Publication:

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

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.