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https://codas.org.br/article/doi/10.1590/2317-1782/e20250182pt
CoDAS
Original Article

Uso da mindfulness no tratamento do zumbido: consenso baseado na opinião de especialistas brasileiros

Use of mindfulness in the treatment of tinnitus: consensus based on the opinion of Brazilian experts

Mônica Claudino Medeiros Honorato; Mariana Lopes Martins; Lidiane Maria de Brito Macedo Ferreira; Erika Baroni Mantello; Marine Raquel Diniz da Rosa

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Resumo

Objetivo: Desenvolver um consenso com experts otorrinolaringologistas, fonoaudiólogos e fisioterapeutas acerca dos critérios de recomendação e uso da mindfulness aplicada no tratamento do zumbido. Método: Estudo observacional, descritivo, quantitativo e transversal, conduzido de forma online. A amostra por conveniência contou, inicialmente, com 23 especialistas. Aplicou-se o método Delphi em duas etapas, com fornecimento de feedback e anonimato das respostas. A primeira etapa consistiu em perguntas objetivas e subjetivas. A segunda etapa contou com 10 participantes, que avaliaram 34 afirmativas derivadas da etapa inicial. Os especialistas analisaram cada item e demonstraram sua concordância em uma escala likert de cinco pontos. Utilizou-se o coeficiente de validade de conteúdo (CVC) para investigar o grau de concordância entre os juízes e selecionar os itens finais. Resultados: Houve consenso em 25 dos 34 itens (CVC ≥ 0,70). Os especialistas consideram que a mindfulness é um recurso terapêutico para o zumbido, porém não como monoterapia. Foi consenso a indicação da aplicação uma vez por semana, pelo menos, 30 minutos, com prática diária domiciliar. O seguimento da terapia após 8 semanas pode ser feito por meio de escalas como Tinnitus Handicap Inventory e a Escala Visual Analógica. Conclusão: Há consenso sobre o uso da mindfulness no tratamento (não isolado) do zumbido com protocolo semanal (8 semanas), duração de 30 minutos cada sessão e acompanhamento por meio do THI e EVA. Tais recomendações devem ser exploradas em ensaios clínicos, investigando os efeitos a curto e longo prazo, em prol de evidências científicas e padronização de protocolos clínicos.

Palavras-chave

Zumbido; Atenção Plena; Técnica Delphi; Consenso; Terapias Complementares

Abstract

Purpose: To develop a consensus among otolaryngologists, speech-language-hearing pathologists, and physical therapists regarding the criteria for recommending and using mindfulness in the treatment of tinnitus. Methods: Observational, descriptive, quantitative, cross-sectional study conducted online. The convenience sample initially consisted of 23 specialists. The Delphi method was applied in two stages, providing feedback with anonymous responses. The first stage consisted of objective and subjective questions. The second stage involved 10 participants, who evaluated 34 statements derived from the initial stage. The specialists analyzed each item and demonstrated their agreement on a 5-point Likert scale. The content validity coefficient (CVC) was used to investigate the degree of interrater agreement and select the final items. Results: There was consensus on 25 of the 34 items (CVC ≥ 0.70). The specialists consider mindfulness to be a therapeutic resource for tinnitus, but not as monotherapy. There was consensus on recommending application once a week, for at least 30 minutes, with daily home practice. Follow-up therapy after 8 weeks can be done using scales such as the Tinnitus Handicap Inventory and the Visual Analogue Scale. Conclusion: There is consensus on the combined (not alone) use of mindfulness in the treatment of tinnitus with a weekly protocol (8 weeks), lasting 30 minutes per session, monitored using the THI and VAS. These recommendations should be explored in clinical trials, investigating the short- and long-term effects to provide scientific evidence and standardize clinical protocols.

Keywords

Tinnitus; Mindfulness; Delphi Technique; Consensus; Complementary Therapies

References

  • Han BI, Lee HW, Ryu S, Kim JS. Tinnitus update. J Clin Neurol. 2021;17(1):1-10. https://doi.org/10.3988/jcn.2021.17.1.1 PMid:33480192.
    » https://doi.org/10.3988/jcn.2021.17.1.1
  • 2Jarach C, Lugo A, Scala M, Van Den Brandt P, Cederroth C, Odone A, et al. Global prevalence and incidence of tinnitus: a systematic review and meta-analysis. JAMA Neurol. 2022;79(9):888-900. https://doi.org/10.1001/jamaneurol.2022.2189 PMid:35939312.
    » https://doi.org/10.1001/jamaneurol.2022.2189
  • 3Person OC, Angélico FV Jr, Altoé J, Portes LM, Lopes PR, Puga MÊS. What do Cochrane systematic reviews say about therapeutic tinnitus interventions? ABCS Health Sci. 2022;47:1565-72. https://doi.org/10.7322/abcshs.2020111.1565
    » https://doi.org/10.7322/abcshs.2020111.1565
  • 4Rademaker M, Stegeman I, Ho-Kang-You KE, Stokroos RJ, Smit AL. The effect of mindfulness-based interventions on tinnitus distress. a systematic review. Front Neurol. 2019;10:1135. https://doi.org/10.3389/fneur.2019.01135 PMid:31736854.
    » https://doi.org/10.3389/fneur.2019.01135
  • 5De Ridder D, Schlee W, Vanneste S, Londero A, Weisz N, Kleinjung T, et al. Tinnitus and tinnitus disorder: theoretical and operational definitions (an international multidisciplinary proposal). Prog Brain Res. 2021;260:1-25. https://doi.org/10.1016/bs.pbr.2020.12.002 PMid:33637213.
    » https://doi.org/10.1016/bs.pbr.2020.12.002
  • 6Gasparre D, Pepe I, Laera D, Abbatantuono C, de Caro MF, Taurino A, et al. Cognitive functioning and psychosomatic syndromes in a subjective tinnitus sample. Front Psychol. 2023;14:1256291. https://doi.org/10.3389/fpsyg.2023.1256291 PMid:38192387.
    » https://doi.org/10.3389/fpsyg.2023.1256291
  • 7Niemann U, Boecking B, Brueggemann P, Spiliopoulou M, Mazurek B. Heterogeneity in response to treatment across tinnitus phenotypes. Sci Rep. 2024;14(1):2111. https://doi.org/10.1038/s41598-024-52651-x PMid:38267701.
    » https://doi.org/10.1038/s41598-024-52651-x
  • 8Philippot P, Nef F, Clauw L, de Romrée M, Segal Z. A Randomized controlled trial of mindfulness-based cognitive therapy for treating tinnitus. Clin Psychol Psychother. 2012;19(5):411-9. https://doi.org/10.1002/cpp.756 PMid:21567655.
    » https://doi.org/10.1002/cpp.756
  • 9Rademaker M, Stegeman I, Lieftink A, Somers M, Stokroos R, Smit A. MinT-trial: mindfulness versus cognitive behavioural therapy in tinnitus patients: protocol for a randomised controlled, non-inferiority trial. BMJ Open. 2020;10(2):e033210. https://doi.org/10.1136/bmjopen-2019-033210 PMid:32102813.
    » https://doi.org/10.1136/bmjopen-2019-033210
  • 10Mckenna L, Marks EM, Vogt F. Mindfulness-based cognitive therapy for chronic tinnitus: evaluation of benefits in a large sample of patients attending a tinnitus clinic. Ear Hear. 2018;39(2):359-66. https://doi.org/10.1097/AUD.0000000000000491 PMid:28945659.
    » https://doi.org/10.1097/AUD.0000000000000491
  • 11McKenna L, Marks EM, Hallsworth CA, Schäette R. Mindfulness-based cognitive therapy as a treatment for chronic tinnitus: a randomized controlled trial. Psychother Psychosom. 2017;86(6):351-61. https://doi.org/10.1159/000478267 PMid:29131084.
    » https://doi.org/10.1159/000478267
  • 12Marks E, Smith P, Mckenna L. I wasn’t at war with the noise: how mindfulness based cognitive therapy changes patients’ experiences of tinnitus. Front Psychol. 2020;11:483. https://doi.org/10.3389/fpsyg.2020.00483 PMid:32362850.
    » https://doi.org/10.3389/fpsyg.2020.00483
  • 13Roland LT, Lenze EJ, Hardin FM, Kallogjeri D, Nicklaus J, Wineland AM, et al. Effects of mindfulness-based stress reduction therapy on subjective bother and neural connectivity in chronic tinnitus. Otolaryngol Head Neck Surg. 2015;152(5):919-26. https://doi.org/10.1177/0194599815571556 PMid:25715350.
    » https://doi.org/10.1177/0194599815571556
  • 14Shang Z. Use of Delphi in health sciences research: a narrative review. Medicine. 2023;102(7):e32829. https://doi.org/10.1097/MD.0000000000032829 PMid:36800594.
    » https://doi.org/10.1097/MD.0000000000032829
  • 15Spranger J, Homberg A, Sonnberger M, Niederberger M. Reporting guidelines for Delphi techniques in health sciences: a methodological review. Z Evid Fortbild Qual Gesundhwes. 2022;172:1-11. https://doi.org/10.1016/j.zefq.2022.04.025 PMid:35718726.
    » https://doi.org/10.1016/j.zefq.2022.04.025
  • 16Marques JBV, Freitas D. Método DELPHI: caracterização e potencialidades na pesquisa em Educação. Pro-Posições. 2018;29(2):389-415. https://doi.org/10.1590/1980-6248-2015-0140
    » https://doi.org/10.1590/1980-6248-2015-0140
  • 17Tunkel DE, Bauer CA, Sun GH, Rosenfeld RM, Chandrasekhar SS, Cunningham ER Jr, et al. Clinical practice guideline: tinnitus. Otolaryngol Head Neck Surg. 2014;151(2):S1-40. https://doi.org/10.1177/0194599814545325 PMid:25273878.
    » https://doi.org/10.1177/0194599814545325
  • 18Arif M, Sadlier M, Rajenderkumar D, James J, Tahir T. A randomised controlled study of mindfulness meditation versus relaxation therapy in the management of tinnitus. J Laryngol Rhinol Otol. 2017;131(6):501-7. https://doi.org/10.1017/S002221511700069X PMid:28357966.
    » https://doi.org/10.1017/S002221511700069X
  • 19Valim CCA, Sanchez TG. The tinnitus total remission: targeting treatment to the etiological hypothesis. J Otolaryngol. 2018;10(3):153-5. https://doi.org/10.15406/joentr.2018.10.00335
    » https://doi.org/10.15406/joentr.2018.10.00335
  • 20Liu H, Zhang J, Yang S, Wang X, Zhang W, Li J, et al. Efficacy of sound therapy interventions for tinnitus management: A protocol for systematic review and network meta-analysis. Medicine. 2021;100(41):e27509. https://doi.org/10.1097/MD.0000000000027509 PMid:34731137.
    » https://doi.org/10.1097/MD.0000000000027509
  • 21Sanchez TG, Valim CCA, Schlee W. Long-lasting total remission of tinnitus: a systematic collection of cases. Prog Brain Res. 2021;260:269-82. https://doi.org/10.1016/bs.pbr.2020.05.023 PMid:33637222.
    » https://doi.org/10.1016/bs.pbr.2020.05.023
  • 22Mazurek B, Hesse G, Dobel C, Kratzsch V, Lahmann C, Sattel H, and the Guideline group. Clinical practice guideline: chronic tinnitus—diagnosis and treatment. Dtsch Arztebl Int. 2022;119(13):219-25. https://doi.org/10.3238/arztebl.m2022.0135 PMid:35197187.
    » https://doi.org/10.3238/arztebl.m2022.0135
  • 23Wu Y, Tang D, Mao H, Sun S, Li H. Comparison of guidelines on tinnitus. Chinese Journal of Otorhinolaryngology. 2023;58(8):834-40. https://doi.org/10.3760/cma.j.cn115330-20221023-00626 PMid:37599251.
    » https://doi.org/10.3760/cma.j.cn115330-20221023-00626
  • 24Lee HY, Jung DJ. Recent updates on tinnitus management. J Audiol Otol. 2023;27(4):181-92. https://doi.org/10.7874/jao.2023.00416 PMid:37872753.
    » https://doi.org/10.7874/jao.2023.00416
  • 25Lima LC, Mendes LC. Mindfulness and psychological well-being: effects of a mindfulness-based health promotion program on healthy adults. Trends Psychol. 2020;28(2):213-29. https://doi.org/10.1007/s43076-020-00020-8
    » https://doi.org/10.1007/s43076-020-00020-8
  • 26Gans JJ, O’sullivan P, Bircheff V. Mindfulness based tinnitus stress reduction pilot study. Mindfulness (N Y). 2014;5(3):322-33. https://doi.org/10.1007/s12671-012-0184-4
    » https://doi.org/10.1007/s12671-012-0184-4
  • 27Nascimento IP, Almeida AA, Diniz J, Martins ML, Freitas TMMWC, Rosa MRD. Tinnitus evaluation: relationship between pitch matching and loudness, visual analog scale and tinnitus handicap inventory. Braz J Otorhinolaryngol. 2019;85(5):611-6. https://doi.org/10.1016/j.bjorl.2018.05.006 PMid:29983341.
    » https://doi.org/10.1016/j.bjorl.2018.05.006
  • 28Gos E, Sagan A, Skarzynski PH, Skarzynski H. Improved measurement of tinnitus severity: study of the dimensionality and reliability of the Tinnitus Handicap Inventory. PLoS One. 2020;15(8):e0237778. https://doi.org/10.1371/journal.pone.0237778 PMid:32841249.
    » https://doi.org/10.1371/journal.pone.0237778
  • 29Shin SH, Byun SW, Kim SJ, Lee HY. Measures of subjective tinnitus: what does visual analog scale stand for? J Am Acad Audiol. 2022;33(2):92-7. https://doi.org/10.1055/s-0041-1736649 PMid:36049754.
    » https://doi.org/10.1055/s-0041-1736649
  • 30Raj-Koziak D, Gos E, Swierniak W, Rajchel JJ, Karpiesz L, Niedzialek I, et al. Visual analogue scales as a tool for initial assessment of tinnitus severity: psychometric evaluation in a clinical population. Audiol Neurootol. 2018;23(4):229-37. https://doi.org/10.1159/000494021 PMid:30439712.
    » https://doi.org/10.1159/000494021
  • 31Gouveia CCV. Remissão total do zumbido: caracterização do perfil dos indivíduos e tratamentos realizados [dissertação]. São Paulo: Faculdade de Medicina, Universidade de São Paulo; 2018.

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