Authors: Abubakar Mairiga, Naveed Anwar, Biddy Casselden
Abstract: Background: Tinnitus is a chronic auditory disorder affecting an estimated 10–15% of the United Kingdom adult population and approximately 50 million Americans, characterised by the perception of phantom sounds in the absence of external stimuli. Despite the absence of a definitive cure, mobile health (mHealth) applications have emerged as accessible self-management tools. However, critical gaps remain in the evaluation of these applications across dimensions of accessibility, evidence-based content, functionality, and personalisation. Objective: This study aimed to conduct a comprehensive, mixed-methods evaluation of mobile applications for tinnitus management, focusing on their efficacy, user satisfaction, and the tension between high over-all positive sentiment and persistent limitations in evidence-based content, personalisation, and user accessibility. Methods: A three-strand mixed-methods design was employed: (1) sentiment analysis of 13,096 user reviews from 42 tinnitus management applications across Google Play and Apple App Store (July–December 2022), collected using Appbot; (2) a cross-sectional online survey of 171 participants with self-reported tinnitus, conducted between March and June 2024; and (3) in-depth semi-structured interviews with 19 purposively selected participants. Quantitative data were analysed using descriptive statistics, chi-square tests of independence, and Spearman rank correlation. Qualitative data were thematically analysed using NVivo. Re-sults: Sentiment analysis revealed that 72.38% of 13,096 reviews were positive, and the overall average app rating was 4.29 out of 5 stars. Google Play exhibited higher positive sentiment (79.49%) compared to iOS (65.42%). ReSound Tinnitus Relief was the top-rated application by volume (n=3,452 reviews; mean rating=4.61). Survey findings revealed that 91.4% of 171 tinnitus sufferers had never used a tinnitus-specific mobile application. Among the 14 active app users, ambient sounds (71.43% useful/very useful) and information about tinnitus (64.29%) were the most valued features. Spearman rank correlation confirmed significant positive associations between app feature information and health content quality (ρ=0.73, P<.001), app use and user experience (ρ=0.68, P<.001), and app use and well-being indicators (ρ=0.71, P<.001). Interview data revealed four core themes: apps as lifesavers for sleep and emotional stress management, value and connectivity through app use, rele-vance of educational content, and effects on tinnitus management and well-being. Conclusions: Tinnitus management mobile applications demonstrate significant promise as tools for sleep improvement, stress reduction, and patient education, with strong positive user sentiment. However, a paradoxical finding, high satisfaction among the 8.6% of users who adopt apps versus 91.4% non-adoption, reveals major systemic barriers including low awareness, inadequate personalisation, and insufficient evidence-based content. Collaborative development among app developers, clinicians, and researchers is essential to close this efficacy–accessibility gap.
