to tinnitus. There is also an ear infection quiz that users can take, but again its relevance to the main topic is very tenuous. A very promising section on “self-care at home” was a disappointment because the link simply advised that you should not self-care at home until an evaluation by a health care professional has been carried out. The section dealing with prevention was slightly better but since the cause of tinnitus is many and varied and the only advice offered was to avoid damaging your hearing by using appropriate hearing protection, this is somewhat limited.
However, one good section in this web site comes under the heading of “Viewers Comments and Reviews”. This is essentially a forum where users can contribute with comments on a variety of tinnitus topics including causes and effective treatments. This type of forum can be particularly useful for people who have recently acquired the condition and are looking for help in managing the problem. Many of the comments show that it can be managed and that people do cope with tinnitus is remarkably positive ways. This web site is worth looking at if only for this section.
British Tinnitus Association (BTA)
The BTA is the UK equivalent of the ATA discussed above. The BTA has not been around quite as long as the ATA, being founded in 1979, and whereas the ATA is essentially a fund raiser for research, the main focus of the BTA is providing help and support for people with tinnitus. The web site is very well designed with four main sections providing information on the causes of tinnitus, on-going research, a section for health professionals, and what is of most interest in this review, support and services for sufferers.
The “What is Tinnitus” section is excellently written with clear content and good advice. There are also leaflets in PDF format that can be downloaded if required. A novel feature for web sites dealing with the condition is the audio simulation that this web site provides and that can be listened to online. The sounds mimic the wide variety of audio disturbances that sufferers have to cope with day after day often for years. Users should be aware that listening to this simulation can itself be quite disturbing, but nonetheless it is an excellent way of conveying the nature of the problem.
The section on “Research” is something of a disappointment. There are no actual research papers included, or if they are they were not possible for this reviewer to find. There is a research summary section which looked promising but again was a disappointment because the most recent summary report was from 2006! This badly needs updating.
The section aimed at “Health Professionals” is good, with advice for general practitioners, audiologists and other hearing professionals. Professional users will also find details of the BTA Annual Conference, book reviews and access to dozens of leaflets and relevant publications.
These same publications are also available in the “Support Services” section along with many others that would be of interest to the lay user or tinnitus sufferer. The “Real Lives” section gives users access to the comments and discussions by people who have tinnitus. Part of this section involves video diaries from musicians and DJs who have developed tinnitus as a result of their work. While this section does provide a valuable insight into the lives of people with the condition it is not a forum as such in that “live” information exchange is not possible. A forum is available as part of the Support Service but users will have to be over 16 years of age and they will have to register with the BTA before the forums can be accessed.
Also within the “Support Services” section users will find access to support groups although in some instances the “group” is simply a single volunteer!
The one thing that appears to be lacking in this section, which was easily found in the ATA web site, is real practical advice on how to cope on a day-to-day basis. A quick look at the forum shows that this is what people are seeking and the web site could be greatly improved if this sort of information was provided.