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Niemann U, Boecking B, Brueggemann P, Spiliopoulou M, Mazurek B. Heterogeneity in response to treatment across tinnitus phenotypes. Sci Rep 2024; 14:2111. [PMID: 38267701 PMCID: PMC10808188 DOI: 10.1038/s41598-024-52651-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/22/2024] [Indexed: 01/26/2024] Open
Abstract
The clinical heterogeneity of chronic tinnitus poses major challenges to patient management and prompts the identification of distinct patient subgroups (or phenotypes) that respond more predictable to a particular treatment. We model heterogeneity in treatment response among phenotypes of tinnitus patients concerning their change in self-reported health burden, psychological characteristics, and tinnitus characteristics. Before and after a 7-day multimodal treatment, 989 tinnitus patients completed 14 assessment questionnaires, from which 64 variables measured general tinnitus characteristics, quality of life, pain experiences, somatic expressions, affective symptoms, tinnitus-related distress, internal resources, and perceived stress. Our approach encompasses mechanisms for patient phenotyping, visualizations of the phenotypes and their change with treatment in a projected space, and the extraction of patient subgroups based on their change with treatment. On average, all four distinct phenotypes identified at the pre-intervention baseline showed improved values for nearly all the considered variables following the intervention. However, a considerable intra-phenotype heterogeneity was noted. Five clusters of change reflected variations in the observed improvements among individuals. These patterns of treatment effects were identified to be associated with baseline phenotypes. Our exploratory approach establishes a groundwork for future studies incorporating control groups to pinpoint patient subgroups that are more likely to benefit from specific treatments. This strategy not only has the potential to advance personalized medicine but can also be extended to a broader spectrum of patients with various chronic conditions.
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Affiliation(s)
- Uli Niemann
- University Library, Otto von Guericke University Magdeburg, Universitätsplatz 2, Magdeburg, 39106, Germany.
- Faculty of Computer Science, Otto von Guericke University Magdeburg, Universitätsplatz 2, Magdeburg, 39106, Germany.
| | - Benjamin Boecking
- Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Petra Brueggemann
- Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Myra Spiliopoulou
- Faculty of Computer Science, Otto von Guericke University Magdeburg, Universitätsplatz 2, Magdeburg, 39106, Germany
| | - Birgit Mazurek
- Charité-Universitaetsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin, 10117, Germany
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Mazurek B, Hesse G, Sattel H, Kratzsch V, Lahmann C, Dobel C. S3 Guideline: Chronic Tinnitus : German Society for Otorhinolaryngology, Head and Neck Surgery e. V. (DGHNO-KHC). HNO 2022; 70:795-827. [PMID: 36227338 PMCID: PMC9581878 DOI: 10.1007/s00106-022-01207-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Birgit Mazurek
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Gerhard Hesse
- Tinnitus-Klinik, KH Bad Arolsen, Große Allee 50, 34454, Bad Arolsen, Germany.
- Universität Witten/Herdecke, Witten, Germany.
| | - Heribert Sattel
- Klinikum rechts der Isar, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Technical University of Munich, Langerstr. 3, 81675, Munich, Germany
| | - Volker Kratzsch
- Abt. Hörbehinderung, Tinnitus und Schwindelerkrankungen, VAMED Rehaklinik Bad Grönenbach, Sebastian-Kneipp-Allee 3-5, 87730, Bad Grönenbach, Germany
| | - Claas Lahmann
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Hauptstr. 8, 79104, Freiburg, Germany
| | - Christian Dobel
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
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3
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Basso L, Boecking B, Neff P, Brueggemann P, El-Ahmad L, Brasanac J, Rose M, Gold SM, Mazurek B. Negative Associations of Stress and Anxiety Levels With Cytotoxic and Regulatory Natural Killer Cell Frequency in Chronic Tinnitus. Front Psychol 2022; 13:871822. [PMID: 35814090 PMCID: PMC9262102 DOI: 10.3389/fpsyg.2022.871822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/25/2022] [Indexed: 12/04/2022] Open
Abstract
Background Depression and anxiety are known to be associated with stress-induced changes in the immune system. Bothersome tinnitus can be related to stress and often co-occurs with depression and anxiety. This study investigates associations of psychological and audiological tinnitus-related factors with inflammatory parameters and immune cell subsets in chronic tinnitus patients as well as treatment-related effects. Methods This longitudinal study of inpatients treated with compact multimodal tinnitus-specific cognitive behavioral therapy included four repeated measurement sessions: baseline (N = 41), treatment end, 7.8-week (N = 35), and 13.8-week follow-up (N = 34). Data collection included audiometric testing, blood sampling, and psychometric questionnaires: Tinnitus Handicap Inventory (THI), Perceived Stress Questionnaire (PSQ-20), and Hospital Anxiety Depression Scale (HADS). Flow cytometry was used to analyze immune cell subsets. Statistical analyses comprised correlation and network analysis (cross-sectional), and linear mixed effect models (longitudinal). Results Bootstrapped network analysis showed negative averaged cross-sectional associations of cytotoxic natural killer (NKc) cell frequency (CD56 + CD16+) and PSQ-20 (−0.21 [−0.48, 0]) and of regulatory natural killer (NKreg) cell frequency (CD56 + CD16dim/−) and HADS anxiety (−0.14 [−0.38, 0]). No significant treatment effects were found. A negative predictive effect of baseline PSQ-20 scores (β = −6.22 [−12.18, −0.26], p = 0.041) and a positive predictive effect of baseline ferritin levels (β = 8.90 [2.76, 15.03], p = 0.004) on NKc cell frequency across the repeated measurement sessions were observed. Conclusion We observed negative relationships between perceived stress levels and NKc cell frequency and between anxiety levels and NKreg cell frequency in chronic tinnitus patients. These exploratory results suggest stress−/anxiety-related immune alterations in bothersome tinnitus but need to be tested in further confirmatory studies with larger sample sizes. The potential of NK cells as biomarkers of emotional distress in chronic tinnitus should be further investigated.
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Affiliation(s)
- Laura Basso
- Tinnitus Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Benjamin Boecking
- Tinnitus Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Patrick Neff
- Center for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Center for Neuroprosthetics, Institute of Bioengineering, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Petra Brueggemann
- Tinnitus Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Linda El-Ahmad
- Medical Department, Section of Psychosomatic Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jelena Brasanac
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Rose
- Medical Department, Section of Psychosomatic Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan M. Gold
- Medical Department, Section of Psychosomatic Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Birgit Mazurek
- Tinnitus Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
- *Correspondence: Birgit Mazurek,
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Brueggemann P, Mebus W, Boecking B, Amarjargal N, Niemann U, Spiliopoulou M, Dobel C, Rose M, Mazurek B. Dimensions of Tinnitus-Related Distress. Brain Sci 2022; 12:brainsci12020275. [PMID: 35204037 PMCID: PMC8870247 DOI: 10.3390/brainsci12020275] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives: (1) To determine which psychosocial aspects predict tinnitus-related distress in a large self-reported dataset of patients with chronic tinnitus, and (2) to identify underlying constructs by means of factor analysis. Methods: A cohort of 1958 patients of the Charité Tinnitus Center, Berlin completed a large questionnaire battery that comprised sociodemographic data, tinnitus-related distress, general psychological stress experience, emotional symptoms, and somatic complaints. To identify a construct of “tinnitus-related distress”, significant predictive items were grouped using factor analysis. Results: For the prediction of tinnitus-related distress (linear regression model with R2 = 0.7), depressive fatigue symptoms (concentration, sleep, rumination, joy decreased), the experience of emotional strain, somatization tendencies (pain experience, doctor contacts), and age appeared to play a role. The factor analysis revealed five factors: “stress”, “pain experience”, “fatigue”, “autonomy”, and low “educational level”. Conclusions: Tinnitus-related distress is predicted by psychological and sociodemographic indices. Relevant factors seem to be depressive exhaustion with somatic expressions such as sleep and concentration problems, somatization, general psychological stress, and reduced activity, in addition to higher age.
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Affiliation(s)
- Petra Brueggemann
- Tinnitus Center, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (P.B.); (W.M.); (B.B.); (N.A.)
| | - Wilhelm Mebus
- Tinnitus Center, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (P.B.); (W.M.); (B.B.); (N.A.)
| | - Benjamin Boecking
- Tinnitus Center, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (P.B.); (W.M.); (B.B.); (N.A.)
| | - Nyamaa Amarjargal
- Tinnitus Center, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (P.B.); (W.M.); (B.B.); (N.A.)
| | - Uli Niemann
- Knowledge Management & Discovery Lab, Faculty of Computer Science, Otto von Guericke University, 39106 Magdeburg, Germany; (U.N.); (M.S.)
| | - Myra Spiliopoulou
- Knowledge Management & Discovery Lab, Faculty of Computer Science, Otto von Guericke University, 39106 Magdeburg, Germany; (U.N.); (M.S.)
| | - Christian Dobel
- Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany;
| | - Matthias Rose
- Medical Department, Section of Psychosomatic Medicine, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - Birgit Mazurek
- Tinnitus Center, Charité—Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (P.B.); (W.M.); (B.B.); (N.A.)
- Knowledge Management & Discovery Lab, Faculty of Computer Science, Otto von Guericke University, 39106 Magdeburg, Germany; (U.N.); (M.S.)
- Correspondence: ; Tel.: +49-30-450-555-009
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5
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Basso L, Boecking B, Neff P, Brueggemann P, Mazurek B, Peters EMJ. Psychological Treatment Effects Unrelated to Hair-Cortisol and Hair-BDNF Levels in Chronic Tinnitus. Front Psychiatry 2022; 13:764368. [PMID: 35250657 PMCID: PMC8895295 DOI: 10.3389/fpsyt.2022.764368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/04/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Currently, there are no objective markers to measure treatment efficacy in chronic (distressing) tinnitus. This study explores whether stress-related biomarkers cortisol and brain-derived neurotrophic factor (BDNF) measured in hair samples of chronic tinnitus patients change after compact multimodal tinnitus-specific cognitive behavioral therapy. METHODS In this longitudinal study, hair-cortisol and hair-BDNF levels, self-reported tinnitus-related distress (Tinnitus Questionnaire; TQ), and perceived stress (Perceived Stress Questionnaire; PSQ-20) were assessed before and 3 months after 5 days of treatment in N = 80 chronic tinnitus patients. Linear mixed-effects models with backward elimination were used to assess treatment-induced changes, and a cross-lagged panel model (structural equation model) was used for additional exploratory analysis of the temporal associations between TQ and hair-BDNF. RESULTS At follow-up, a reduction in TQ (p < 0.001) and PSQ-20 scores (p = 0.045) was observed, which was not influenced by baseline hair-cortisol or hair-BDNF levels. No changes in biomarker levels were observed after treatment. The exploratory analysis tentatively suggests that a directional effect of baseline TQ scores on hair-BDNF levels at follow-up (trend; p = 0.070) was more likely than the opposite directional effect of baseline hair-BDNF levels on TQ scores at follow-up (n.s.). DISCUSSION While the treatment effectively reduced tinnitus-related distress and perceived stress in chronic tinnitus patients, this effect was not mirrored in biological changes. However, the lack of changes in hair-cortisol and hair-BDNF levels might have been influenced by the treatment duration, follow-up interval, or confounding medical factors, and therefore must be interpreted with caution. The relationship between tinnitus-related distress and hair-BDNF levels should be explored further to obtain a better understanding of stress-related effects in chronic tinnitus.
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Affiliation(s)
- Laura Basso
- Tinnitus Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Benjamin Boecking
- Tinnitus Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Patrick Neff
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.,University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland.,Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Petra Brueggemann
- Tinnitus Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Birgit Mazurek
- Tinnitus Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Eva M J Peters
- Psychoneuroimmunology Laboratory, Department of Psychosomatic Medicine and Psychotherapy, Justus-Liebig University Giessen, Giessen, Germany.,Psychosomatics and Psychotherapy, Charité Center 12 Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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6
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Schoisswohl S, Langguth B, Schecklmann M, Bernal-Robledano A, Boecking B, Cederroth CR, Chalanouli D, Cima R, Denys S, Dettling-Papargyris J, Escalera-Balsera A, Espinosa-Sanchez JM, Gallego-Martinez A, Giannopoulou E, Hidalgo-Lopez L, Hummel M, Kikidis D, Koller M, Lopez-Escamez JA, Marcrum SC, Markatos N, Martin-Lagos J, Martinez-Martinez M, Martinez-Martinez M, Ferron MM, Mazurek B, Mueller-Locatelli N, Neff P, Oppel K, Perez-Carpena P, Robles-Bolivar P, Rose M, Schiele T, Schiller A, Simoes J, Stark S, Staudinger S, Stege A, Verhaert N, Schlee W. Unification of Treatments and Interventions for Tinnitus Patients (UNITI): a study protocol for a multi-center randomized clinical trial. Trials 2021; 22:875. [PMID: 34863270 PMCID: PMC8642746 DOI: 10.1186/s13063-021-05835-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/15/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Tinnitus represents a relatively common condition in the global population accompanied by various comorbidities and severe burden in many cases. Nevertheless, there is currently no general treatment or cure, presumable due to the heterogeneity of tinnitus with its wide variety of etiologies and tinnitus phenotypes. Hence, most treatment studies merely demonstrated improvement in a subgroup of tinnitus patients. The majority of studies are characterized by small sample sizes, unstandardized treatments and assessments, or applications of interventions targeting only a single organ level. Combinatory treatment approaches, potentially targeting multiple systems as well as treatment personalization, might provide remedy and enhance treatment responses. The aim of the present study is to systematically examine established tinnitus therapies both alone and in combination in a large sample of tinnitus patients. Further, it wants to provide the basis for personalized treatment approaches by evaluating a specific decision support system developed as part of an EU-funded collaborative project (Unification of treatments and interventions for tinnitus patients; UNITI project). METHODS/STUDY DESIGN This is a multi-center parallel-arm randomized clinical trial conducted at five different clinical sites over the EU. The effect of four different tinnitus therapy approaches (sound therapy, structured counseling, hearing aids, cognitive behavioral therapy) applied over a time period of 12 weeks as a single or rather a combinatory treatment in a total number of 500 chronic tinnitus patients will be investigated. Assessments and interventions are harmonized over the involved clinical sites. The primary outcome measure focuses on the domain tinnitus distress assessed via the Tinnitus Handicap Inventory. DISCUSSION Results and conclusions from the current study might not only provide an essential contribution to combinatory and personalized treatment approaches in tinnitus but could also provide more profound insights in the heterogeneity of tinnitus, representing an important step towards a cure for tinnitus. TRIAL REGISTRATION ClinicalTrials.gov NCT04663828 . Registered on 11 December 2020.
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Affiliation(s)
- Stefan Schoisswohl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany.
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany
| | - Martin Schecklmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany
| | - Alberto Bernal-Robledano
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Benjamin Boecking
- Tinnitus Center, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt Universität Berlin, Berlin, Germany
| | | | | | - Rilana Cima
- Department of Health Psychology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sam Denys
- Department of Neurosciences, Research group Experimental Oto-Rhino-Laryngology, University of Leuven, Leuven, Belgium.,Department of Otorhinolaryngology - Head and Neck surgery, University Hospitals Leuven, Leuven, Belgium.,Multidisciplinary University Center for Speech-Language Pathology and Audiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Alba Escalera-Balsera
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | - Juan Manuel Espinosa-Sanchez
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | - Alvaro Gallego-Martinez
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | | | - Leyre Hidalgo-Lopez
- Department of Mental Health, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Michael Hummel
- Central Biobank Charité, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt Universität Berlin, Berlin, Germany
| | - Dimitris Kikidis
- Department of Otolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General Hospital, Athens, Greece
| | - Michael Koller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Jose A Lopez-Escamez
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain.,Department of Surgery, Division of Otolaryngology, Universidad de Granada, Granada, Spain
| | - Steven C Marcrum
- Department of Otolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Nikolaos Markatos
- Department of Otolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General Hospital, Athens, Greece
| | - Juan Martin-Lagos
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria ibs. GRANADA, Hospital Universitario Clinico San Cecilio, Granada, Spain
| | - Maria Martinez-Martinez
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | - Marta Martinez-Martinez
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Department of Otolaryngology, Instituto de Investigacion Biosanitaria ibs. GRANADA, Hospital Universitario Clinico San Cecilio, Granada, Spain
| | - Maria Mata Ferron
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | - Birgit Mazurek
- Tinnitus Center, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt Universität Berlin, Berlin, Germany
| | - Nicolas Mueller-Locatelli
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria ibs. GRANADA, Hospital Universitario Clinico San Cecilio, Granada, Spain
| | - Patrick Neff
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany.,Center for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Kevin Oppel
- Terzo-Institute for Applied Hearing Research, ISMA, Sonneberg, Germany
| | - Patricia Perez-Carpena
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | - Paula Robles-Bolivar
- Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO, Center for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | - Matthias Rose
- Department of Psychosomatic and Psychotherapy, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt Universität Berlin, Berlin, Germany
| | - Tabea Schiele
- Tinnitus Center, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt Universität Berlin, Berlin, Germany
| | - Axel Schiller
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany
| | - Jorge Simoes
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany
| | - Sabine Stark
- Tinnitus Center, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt Universität Berlin, Berlin, Germany
| | - Susanne Staudinger
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany
| | - Alexandra Stege
- Central Biobank Charité, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt Universität Berlin, Berlin, Germany
| | - Nicolas Verhaert
- Department of Neurosciences, Research group Experimental Oto-Rhino-Laryngology, University of Leuven, Leuven, Belgium.,Department of Otorhinolaryngology - Head and Neck surgery, University Hospitals Leuven, Leuven, Belgium.,Multidisciplinary University Center for Speech-Language Pathology and Audiology, University Hospitals Leuven, Leuven, Belgium
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, Universitaetsstraße 84, 93053, Regensburg, Germany
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7
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Boecking B, Brueggemann P, Kleinjung T, Mazurek B. All for One and One for All? - Examining Convergent Validity and Responsiveness of the German Versions of the Tinnitus Questionnaire (TQ), Tinnitus Handicap Inventory (THI), and Tinnitus Functional Index (TFI). Front Psychol 2021; 12:596037. [PMID: 33776834 PMCID: PMC7994766 DOI: 10.3389/fpsyg.2021.596037] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/15/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Measurement of tinnitus-related distress and treatment responsiveness is key in understanding, conceptualizing and addressing this often-disabling symptom. Whilst several self-report measures exist, the heterogeneity of patient populations, available translations, and treatment contexts requires ongoing psychometric replication and validation efforts. OBJECTIVE To investigate the convergent validity and responsiveness of the German versions of the Tinnitus Questionnaire [TQ], Tinnitus Handicap Inventory [THI], and Tinnitus Functional Index [TFI] in a large German-speaking sample of patients with chronic tinnitus who completed a psychologically anchored 7-day Intensive Multimodal Treatment Programme. METHODS Two-hundred-and-ten patients with chronic tinnitus completed all three questionnaires at baseline and post-treatment. Intraclass correlation coefficients determined the convergent validity of each questionnaire's total and subscale scores. Treatment responsiveness was investigated by [a] comparing treatment-related change in responders vs. non-responders as classified by each questionnaire's minimal clinically important difference-threshold, and [b] comparing agreement between the questionnaires' responder classifications. RESULTS The total scores of all three questionnaires showed high agreement before and after therapy (TQ | THI: 0.80 [Pre], 0.83 [Post], TQ | TFI: 0.72 [Pre], 0.78 [Post], THI | TFI: 0.76 [Pre] 0.80 [Post]). All total scores changed significantly with treatment yielding small effect sizes. The TQ and TFI yielded comparable (19.65 and 18.64%) and the THI higher responder rates (38.15%). The TQ | THI and TQ | TFI showed fair, and the THI | TFI moderate agreement of responder classifications. Independent of classification, responders showed significantly higher change rates than non-responders across most scores. Each questionnaire's total change score distinguished between responders and non-responders as classified by the remaining two questionnaires. CONCLUSION The total scores of all three questionnaires show high convergent validity and thus, comparability across clinical and research contexts. By contrast, subscale scores show high inconsistency. Whilst the TFI appears well suited for research purposes, the THI may be better suited to measure psychological aspects of tinnitus-related distress and their changes with accordingly focused treatment approaches.
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Affiliation(s)
| | | | - Tobias Kleinjung
- Department of Otorhinolaryngology, University Hospital of Zürich, Zurich, Switzerland
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Elarbed A, Fackrell K, Baguley DM, Hoare DJ. Tinnitus and stress in adults: a scoping review. Int J Audiol 2020; 60:171-182. [PMID: 33000672 DOI: 10.1080/14992027.2020.1827306] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Tinnitus and stress are recurrently reported together. The strength and direction of this relationship is not clear. The aim of this review is to catalogue the evidence of this relationship, how it has been described in adults and which instruments were used. DESIGN Five-stage framework was followed. An online search of databases and published journals were conducted. The main inclusion criteria were original studies published in English and conducted in an adult human population, in which both tinnitus and stress were measured using different instruments. STUDY SAMPLES 5699 records were identified in the searching stage and 50 studies were eligible for data extraction. RESULTS Measurements of perceived stress were most frequently used. Tinnitus patients tend to report louder and more bothersome tinnitus when they are stressed, but not all tinnitus patients associated stress with the onset or the severity of their tinnitus. Any positive correlation reported between stress and tinnitus levels varied in strength according to the used instrument. Post-intervention changes in stress and tinnitus levels showed inconsistency. CONCLUSION There is considerable room for further research to study the relationship between stress and tinnitus. We highlight principal issues that should be considered in future studies.
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Affiliation(s)
- Asma Elarbed
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK.,Hearing Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Kathryn Fackrell
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK.,Hearing Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - David M Baguley
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK.,Hearing Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Derek J Hoare
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK.,Hearing Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
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Boecking B, von Sass J, Sieveking A, Schaefer C, Brueggemann P, Rose M, Mazurek B. Tinnitus-related distress and pain perceptions in patients with chronic tinnitus - Do psychological factors constitute a link? PLoS One 2020; 15:e0234807. [PMID: 32584841 PMCID: PMC7316290 DOI: 10.1371/journal.pone.0234807] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/02/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the co-occurrence of tinnitus-related distress and pain experiences alongside psychological factors that may underlie their association. METHOD Patients with chronic tinnitus (N = 1238) completed a questionnaire battery examining tinnitus-related distress and affective and sensory pain perceptions. A series of simple, parallel- and serial multiple mediator models examined indirect effects of psychological comorbidities as well as -process variables including depressivity, perceived stress and coping attitudes. Moderator and moderated mediation analyses examined differential relational patterns in patients with decompensated vs. compensated tinnitus. RESULTS There were significant associations between tinnitus-related distress and pain perceptions. These were partially mediated by most specified variables. Psychological comorbidities appeared to influence tinnitus-pain associations through their impact on depressivity, perceived stress, and coping attitudes. Some specific differences in affective vs. sensory pain perception pathways emerged. Patients with decompensated tinnitus yielded significantly higher symptom burden across all measured indices. Tinnitus decompensation was associated with heightened associations between [1] tinnitus-related distress and pain perceptions, depressivity and negative coping attitudes; and [2] most psychological comorbidities and sensory, but not affective pain perception. Moderated mediation analyses revealed stronger indirect effects of depressivity and anxiety in mediating affective-, and anxiety in mediating sensory pain perception in patients with decompensated tinnitus. CONCLUSION Psychological constructs mediate the co-occurrence of tinnitus- and pain-related symptoms across different levels of tinnitus-related distress. Psychological treatment approaches should conceptualize and address individualised interactions of common cognitive-emotional processes in addressing psychosomatic symptom clusters across syndromatic patients with varying distress levels.
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Affiliation(s)
- Benjamin Boecking
- Tinnitus Center, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | | | - Antonia Sieveking
- Tinnitus Center, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | | | - Petra Brueggemann
- Tinnitus Center, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Rose
- Division of Psychosomatic Medicine, Medical Department, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Birgit Mazurek
- Tinnitus Center, Charité–Universitätsmedizin Berlin, Berlin, Germany
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Niemann U, Boecking B, Brueggemann P, Mebus W, Mazurek B, Spiliopoulou M. Tinnitus-related distress after multimodal treatment can be characterized using a key subset of baseline variables. PLoS One 2020; 15:e0228037. [PMID: 31999776 PMCID: PMC6991951 DOI: 10.1371/journal.pone.0228037] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/06/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic tinnitus is a complex condition that can be associated with considerable distress. Whilst cognitive-behavioral treatment (CBT) approaches have been shown to be effective, not all patients benefit from psychological or psychologically anchored multimodal therapies. Determinants of tinnitus-related distress thus provide valuable information about tinnitus characterization and therapy planning. OBJECTIVE The study aimed to develop machine learning models that use variables (or "features") obtained before treatment to characterize patients' tinnitus-related distress status after treatment. Whilst initially all available variables were considered for model training, the final model was required to achieve highest predictive performance using only a small number of features. METHODS 1,416 tinnitus patients (decompensated tinnitus: 32%) who completed a 7-day multimodal treatment encompassing tinnitus-specific components, CBT, physiotherapy and informational counseling were included in the analysis. At baseline, patients were assessed using 205 features from 10 questionnaires comprising sociodemographic and clinical information. A data-driven workflow was developed consisting of (a) an initial exploratory correlation analysis, (b) supervised machine learning to predict tinnitus-related distress after treatment (T1) using baseline data only (T0), and (c) post-hoc analysis of the best model to facilitate model inspection and understanding. Classification methods were embedded in a feature elimination wrapper that iteratively learned on features found to be important for the model in the preceding iteration, in order to keep the performance stable while successively reducing the model complexity. 10-fold cross-validation with area under the curve (AUC) as performance measure was implemented for model generalization error estimation. RESULTS The best machine learning classifier (gradient boosted trees) can predict tinnitus-related distress in T1 with AUC = 0.890 using 26 features. Subjectively perceived tinnitus-related impairment, depressivity, sleep problems, physical health-related impairments in quality of life, time spent to complete questionnaires and educational level exhibited a high attribution towards model prediction. CONCLUSIONS Machine learning can reliably identify baseline features recorded prior to treatment commencement that characterize tinnitus-related distress after treatment. The identification of key features can contribute to an improved understanding of multifactorial contributors to tinnitus-related distress and thereon based multimodal treatment strategies.
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Affiliation(s)
- Uli Niemann
- Faculty of Computer Science, Otto von Guericke University Magdeburg, Universitaetsplatz 2, Magdeburg, Germany
| | - Benjamin Boecking
- Tinnitus Center, Charité Universitaetsmedizin Berlin, Charitéplatz 1, Berlin, Germany
| | - Petra Brueggemann
- Tinnitus Center, Charité Universitaetsmedizin Berlin, Charitéplatz 1, Berlin, Germany
| | - Wilhelm Mebus
- Tinnitus Center, Charité Universitaetsmedizin Berlin, Charitéplatz 1, Berlin, Germany
| | - Birgit Mazurek
- Tinnitus Center, Charité Universitaetsmedizin Berlin, Charitéplatz 1, Berlin, Germany
| | - Myra Spiliopoulou
- Faculty of Computer Science, Otto von Guericke University Magdeburg, Universitaetsplatz 2, Magdeburg, Germany
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ICD-10 Symptom Rating questionnaire for assessment of psychological comorbidities in patients with chronic tinnitus. HNO 2019; 67:46-50. [DOI: 10.1007/s00106-019-0625-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Brueggemann P, Szczepek AJ, Seydel C, Schaefer C, Amarjargal N, Boecking B, Rose M, Mazurek B. ICD-10-Symptom-Rating-Fragebogen zur Beurteilung psychischer Komorbiditäten bei Patienten mit chronischem Tinnitus. HNO 2019; 67:178-183. [DOI: 10.1007/s00106-019-0618-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
Tinnitus is a common symptom of unclear origin that can be multifactorially caused and maintained. It is frequently, but not inevitably, associated with hearing loss. Emotional distress and maladaptive coping strategies - that are associated with or amplified by the tinnitus percept - pose key targets for psychological interventions. Once somatic contributors are identified and treated as applicable, psychological approaches comprise normalizing psychoeducational and psychotherapeutic interventions. Measures to improve hearing perception (e. g., hearing aids or cochlear implants) can also contribute to tinnitus habituation through direct (improvement of hearing perception) or indirect (improvement of emotional wellbeing or quality of life) effects.
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Affiliation(s)
- B Boecking
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Karlplatz 7, 10117, Berlin, Deutschland.
| | - P Brueggemann
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Karlplatz 7, 10117, Berlin, Deutschland
| | - B Mazurek
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Karlplatz 7, 10117, Berlin, Deutschland
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