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Patil JD, Alrashid MA, Eltabbakh A, Fredericks S. The association between stress, emotional states, and tinnitus: a mini-review. Front Aging Neurosci 2023; 15:1131979. [PMID: 37207076 PMCID: PMC10188965 DOI: 10.3389/fnagi.2023.1131979] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Extensive literature supporting the view of tinnitus induced stress in patients is available. However, limited evidence has been produced studying the opposite, that is, does stress cause tinnitus? The hypothalamus pituitary adrenal axis, one of the main neuroendocrine systems involved in stress response, is commonly disturbed in tinnitus patients. Patients with chronic tinnitus have been shown to develop abnormal responses to psycho-social stress, where the hypothalamus pituitary adrenal axis response is weaker and delayed, suggesting chronic stress contributes to the development of chronic tinnitus. The sympathetic branch of the autonomic nervous system also plays a major role in stress response and its chronic hyperactivity seems to be involved in developing tinnitus. Psycho-social stress has been shown to share the same probability of developing tinnitus as occupational noise and contributes to worsening tinnitus. Additionally, exposure to high stress levels and occupational noise doubles the likelihood of developing tinnitus. Interestingly, short-term stress has been shown to protect the cochlea in animals, but chronic stress exposure has negative consequences. Emotional stress also worsens pre-existing tinnitus and is identified as an important indicator of tinnitus severity. Although there is limited body of literature, stress does seem to play a vital role in the development of tinnitus. This review aims to highlight the association between stress, emotional states, and the development of tinnitus while also addressing the neural and hormonal pathways involved.
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Affiliation(s)
- Jayaditya Devpal Patil
- Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
- *Correspondence: Jayaditya Devpal Patil,
| | | | - Ayah Eltabbakh
- Royal College of Surgeons in Ireland, Al Muharraq, Bahrain
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Ruan J, Hu X, Liu Y, Han Z, Ruan Q. Vulnerability to chronic stress and the phenotypic heterogeneity of presbycusis with subjective tinnitus. Front Neurosci 2022; 16:1046095. [PMID: 36620444 PMCID: PMC9812577 DOI: 10.3389/fnins.2022.1046095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Age-related functional reserve decline and vulnerability of multiple physiological systems and organs, as well as at the cellular and molecular levels, result in different frailty phenotypes, such as physical, cognitive, and psychosocial frailty, and multiple comorbidities, including age-related hearing loss (ARHL) and/or tinnitus due to the decline in auditory reserve. However, the contributions of chronic non-audiogenic cumulative exposure, and chronic audiogenic stress to phenotypic heterogeneity of presbycusis and/or tinnitus remain elusive. Because of the cumulative environmental stressors throughout life, allostasis systems, the hypothalamus-pituitary-adrenal (HPA) and the sympathetic adrenal-medullary (SAM) axes become dysregulated and less able to maintain homeostasis, which leads to allostatic load and maladaptation. Brain-body communication via the neuroendocrine system promotes systemic chronic inflammation, overmobilization of energetic substances (glucose and lipids), and neuroplastic changes via the non-genomic and genomic actions of glucocorticoids, catecholamines, and their receptors. These systemic maladaptive alterations might lead to different frailty phenotypes and physical, cognitive, and psychological comorbidities, which, in turn, cause and exacerbate ARHL and/or tinnitus with phenotypic heterogeneity. Chronic audiogenic stressors, including aging accompanying ontological diseases, cumulative noise exposure, and ototoxic drugs as well as tinnitus, activate the HPA axis and SAM directly and indirectly by the amygdala, promoting allostatic load and maladaptive neuroplasticity in the auditory system and other vulnerable brain regions, such as the hippocampus, amygdala, and medial prefrontal cortex (mPFC). In the auditory system, peripheral deafferentation, central disinhibition, and tonotopic map reorganization may trigger tinnitus. Cross-modal maladaptive neuroplasticity between the auditory and other sensory systems is involved in tinnitus modulation. Persistent dendritic growth and formation, reduction in GABAergic inhibitory synaptic inputs induced by chronic audiogenic stresses in the amygdala, and increased dendritic atrophy in the hippocampus and mPFC, might involve the enhancement of attentional processing and long-term memory storage of chronic subjective tinnitus, accompanied by cognitive impairments and emotional comorbidities. Therefore, presbycusis and tinnitus are multisystem disorders with phenotypic heterogeneity. Stressors play a critical role in the phenotypic heterogeneity of presbycusis. Differential diagnosis based on biomarkers of metabonomics study, and interventions tailored to different ARHL phenotypes and/or tinnitus will contribute to healthy aging and improvement in the quality of life.
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Affiliation(s)
- Jian Ruan
- Department of Otolaryngology, Huadong Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiuhua Hu
- Laboratory of Aging, Anti-aging & Cognitive Performance, Shanghai Institute of Geriatrics and Gerontology, Huadong Hospital, Fudan University, Shanghai, China,Shanghai Key Laboratory of Clinical Geriatrics, Research Center of Aging and Medicine, Huadong Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuehong Liu
- Department of Otolaryngology, Huadong Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhao Han
- Department of Otolaryngology, Huadong Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qingwei Ruan
- Laboratory of Aging, Anti-aging & Cognitive Performance, Shanghai Institute of Geriatrics and Gerontology, Huadong Hospital, Fudan University, Shanghai, China,Shanghai Key Laboratory of Clinical Geriatrics, Research Center of Aging and Medicine, Huadong Hospital, Shanghai Medical College, Fudan University, Shanghai, China,*Correspondence: Qingwei Ruan,
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Quality of Life and Psychological Distress in Portuguese Older Individuals with Tinnitus. Brain Sci 2021; 11:brainsci11070953. [PMID: 34356187 PMCID: PMC8306429 DOI: 10.3390/brainsci11070953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 11/24/2022] Open
Abstract
Tinnitus is the perception of a sound without an external source, often associated with adverse psychological and emotional effects leading to impaired quality of life (QoL). The present study investigated QoL and psychological distress in tinnitus patients and analysed the effects of associated comorbidities. Tonal and speech audiometry, tinnitus assessment, and clinical interviews were obtained from 122 Portuguese individuals (aged from 55 to 75). Portuguese versions of the Brief Symptoms Inventory (BSI), the Medical Outcomes Study Short Form Health Survey (MOS SF-36) and Tinnitus Handicap Inventory (THI) were used to evaluate psychological distress, health-related QoL, social difficulties and tinnitus severity. The presence of tinnitus was significantly associated with hearing loss. The increases in tinnitus severity were associated with decreases in QoL, particularly regarding MOS SF-36 subscales “perception of health”, “social functioning”, and “mental health”. Regarding BSI, patients with greater tinnitus severity had more severe psychopathology symptoms, measured with scales “Obsessive–compulsive”, “Depression”, “Anxiety”, “Hostility” and “Phobic Anxiety”. Our study supports the notion of the negative impact of increased tinnitus severity on QoL and psychological distress in older adults. Presented data strengthen the importance of a multidisciplinary approach to tinnitus assessment and treatment.
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Objective and Measurable Biomarkers in Chronic Subjective Tinnitus. Int J Mol Sci 2021; 22:ijms22126619. [PMID: 34205595 PMCID: PMC8235100 DOI: 10.3390/ijms22126619] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 12/18/2022] Open
Abstract
Tinnitus is associated with increased social costs and reduced quality of life through sleep disorders or psychological distress. The pathophysiology of chronic subjective tinnitus, which accounts for most tinnitus, has not been clearly elucidated. This is because chronic subjective tinnitus is difficult to evaluate objectively, and there are no objective markers that represent the diagnosis or therapeutic effect of tinnitus. Based on the results of studies on patients with chronic subjective tinnitus, objective and measurable biomarkers that help to identify the pathophysiology of tinnitus have been summarized. A total of 271 studies in PubMed, 303 in EMBASE, and 45 in Cochrane Library were found on biomarkers related to chronic subjective tinnitus published until April 2021. Duplicate articles, articles not written in English, review articles, case reports, and articles that did not match our topic were excluded. A total of 49 studies were included. Three specimens, including blood, saliva, and urine, and a total of 58 biomarkers were used as indicators for diagnosis, evaluation, prognosis, and therapeutic effectiveness of tinnitus. Biomarkers were classified into eight categories comprising metabolic, hemostatic, inflammatory, endocrine, immunological, neurologic, and oxidative parameters. Biomarkers can help in the diagnosis, measure the severity, predict prognosis, and treatment outcome of tinnitus.
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Refat F, Wertz J, Hinrichs P, Klose U, Samy H, Abdelkader RM, Saemisch J, Hofmeier B, Singer W, Rüttiger L, Knipper M, Wolpert S. Co-occurrence of Hyperacusis Accelerates With Tinnitus Burden Over Time and Requires Medical Care. Front Neurol 2021; 12:627522. [PMID: 33815254 PMCID: PMC8012887 DOI: 10.3389/fneur.2021.627522] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/22/2021] [Indexed: 12/14/2022] Open
Abstract
Although tinnitus represents a major global burden, no causal therapy has yet been established. Ongoing controversies about the neuronal pathophysiology of tinnitus hamper efforts in developing advanced therapies. Hypothesizing that the unnoticed co-occurrence of hyperacusis and differences in the duration of tinnitus may possibly differentially influence the neural correlate of tinnitus, we analyzed 33 tinnitus patients without (T-group) and 20 tinnitus patients with hyperacusis (TH-group). We found crucial differences between the T-group and the TH-group in the increase of annoyance, complaints, tinnitus loudness, and central neural gain as a function of tinnitus duration. Hearing thresholds did not differ between T-group and TH-group. In the TH-group, the tinnitus complaints (total tinnitus score) were significantly greater from early on and the tinnitus intensity distinctly increased over time from ca. 12 to 17 dB when tinnitus persisted more than 5 years, while annoyance responses to normal sound remained nearly constant. In contrast, in the T-group tinnitus complaints remained constant, although the tinnitus intensity declined over time from ca. 27 down to 15 dB beyond 5 years of tinnitus persistence. This was explained through a gradually increased annoyance to normal sound over time, shown by a hyperacusis questionnaire. Parallel a shift from a mainly unilateral (only 17% bilateral) to a completely bilateral (100%) tinnitus percept occurred in the T-group, while bilateral tinnitus dominated in the TH-group from the start (75%). Over time in the T-group, ABR wave V amplitudes (and V/I ratios) remained reduced and delayed. By contrast, in the TH-group especially the ABR wave III and V (and III/I ratio) continued to be enhanced and shortened in response to high-level sound stimuli. Interestingly, in line with signs of an increased co-occurrence of hyperacusis in the T-group over time, ABR wave III also slightly increased in the T-group. The findings disclose an undiagnosed co-occurrence of hyperacusis in tinnitus patients as a main cause of distress and the cause of complaints about tinnitus over time. To achieve urgently needed and personalized therapies, possibly using the objective tools offered here, a systematic sub-classification of tinnitus and the co-occurrence of hyperacusis is recommended.
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Affiliation(s)
- Fatma Refat
- Audio-Vestibular Unit, Department of Ear Nose Throat, Minia University, Minia, Egypt.,Tübingen Hearing Research Centre, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Jakob Wertz
- Tübingen Hearing Research Centre, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Pauline Hinrichs
- Tübingen Hearing Research Centre, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Uwe Klose
- Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany
| | - Hesham Samy
- Audio-Vestibular Unit, Department of Ear Nose Throat, Minia University, Minia, Egypt
| | | | - Jörg Saemisch
- Tübingen Hearing Research Centre, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Benedikt Hofmeier
- Tübingen Hearing Research Centre, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Wibke Singer
- Tübingen Hearing Research Centre, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Lukas Rüttiger
- Tübingen Hearing Research Centre, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Marlies Knipper
- Tübingen Hearing Research Centre, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
| | - Stephan Wolpert
- Tübingen Hearing Research Centre, Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany
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Abstract
In this chapter, I address the topic of tinnitus in the context of the patient's trajectory of care, with special attention to psychological comorbidities. Although most patients will cope with tinnitus and need no more than information and reassurance from professionals, a proportion of patients will need more supportive management. Assessment of psychological comorbidities is important to determine how urgent they should be seen in the clinic and their specific needs. The most frequent complaints are stress, depression, and anxiety. Although the direction of this relationship is still unclear (are comorbidities at the origin of tinnitus or are they a consequence of it), it is evident that the more serious comorbidities are at the onset of tinnitus, the worse the prognosis. Therefore, an assessment at the initial visit in the clinic is of utmost importance. There are valid and reliable psychometric tools to quickly draw a portrait of the psychological state of patients that can be used by audiologists, psychologists, or doctors. Therapeutic avenues can then be discussed with the patients to ensure them the best support possible.
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La X, Wang W, Zhang M, Liang L. Definition and Multiple Factors of Recurrent Spontaneous Abortion. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1300:231-257. [PMID: 33523437 DOI: 10.1007/978-981-33-4187-6_11] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Recurrent spontaneous abortion (RSA) is usually defined as three or more spontaneous abortions prior to 20-28 weeks gestation. RSA affects approximately 2-5% of all women of childbearing age, and it brings tremendous psychological and psychiatric trauma to the women and also results in economic burden. The causes could be female age, anatomical and chromosomal abnormalities, genetic, endocrinological, placental anomalies, infection, smoking and alcohol consumption, psychological factor, exposure to environmental factors such as heavy metal, environment pollution, and radiation.
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Affiliation(s)
- Xiaolin La
- Reproductive Medicine Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Wenjuan Wang
- Reproductive Medical Center, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, P.R. China
| | - Meng Zhang
- Reproductive Medicine Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Li Liang
- Reproductive Medical Center, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, P.R. China
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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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Saxena U, Singh BP, Kumar SBR, Chacko G, Bharath KNSV. Acoustic Reflexes in Individuals Having Hyperacusis of the Auditory Origin. Indian J Otolaryngol Head Neck Surg 2020; 72:497-502. [PMID: 33088781 DOI: 10.1007/s12070-020-02002-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022] Open
Abstract
Functional role of the acoustic reflex in preventing over stimulation of the inner auditory system by decreasing sound intensity along with the previous reports of acoustic reflex abnormalities in individuals having hyperacusis point towards the involvement of acoustic reflex deficit in the origin of hyperacusis especially when any medical condition leading to hyperacusis is not associated. However this issue remains contradictory owing to limited comprehensive investigation. This study was undertaken to ascertain the relationship between hyperacusis and the acoustic reflex. Threshold, amplitude and latency of the acoustic reflex were measured in two different groups of individuals having hyperacusis; Group 1: 14 individuals having hyperacusis with hearing loss (HwHL) and Group 2: 17 individuals having hyperacusis without hearing loss (HwoHL). Control group (Group 3) consisted of 15 normal hearing individuals who never experienced hyperacusis. Result showed a significant group effect on all the measured characteristics of the acoustic reflex. ARTs were found to be significantly higher in HwHL and HwoHL when compared to NHwoH. ARTs were statistically similar for HwoHL and NHwoH. HwoHL's ARAs and ARLs were significantly smaller and prolonged, respectively, when compared to HwHL and NHwoH. HwHL and NHwoH had statistically similar ARAs and ARLs. This study confirms acoustic reflex abnormalities in some individuals having hyperacusis with or without hearing loss. It further highlight the importance of involving acoustic reflex testing in the assessment of hyperacusis especially when hyperacusis is not associated with hearing loss or any other medical condition that may lead to hyperacusis.
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Affiliation(s)
- Udit Saxena
- MAA Institute of Speech and Hearing, Osmania University, Hyderabad, India.,Department (Speech and Hearing), MAA ENT Hospital, Hyderabad, India
| | - Bhanu Pratap Singh
- Department of ENT, Hind Institute of Medical Sciences, Uttar Pradesh, Sitapur, India
| | - S B Rathna Kumar
- Ali Yavar Jung National Institute of Speech and Hearing Disabilities (Divyangjan), Mumbai, India
| | - Gish Chacko
- MAA Institute of Speech and Hearing, Osmania University, Hyderabad, India
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Jackson JG. The Cortisol Awakening Response: A Feasibility Study Investigating the Use of the Area Under the Curve With Respect to Increase as an Effective Objective Measure of Tinnitus Distress. Am J Audiol 2019; 28:583-596. [PMID: 31318575 DOI: 10.1044/2019_aja-18-0174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Tinnitus is a chronic medical condition that can result in distress, concentration difficulties, and clinical depression. An effective, objective measure of tinnitus distress does not currently exist. Endocrinal studies into the condition have been few, with those investigating the cortisol awakening response limited in scope. It was hypothesized that distressed individuals with tinnitus would awaken and be unable to effectively prepare for the day ahead due to a blunted cortisol response. Method Twenty individuals with varying tinnitus distress were compared with a control group (n = 10) in a pilot study, which measured salivary cortisol concentrations on awakening. Multiple exclusion variables were applied. Results In line with previous studies, total cortisol volume (as measured by area under the curve) was not found to be significantly different in the most distressed individuals with tinnitus, F(2, 26) = 0.254, p = .777ns. However, a separate measure of changing cortisol levels-the area under the curve with respect to increase (or AUCi)-was found to be significantly less robust in those individuals reporting the most severe tinnitus distress, F(2, 26) = 7.671, p = .002. This indicates that fewer resources would be available to cope with the demands of the day ahead. Additionally, the AUCi correlated negatively with tinnitus distress later the same day. Conclusions Relationships between proposed objective and self-reported components of self-reported tinnitus distress are considered, with some aspects of tinnitus distress more closely related to physiological mechanisms than others. It is suggested that, with further research, the cortisol awakening response (AUCi) may be put forward as a credible objective biomarker of tinnitus distress.
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Affiliation(s)
- James George Jackson
- Psychology, Sociology and Criminology Group, School of Social and Health Sciences, Leeds Trinity University, Horsforth, United Kingdom
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12
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Changes in tinnitus and physiological biomarkers of stress in response to short-term broadband noise and sounds of nature. Complement Ther Med 2019; 46:62-68. [PMID: 31519289 DOI: 10.1016/j.ctim.2019.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/09/2019] [Accepted: 07/24/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Tinnitus is the perception of sound when no external sound source is present. In some cases, this perception coincides with, or results in, stress. Tinnitus-related distress has been associated with increased levels of cortisol and elevated levels of sympathetic tone. Our primary hypothesis was that short-term sound exposure would reduce tinnitus perception and various physiological measures of stress. A secondary hypothesis was that a self-selected nature sound would reduce physiological markers of stress more than broadband noise. METHODS Twenty-one participants with constant bothersome tinnitus underwent an audiological assessment. Measurements of blood pressure, heart rate, salivary cortisol and cortisone concentrations, and tinnitus ratings were carried out three times: prior to and, in a counterbalance order, after 30 min of broadband noise and after 30 min of a self-selected nature sound (from: ocean waves, stream, rain or shower sounds). RESULTS Findings revealed significant reductions in blood pressure measurements following broadband noise. None of the other stress measures demonstrated a statistically significant change. Both broadband noise and nature sounds elicited significant improvements in ratings of tinnitus. CONCLUSIONS While both sound types had a positive impact on many dimensions of tinnitus, only the broadband noise was associated with a reduction in blood pressure. These results are consistent with a complex interaction between sound and tinnitus and suggest a multifactorial basis to sound therapy that includes a reduction in arousal.
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14
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Abstract
Tinnitus is the sensation of hearing a sound with no external auditory stimulus present. It is a public health issue correlated with multiple comorbidities and precipitating factors such as noise exposure, military service, and traumatic brain injury, migraine, insomnia, small vessel disease, smoking history, stress exposure, anxiety, depression, and socioeconomic status. Clinical experience and a recent literature review point at tinnitus as a neuropsychiatric condition involving both auditory and nonauditory cortical areas of the brain and affecting brain-auditory circuitry. In fact, brain-ear connections have been highlighted in different models. Forward management of this disorder should take this body of research into consideration as tinnitus remains a challenging condition to evaluate and treat with current management protocols still symptomatic at best. With a better understanding of the etiologic factors and comorbidities of tinnitus, additional research trials and new therapeutic approaches could see the light to tackle this public health disability bringing hope to patients and doctors.
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Affiliation(s)
- Zeina Chemali
- Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
| | - R Nehmé
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States
| | - Gregory Fricchione
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Möhrle D, Hofmeier B, Amend M, Wolpert S, Ni K, Bing D, Klose U, Pichler B, Knipper M, Rüttiger L. Enhanced Central Neural Gain Compensates Acoustic Trauma-induced Cochlear Impairment, but Unlikely Correlates with Tinnitus and Hyperacusis. Neuroscience 2018; 407:146-169. [PMID: 30599268 DOI: 10.1016/j.neuroscience.2018.12.038] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 01/09/2023]
Abstract
For successful future therapeutic strategies for tinnitus and hyperacusis, a subcategorization of both conditions on the basis of differentiated neural correlates would be of invaluable advantage. In the present study, we used our refined operant conditioning animal model to divide equally noise-exposed rats into groups with either tinnitus or hyperacusis, with neither condition, or with both conditions co-occurring simultaneously. Using click stimulus and noise burst-evoked Auditory Brainstem Responses (ABR) and Distortion Product Otoacoustic Emissions, no hearing threshold difference was observed between any of the groups. However, animals with neither tinnitus nor hyperacusis responded to noise trauma with shortened ABR wave I and IV latencies and elevated central neuronal gain (increased ABR wave IV/I amplitude ratio), which was previously assumed in most of the literature to be a neural correlate for tinnitus. In contrast, animals with tinnitus had reduced neural response gain and delayed ABR wave I and IV latencies, while animals with hyperacusis showed none of these changes. Preliminary studies, aimed at establishing comparable non-invasive objective tools for identifying tinnitus in humans and animals, confirmed reduced central gain and delayed response latency in human and animals. Moreover, the first ever resting state functional Magnetic Resonance Imaging (rs-fMRI) analyses comparing humans and rats with and without tinnitus showed reduced rs-fMRI activities in the auditory cortex in both patients and animals with tinnitus. These findings encourage further efforts to establish non-invasive diagnostic tools that can be used in humans and animals alike and give hope for differentiated classification of tinnitus and hyperacusis.
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Affiliation(s)
- Dorit Möhrle
- University of Tübingen, Department of Otolaryngology, Head & Neck Surgery, Tübingen Hearing Research Centre (THRC), Molecular Physiology of Hearing, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany.
| | - Benedikt Hofmeier
- University of Tübingen, Department of Otolaryngology, Head & Neck Surgery, Tübingen Hearing Research Centre (THRC), Molecular Physiology of Hearing, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany.
| | - Mario Amend
- University of Tübingen, Department of Preclinical Imaging and Radiopharmacy, University Hospital Tübingen, Röntgenweg 13, 72076 Tübingen, Germany.
| | - Stephan Wolpert
- University of Tübingen, Department of Otolaryngology, Head & Neck Surgery, Tübingen Hearing Research Centre (THRC), Molecular Physiology of Hearing, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany.
| | - Kun Ni
- University of Tübingen, Department of Otolaryngology, Head & Neck Surgery, Tübingen Hearing Research Centre (THRC), Molecular Physiology of Hearing, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany; Shanghai Jiao Tong University, Department of Otolaryngology, Head & Neck Surgery, Shanghai Children's Hospital, Shanghai Luding Road, NO. 355. Putuo District, 200062 Shanghai, China.
| | - Dan Bing
- University of Tübingen, Department of Otolaryngology, Head & Neck Surgery, Tübingen Hearing Research Centre (THRC), Molecular Physiology of Hearing, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany.
| | - Uwe Klose
- University Hospital Tübingen, Department of Diagnostic and Interventional Neuroradiology, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
| | - Bernd Pichler
- University of Tübingen, Department of Preclinical Imaging and Radiopharmacy, University Hospital Tübingen, Röntgenweg 13, 72076 Tübingen, Germany.
| | - Marlies Knipper
- University of Tübingen, Department of Otolaryngology, Head & Neck Surgery, Tübingen Hearing Research Centre (THRC), Molecular Physiology of Hearing, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany.
| | - Lukas Rüttiger
- University of Tübingen, Department of Otolaryngology, Head & Neck Surgery, Tübingen Hearing Research Centre (THRC), Molecular Physiology of Hearing, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany.
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16
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Miaskowski C, Paul SM, Mastick J, Abrams G, Topp K, Smoot B, Kober KM, Chesney M, Mazor M, Mausisa G, Schumacher M, Conley YP, Sabes JH, Cheung S, Wallhagen M, Levine JD. Associations Between Perceived Stress and Chemotherapy-Induced Peripheral Neuropathy and Otoxicity in Adult Cancer Survivors. J Pain Symptom Manage 2018; 56:88-97. [PMID: 29524582 PMCID: PMC6015523 DOI: 10.1016/j.jpainsymman.2018.02.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 02/27/2018] [Accepted: 02/27/2018] [Indexed: 11/22/2022]
Abstract
CONTEXT The most common adverse effects from neurotoxic chemotherapy are chemotherapy-induced neuropathy (CIPN), hearing loss, and tinnitus. Although associations between perceived stress and persistent pain, hearing loss, and tinnitus are documented, no studies have examined these associations in cancer survivors who received neurotoxic chemotherapy. OBJECTIVES In this cross-sectional study, we evaluated for associations between perceived stress and the occurrence of CIPN, hearing loss, and tinnitus, in 623 adult cancer survivors who received platinum and/or taxane compounds. METHODS Survivors completed self-report measures of hearing loss, tinnitus, and perceived stress (i.e., Impact of Events Scale-Revised [IES-R]). Separate logistic regression analyses were done for each neurotoxicity to evaluate whether each of the IES-R subscale (i.e., intrusion, avoidance, hyperarousal) and total scores made a significant independent contribution to neurotoxicity group membership. RESULTS Of the 623 survivors in this study, 68.4% had CIPN, 34.5% reported hearing loss, and 31.0% reported tinnitus. Older age, higher body mass index, poorer functional status, being born prematurely, cancer diagnosis, and higher intrusion (P = 0.013), hyperarousal (P = 0.014), and total (P = 0.047) IES-R scores were associated with CIPN. Older age, being male, poorer functional status, a worse comorbidity profile, and a higher IES-R hyperarousal (P = 0.007) score were associated with hearing loss. Being male, having less education, a worse comorbidity profile, and a higher IES-R hyperarousal (P = 0.029) score were associated with tinnitus. CONCLUSION These findings suggest that increased levels of perceived stress are associated with the most common chemotherapy-induced neurotoxicities.
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Affiliation(s)
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Judy Mastick
- School of Nursing, University of California, San Francisco, California, USA
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, California, USA
| | - Kimberly Topp
- School of Medicine, University of California, San Francisco, California, USA
| | - Betty Smoot
- School of Medicine, University of California, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA
| | - Margaret Chesney
- School of Medicine, University of California, San Francisco, California, USA
| | - Melissa Mazor
- School of Nursing, University of California, San Francisco, California, USA
| | - Grace Mausisa
- School of Nursing, University of California, San Francisco, California, USA
| | - Mark Schumacher
- School of Medicine, University of California, San Francisco, California, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Steven Cheung
- School of Medicine, University of California, San Francisco, California, USA
| | - Margaret Wallhagen
- School of Nursing, University of California, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA; School of Dentistry, University of California, San Francisco, California, USA
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17
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Tinnitus, depression, and suicidal ideation in adults: A nationally representative general population sample. J Psychiatr Res 2018; 98:124-132. [PMID: 29406247 DOI: 10.1016/j.jpsychires.2018.01.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 11/24/2022]
Abstract
Tinnitus is strongly associated with psychiatric symptoms, including depression and suicidality. We aimed to further investigate the association of tinnitus with depressive mood and/or suicidal ideation, and explore the shared risk factors for these within a representative sample of the adult general population. We also investigated potential mediation pathways among tinnitus, suicidal ideation, depression, shared risk factors, and perceived stress levels. We analysed data from 28,930 adults (aged ≥19 years) from the fourth and fifth Korea National Health and Nutrition Examination Surveys (KNHANES) conducted from 2008 to 2012 in South Korea. We investigated the presence and severity of tinnitus, depressive mood, suicidal ideation, perceived usual stress level, and socioeconomic and health-related variables. We conducted logistic regression and mediation analyses. Tinnitus and its severity were significantly associated with depressive mood and suicidal ideation. Tinnitus, depressive mood, and suicidal ideation shared common socioeconomic and health-related risk factors. Tinnitus significantly mediated the association of shared risk factors for depressive mood and suicidal ideation. Perceived usual stress level mediates the association of tinnitus with depressive mood and suicidal ideation. The correlation of perceived usual stress levels with depression and suicidal ideation was also mediated by tinnitus. Our findings implicate that tinnitus may contribute substantially to the development of depressive symptom and suicidal ideation in adults via apparent interactions with shared risk factors and stress levels.
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18
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Probst T, Pryss RC, Langguth B, Rauschecker JP, Schobel J, Reichert M, Spiliopoulou M, Schlee W, Zimmermann J. Does Tinnitus Depend on Time-of-Day? An Ecological Momentary Assessment Study with the "TrackYourTinnitus" Application. Front Aging Neurosci 2017; 9:253. [PMID: 28824415 PMCID: PMC5539131 DOI: 10.3389/fnagi.2017.00253] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 07/17/2017] [Indexed: 12/25/2022] Open
Abstract
Only few previous studies used ecological momentary assessments to explore the time-of-day-dependence of tinnitus. The present study used data from the mobile application “TrackYourTinnitus” to explore whether tinnitus loudness and tinnitus distress fluctuate within a 24-h interval. Multilevel models were performed to account for the nested structure of assessments (level 1: 17,209 daily life assessments) nested within days (level 2: 3,570 days with at least three completed assessments), and days nested within participants (level 3: 350 participants). Results revealed a time-of-day-dependence of tinnitus. In particular, tinnitus was perceived as louder and more distressing during the night and early morning hours (from 12 a.m. to 8 a.m.) than during the upcoming day. Since previous studies suggested that stress (and stress-associated hormones) show a circadian rhythm and this might influence the time-of-day-dependence of tinnitus, we evaluated whether the described results change when statistically controlling for subjectively reported stress-levels. Correcting for subjective stress-levels, however, did not change the result that tinnitus (loudness and distress) was most severe at night and early morning. These results show that time-of-day contributes to the level of both tinnitus loudness and tinnitus distress. Possible implications of our results for the clinical management of tinnitus are that tailoring the timing of therapeutic interventions to the circadian rhythm of individual patients (chronotherapy) might be promising.
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Affiliation(s)
- Thomas Probst
- Georg-Elias-Müller-Institute for Psychology, Georg-August-University GöttingenGöttingen, Germany.,Department for Psychotherapy and Biopsychosocial Health, Danube University KremsKrems an der Donau, Austria
| | - Rüdiger C Pryss
- Department for Psychotherapy and Biopsychosocial Health, Danube University KremsKrems an der Donau, Austria
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy of the University of Regensburg at Bezirksklinikum RegensburgRegensburg, Germany
| | - Josef P Rauschecker
- Program in Cognitive and Computational Systems, Georgetown University WashingtonWashington, DC, United States.,Institute for Advanced Study, Technical University MunichMunich, Germany
| | - Johannes Schobel
- Department for Psychotherapy and Biopsychosocial Health, Danube University KremsKrems an der Donau, Austria
| | - Manfred Reichert
- Department for Psychotherapy and Biopsychosocial Health, Danube University KremsKrems an der Donau, Austria
| | - Myra Spiliopoulou
- Department of Technical and Business Information Systems, Otto-von-Guericke-University MagdeburgMagdeburg, Germany
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy of the University of Regensburg at Bezirksklinikum RegensburgRegensburg, Germany
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19
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Milloy V, Fournier P, Benoit D, Noreña A, Koravand A. Auditory Brainstem Responses in Tinnitus: A Review of Who, How, and What? Front Aging Neurosci 2017; 9:237. [PMID: 28785218 PMCID: PMC5519563 DOI: 10.3389/fnagi.2017.00237] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 07/06/2017] [Indexed: 12/27/2022] Open
Abstract
The auditory brainstem response (ABR) in tinnitus subjects has been extensively investigated over the last decade with the hopes of finding possible abnormalities related to the pathology. Despite this effort, the use of the ABR for tinnitus diagnosis or as an outcome measure is under debate. The present study reviewed published literature on ABR and tinnitus. The authors searched PubMed, MedLine, Embase, PsycINFO, and CINAHL, and identified additional records through manually searching reference lists and gray literature. There were 4,566 articles identified through database searching and 151 additional studies through the manual search (4,717 total): 2,128 articles were removed as duplicates, and 2,567 records did not meet eligibility criteria. From the final 22 articles that were included, ABR results from 1,240 tinnitus subjects and 664 control subjects were compiled and summarized with a focus on three main areas: the participant characteristics, the methodology used, and the outcome measures of amplitude and/or latency of waves I, III, and V. The results indicate a high level of heterogeneity between the studies for all the assessed areas. Amplitude and latency differences between tinnitus and controls were not consistent between studies. Nevertheless, the longer latency and reduced amplitude of wave I for the tinnitus group with normal hearing compared to matched controls was the most consistent finding across studies. These results support the need for greater stratification of the tinnitus population and the importance of a standardized ABR method to make comparisons between studies possible.
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Affiliation(s)
- Victoria Milloy
- School of Rehabilitation Sciences, University of OttawaOttawa, ON, Canada
| | - Philippe Fournier
- Centre National de la Recherche Scientifique, Aix-Marseille UniversityMarseille, France
| | - Daniel Benoit
- School of Rehabilitation Sciences, University of OttawaOttawa, ON, Canada
| | - Arnaud Noreña
- Centre National de la Recherche Scientifique, Aix-Marseille UniversityMarseille, France
| | - Amineh Koravand
- School of Rehabilitation Sciences, University of OttawaOttawa, ON, Canada
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20
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Jafari Z, Faraji J, Mirza Agha B, Metz GAS, Kolb BE, Mohajerani MH. The Adverse Effects of Auditory Stress on Mouse Uterus Receptivity and Behaviour. Sci Rep 2017; 7:4720. [PMID: 28680154 PMCID: PMC5498668 DOI: 10.1038/s41598-017-04943-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 05/23/2017] [Indexed: 12/20/2022] Open
Abstract
Stress during gestation has harmful effects on pregnancy outcome and can lead to spontaneous abortion. Few studies, however, have addressed the impact of gestational stress, particularly auditory stress, on behavioural performance and pregnancy outcome in mice. This study aimed to examine the effect of two types of gestational stress on uterus receptivity and behavioural performance. Pregnant C57BL/6 mice were randomly assigned to either auditory or physical stress conditions or a control condition from gestational days 12-16. The auditory stress regimen used loud 3000 Hz tone, while the physical stressor consisted of restraint and exposure to an elevated platform. Three behavioural tests were performed in the dams after weaning. Uterine receptivity was investigated by counting the number of sites of implantation and fetal resorption. Also, the offspring survival rates during the early postnatal period were calculated. Auditory stress caused an increase in anxiety-like behaviour, reduced time spent exploring new object/environment, and reduced balance when compared to the physical stress and control groups. Auditory stress also caused higher rates of resorbed embryos and reduction of litter size. Our results suggest that the adverse effect of noise stress is stronger than physical stress for both uterus receptivity and behavioural performance of the dams.
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Affiliation(s)
- Zahra Jafari
- Department of Neuroscience, Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada
- School of Rehabilitation Sciences, Iran University of Medical Science (IUMS), Tehran, Iran
| | - Jamshid Faraji
- Department of Neuroscience, Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada
- Golestan University of Medical Sciences, Faculty of Nursing & Midwifery, Gorgan, Iran
| | - Behroo Mirza Agha
- Department of Neuroscience, Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada
| | - Gerlinde A S Metz
- Department of Neuroscience, Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada
| | - Bryan E Kolb
- Department of Neuroscience, Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada.
| | - Majid H Mohajerani
- Department of Neuroscience, Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada.
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21
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Alsalman OA, Tucker D, Vanneste S. Salivary Stress-Related Responses in Tinnitus: A Preliminary Study in Young Male Subjects with Tinnitus. Front Neurosci 2016; 10:338. [PMID: 27489534 PMCID: PMC4951498 DOI: 10.3389/fnins.2016.00338] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 07/04/2016] [Indexed: 11/25/2022] Open
Abstract
Objective: This preliminary study examined if baseline measures of stress-related biomarkers as measured by salivary secretions of specific autonomic [measured by salivary α-amylase (sAA)], endocrine (measured by salivary cortisol), and immune (measured by salivary neopterin) responses are greater in male subjects with tinnitus in response to an induced-stress task. Method: Twenty male subjects with no significant hearing loss, 10 with tinnitus, and 10 without tinnitus were enrolled in this study.Salivary secretions were collected before and after the induced stress task at four different time intervals. Results: sAA levels were lower in the tinnitus group in comparison to subjects without tinnitus, suggesting impaired sympathetic activity in the subjects with tinnitus although these levels remained stable throughout the stress experiment.While no significant effects could be obtained for salivary cortisol or neopterin, salivary neopterin levels were trending toward significance over all measurements. Behavioral measures of stress were found to correlate negatively with measures of sAA and salivary neopterin. Conclusion: The results of this study suggest impaired stress-related sAA mechanisms in male subjects with tinnitus, as evidenced by the different stress reactions induced in the endocrine system (as measured by salivary cortisol) and the immune system (as measured by salivary neopterin).
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Affiliation(s)
- Ola A Alsalman
- Lab for Clinical and Integrative Neuroscience, School of Behavioral and Brain Sciences, The University of Texas at Dallas Dallas, TX, USA
| | - Denise Tucker
- Department of Communication Sciences and Disorders, University of North Carolina at Greensboro Greensboro, NC, USA
| | - Sven Vanneste
- Lab for Clinical and Integrative Neuroscience, School of Behavioral and Brain Sciences, The University of Texas at Dallas Dallas, TX, USA
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22
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Probst T, Pryss R, Langguth B, Schlee W. Emotional states as mediators between tinnitus loudness and tinnitus distress in daily life: Results from the "TrackYourTinnitus" application. Sci Rep 2016; 6:20382. [PMID: 26853815 PMCID: PMC4745045 DOI: 10.1038/srep20382] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 12/30/2015] [Indexed: 01/14/2023] Open
Abstract
The psychological process how tinnitus loudness leads to tinnitus distress remains unclear. This cross-sectional study investigated the mediating role of the emotional state "stress level" and of the two components of the emotional state "arousal" and "valence" with N = 658 users of the "TrackYourTinnitus" smartphone application. Stress mediated the relationship between tinnitus loudness and tinnitus distress in a simple mediation model and even in a multiple mediation model when arousal and valence were held constant. Arousal mediated the loudness-distress relationship when holding valence constant, but not anymore when controlling for valence as well as for stress. Valence functioned as a mediator when controlling for arousal and even when holding arousal and stress constant. The direct effect of tinnitus loudness on tinnitus distress remained significant in all models. This study demonstrates that emotional states affect the process how tinnitus loudness leads to tinnitus distress. We thereby could show that the mediating influence of emotional valence is at least equally strong as the influence of stress. Implications of the findings for future research, assessment, and clinical management of tinnitus are discussed.
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Affiliation(s)
- Thomas Probst
- Department of Psychology, University of Regensburg, Germany.,Department of Psychology and Psychotherapy, University of Witten/Herdecke, Germany
| | - Rüdiger Pryss
- Institute of Databases and Information System, Ulm University, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany
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23
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Pattyn T, Van Den Eede F, Vanneste S, Cassiers L, Veltman DJ, Van De Heyning P, Sabbe BCG. Tinnitus and anxiety disorders: A review. Hear Res 2015; 333:255-265. [PMID: 26342399 DOI: 10.1016/j.heares.2015.08.014] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/06/2015] [Accepted: 08/27/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND The most common form of tinnitus is a subjective, auditory, and distressing phantom phenomenon. Comorbidity with depression is high but other important psychiatric disorders such as anxiety disorders have received less attention. The current paper reviews the literature on the associations between tinnitus and anxiety disorders and the underlying pathophysiology, and discusses the clinical implications. METHODOLOGY PubMed and Web of Science were searched for all articles published up until October 2014 using combinations of the following search strings "Tinnitus", "Anxiety disorder", "Panic Disorder", "Generalized Anxiety Disorder", "Post traumatic stress disorder", "PTSD" "Social Phobia", "Phobia Disorder", "Obsessive Compulsive Disorder", "Agoraphobia". RESULTS A total of 117 relevant papers were included. A 45% lifetime prevalence of anxiety disorders is reported in tinnitus populations, while an important overlap in associated (sub)cortical brain areas and cortico-subcortical networks involved in attention, distress, and memory functions is suggested. A disturbed hypothalamic-pituitary-adrenal axis function can be found in tinnitus and in anxiety disorders but, in comorbidity, the direction of the dysfunction is unclear. CONCLUSION Comorbidity is high and screening for and treatment of anxiety disorders is recommended in moderate to severe tinnitus, as, given the overlap in the structural and functional brain circuitries involved, theoretically, their management could improve (subjective) levels of tinnitus although further empirical research on this topic is required.
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Affiliation(s)
- T Pattyn
- University of Antwerp, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp, Belgium; University Department of Psychiatry, Campus Antwerp University Hospital, Antwerp, Belgium.
| | - F Van Den Eede
- University Department of Psychiatry, Campus Antwerp University Hospital, Antwerp, Belgium; University of Antwerp, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp, Belgium
| | - S Vanneste
- University of Antwerp, Department of Translational Neuroscience, Faculty of Medicine, Antwerp, Belgium; University of Texas, School of Behavioral and Brain Sciences, Dallas, Richardson, TX, United States
| | - L Cassiers
- University of Antwerp, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp, Belgium; University Department of Psychiatry, Campus Antwerp University Hospital, Antwerp, Belgium
| | - D J Veltman
- VU University Medical Centre, Department of Psychiatry and EMGO Institute of Health and Care Research and Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - P Van De Heyning
- University of Antwerp, Department of Translational Neuroscience, Faculty of Medicine, Antwerp, Belgium; Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - B C G Sabbe
- University of Antwerp, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp, Belgium; University Department of Psychiatry, Campus Psychiatric Hospital Duffel, Duffel, Belgium
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24
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Eggermont JJ, Roberts LE. Tinnitus: animal models and findings in humans. Cell Tissue Res 2015; 361:311-36. [PMID: 25266340 PMCID: PMC4487353 DOI: 10.1007/s00441-014-1992-8] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/14/2014] [Indexed: 12/19/2022]
Abstract
Chronic tinnitus (ringing of the ears) is a medically untreatable condition that reduces quality of life for millions of individuals worldwide. Most cases are associated with hearing loss that may be detected by the audiogram or by more sensitive measures. Converging evidence from animal models and studies of human tinnitus sufferers indicates that, while cochlear damage is a trigger, most cases of tinnitus are not generated by irritative processes persisting in the cochlea but by changes that take place in central auditory pathways when auditory neurons lose their input from the ear. Forms of neural plasticity underlie these neural changes, which include increased spontaneous activity and neural gain in deafferented central auditory structures, increased synchronous activity in these structures, alterations in the tonotopic organization of auditory cortex, and changes in network behavior in nonauditory brain regions detected by functional imaging of individuals with tinnitus and corroborated by animal investigations. Research on the molecular mechanisms that underlie neural changes in tinnitus is in its infancy and represents a frontier for investigation.
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Affiliation(s)
- Jos J Eggermont
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, and Department of Psychology, University of Calgary, 2500 University Drive N.W, Calgary, AB, Canada,
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25
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26
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Tinnitus prevalence in the city of São Paulo. Braz J Otorhinolaryngol 2015; 81:167-76. [PMID: 25631578 PMCID: PMC9449016 DOI: 10.1016/j.bjorl.2014.12.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 07/20/2014] [Indexed: 11/23/2022] Open
Abstract
Introduction The public and private health care in the city of São Paulo has no data on tinnitus prevalence. Objective Determine tinnitus prevalence in São Paulo city. Study design Series study. Methods Cross-sectional study by field questionnaire with 1960 interviews. Predictor variables included gender, age, tinnitus. Results The prevalence of tinnitus was 22%. It affects more women (26%) than men (17%) and increases with advancing age. Approximately one third of cases (32%) assert that they have constant tinnitus (i.e., “ringing”), while most describe intermittent tinnitus (68%). The majority (64%) reported feeling annoyed, while others (36%) denied any annoyance. Among women, the occurrence of an annoying tinnitus was significantly higher (73%) than among men (50%). The percentages were: mildly annoying (11%), moderately annoying (55%), and severely annoying (34%). Tinnitus interferes with daily activities in 18% of those reporting to be annoyed. Conclusion The population in the city of São Paulo suffering from tinnitus was more prevalent than previously estimated. Generally, it affects more women and those without occupation, and increases significantly with age. Most respondents described the tinnitus as annoying, and this was more prevalent in females. The degree of discomfort measured by a Visual Analogue Scale showed moderate tinnitus, with responses averaging 6.3.
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27
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Tyler RS, Pienkowski M, Roncancio ER, Jun HJ, Brozoski T, Dauman N, Coelho CB, Andersson G, Keiner AJ, Cacace AT, Martin N, Moore BCJ. A review of hyperacusis and future directions: part I. Definitions and manifestations. Am J Audiol 2014; 23:402-19. [PMID: 25104073 DOI: 10.1044/2014_aja-14-0010] [Citation(s) in RCA: 185] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Hyperacusis can be extremely debilitating, and at present, there is no cure. We provide an overview of the field, and possible related areas, in the hope of facilitating future research. METHOD We review and reference literature on hyperacusis and related areas. We have divided the review into 2 articles. In Part I, we discuss definitions, epidemiology, different etiologies and subgroups, and how hyperacusis affects people. In Part II, we review measurements, models, mechanisms, and treatments, and we finish with some suggestions for further research. RESULTS Hyperacusis encompasses a wide range of reactions to sound, which can be grouped into the categories of excessive loudness, annoyance, fear, and pain. Many different causes have been proposed, and it will be important to appreciate and quantify different subgroups. Reasonable approaches to assessing the different forms of hyperacusis are emerging, including psychoacoustical measures, questionnaires, and brain imaging. CONCLUSIONS Hyperacusis can make life difficult for many, forcing sufferers to dramatically alter their work and social habits. We believe this is an opportune time to explore approaches to better understand and treat hyperacusis.
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Affiliation(s)
| | | | | | | | - Tom Brozoski
- Southern Illinois University School of Medicine, Springfield
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28
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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. [PMID: 25339938 PMCID: PMC4186305 DOI: 10.3389/fneur.2014.00196] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/17/2014] [Indexed: 11/13/2022] Open
Abstract
The importance of psychological factors in tinnitus distress has been formally recognized for almost three decades. The psychological understanding of why tinnitus can be a distressing condition posits that it becomes problematic when it acquires an emotive significance through cognitive processes. Principle therapeutic efforts are directed at reducing or removing the cognitive (and behavioral) obstacles to habituation. Here, the evidence relevant to a new psychological model of tinnitus is critically reviewed. The model posits that patients' interpretations of tinnitus and the changes in behavior that result are given a central role in creating and maintaining distress. The importance of selective attention and the possibility that this leads to distorted perception of tinnitus is highlighted. From this body of evidence, we propose a coherent cognitive-behavioral model of tinnitus distress that is more in keeping with contemporary psychological theories of clinical problems (particularly that of insomnia) and which postulates a number of behavioral processes that are seen as cognitively mediated. This new model provides testable hypotheses to guide future research to unravel the complex mechanisms underpinning tinnitus distress. It is also well suited to define individual symptomatology and to provide a framework for the delivery of cognitive-behavioral therapy.
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Affiliation(s)
- Laurence McKenna
- Royal National Throat Nose and Ear Hospital, University College Hospitals , London , UK
| | - Lucy Handscomb
- Nottingham Hearing Biomedical Research Unit, National Institute for Health Research (NIHR), University of Nottingham , Nottingham , UK ; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham , Nottingham , UK ; UCL Ear Institute, University College London , London , UK
| | - Derek J Hoare
- Nottingham Hearing Biomedical Research Unit, National Institute for Health Research (NIHR), University of Nottingham , Nottingham , UK ; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham , Nottingham , UK
| | - Deborah A Hall
- Nottingham Hearing Biomedical Research Unit, National Institute for Health Research (NIHR), University of Nottingham , Nottingham , UK ; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham , Nottingham , UK
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Minen MT, Camprodon J, Nehme R, Chemali Z. The neuropsychiatry of tinnitus: a circuit-based approach to the causes and treatments available. J Neurol Neurosurg Psychiatry 2014; 85:1138-44. [PMID: 24744443 DOI: 10.1136/jnnp-2013-307339] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Patients presenting with tinnitus commonly have neuropsychiatric symptoms with which physicians need to be familiar. We provide an overview of tinnitus, including its types and pathophysiology. We discuss how recent methods such as transcranial magnetic stimulation, positron emission tomography, MRI, magnetoencephalography and quantitative EEG improve our understanding of the pathophysiology of tinnitus and connect tinnitus to the neuropsychiatric symptoms. We then explain why treatment of the tinnitus patient falls within the purview of neuropsychiatry. Psychiatric problems such as depression, anxiety and personality disorders are discussed. We also discuss how stress, headache, cognitive processing speed and sleep disturbance are associated with tinnitus. Finally, we provide a brief overview of treatment options and discuss the efficacy of various medications, including benzodiazepines, antidepressants, antipsychotics and mood-stabilising agents, and various non-pharmacological treatment options, such as cognitive behavioural therapy, habituation therapy and acupuncture. We also discuss how brain stimulation therapies are being developed for the treatment of tinnitus. In conclusion, a review of the literature demonstrates the varied neuropsychiatric manifestations of tinnitus. Imaging studies help to explain the mechanism of the association. However, more research is needed to elucidate the neurocircuitry underlying the association.
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Affiliation(s)
- Mia T Minen
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA
| | - Joan Camprodon
- Harvard Medical School, Boston, Massachusetts, USA Departments of Neurology and Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Romy Nehme
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zeina Chemali
- Harvard Medical School, Boston, Massachusetts, USA Departments of Neurology and Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA Massachusetts Eye Ear Infirmary, Boston, Massachusetts, USA
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Salviati M, Bersani FS, Terlizzi S, Melcore C, Panico R, Romano GF, Valeriani G, Macrì F, Altissimi G, Mazzei F, Testugini V, Latini L, Delle Chiaie R, Biondi M, Cianfrone G. Tinnitus: clinical experience of the psychosomatic connection. Neuropsychiatr Dis Treat 2014; 10:267-75. [PMID: 24550676 PMCID: PMC3925227 DOI: 10.2147/ndt.s49425] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The connection between psychopathology and tinnitus is complex and not adequately studied. The aim of this study is to investigate the relationship between tinnitus and psychiatric comorbidities from different points of view: categorical, dimensional, temperamental, and perceived stress level. METHODS Two hundred and thirty-nine patients affected by tinnitus were recruited between January and October 2012. Patients underwent a preliminary battery of tests including the Tinnitus Handicap Inventory (THI), Symptom Check List (SCL90-R), Temperament and Character Inventory (TCI), and Stress-Related Vulnerability Scale (VRS), and eventually a full psychiatric evaluation. RESULTS One hundred and fourteen patients (48% of the total sample) presented psychiatric comorbidity. Among these, a higher prevalence of depression, somatization, obsession, and anxiety was found. More than 41% of patients affected by decompensated tinnitus reported a family history of psychiatric disorders. Significant positive correlations between the psychopathological screening tools (SCL90-R and VRS) and THI were found. Patients affected by comorbid psychiatric disorder showed specific temperamental and characterial predispositions. CONCLUSION Psychiatric comorbidity in subjects affected by tinnitus is frequent. Stress can be considered as a factor leading to damage and dysfunction of the auditory apparatus. The vulnerability to neurotic disorders and the lack of coping capabilities can play a critical role in the clinical history of patients affected by severe tinnitus.
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Affiliation(s)
- Massimo Salviati
- Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC), Sapienza University of Rome, Rome, Italy
| | - Francesco Saverio Bersani
- Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC), Sapienza University of Rome, Rome, Italy
| | - Samira Terlizzi
- Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC), Sapienza University of Rome, Rome, Italy
| | - Claudia Melcore
- Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC), Sapienza University of Rome, Rome, Italy
| | - Roberta Panico
- Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC), Sapienza University of Rome, Rome, Italy
| | - Graziella Francesca Romano
- Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC), Sapienza University of Rome, Rome, Italy
| | - Guiseppe Valeriani
- Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC), Sapienza University of Rome, Rome, Italy
| | - Francesco Macrì
- Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC), Sapienza University of Rome, Rome, Italy
| | | | - Filippo Mazzei
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Valeria Testugini
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Luca Latini
- Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC), Sapienza University of Rome, Rome, Italy
| | - Roberto Delle Chiaie
- Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC), Sapienza University of Rome, Rome, Italy
| | - Massimo Biondi
- Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC), Sapienza University of Rome, Rome, Italy
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Kim DK, Chung DY, Bae SC, Park KH, Yeo SW, Park SN. Diagnostic value and clinical significance of stress hormones in patients with tinnitus. Eur Arch Otorhinolaryngol 2013; 271:2915-21. [DOI: 10.1007/s00405-013-2785-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 10/16/2013] [Indexed: 01/15/2023]
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Pace E, Zhang J. Noise-induced tinnitus using individualized gap detection analysis and its relationship with hyperacusis, anxiety, and spatial cognition. PLoS One 2013; 8:e75011. [PMID: 24069375 PMCID: PMC3771890 DOI: 10.1371/journal.pone.0075011] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 08/10/2013] [Indexed: 01/12/2023] Open
Abstract
Tinnitus has a complex etiology that involves auditory and non-auditory factors and may be accompanied by hyperacusis, anxiety and cognitive changes. Thus far, investigations of the interrelationship between tinnitus and auditory and non-auditory impairment have yielded conflicting results. To further address this issue, we noise exposed rats and assessed them for tinnitus using a gap detection behavioral paradigm combined with statistically-driven analysis to diagnose tinnitus in individual rats. We also tested rats for hearing detection, responsivity, and loss using prepulse inhibition and auditory brainstem response, and for spatial cognition and anxiety using Morris water maze and elevated plus maze. We found that our tinnitus diagnosis method reliably separated noise-exposed rats into tinnitus(+) and tinnitus(−) groups and detected no evidence of tinnitus in tinnitus(−) and control rats. In addition, the tinnitus(+) group demonstrated enhanced startle amplitude, indicating hyperacusis-like behavior. Despite these results, neither tinnitus, hyperacusis nor hearing loss yielded any significant effects on spatial learning and memory or anxiety, though a majority of rats with the highest anxiety levels had tinnitus. These findings showed that we were able to develop a clinically relevant tinnitus(+) group and that our diagnosis method is sound. At the same time, like clinical studies, we found that tinnitus does not always result in cognitive-emotional dysfunction, although tinnitus may predispose subjects to certain impairment like anxiety. Other behavioral assessments may be needed to further define the relationship between tinnitus and anxiety, cognitive deficits, and other impairments.
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Affiliation(s)
- Edward Pace
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Jinsheng Zhang
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, United States of America
- Department of Communication Sciences & Disorders, Wayne State University College of Liberal Arts & Sciences, Detroit, Michigan, United States of America
- * E-mail:
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Hébert S, Fournier P, Noreña A. The auditory sensitivity is increased in tinnitus ears. J Neurosci 2013; 33:2356-64. [PMID: 23392665 PMCID: PMC6619157 DOI: 10.1523/jneurosci.3461-12.2013] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 11/26/2012] [Accepted: 11/29/2012] [Indexed: 12/23/2022] Open
Abstract
Increased auditory sensitivity, also called hyperacusis, is a pervasive complaint of people with tinnitus. The high prevalence of hyperacusis in tinnitus subjects suggests that both symptoms have a common origin. It has been suggested that they may result from a maladjusted increase of central gain attributable to sensory deafferentation. More specifically, tinnitus and hyperacusis could result from an increase of spontaneous and stimulus-induced activity, respectively. One prediction of this hypothesis is that auditory sensitivity should be increased in tinnitus compared with non-tinnitus subjects. The purpose of this study was to test this prediction by examining the loudness functions in tinnitus ears (n = 124) compared with non-tinnitus human ears (n = 106). Because tinnitus is often accompanied by hearing loss and that hearing loss makes it difficult to disentangle hypersensitivity (hyperacusis) to loudness recruitment, tinnitus and non-tinnitus ears were carefully matched for hearing loss. Our results show that auditory sensitivity is enhanced in tinnitus subjects compared with non-tinnitus subjects, including subjects with normal audiograms. We interpreted these findings as compatible with a maladaptive central gain in tinnitus.
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Affiliation(s)
- Sylvie Hébert
- School of Speech Pathology and Audiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec H3C 3J7, Canada.
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Hébert S, Canlon B, Hasson D. Emotional exhaustion as a predictor of tinnitus. PSYCHOTHERAPY AND PSYCHOSOMATICS 2013; 81:324-6. [PMID: 22854311 DOI: 10.1159/000335043] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 11/13/2011] [Indexed: 11/19/2022]
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Canlon B, Theorell T, Hasson D. Associations between stress and hearing problems in humans. Hear Res 2013; 295:9-15. [DOI: 10.1016/j.heares.2012.08.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 08/24/2012] [Accepted: 08/27/2012] [Indexed: 12/20/2022]
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Wallhäusser-Franke E, Schredl M, Delb W. Tinnitus and insomnia: is hyperarousal the common denominator? Sleep Med Rev 2012; 17:65-74. [PMID: 22750224 DOI: 10.1016/j.smrv.2012.04.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 04/12/2012] [Accepted: 04/13/2012] [Indexed: 10/28/2022]
Abstract
Tinnitus is an auditory sensation that is generated by aberrant activation within the auditory system. Sleep disturbances are a frequent problem in the tinnitus population. They are known to worsen the distress caused by the tinnitus which in turn worsens sleep quality. Beyond that, disturbed sleep is a risk factor for mental health problems and distressing tinnitus is often associated with enhanced depressivity, anxiety, and somatic symptom severity. Moreover there is evidence that therapies which alleviate tinnitus-related distress have a positive influence on sleep quality and help interrupt this vicious cycle. This suggests that distressing tinnitus and insomnia may both be promoted by similar physiological mechanisms. One candidate mechanism is hyperarousal caused by enhanced activation of the sympathetic nervous system. There is increasing evidence for hyperarousal in insomnia patients, and animal models of tinnitus and insomnia show conspicuous similarities in the activation pattern of limbic and autonomous brain regions. In this article we review the evidence for this hypothesis which may have implications for therapeutic intervention in tinnitus patients with comorbid insomnia.
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Affiliation(s)
- Elisabeth Wallhäusser-Franke
- Medical Faculty Mannheim, Heidelberg University, Department of Phoniatrics and Audiology, Tridomus House C, Ludolf-Krehl-Str. 13-17, 68167 Mannheim, Germany.
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Mazurek B, Haupt H, Olze H, Szczepek AJ. Stress and tinnitus-from bedside to bench and back. Front Syst Neurosci 2012; 6:47. [PMID: 22701404 PMCID: PMC3371598 DOI: 10.3389/fnsys.2012.00047] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 05/26/2012] [Indexed: 12/14/2022] Open
Abstract
The aim of this review is to focus the attention of clinicians and basic researchers on the association between psycho-social stress and tinnitus. Although tinnitus is an auditory symptom, its onset and progression often associates with emotional strain. Recent epidemiological studies have provided evidence for a direct relationship between the emotional status of subjects and tinnitus. In addition, studies of function, morphology, and gene and protein expression in the auditory system of animals exposed to stress support the notion that the emotional status can influence the auditory system. The data provided by clinical and basic research with use of animal stress models offers valuable clues for an improvement in diagnosis and more effective treatment of tinnitus.
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Affiliation(s)
- Birgit Mazurek
- Molecular Biology Research Laboratory, Department of Otorhinolaryngology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte Berlin, Germany
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Fournier P, Hébert S. Gap detection deficits in humans with tinnitus as assessed with the acoustic startle paradigm: does tinnitus fill in the gap? Hear Res 2012; 295:16-23. [PMID: 22688322 DOI: 10.1016/j.heares.2012.05.011] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 05/27/2012] [Accepted: 05/30/2012] [Indexed: 11/19/2022]
Abstract
The measurement of tinnitus in humans relies on subjective measures such as self-report, visual analog scales and questionnaires. Gap detection impairments have been tested in animals in an attempt to objectify the presence of tinnitus. The main purpose of this study was to investigate the gap startle paradigm in human participants with high-frequency tinnitus. Fifteen adults with bilateral high-frequency tinnitus but normal hearing at standard frequencies and seventeen matched controls without tinnitus were tested. The psychoacoustic characteristics of the tinnitus spectrum (pitch and loudness) were assessed using novel participant-directed custom-made methods. The startle task consisted of startle-alone, prepulse inhibition and gap-in-noise condition at low- and high-background noise frequencies. All measurements were retested after several months. Data indicate normal prepulse inhibition but higher reactivity to the startle sounds in the tinnitus group in comparison with controls. Most importantly, the tinnitus group displayed a consistent deficit in gap processing at both low- and high-background noise frequencies. All effects were identified consistently and were reproducible at retest. We propose that the higher reactivity to startle might reflect hyperacusis and that the gap deficit might be an index of abnormal cortical auditory processing in tinnitus.
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Affiliation(s)
- Philippe Fournier
- École d'orthophonie et d'audiologie, Faculty of medicine, Université de Montréal, C.P.6128, succ. Centre-Ville, Montréal, QC, Canada H3C 3J7
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Belli H, Belli S, Oktay MF, Ural C. Psychopathological dimensions of tinnitus and psychopharmacologic approaches in its treatment. Gen Hosp Psychiatry 2012; 34:282-9. [PMID: 22285367 DOI: 10.1016/j.genhosppsych.2011.12.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Revised: 12/18/2011] [Accepted: 12/20/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this review to investigate presence of psychopathological states and efficacy of psychopharmacological drugs in the treatment of tinnitus. MATERIALS AND METHODS An extensive Internet search has been performed for this aim through PubMed by using related key words in English. RESULTS Higher anxiety and depression levels and somatoform disorder clusters are defined in patients with tinnitus. Additionally, impulsivity, hostility, demanding, physical discomfort, anxiety for health, emotionality and suicidal tendency are also defined in these people. Personality characteristics in these patients are depression, hysteria and hypochondriac features. Besides these symptom clusters, more severe psychopathologies like personality disorders may be encountered in these patients. Sertraline, paroxetine and nortriptyline can be considered as the first-line antidepressants in the psychopharmacological treatment of tinnitus. There are studies which have reported the efficacy of sulpiride. Carbamazepine, valproate and gabapentin can be effective as mood stabilizers. Short-acting benzodiazepines like alprazolam and midazolam are effective in signs of anxiety. Clonazepam and diazepam can be evaluated as other options. However, some glutamate receptor antagonists also can be used in the treatment of tinnitus. Disturbed sleep is frequently associated with tinnitus. Sleep disturbance can disrupt the quality of life in the patients with tinnitus. These patients might benefit from cognitive-behavioral therapy, which offers the promise of relief from tinnitus-related distress and insomnia. CONCLUSION When pathophysiologic reasons are excluded, it should be at least considered that tinnitus is exaggerated by psychopathological symptoms. Life quality of patients can be increased by treating these symptoms.
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Affiliation(s)
- Hasan Belli
- Bagcilar Education And Research Hospital, Department of Psychiatry, 34400 Istanbul, Turkey.
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Simoens VL, Hébert S. Cortisol suppression and hearing thresholds in tinnitus after low-dose dexamethasone challenge. BMC EAR, NOSE, AND THROAT DISORDERS 2012; 12:4. [PMID: 22449242 PMCID: PMC3328238 DOI: 10.1186/1472-6815-12-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 03/26/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND Tinnitus is a frequent, debilitating hearing disorder associated with severe emotional and psychological suffering. Although a link between stress and tinnitus has been widely recognized, the empirical evidence is scant. Our aims were to test for dysregulation of the stress-related hypothalamus-pituitary adrenal (HPA) axis in tinnitus and to examine ear sensitivity variations with cortisol manipulation. METHODS Twenty-one tinnitus participants and 21 controls comparable in age, education, and overall health status but without tinnitus underwent basal cortisol assessments on three non-consecutive days and took 0.5 mg of dexamethasone (DEX) at 23:00 on the first day. Cortisol levels were measured hourly the next morning. Detection and discomfort hearing thresholds were measured before and after dexamethasone suppression test. RESULTS Both groups displayed similar basal cortisol levels, but tinnitus participants showed stronger and longer-lasting cortisol suppression after DEX administration. Suppression was unrelated to hearing loss. Discomfort threshold was lower after cortisol suppression in tinnitus ears. CONCLUSIONS Our findings suggest heightened glucocorticoid sensitivity in tinnitus in terms of an abnormally strong glucocorticoid receptor (GR)-mediated HPA-axis feedback (despite a normal mineralocorticoid receptor (MR)-mediated tone) and lower tolerance for sound loudness with suppressed cortisol levels. Long-term stress exposure and its deleterious effects therefore constitute an important predisposing factor for, or a significant pathological consequence of, this debilitating hearing disorder.
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Affiliation(s)
- Veerle L Simoens
- Cognitive Brain Research Unit, Cognitive Science, Department of Behavioural Sciences, University of Helsinki, Helsinki, P.O. Box 9 00014, Finland
- Finnish Centre of Excellence in Interdisciplinary Music Research, Department of Music, University of Jyväskylä, Jyväskylä, Finland
- BRAMS, International Laboratory for Brain, Music, and Sound research, Montreal, Canada
| | - Sylvie Hébert
- BRAMS, International Laboratory for Brain, Music, and Sound research, Montreal, Canada
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Canada, and Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montréal, Canada
- Université de Montréal BRAMS, Pavillon 1420, Mont-Royal C.P. 6128, succ. Centre-ville, Montréal, QC H3C 3J7, Canada
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Heinecke K, Weise C, Rief W. Psychophysiological effects of biofeedback treatment in tinnitus sufferers. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2011; 48:223-39. [DOI: 10.1348/014466508x386207] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Hasson D, Theorell T, Wallén MB, Leineweber C, Canlon B. Stress and prevalence of hearing problems in the Swedish working population. BMC Public Health 2011; 11:130. [PMID: 21345187 PMCID: PMC3056746 DOI: 10.1186/1471-2458-11-130] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 02/23/2011] [Indexed: 01/15/2023] Open
Abstract
Background Current human and experimental studies are indicating an association between stress and hearing problems; however potential risk factors have not been established. Hearing problems are projected to become among the top ten disabilities according to the WHO in the near future. Therefore a better understanding of the relationships between stress and hearing is warranted. Here we describe the prevalence of two common hearing problems, i.e. hearing complaints and tinnitus, in relation to different work-and health-related stressors. Methods A total of 18,734 individuals were invited to participate in the study, out of which 9,756 (52%) enrolled. Results The results demonstrate a clear and mostly linear relationship between higher prevalence of hearing problems (tinnitus or hearing loss or both) and different stressors, e.g. occupational, poorer self-rated health, long-term illness, poorer sleep quality, and higher burnout scores. Conclusions The present study unambiguously demonstrates associations between hearing problems and various stressors that have not been previously described for the auditory system. These findings will open new avenues for future investigations.
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Affiliation(s)
- Dan Hasson
- Karolinska Institutet, Department of Physiology and Pharmacology, Stockholm, Sweden.
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43
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Knipper M, Zimmermann U, Müller M. Molecular aspects of tinnitus. Hear Res 2010; 266:60-9. [DOI: 10.1016/j.heares.2009.07.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 07/28/2009] [Accepted: 07/28/2009] [Indexed: 01/18/2023]
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Hasson D, Theorell T, Liljeholm-Johansson Y, Canlon B. Psychosocial and physiological correlates of self-reported hearing problems in male and female musicians in symphony orchestras. Int J Psychophysiol 2009; 74:93-100. [PMID: 19666059 DOI: 10.1016/j.ijpsycho.2009.07.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Revised: 07/01/2009] [Accepted: 07/27/2009] [Indexed: 11/29/2022]
Abstract
Experimental and epidemiological research indicate an association between long-term stress and hearing problems, yet the mechanisms underlying these disorders are not yet fully established. Thus, in order to better understand the pathogenesis of stress-related hearing problems, the present study explored the symptoms and general physiological and psychosocial status of musicians in symphony orchestras. Orchestral musicians are an ideal group to study since physical, psychosocial, work-environmental and acoustic stressors are highly prevalent. The subjects where obtained from two different studies. The first group included 250 participants from 12 orchestras and is entitled "the epidemiological study". The second group, entitled "the longitudinal study", included 47 musicians who were assessed at five occasions (every half year) during two years. Thirty-one of the 47 participants were selected for sampling of physiological variables, i.e. 24-hour ECG to assess heart rate variability to evaluate the synergistic action of the autonomic system as well as saliva cortisol and testosterone levels. The results indicate that self-reported hearing problems are associated with perceived poorer psychosocial environment, as well as mental health symptoms and stress. High-frequency power of heart rate variability (parasympathetic activity) showed a negative relationship to hearing problems, implying a poorer ability to "unwind" from stress. Cortisol levels were not correlated to hearing problems whereas testosterone levels showed a tendency to be lower in subjects with hearing problems than in others. These findings provide evidence for a relationship between long-term stress and self-reported hearing problems and demonstrate a protective role of parasympathetic and anabolic activity on hearing status.
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Affiliation(s)
- Dan Hasson
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
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Salivary cortisol levels, subjective stress, and tinnitus intensity in tinnitus sufferers during noise exposure in the laboratory. Int J Hyg Environ Health 2009; 212:37-44. [DOI: 10.1016/j.ijheh.2007.11.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Revised: 11/22/2007] [Accepted: 11/27/2007] [Indexed: 11/20/2022]
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Heinecke K, Weise C, Schwarz K, Rief W. Physiological and psychological stress reactivity in chronic tinnitus. J Behav Med 2008; 31:179-88. [PMID: 18193350 DOI: 10.1007/s10865-007-9145-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Accepted: 12/07/2007] [Indexed: 10/22/2022]
Abstract
Several models of tinnitus maintenance emphasize the importance of cognitive, emotional and psychophysiological processes. These factors contribute to distress in patients with decompensated tinnitus symptoms. We investigated whether tinnitus patients show increased physiological levels of arousal, more intense stress reactivity patterns and exaggerated psychological strain compared to healthy controls. Seventy tinnitus patients and 55 healthy controls underwent various stress tests. Muscular reactivity and peripheral arousal as well as strain ratings were assessed. Tinnitus patients reported significantly more strain during stress tests compared to healthy controls. Few physiological reactivity patterns differed significantly between the two groups. The physiological data thus only partly supported a hyperreactivity hypothesis. Strain reports and physiological data were only marginally correlated. Tinnitus patients show maladaptive appraisal processes during stress exposure, yet physiological reactivity is only slightly affected. Treatment programs for patients with decompensated tinnitus symptoms should account for appraisal processes and coping mechanisms in stressful situations.
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Affiliation(s)
- Kristin Heinecke
- Section Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstr. 18, 35032 Marburg, Germany.
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Abstract
OBJECTIVES Sleep difficulties are among the most frequent complaints associated with tinnitus. Yet most studies reporting on this problem are rather succinct, and all of them lack proper age- and health-matched control subjects. DESIGN The present study reports on 102 participants (51 with and 51 without tinnitus), assessed with the Pittsburgh Sleep Quality Index (PSQI), the Beck-II depression inventory, a hyperacusis questionnaire, and a tinnitus-reaction questionnaire (tinnitus group only). Participants were matched for health and relevant socioeconomic factors. RESULTS Results show that tinnitus patients have greater self-reported sleep difficulties compared with control subjects, specifically sleep efficiency and sleep quality, and that high tinnitus-related distress is associated with greater sleep disturbance. CONCLUSIONS Rather than hearing loss, sleep complaints in this population are mainly explained by hyperacusis, a hallmark of tinnitus, and to a lesser extent by subclinical depressive symptoms.
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Affiliation(s)
- Sylvie Hébert
- Ecole d'orthophonie et d'audiologie, Centre de recherche en neuropsychologie et en cognition, Université de Montréal, Canada.
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49
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Horner KC, Cazals Y, Guieu R, Lenoir M, Sauze N. Experimental estrogen-induced hyperprolactinemia results in bone-related hearing loss in the guinea pig. Am J Physiol Endocrinol Metab 2007; 293:E1224-32. [PMID: 17711987 DOI: 10.1152/ajpendo.00279.2007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Our group (Horner KC, Guieu R, Magnan J, Chays A, Cazals Y. Neuropsychopharmacology 26: 135-138, 2002) has earlier described hyperprolactinemia in some patients presenting inner ear dysfunction. However, in that study, it was not possible to determine whether hyperprolactinemia was a cause or an effect of the symptoms. To investigate the effect of hyperprolactinemia on inner ear function, we first developed a model of hyperprolactinemia in estrogen-primed Fischer 344 rats and then performed functional studies on pigmented guinea pigs. Hyperprolactinemia induced, after 2 mo, a hearing loss of approximately 30-40 dB across all frequencies, as indicated by the compound action potential audiogram. During the 3rd mo, the hearing loss continued to deteriorate. The threshold shifts were more substantial in males than in females. Observations under a dissection microscope revealed bone dysmorphology of the bulla and the cochlea. Light microscopy observations of cryostat sections confirmed bone-related pathology of the bony cochlear bulla and the cochlear wall and revealed morphopathology of the stria vascularis and spiral ligament. Scanning electron microscopy revealed loss of hair cells and stereocilia damage, in particular in the upper three cochlear turns and the two outermost hair cell rows. The data provide the first evidence of otic capsule and hair cell pathology associated with estrogen-induced prolonged hyperprolactinemia and suggest that conditions such as pregnancy, anti-psychotic drug treatment, aging, and/or stress might lead to similar ear dysfunctions.
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Affiliation(s)
- Kathleen C Horner
- CNRS UMR 6153-1147 INRA, Université Paul Cézanne, Faculté des Sciences et Techniques, Campus St Jérôme, Cases 351 352, Ave Escadrille Normandie Niémen, 13397, Marseille Cedex 20, France.
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50
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Hébert S, Lupien SJ. The sound of stress: Blunted cortisol reactivity to psychosocial stress in tinnitus sufferers. Neurosci Lett 2007; 411:138-42. [PMID: 17084027 DOI: 10.1016/j.neulet.2006.10.028] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 10/06/2006] [Accepted: 10/13/2006] [Indexed: 11/16/2022]
Abstract
Clinical observations suggest that tinnitus is modulated by stress. However, there is little empirical data to support the link between stress and tinnitus. In this study, we measured the stress hormone cortisol to examine the reactivity of the hypothalamic-pituitary-adrenal (HPA) axis in tinnitus participants as well as in healthy controls without tinnitus. Eighteen participants with tinnitus and 18 controls without tinnitus were exposed to the Trier Social Stress Task and cortisol sampling and subjective ratings were obtained at regular intervals. Tinnitus participants displayed a blunted cortisol response to psychosocial stress, in comparison with healthy controls who had a typical cortisol release about 30 min after the beginning of the experiment. The blunted cortisol response displayed by the tinnitus participants suggests that they have an anomaly along the HPA axis. Their cortisol response is similar to that found in other bodily stress-related diseases and thus suggests that tinnitus is related to stress. However, tinnitus intensity might not be modulated by stress in a concurrent manner.
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Affiliation(s)
- Sylvie Hébert
- Ecole d'orthophonie et d'audiologie, Université de Montréal, Canada; Centre de recherche, Institut universitaire de gériatrie de Montréal, Canada.
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