Digital therapeutics for tinnitus in emerging markets: a content analysis and quality assessment using the mobile app rating scale

Shwetha C. Poojary; Prasanna Nayak

doi:10.18203/issn.2454-5929.ijohns20262381

Authors

Shwetha C. Poojary Department of ENT, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India
Prasanna Nayak Department of Paediatrics, Father Muller Medical College, Mangalore, Karnataka, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20262381

Keywords:

Mobile applications, Digital therapeutics, Tinnitus, Neural plasticity, Telemedicine

Abstract

Background: Chronic subjective tinnitus remains a significant clinical challenge globally, characterized by the phantom perception of sound in the absence of external stimuli. While its etiology is multifactorial, the transition from acute perception to chronic distress is increasingly understood through the lens of maladaptive neuroplasticity and increased central gain.

Methods: A systematic prospective analysis and quality assessment were conducted on ten leading mHealth applications. Evaluation was performed using the 23-item Mobile app rating scale (MARS), which provides an objective framework across four objective subscales: engagement, functionality, aesthetics, and information quality, alongside a subjective quality subscale.

Results: The assessment revealed a highly capable but subscription-heavy landscape. Inter-rater reliability was strong (κ=0.86). Oto achieved the highest overall MARS score (4.52), followed closely by MindEar (4.43) and Tinnitus Pro (4.33). While apps like myNoise led in technical functionality (4.8), others like T-minus excelled in visual aesthetics (4.9). Clinical data integrated into the reviews highlighted that AI-driven interventions, such as MindEar, can result in significant reductions in Tinnitus functional index (TFI) scores for 64% of users.

Conclusions: Digital therapeutics offer transformative potential for tinnitus habituation through cognitive behavioral therapy (CBT), sound enrichment, and AI-driven coaching. However, significant socio-technical barriers persist in rural Indian contexts, particularly within the Karnataka region, including linguistic limitations and low digital literacy among seniors. Future adoption in emerging markets requires integrating mHealth into the primary health center (PHC) framework and utilizing community health workers (CHWs) as digital mediators.

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References

Aryal S, Sharma Y, Prabhu P. Prevalence of tinnitus and its characteristics among Indian adult population. Ann Otol Neurotol. 2022;5(1):15-20. DOI: https://doi.org/10.1055/s-0043-1769889

Henry JA, Dennis KC, Schechter MA. General review of tinnitus: prevalence, mechanisms, effects, and management. J Speech Lang Hear Res. 2005;48(5):1204-35. DOI: https://doi.org/10.1044/1092-4388(2005/084)

Baguley D, McFerran D, Hall D. Tinnitus. Lancet. 2013;382(9904):1600-7. DOI: https://doi.org/10.1016/S0140-6736(13)60142-7

Noreña AJ. Revisiting the cochlear and central mechanisms of tinnitus and therapeutic approaches. Audiol Neurootol. 2015;20(1):53-9. DOI: https://doi.org/10.1159/000380749

Cederroth CR, Gallus S, Hall DA, Kleinjung T, Langguth B, Maruotti A, et al. Editorial: Towards an Understanding of Tinnitus Heterogeneity. Front Aging Neurosci. 2019;11:53. DOI: https://doi.org/10.3389/fnagi.2019.00053

Lenarz T, Schreiner C, Snyder RL, Ernst A. Neural mechanisms of tinnitus. Eur Arch Otorhinolaryngol. 1993;249(8):441-6. DOI: https://doi.org/10.1007/BF00168851

Kujawa SG, Liberman MC. Adding insult to injury: cochlear nerve degeneration after "temporary" noise-induced hearing loss. J Neurosci. 2009;29(45):14077-85. DOI: https://doi.org/10.1523/JNEUROSCI.2845-09.2009

Guitton MJ, Caston J, Ruel J, Johnson RM, Pujol R, Puel JL. Salicylate induces tinnitus through activation of cochlear NMDA receptors. J Neurosci. 2003;23(9):3944-52. DOI: https://doi.org/10.1523/JNEUROSCI.23-09-03944.2003

Kaltenbach JA, Afman CE. Hyperactivity in the dorsal cochlear nucleus after intense sound exposure and its resemblance to tone-evoked activity: a physiological model for tinnitus. Hear Res. 2000;140(1-2):165-72. DOI: https://doi.org/10.1016/S0378-5955(99)00197-5

Mühlau M, Rauschecker JP, Oestreicher E, Gaser C, Röttinger M, Wohlschläger AM, et al. Structural brain changes in tinnitus. Cereb Cortex. 2006;16(9):1283-8. DOI: https://doi.org/10.1093/cercor/bhj070

Vanneste S, De Ridder D. The auditory and non-auditory brain areas involved in tinnitus. An emergent property of multiple parallel overlapping subnetworks. Front Syst Neurosci. 2012;6:31. DOI: https://doi.org/10.3389/fnsys.2012.00031

McKenna L, Handscomb L, Hoare DJ, Hall DA. A scientific cognitive-behavioral model of tinnitus: novel conceptualizations of tinnitus distress. Front Neurol. 2014;5:196. DOI: https://doi.org/10.3389/fneur.2014.00196

Beukes EW, Baguley DM, Jacquemin L, Lourenco MPCG, Allen PM, Onozuka J, et al. Changes in Tinnitus Experiences During the COVID-19 Pandemic. Front Public Health. 2020;8:592878. DOI: https://doi.org/10.3389/fpubh.2020.592878

Stoyanov SR, Hides L, Kavanagh DJ, Zelenko O, Tjondronegoro D, Mani M. Mobile app rating scale: a new tool for assessing the quality of health mobile apps. JMIR Mhealth Uhealth. 2015;3(1):e27. DOI: https://doi.org/10.2196/mhealth.3422

Bardy F, Jacquemin L, Wong CL, Maslin MRD, Purdy SC, Thai-Van H. Delivery of internet-based cognitive behavioral therapy combined with human-delivered telepsychology in tinnitus sufferers through a chatbot-based mobile app. Front Audiol Otol. 2023;1:1302215. DOI: https://doi.org/10.3389/fauot.2023.1302215

Meikle MB, Henry JA, Griest SE, Stewart BJ, Abrams HB, McArdle R, et al. The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus. Ear Hear. 2012;33(2):153-76. DOI: https://doi.org/10.1097/AUD.0b013e31822f67c0

Tyler RS, Deshpande AK, Lau CC, Kuk F. The Effectiveness of the Progression of Widex Zen Tinnitus Therapy: A Pilot Study. Am J Audiol. 2017;26(3):283-92. DOI: https://doi.org/10.1044/2017_AJA-16-0009

Sweetow RW, Jeppesen KM. A new integrated program for tinnitus patient management: Widex Zen Therapy. Hear Rev. 2012;19(7):20-7.

Sinha R, Shivaswamy J. Prevalence of communication disorders in Mandya district. Mysore: All India Institute of Speech and Hearing (AIISH). AIISH Research Fund Project Report; 2017.

Thirunavukkarasu K, Geetha C. One-year prevalence and risk factors of tinnitus in older individuals with otological problems. Int Tinnitus J. 2013;18(2):175-81. DOI: https://doi.org/10.5935/0946-5448.20130023

Khare V, Silawat S, Shrivastava A, Saroshe S, Dixit S. A cross-sectional study to assess the utilization and perception of online health applications (mHealth apps) among urban residents of Indore city, India. Int J Med Public Health. 2025;15(3):1792-6.

Molon JN. Mobile App Rating Scale (User Version) for the assessment of a community health worker medical application. Mhealth. 2025;11:48. DOI: https://doi.org/10.21037/mhealth-25-22