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The University of Iowa
Department of Otolaryngology--Head & Neck Surgery
General Questionnaire to determine research candidacy:
We are writing to invite you to participate in a research registry study. The purpose of the study is to help you determine if you are a candidate for a tinnitus study in the following areas of research:
Combination wearable device
Sound generating device (masker)
Medications and dietary supplements
Appropriateness of different background sounds to partially mask tinnitus
We are inviting you to be in this registry study because you may have tinnitus. Approximately 50,000 people will take part in this study at the University of Iowa.
You must be 18 years old to participate in this study.
If you agree to participate, we would like you to complete an online survey. This is a one-time survey/questionnaire experience. If you choose to skip a question, the survey will not allow you to continue. It will take approximately 15 minutes or more to complete; however, you may take as long as you need.
After answering the online survey you will be told if you are a candidate for a specific study. If you are a candidate and are interested in participating in the study, you will be asked to leave your name, telephone number and/or email address. We will use this information to contact you to schedule a clinic visit and to discuss in more detail the specific study for which you will consent separately. We will keep the information you provide confidential; however, federal regulatory agencies and the University of Iowa Institutional Review Board (a committee that reviews and approves research studies) may inspect and copy records pertaining to this research. Information collected as part of this study will be stored and may be used in other studies.
If we write a report about this study we will do so in such a way that you cannot be identified.
There are no known risks from being in this registry study, and you will not benefit personally. However we hope that others may benefit in the future from what we learn as a result of this study.
You will not have any costs for being in this research study.
You will not be paid for being in this research study.
Taking part in this research study is completely voluntary. If you decide not to be in this study, or if you stop participating at any time, you won’t be penalized or lose any benefits for which you otherwise qualify.
If you have any questions about the research study itself, please contact Shelley Witt (319) 356-3969. If you experience a research-related injury, please contact: Shelley Witt (319) 356-3969. If you have questions about the rights of research subjects, please contact the Human Subjects Office, 105 Hardin Library for the Health Sciences, 600 Newton Road, University of Iowa, Iowa City, IA 52242-1098, (319) 335-6564, or e-mail
. To offer input about your experiences as a research subject or to speak to someone other than the research staff, call the Human Subjects Office at the number above.
Thank you very much for your consideration. Submission of the completed online survey indicates your willingness to participate in this registry study.
Richard S. Tyler, PhD
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