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Boecking B, Brueggemann P, Rose M, Mazurek B. [Chronic tinnitus: An interplay between somatic and psychological factors]. HNO 2023; 71:719-730. [PMID: 37702794 DOI: 10.1007/s00106-023-01370-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/14/2023]
Abstract
Chronic tinnitus is a common, sometimes highly distressing phenomenon that can be triggered and maintained by an interplay of physical and psychological factors. Partnering with clinical psychology and psychosomatic medicine, modern otolaryngology integrates both medical (e.g., hearing loss) and psychological influences (e.g., interactions between biographical experiences, personality traits, subjective evaluation of intrapsychic and interpersonal stimuli, emotional states, and intrapsychic or interpersonal emotion regulation strategies). Both groups of variables can influence the intensity and course of chronic tinnitus symptomatology both directly and indirectly, whereby the quality and relative degrees of psychological and physical components in a person's self-experience can fluctuate. With this in mind, the present article distinguishes between chronic tinnitus symptomatology with or without hearing loss-and strongly advocates for an integrated understanding of the symptomatology within a holistic psychological frame of reference. After a brief introduction to the principles of psychosomatic medicine and psychotherapy, the article discusses psychological case conceptualization using a vulnerability-stress-coping (VSC) model as an example, outlines clinical aspects and diagnostics of chronic tinnitus symptomatology, and concludes with a conceptualization of chronic tinnitus-related distress as a function of person-centered VSC interactions.
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Affiliation(s)
- Benjamin Boecking
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Luisenstraße 13, 10117, Berlin, Deutschland
| | - Petra Brueggemann
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Luisenstraße 13, 10117, Berlin, Deutschland
| | - Matthias Rose
- Medizinische Klinik mit Schwerpunkt für Psychosomatik und Psychotherapie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Birgit Mazurek
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Luisenstraße 13, 10117, Berlin, Deutschland.
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Sanfins MD, Donadon C, Gos E, Serra AP, Rezende A, Ferrazoli N, Skarżyński PH. Skarzynski Tinnitus Scale: Cultural Adaptation and Validation to Brazilian Portuguese. Int Arch Otorhinolaryngol 2023; 27:e400-e406. [PMID: 37564479 PMCID: PMC10411171 DOI: 10.1055/s-0042-1742351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/03/2021] [Indexed: 08/12/2023] Open
Abstract
Introduction Tinnitus is a prevalent condition among many different populations. Since tinnitus is subjective, self-report questionnaires are one way of assessing how much the condition interferes with the quality of life of an individual. Objective The aim of the present study was to translate and cross-culturally adapt the Skarzynski Tinnitus Scale (STS) into Brazilian Portuguese and validate its psychometric properties. Methods The STS was translated and cross-culturally adapted using five main steps. Fifty-eight individuals who had continuous tinnitus were invited to complete the questionnaire. Pure tone audiometry (air and bone conduction) were also done. Results No major changes were necessary in translating the scale. The overall score was 1.3 (range 0-4). Internal consistency was tested by Cronbach α, which ranged from 0.54 to 0.85. Differences between genders and between subscales and the total score were not significant. A statistically significant difference was only found in the coping subscale, in which normal hearing subjects had higher scores than those with hearing loss. Conclusion The translation and adaptation of the STS established linguistic and cultural equivalence with the original. In addition, it exhibited good internal consistency. Our results suggest that the STS is suitable for use in a clinical setting.
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Affiliation(s)
- Milaine Dominici Sanfins
- Postgraduate Program in Audiology, Albert Einstein Instituto Israelita de Ensino e Pesquisa, São Paulo, SP, Brazil
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Caroline Donadon
- Postgraduate Program in Child and Adolescent Health, Universidade de Campinas, Campinas, SP, Brazil
| | - Elżbieta Gos
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
| | - Ana Paula Serra
- Department of Otorhinolaryngology, Clínica Ouvire, Campinas, SP, Brazil
| | - Adriano Rezende
- Department of Otorhinolaryngology, Clínica Ouvire, Campinas, SP, Brazil
| | - Natalia Ferrazoli
- Postgraduate Program in Health, Interdisciplinary Practice and Rehabilitation School of Medical Sciences, Campinas, SP, Brazil
- Departament of Audiology, Clinica Ouvire, Campinas, SP, Brazil
| | - Piotr Henryk Skarżyński
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany, Poland
- Department of Heart Failure and Cardiac Rehabilitation, Institute of Sensory Organs, Warsaw, Poland
- Department of Otorhinolaryngology, Institute of Sensory Organs, Kajetany, Poland
- ENT Departament, Maria Curie-Sklodowska University, Lublin, Poland
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Jensen M, Alanis JCG, Hüttenrauch E, Winther-Jensen M, Chavanon ML, Andersson G, Weise C. Does it matter what is trained? A randomized controlled trial evaluating the specificity of alpha/delta ratio neurofeedback in reducing tinnitus symptoms. Brain Commun 2023; 5:fcad185. [PMID: 37680692 PMCID: PMC10481778 DOI: 10.1093/braincomms/fcad185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/18/2023] [Accepted: 06/22/2023] [Indexed: 09/09/2023] Open
Abstract
Previous studies showed that alpha/delta ratio neurofeedback was effective in reducing unpleasant psychological, emotional and perceptual consequences of tinnitus. The main goal of the present study was to investigate, whether the specific combination of enhancing alpha frequency band activity and reducing delta frequency band activity was necessary, or merely sufficient, to obtain a positive treatment outcome regarding tinnitus distress and intensity. A second research aim was to assess the relative contribution of neurofeedback-related non-specific and general non-specific effects in neurofeedback treatment. In a three-arm, randomized controlled trial, 94 chronic tinnitus patients were randomly assigned to one of three conditions: alpha/delta ratio neurofeedback (n = 31), beta/theta ratio neurofeedback (n = 28) and non-neurofeedback minimal treatment intervention (n = 35). Neurofeedback participants underwent 10 treatment sessions over a 4-week period. Outcome measures were collected pre-, mid- and post-interventions and at 3-months follow-up. The Tinnitus Handicap Inventory and the Tinnitus Magnitude Index were used as primary outcome measures for tinnitus distress and tinnitus intensity. EEG data recorded during training supplemented primary outcomes. Since data were repeated measures, the analyses used a two-level mixed effects model approach including by-subject random effects (random intercept). For the Tinnitus Handicap Inventory, the results showed no interaction effect. For the Tinnitus Magnitude Index, the analysis showed a significant time × group interaction, indicating that both alpha/delta ratio neurofeedback and beta/theta ratio neurofeedback reported reduced tinnitus intensity. Analysis of EEG data showed a consistent pattern for the alpha/delta ratio over the course of training. Compared to beta/theta ratio neurofeedback, alpha/delta ratio neurofeedback showed an elevated response. Conversely, for the beta ratio to theta ratio, the pattern was more inconsistent, with no clear indication of superiority for beta/theta ratio neurofeedback over alpha/delta ratio neurofeedback. The main question of this piece of research was whether alpha/delta ratio neurofeedback demonstrated frequency band specificity in the alleviation of tinnitus distress and perceived intensity. Results showed that alpha/delta ratio neurofeedback was sufficient but importantly 'not' necessary to achieve a positive outcome on both the Tinnitus Handicap Inventory and Tinnitus Magnitude Index, when compared to beta/theta ratio neurofeedback. Still, the data suggest a trend towards specificity for alpha/delta ratio neurofeedback. Because of this, it may be too premature to discard alpha/delta ratio neurofeedback in the treatment of tinnitus. Recommendations for future studies are outlined.
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Affiliation(s)
- Martin Jensen
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, 35032 Marburg, Germany
- Eriksholm Research Centre, 3070 Snekkersten, Denmark
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology and Audiology, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Jose Carlos Garcia Alanis
- Division of Clinical Child and Adolescent Psychology, Department of Psychology, Philipps University Marburg, 35032 Marburg, Germany
| | - Eva Hüttenrauch
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, 35032 Marburg, Germany
| | - Matilde Winther-Jensen
- Department of Data, Biostatistics and Pharmacoepidemiology, Centre for Clinical Research and Prevention, Copenhagen University Hospital Bispebjerg-Frederiksberg, 2000 Copenhagen, Denmark
| | - Mira-Lynn Chavanon
- Division of Clinical Child and Adolescent Psychology, Department of Psychology, Philipps University Marburg, 35032 Marburg, Germany
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, 58183 Linkoping, Sweden
| | - Cornelia Weise
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, 35032 Marburg, Germany
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Hackenberg B, O'Brien K, Döge J, Lackner KJ, Beutel ME, Münzel T, Pfeiffer N, Schulz A, Schmidtmann I, Wild PS, Matthias C, Bahr-Hamm K. Tinnitus Prevalence in the Adult Population-Results from the Gutenberg Health Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59030620. [PMID: 36984621 PMCID: PMC10052845 DOI: 10.3390/medicina59030620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Abstract
Background and Objectives: Tinnitus is a common symptom in medical practice, although data on its prevalence vary. As the underlying pathophysiological mechanism is still not fully understood, hearing loss is thought to be an important risk factor for the occurrence of tinnitus. The aim of this study was to assess tinnitus prevalence in a large German cohort and to determine its dependence on hearing impairment. Materials and Methods: The Gutenberg Health Study (GHS) is a population-based cohort study and representative for the population of Mainz and its district. Participants were asked whether they suffer from tinnitus and how much they are burdened by it. Extensive audiological examinations using bone- and air-conduction were also performed. Results: 4942 participants (mean age: 61.0, 2550 men and 2392 women) were included in the study. The overall prevalence of tinnitus was 26.1%. Men were affected significantly more often than women. The prevalence of tinnitus increased with age, peaking at ages 75 to 79 years. Considering only annoying tinnitus, the prevalence was 9.8%. Logistic regression showed that participants with severe to complete hearing loss (>65 dB) were more likely to have tinnitus. Conclusions: Tinnitus is a common symptom, and given demographic changes, its prevalence is expected to increase.
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Affiliation(s)
- Berit Hackenberg
- Department of Otorhinolaryngology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Karoline O'Brien
- Department of Otorhinolaryngology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Julia Döge
- Department of Otorhinolaryngology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Karl J Lackner
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, 55131 Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, 55131 Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology-Cardiology I, University Medical Center Mainz, 55131 Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine-Department of Cardiology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Irene Schmidtmann
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, 55131 Mainz, Germany
| | - Philipp S Wild
- Preventive Cardiology and Preventive Medicine-Department of Cardiology, University Medical Center Mainz, 55131 Mainz, Germany
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, 55131 Mainz, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site RhineMain, 60549 Mainz, Germany
- Institute of Molecular Biology (IMB), 55128 Mainz, Germany
| | - Christoph Matthias
- Department of Otorhinolaryngology, University Medical Center Mainz, 55131 Mainz, Germany
| | - Katharina Bahr-Hamm
- Department of Otorhinolaryngology, University Medical Center Mainz, 55131 Mainz, Germany
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Factors associated with Self Rated Health in persons with tinnitus from the general population. J Psychosom Res 2022; 153:110693. [PMID: 34920266 DOI: 10.1016/j.jpsychores.2021.110693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Tinnitus, the perception of a sound without a corresponding external source, may be associated with decreased Self-Rated Health (SRH). Most research on tinnitus has been done in clinical populations. We aimed to study factors associated with SRH in individuals reporting tinnitus from the general population. METHODS In this cross-sectional study, we used data of participants of the Lifelines population-based cohort who answered the question: "Do you hear soughing or whistling in your ear or ears?" (N=124,490). SRH was assessed using the RAND-36 item on SRH. Linear regression was used to study associations between SRH and impairment of hearing, physical and mental health, lifestyle, personality, and demographic features, in the group reporting always tinnitus (N=8,011). Models were also run in the entire study cohort, to test whether tinnitus was associated with SRH after adjustment for these variables. RESULTS Of all participants, 6.4% reported always hearing tinnitus, with 83.7% of these reporting good to excellent SRH. The strongest positive associations with SRH in the group reporting always tinnitus were found for younger age, higher education levels, good sleep quality, more social contacts, absence of irritable bowel syndrome and fibromyalgia, high competence, and low impulsivity. In the total population, tinnitus was negatively associated with SRH, while adjusting for demographic features, physical and mental health history, lifestyle, and personality. CONCLUSION Our findings contribute to increased understanding of resilience towards the negative consequences of tinnitus. In their early encounters with tinnitus patients, clinicians could focus on self-help regarding sleep hygiene and stimulate social activities.
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Understanding Factors That Cause Tinnitus: A Mendelian Randomization Study in the UK Biobank. Ear Hear 2021; 43:70-80. [PMID: 34108397 DOI: 10.1097/aud.0000000000001074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the causal role of established risk factors and associated conditions to tinnitus and tinnitus severity in the UK Biobank. DESIGN The prospective cohort study with large dataset of >500,000 individuals. The analytical sample of 129,731 individuals in the UK Biobank of European descent. Participants were recruited from National Health Service registries, baseline age range between 37 and 73 years, response rate to baseline survey 6%. Participants were asked subjective questions about tinnitus and its severity. Previously observed associations (n = 23) were confirmed in the UK Biobank using logistic and ordinal regression models. Two-sample Mendelian randomization approaches were then used to test causal relationships between the 23 predictors and tinnitus and tinnitus severity. The main outcome measures were observational and genetic association between key demographics and determinants and two tinnitus outcomes (current tinnitus and tinnitus severity). RESULTS Prevalence of tinnitus was 20% and severe tinnitus 3.8%. The observational results are consistent with the previous literature, with hearing loss, older age, male gender, high BMI, higher deprivation, higher blood pressure, smoking history, as well as numerous comorbidities being associated with higher odds of current tinnitus. Mendelian randomization results showed causal correlations with tinnitus. Current tinnitus was predicted by genetically instrumented hearing loss (odds ratio [OR]: 8.65 [95% confidence interval (CI): 6.12 to 12.23]), major depression (OR: 1.26 [95% CI: 1.06 to 1.50]), neuroticism (OR: 1.48 [95% CI: 1.28 to 1.71]), and higher systolic blood pressure (OR: 1.01 [95% CI:1.00 to 1.02]). Lower odds of tinnitus were associated with longer duration in education (OR: 0.74 [95% CI: 0.63 to 0.88]), higher caffeine intake (OR: 0.89 [95% CI: 0.83 to 0.95]) and being a morning person (OR: 0.94 [95% CI: 0.90 to 0.98]). Tinnitus severity was predicted by a higher genetic liability to neuroticism (OR: 1.15 [95% CI: 1.06 to 1.26]) and schizophrenia (OR: 1.02 [95% CI: 1.00 to 1.04]). CONCLUSIONS Tinnitus data from the UK Biobank confirm established associated factors in the literature. Genetic analysis determined causal relationships with several factors that expand the understanding of the etiology of tinnitus and can direct future pathways of clinical care and research.
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Comparison of two disease‑specific instruments assessing health-related quality of life in patients with chronic otitis media. Eur Arch Otorhinolaryngol 2021; 279:703-711. [PMID: 33788035 PMCID: PMC8794985 DOI: 10.1007/s00405-021-06702-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/10/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE Evaluating the current health state in chronic otitis media (COM), audiologic results are complemented by subjective outcomes, such as health-related quality of life (HRQoL). Two disease-specific instruments assessing HRQoL in COM in German-speaking patients exist, i.e., the chronic otitis media outcome test (COMOT-15) and the Zurich chronic middle ear inventory (ZCMEI-21). Since the psychometric properties of these questionnaires in a concurrent application are unknown, the aim of this study was to compare the COMOT-15 and the ZCMEI-21. METHODS HRQoL was assessed in adult COM patients using the COMOT-15 and the ZCMEI-21. Psychometric properties were determined, including response distribution, concurrent validity, internal consistency, correlation to hearing and gender differences. RESULTS In 173 patients (mean age 51.5 years), both questionnaires showed normally distributed scores without strong floor and ceiling effects. The total scores and subscores of both questionnaires exhibited satisfactory internal consistency (Cronbach's α 0.7-0.9) with the exception of the COMOT-15 hearing subscore (α = 0.94) and the ZCMEI-21 medical resource subscore (α = 0.66). Fair correlations between the air conduction pure-tone average and the total scores were found (COMOT-15: r = 0.36, p < 0.0001; ZCMEI-21: r = 0.34, p < 0.0001). CONCLUSION In the first study comparing the COMOT-15 and the ZCMEI-21, both questionnaires exhibited satisfactory psychometric properties with several subtle differences. The COMOT-15 has a strong focus on hearing with a probably redundant content of the hearing subscore and may be suited for hearing-focused research questions. The ZCMEI-21 provides a comprehensive assessment of the COM symptom complex and may therefore also be used in research settings, where ear discharge, vertigo or pain should be covered.
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Abstract
INTRODUCTION Tinnitus loudness is a subjective measure, and it does not directly reflect either tinnitus severity or the impact on daily life. Nevertheless, loud tinnitus may be the most frequent clinical complaint of tinnitus patients. Factors contributing to the loudness of the phantom sound have rarely been studied. We evaluated both matched and self-rated loudness in a large sample of patients with tinnitus and analyzed the influencing factors among demographic, hearing, and tinnitus characteristics. METHODS Two hundred ninety-nine patients with chronic tinnitus were enrolled. We evaluated the matched loudness, minimal masking level (MML), and visual analog scale (VAS) loudness. Stepwise multiple regression analyses were performed for each loudness measure using independent variables of age, sex, time since tinnitus onset, tinnitus laterality, pure-tone average, tinnitus pitch, tinnitus handicap inventory (THI) score, VAS annoyance, disturbance and daily tinnitus duration, and depression score. We calculated bivariate correlations between each loudness measure and all independent variables. RESULTS The psychoacoustic loudness measures (matched loudness and MML) were highly correlated and were affected by the hearing deficit and tinnitus pitch (Pearson r > 0.5 for pure tone averages, and r > 0.3 for tinnitus pitch for both variables, p < 0.05), whereas the subjective measurement (VAS loudness) exhibited little to no correlation with the other two measures and was related to psycho-emotional factors such as the THI score, VAS variables, and depression (Pearson r > 0.6 for VAS annoyance, r > 0.4 for VAS daily duration and disturbance and THI score, r > 0.3 for the depression score, p < 0.05). CONCLUSION The matched tinnitus loudness and MML values were influenced principally by the extent of hearing loss and related factors, suggesting that rehabilitation using hearing aids could help reduce perception of tinnitus loudness. A psycho-emotional approach might more effectively lessen self-perceived loudness.
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Gos E, Rajchel JJ, Dziendziel B, Kutyba J, Bienkowska K, Swierniak W, Gocel M, Raj-Koziak D, Skarzynski PH, Skarzynski H. How to Interpret Tinnitus Functional Index Scores: A Proposal for a Grading System Based on a Large Sample of Tinnitus Patients. Ear Hear 2020; 42:654-661. [PMID: 33156124 DOI: 10.1097/aud.0000000000000967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The Tinnitus Functional Index (TFI) is considered the gold standard in measuring tinnitus severity. The aim of the study was to establish reference values to improve the interpretability of TFI scores. DESIGN Results from 1114 patients with tinnitus were retrospectively analyzed. The participants were consecutive patients who attended our tertiary referral Ear, Nose, and Throat Center. The eligibility criteria were: at least 18 years old, persistent tinnitus, completed pure-tone audiometry, and answered all 25 items on the TFI. Hearing status (normal hearing vs. hearing impairment) was established according to the recommendation of the Bureau International d'Audiophonologie. Means (M) and SD on the TFI were the basis for grading tinnitus severity on four levels: low, lower moderate, upper moderate, and high. To gauge individual scores in clinical practice, percentiles are also proposed. RESULTS All 1114 patients (586 women and 528 men) were Caucasian and aged from 19 to 87 years (M = 50.96; SD = 13.10 years). Tinnitus duration ranged from 0.5 to 50 years (M = 7.17; SD = 7.71 years). There were 258 patients with normal hearing and 856 patients with hearing loss. A score of above 65 points on TFI was established as the cutoff point for diagnosing high tinnitus severity. A regression model associating tinnitus severity with gender, age, tinnitus duration, and hearing loss was statistically significant: F(4,1109) = 8.99; p < 0.001, but the effect was very small (R2adj = 0.028) and only gender and age were associated with TFI global score, while tinnitus severity was not related to tinnitus duration or hearing loss. CONCLUSIONS The reference values proposed here support those reported previously by Meikle et al. They are empirically based and can be used as benchmarks in clinical practice and scientific research. They make it possible to assess tinnitus severity, evaluate individual scores, and categorize individuals with tinnitus. This allows researchers to set inclusion or exclusion criteria when assigning patients to specific groups during clinical trials involving tinnitus intervention strategies.
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Affiliation(s)
- Elzbieta Gos
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw
| | - Joanna J Rajchel
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw
| | - Beata Dziendziel
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw
| | - Justyna Kutyba
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw
| | - Katarzyna Bienkowska
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw
| | - Weronika Swierniak
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw
| | - Maria Gocel
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw
| | - Danuta Raj-Koziak
- Department of Audiology and Phoniatrics, Tinnitus Clinic, Institute of Physiology and Pathology of Hearing, Warsaw
| | - Piotr H Skarzynski
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw.,Heart Failure and Cardiac Rehabilitation Department, Faculty of Medicine, Medical University of Warsaw, Warsaw.,Institute of Sensory Organs, Nadarzyn/Kajetany
| | - Henryk Skarzynski
- Department of Otorhinolaryngosurgery, World Hearing Center, Institute of Physiology and Pathology of Hearing, Warsaw
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van Munster JJCM, van der Valk WH, Stegeman I, Lieftink AF, Smit AL. The Relationship of Tinnitus Distress With Personality Traits: A Systematic Review. Front Neurol 2020; 11:225. [PMID: 32655464 PMCID: PMC7326028 DOI: 10.3389/fneur.2020.00225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/10/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives: An association between tinnitus distress with anxiety and depression is described in literature. A similar relationship might exist between tinnitus distress and personality traits, especially since associations between personality traits and other chronic diseases are already revealed. In this systematic review, we aim to investigate whether personality is a risk factor for tinnitus distress. Design: We searched PubMed and EMBASE databases from inception up to December 31, 2018 for articles on the association between tinnitus distress and personality. Two researchers screened titles, abstracts, and full texts for eligibility. Directness of evidence and risk of bias were assessed. From the included studies, study characteristics and outcome data of tinnitus distress and personality traits were extracted. Results: A total of 323 unique articles were screened of which 11 cross-sectional studies were eligible for critical appraisal and were used for data extraction. Including study populations were heterogenous, and studies scored high to moderate risk of bias. Nine out of 11 articles showed an association between tinnitus distress and the personality of neuroticism. Conclusions: By limitations in the methodology of included studies, the evidence on specific personality traits as a risk factor for tinnitus distress is inconclusive. Some evidence on a positive association with neuroticism is identified. To draw conclusions about causal relations, these further studies should be of longitudinal design in a cohort setting. These studies should assess tinnitus distress using validated questionnaires with multiple personality dimensions and validated questionnaires to assess personality traits.
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Affiliation(s)
- Juliëtte J C M van Munster
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden University, Leiden, Netherlands.,Department of Neurosurgery, Leiden University Medical Center, Leiden University, Leiden, Netherlands
| | - Wouter H van der Valk
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden University, Leiden, Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Arno F Lieftink
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Adriana L Smit
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, Netherlands.,Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
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Biehl R, Boecking B, Brueggemann P, Grosse R, Mazurek B. Personality Traits, Perceived Stress, and Tinnitus-Related Distress in Patients With Chronic Tinnitus: Support for a Vulnerability-Stress Model. Front Psychol 2020; 10:3093. [PMID: 32116880 PMCID: PMC7025561 DOI: 10.3389/fpsyg.2019.03093] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/31/2019] [Indexed: 01/20/2023] Open
Abstract
Background Despite vulnerability-stress models underlying a variety of distress-related emotional syndromes, few studies have investigated interactions between personality factors and subjectively experienced stressors in accounting for tinnitus-related distress. Aim The present study compared personality characteristics between patients with chronic tinnitus and the general population. Within the patient sample, it was further examined whether personality dimensions predicted tinnitus-related distress and, if so, whether differential aspects or levels of perceived stress mediated these effects. Method Applying a cross-sectional design, 100 patients with chronic tinnitus completed the Freiburger Persönlichkeitsinventar (FPI-R) measuring personality, the Perceived Stress Questionnaire (PSQ-20) measuring perceived stress and the German version of the Tinnitus Questionnaire (TQ) measuring tinnitus-related distress. FPI-R scores were compared with normed values obtained from a representative German reference population. Mediation analyses were computed specifying FPI-R scores as independent, PSQ20 scores as mediating and the TQ-total score as dependent variables. Results Patients with chronic tinnitus significantly differed from the general population across a variety of personality indices. Tinnitus-related distress was mediated by differential interactions between personality factors and perceived stress dimensions. Conclusion In conceptualizing tinnitus-related distress, idiosyncratic assessments of vulnerability-stress interactions are crucial for devising effective psychological treatment strategies. Patients' somatic complaints and worries appear to be partly informed by opposing tendencies reflecting emotional excitability vs. aggressive inhibition - suggesting emotion-focused treatment strategies as a promising new direction for alleviating distress.
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Affiliation(s)
- Raphael Biehl
- Tinnitus Center, Charité - Universitätsmedizin-Berlin, Berlin, Germany
| | - Benjamin Boecking
- Tinnitus Center, Charité - Universitätsmedizin-Berlin, Berlin, Germany
| | - Petra Brueggemann
- Tinnitus Center, Charité - Universitätsmedizin-Berlin, Berlin, Germany
| | - Romina Grosse
- Tinnitus Center, Charité - Universitätsmedizin-Berlin, Berlin, Germany
| | - Birgit Mazurek
- Tinnitus Center, Charité - Universitätsmedizin-Berlin, Berlin, Germany
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13
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Sense and Sensibility: A Review of the Behavioral Neuroscience of Tinnitus Sound Therapy and a New Typology. Curr Top Behav Neurosci 2020; 51:213-247. [PMID: 33547596 DOI: 10.1007/7854_2020_183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Tinnitus Sound Therapy is not a single strategy. It consists of many different sound types, targeting many different mechanisms. Therapies that use sound to cover, reduce attention to, or facilitate habituation of tinnitus are among the most common tinnitus treatment paradigms. Recent history has seen a proliferation of sound therapies, but they have each been criticized for having limited empirical support. In this review, Sound Therapy's modern history will be described, and a typology will be introduced and discussed in light of current behavioral neuroscience research. It will be argued that contributing factors to the limited evidence for the efficacy of Sound Therapy are its diversity, plural modes of action, and absence of a clear typology. Despite gaps in understanding the efficacy of sound's effects on tinnitus, there is compelling evidence for its multiple, but related, neurophysiological mechanisms. Evidence suggests that sound may reduce tinnitus through its presence, context, reaction, and potentially adaptation. This review provides insights into the neurocognitive basis of these tinnitus Sound Therapy modes. It concludes that a unifying classification is needed to secure and advance arguments in favor of Sound Therapy.
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14
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Deutsch BC, Piccirillo JF. Momentary Analysis of Tinnitus: Considering the Patient. Curr Top Behav Neurosci 2020; 51:383-401. [PMID: 32808091 DOI: 10.1007/7854_2020_176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Ecological momentary assessment is a valuable research technique meant to capture real-time data and contextualize disease. While more common in neuropsychiatric research, this methodology is exceptionally fit for tinnitus. Tinnitus has been shown to be affected by many patient-level and environment-specific factors. From an individual's baseline anxiety to the level of ambient noise in their environment, the level of bother experienced by those with tinnitus can vary widely. Only assessing tinnitus within a clinical environment can distort the true impact of the disease. Ecological data can minimize bias while generating an individualistic picture of the burden being experienced by the patient. Individual data can also compliment new research methods rooted in precision medicine, providing clearer, better-suited treatments for each patient on the tinnitus spectrum.
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Affiliation(s)
- Brian C Deutsch
- Department of Otolaryngology, Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA. .,Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Jay F Piccirillo
- Department of Otolaryngology, Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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15
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Abstract
How many people are affected by tinnitus? Is the risk of developing tinnitus on the rise or has it been declining over time? What modifiable lifestyle factors could help to prevent tinnitus? These population-based questions can be addressed through epidemiological research. Epidemiology refers to the underlying and basic science of public health. It describes the study of the distribution and determinants of health-related states or events in specified populations and the application of this study to the control of health problems. There are two key concepts in epidemiology: (1) measures of frequency and (2) measures of effect. In this chapter, we introduce the two main measures of frequency, prevalence and incidence. We also introduce the notion of risk factors, critical for understanding measures of effect concerning the risk of developing a health condition. In both sections, we provide illustrative examples from the published literature on tinnitus. We end by offering a critical evaluation of the current status of epidemiological research on tinnitus and point to some promising future directions.
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16
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Vajsakovic D, Maslin M, Searchfield GD. Principles and Methods for Psychoacoustic Evaluation of Tinnitus. Curr Top Behav Neurosci 2020; 51:419-459. [PMID: 33550568 DOI: 10.1007/7854_2020_211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Tinnitus, the perception of sound in the absence of a physical sound in the environment, is highly heterogeneous. It varies in its etiology, characteristics, and impact on an individual's life. The sound is commonly described as "ringing," "buzzing," "crickets," "hissing," "humming." Tinnitus can be acute or chronic, mild or disabling. It can be perceived unilaterally or, more commonly, bilaterally. The sound and its location differ from person to person and fluctuate in the same individual over a certain period of time. This heterogeneity in characterization has important implications for research and clinical practice. Identifying patterns in how tinnitus sounds and its relationship to hearing may aid in identifying different forms of tinnitus and revealing their underlying mechanisms. However, the subjective nature of characterizing tinnitus makes it difficult to reliably define and measure. This chapter will focus on reviewing the psychoacoustic assessment of tinnitus, its relationship to cognitive and behavioral aspects of tinnitus, and its neuropathophysiology. In particular, it will describe the heterogeneity of tinnitus and tinnitus matching, and how individual variability in measures may be used to guide treatment and as a prognostic factor.
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Affiliation(s)
- Dunja Vajsakovic
- Section of Audiology, The University of Auckland, Auckland, New Zealand.,Eisdell Moore Centre, The University of Auckland, Auckland, New Zealand.,Centre for Brain Research, The University of Auckland, Auckland, New Zealand.,Brain Research New Zealand, A Centre of Research Excellence, Auckland, New Zealand
| | - Michael Maslin
- Eisdell Moore Centre, The University of Auckland, Auckland, New Zealand.,School of Psychology, Speech and Hearing, The University of Canterbury, Canterbury, New Zealand
| | - Grant D Searchfield
- Section of Audiology, The University of Auckland, Auckland, New Zealand. .,Eisdell Moore Centre, The University of Auckland, Auckland, New Zealand. .,Centre for Brain Research, The University of Auckland, Auckland, New Zealand. .,Brain Research New Zealand, A Centre of Research Excellence, Auckland, New Zealand.
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17
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Nationwide analysis of the relationships between mental health, body mass index and tinnitus in premenopausal female adults in Korea: 2010-2012 KNHANES. Sci Rep 2018; 8:7028. [PMID: 29728692 PMCID: PMC5935674 DOI: 10.1038/s41598-018-25576-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 04/24/2018] [Indexed: 12/17/2022] Open
Abstract
Tinnitus is related to serious comorbidities such as suicidal ideation and attempts. Body mass index (BMI) is associated with auditory symptoms including hearing loss. The aim of this nationwide, population-based, cross-sectional study was to evaluate the relationship between mental health, body mass index and tinnitus in a Korean premenopausal female population. This study analyzed data from the Korea National Health and Nutrition Examination Surveys in 2010–2012. Data were collected from 4628 19 years or older, premenopausal women. After adjustments, underweight premenopausal women exhibited a higher odds ratio for tinnitus (odd ratio = 1.54; 95% confidence interval = 1.14–2.08) compared with women of normal weight. Moderate and severe tinnitus was highly prevalent in underweight as well as extremely obese women. The prevalence of perceived stress, melancholy, and suicide ideation was significantly higher in women with tinnitus. The prevalence of perceived stress and suicide ideation was significantly higher in underweight women with tinnitus, but that of melancholy was significantly lower. This study demonstrated that underweight premenopausal Korean women had a higher risk of tinnitus, which has grown in importance as a public health issue. Women with tinnitus experience perceived stress and suicide ideation more frequently, but melancholy less frequently than women without.
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18
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Searchfield GD, Linford T, Durai M. Sound therapy and aural rehabilitation for tinnitus: a person centred therapy framework based on an ecological model of tinnitus. Disabil Rehabil 2018; 41:1966-1973. [DOI: 10.1080/09638288.2018.1451928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Grant D. Searchfield
- Eisdell Moore Centre, Centre for Brain Research, Section of Audiology, Brain Research New Zealand, The University of Auckland, Auckland, New Zealand
| | - Tania Linford
- Eisdell Moore Centre, Centre for Brain Research, Section of Audiology, Brain Research New Zealand, The University of Auckland, Auckland, New Zealand
| | - Mithila Durai
- Eisdell Moore Centre, Centre for Brain Research, Section of Audiology, Brain Research New Zealand, The University of Auckland, Auckland, New Zealand
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19
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Abstract
OBJECTIVES The purpose of this longitudinal twin study was to explore the effect of tinnitus on hearing thresholds and threshold shifts over two decades and to investigate the genetic contribution to tinnitus in a male twin cohort (n = 1114 at baseline and 583 at follow-up). The hypothesis was that participants with faster hearing deterioration had a higher risk for developing tinnitus and there is an underlying role of genetic influences on tinnitus. DESIGN Male mono- and dizygotic twin pairs, born between 1914 and 1958 were included. Mixed models were used for comparison of hearing threshold shifts, adjusted for age. A co-twin comparison was made within pairs discordant for tinnitus. The relative influence of genetic and environmental factors was estimated by genetic modeling. RESULTS The overall prevalence of tinnitus was 13.5% at baseline ((Equation is included in full-text article.)age 50) and 34.4% at follow-up ((Equation is included in full-text article.)age 67). The overall incidence proportion was 27.8%. Participants who reported tinnitus at baseline or at both time points were older. At baseline, the hearing thresholds differed between tinnitus cases and controls at all frequencies. New tinnitus cases at follow-up had the greatest hearing threshold shift at the high-frequency area compared with the control group. Within pairs, the tinnitus twin had poorer hearing than his unaffected co-twin, more so for dizygotic than monozygotic twin pairs. The relative proportion of additive genetic factors was approximately 0.40 at both time points, and the influence of individual-specific environment was 0.56 to 0.61. The influence of genetic factors on tinnitus was largely independent of genetic factors for hearing thresholds. CONCLUSIONS Our hypotheses were confirmed: The fastest hearing deterioration occurred for new tinnitus cases. A moderate genetic influence for tinnitus was confirmed.
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20
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A systematic review and meta-analysis of psychological functioning in chronic tinnitus. Clin Psychol Rev 2018; 60:62-86. [DOI: 10.1016/j.cpr.2017.12.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 10/31/2017] [Accepted: 12/28/2017] [Indexed: 11/19/2022]
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21
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Veile A, Zimmermann H, Lorenz E, Becher H. Is smoking a risk factor for tinnitus? A systematic review, meta-analysis and estimation of the population attributable risk in Germany. BMJ Open 2018; 8:e016589. [PMID: 29472253 PMCID: PMC5855477 DOI: 10.1136/bmjopen-2017-016589] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To assess the epidemiological association of smoking status and tinnitus with a systematic review and meta-analysis and to estimate the population attributable risk in Germany. DATA SOURCES A systematic literature search in PubMed and ISI-Web of Science Core Collection resulted in 1026 articles that were indexed until 15 September 2015. Additionally, proceedings of the international tinnitus seminars and reference lists of relevant articles were screened. STUDY SELECTION Two reviewers searched independently for epidemiological studies. Tinnitus as a manifestation of tumours, vascular malformations, specific syndromes or as a consequence of surgical and medical treatment was not considered. Moreover, studies conducted among patients of ear, nose and throat clinics were excluded. DATA EXTRACTION If only raw data were provided, effect sizes were calculated. Further unpublished data were received by corresponding authors. DATA SYNTHESIS Data of 20 studies were pooled. Current smoking (OR 1.21, 95% CI 1.09 to 1.35), former smoking (OR 1.13, 95% CI 1.01 to 1.26) and ever smoking (OR 1.20, 95% CI 1.11 to 1.30) were significantly associated with tinnitus. Moreover, sensitivity analyses for severe tinnitus (OR 1.32, 95% CI 1.10 to 1.58) and for studies of superior quality (OR 1.15, 95% CI 1.03 to 1.29) showed increased risks. According to this, the population attributable risk estimate in Germany is 3.5%. CONCLUSION There is sufficient evidence that smoking is associated with tinnitus. As the review mainly consists of cross-sectional studies, the observed correlation does not give evidence of a causal relationship. Due to the impact of various confounders, further research is needed to provide more evidence on the strength of association and causal relationships.
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Affiliation(s)
- Annette Veile
- Institute of Public Health, Unit of Epidemiology and Biostatistics, University of Heidelberg, Heidelberg, Germany
| | - Heiko Zimmermann
- Institute of Public Health, Unit of Epidemiology and Biostatistics, University of Heidelberg, Heidelberg, Germany
| | - Eva Lorenz
- Institute of Public Health, Unit of Epidemiology and Biostatistics, University of Heidelberg, Heidelberg, Germany
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
| | - Heiko Becher
- Institute of Public Health, Unit of Epidemiology and Biostatistics, University of Heidelberg, Heidelberg, Germany
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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22
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Strumila R, Lengvenytė A, Vainutienė V, Lesinskas E. The role of questioning environment, personality traits, depressive and anxiety symptoms in tinnitus severity perception. Psychiatr Q 2017; 88:865-877. [PMID: 28229347 DOI: 10.1007/s11126-017-9502-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Psychological factors have been described as important for tinnitus severity, but attempts to incorporate them in one picture are sparse. This study investigated to what extent traits (personality), states (depressive and anxiety symptoms), sociodemographic factors and questioning environment influence tinnitus severity perception and how they interplay. Data were obtained from 212 subjects in a survey that was undertaken in 2016 at Vilnius University hospital and via internet. Measures included the Tinnitus Handicap Inventory (THI), Visual Analogue Scale (VAS), Hospital Anxiety and Depression Scale (HADS), Big Five Personality Dimensions Scale and sociodemographic questions. A series of stepwise forward and multiple regression analyses were undertaken to discover how factors interconnect. Female gender, age, living in rural area, but not level of education, were found to be associated with THI and HADS. Total HADS score and of both subscales were linked to scores on THI, VAS scales and all personality traits, except agreeableness (and consciousness for anxiety). Anxiety was the most important predictor for tinnitus severity, followed by depressive symptoms. Only neuroticism from personality dimensions was a predictor of THI score, whereas THI scores did not predict scores on neuroticism. All results in scales were higher in the internet group, except agreeableness and neuroticism, while extroversion correlated negatively with THI score only in the hospital group. Tinnitus severity was highly correlated with depressive, anxiety symptoms and neuroticism. Respondents recruited through internet had higher scores on most parameters. Results emphasize the importance of psychological factors in tinnitus management.
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Affiliation(s)
- Robertas Strumila
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio street 21, LT-03101, Vilnius, Lithuania.
| | - Aistė Lengvenytė
- Faculty of Medicine, Clinic of Psychiatry, Vilnius University, Vasaros street 5, LT-10309, Vilnius, Lithuania
| | - Vija Vainutienė
- Center of Ear, Nose and Throat Diseases, Vilnius University Hospital Santariskiu Clinics, Santariškių street 2, LT-08661, Vilnius, Lithuania
| | - Eugenijus Lesinskas
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio street 21, LT-03101, Vilnius, Lithuania
- Center of Ear, Nose and Throat Diseases, Vilnius University Hospital Santariskiu Clinics, Santariškių street 2, LT-08661, Vilnius, Lithuania
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23
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Noroozian M, Jafari Z, Shahmiri E, Omidvar S, Zendehbad A, Amini N, Radmehr M, Bagherian M, Yoonessi A. Effect of Age, Gender and Hearing Loss on the Degree of Discomfort Due to Tinnitus. Basic Clin Neurosci 2017; 8:435-442. [PMID: 29942427 PMCID: PMC6010657 DOI: 10.29252/nirp.bcn.8.6.435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Tinnitus is one of the complex symptoms of hearing described as a phantom auditory sensation without any external stimulation. Due to the subjective nature of tinnitus, perception and discomfort of tinnitus vary among the patients. The main aim of this study is to investigate the effects of gender, age and the degree of hearing loss on discomfort due to tinnitus. Methods: Eighteen patients with tinnitus, aged 21–72 years, (9 males and 9 females) were recruited. Tinnitus discomfort was investigated by Tinnitus Handicap Inventory (THI) questionnaire. Psychoacoustic assessments of tinnitus and auditory threshold assessments were evaluated using a 2-channel clinical audiometer. Results: The results showed no significant correlation between THI scores with loudness matching (P=0.187), mean of auditory threshold (P=0.304), gender (P=0.93) and age (P=0.200). Also, no significant correlation was found between maximal level of hearing loss and pitch matching (P=0.208). Conclusion: The study findings suggests that tinnitus is not correlated with age, gender and hearing loss. Overall, tinnitus is a complicated clinical condition which its real impact and degree of discomfort are unclear. More investigation is needed to clarify the factors involving in tinnitus annoyance.
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Affiliation(s)
- Maryam Noroozian
- Department of Memory and Behavioral Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Jafari
- Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Basic Sciences, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Elaheh Shahmiri
- Rehabilitation Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Neuroscience, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Omidvar
- Department of Audiology, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azadeh Zendehbad
- Department of Geriatric Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Amini
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahsa Radmehr
- Department of Audiology, School of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Bagherian
- Department of Audiology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Yoonessi
- Department of Neuroscience, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
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24
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Behavioral Animal Model of the Emotional Response to Tinnitus and Hearing Loss. J Assoc Res Otolaryngol 2017; 19:67-81. [PMID: 29047013 DOI: 10.1007/s10162-017-0642-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 09/28/2017] [Indexed: 12/28/2022] Open
Abstract
Increased prevalence of emotional distress is associated with tinnitus and hearing loss. The underlying mechanisms of the negative emotional response to tinnitus and hearing loss remain poorly understood, and it is challenging to disentangle the emotional consequences of hearing loss from those specific to tinnitus in listeners experiencing both. We addressed these questions in laboratory rats using three common rodent anxiety screening assays: elevated plus maze, open field test, and social interaction test. Open arm activity in the elevated plus maze decreased substantially after one trial in controls, indicating its limited utility for comparing pre- and post-treatment behavior. Open field exploration and social interaction behavior were consistent across multiple sessions in control animals. Individual sound-exposed and salicylate-treated rats showed a range of phenotypes in the open field, including reduced entries into the center in some subjects and reduced locomotion overall. In rats screened for tinnitus, less locomotion was associated with higher tinnitus scores. In salicylate-treated animals, locomotion was correlated with age. Sound-exposed and salicylate-treated rats also showed reduced social interaction. These results suggest that open field exploratory activity is a selective measure for identifying tinnitus distress in individual animals, whereas social interaction reflects the general effects of hearing loss. This animal model will facilitate future studies of the structural and functional changes in the brain pathways underlying emotional distress associated with hearing dysfunction, as well as development of novel interventions to ameliorate or prevent negative emotional responses.
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25
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Searchfield GD, Durai M, Linford T. A State-of-the-Art Review: Personalization of Tinnitus Sound Therapy. Front Psychol 2017; 8:1599. [PMID: 28970812 PMCID: PMC5609106 DOI: 10.3389/fpsyg.2017.01599] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 08/31/2017] [Indexed: 12/21/2022] Open
Abstract
Background: There are several established, and an increasing number of putative, therapies using sound to treat tinnitus. There appear to be few guidelines for sound therapy selection and application. Aim: To review current approaches to personalizing sound therapy for tinnitus. Methods: A "state-of-the-art" review (Grant and Booth, 2009) was undertaken to answer the question: how do current sound-based therapies for tinnitus adjust for tinnitus heterogeneity? Scopus, Google Scholar, Embase and PubMed were searched for the 10-year period 2006-2016. The search strategy used the following key words: "tinnitus" AND "sound" AND "therapy" AND "guidelines" OR "personalized" OR "customized" OR "individual" OR "questionnaire" OR "selection." The results of the review were cataloged and organized into themes. Results: In total 165 articles were reviewed in full, 83 contained sufficient details to contribute to answering the study question. The key themes identified were hearing compensation, pitched-match therapy, maskability, reaction to sound and psychosocial factors. Although many therapies mentioned customization, few could be classified as being personalized. Several psychoacoustic and questionnaire-based methods for assisting treatment selection were identified. Conclusions: Assessment methods are available to assist clinicians to personalize sound-therapy and empower patients to be active in therapy decision-making. Most current therapies are modified using only one characteristic of the individual and/or their tinnitus.
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Affiliation(s)
- Grant D. Searchfield
- Section of Audiology, Eisdell Moore Centre, The University of AucklandAuckland, New Zealand
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26
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Durai M, Searchfield GD. A Mixed-Methods Trial of Broad Band Noise and Nature Sounds for Tinnitus Therapy: Group and Individual Responses Modeled under the Adaptation Level Theory of Tinnitus. Front Aging Neurosci 2017; 9:44. [PMID: 28337139 PMCID: PMC5343046 DOI: 10.3389/fnagi.2017.00044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 02/20/2017] [Indexed: 12/12/2022] Open
Abstract
Objectives: A randomized cross-over trial in 18 participants tested the hypothesis that nature sounds, with unpredictable temporal characteristics and high valence would yield greater improvement in tinnitus than constant, emotionally neutral broadband noise. Study Design: The primary outcome measure was the Tinnitus Functional Index (TFI). Secondary measures were: loudness and annoyance ratings, loudness level matches, minimum masking levels, positive and negative emotionality, attention reaction and discrimination time, anxiety, depression and stress. Each sound was administered using MP3 players with earbuds for 8 continuous weeks, with a 3 week wash-out period before crossing over to the other treatment sound. Measurements were undertaken for each arm at sound fitting, 4 and 8 weeks after administration. Qualitative interviews were conducted at each of these appointments. Results: From a baseline TFI score of 41.3, sound therapy resulted in TFI scores at 8 weeks of 35.6; broadband noise resulted in significantly greater reduction (8.2 points) after 8 weeks of sound therapy use than nature sounds (3.2 points). The positive effect of sound on tinnitus was supported by secondary outcome measures of tinnitus, emotion, attention, and psychological state, but not interviews. Tinnitus loudness level match was higher for BBN at 8 weeks; while there was little change in loudness level matches for nature sounds. There was no change in minimum masking levels following sound therapy administration. Self-reported preference for one sound over another did not correlate with changes in tinnitus. Conclusions: Modeled under an adaptation level theory framework of tinnitus perception, the results indicate that the introduction of broadband noise shifts internal adaptation level weighting away from the tinnitus signal, reducing tinnitus magnitude. Nature sounds may modify the affective components of tinnitus via a secondary, residual pathway, but this appears to be less important for sound effectiveness. The different rates of adaptation to broadband noise and nature sound by the auditory system may explain the different tinnitus loudness level matches. In addition to group effects there also appears to be a great deal of individual variation. A sound therapy framework based on adaptation level theory is proposed that accounts for individual variation in preference and response to sound. Clinical Trial Registration: www.anzctr.org.au, identifier #12616000742471.
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Affiliation(s)
- Mithila Durai
- Eisdell Moore Centre, Section of Audiology, University of AucklandAuckland, New Zealand
- Center for Brain Research, University of AucklandAuckland, New Zealand
| | - Grant D. Searchfield
- Eisdell Moore Centre, Section of Audiology, University of AucklandAuckland, New Zealand
- Center for Brain Research, University of AucklandAuckland, New Zealand
- Brain Research New ZealandAuckland, New Zealand
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27
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Durai M, O'Keeffe MG, Searchfield GD. Examining the short term effects of emotion under an Adaptation Level Theory model of tinnitus perception. Hear Res 2016; 345:23-29. [PMID: 28027920 DOI: 10.1016/j.heares.2016.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 12/11/2016] [Accepted: 12/16/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Existing evidence suggests a strong relationship between tinnitus and emotion. The objective of this study was to examine the effects of short-term emotional changes along valence and arousal dimensions on tinnitus outcomes. Emotional stimuli were presented in two different modalities: auditory and visual. The authors hypothesized that (1) negative valence (unpleasant) stimuli and/or high arousal stimuli will lead to greater tinnitus loudness and annoyance than positive valence and/or low arousal stimuli, and (2) auditory emotional stimuli, which are in the same modality as the tinnitus, will exhibit a greater effect on tinnitus outcome measures than visual stimuli. STUDY DESIGN Auditory and visual emotive stimuli were administered to 22 participants (12 females and 10 males) with chronic tinnitus, recruited via email invitations send out to the University of Auckland Tinnitus Research Volunteer Database. Emotional stimuli used were taken from the International Affective Digital Sounds- Version 2 (IADS-2) and the International Affective Picture System (IAPS) (Bradley and Lang, 2007a, 2007b). The Emotion Regulation Questionnaire (Gross and John, 2003) was administered alongside subjective ratings of tinnitus loudness and annoyance, and psychoacoustic sensation level matches to external sounds. RESULTS Males had significantly different emotional regulation scores than females. Negative valence emotional auditory stimuli led to higher tinnitus loudness ratings in males and females and higher annoyance ratings in males only; loudness matches of tinnitus remained unchanged. The visual stimuli did not have an effect on tinnitus ratings. The results are discussed relative to the Adaptation Level Theory Model of Tinnitus. CONCLUSIONS The results indicate that the negative valence dimension of emotion is associated with increased tinnitus magnitude judgements and gender effects may also be present, but only when the emotional stimulus is in the auditory modality. Sounds with emotional associations may be used for sound therapy for tinnitus relief; it is of interest to determine whether the emotional component of sound treatments can play a role in reversing the negative responses discussed in this paper.
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Affiliation(s)
- Mithila Durai
- Department of Audiology, University of Auckland, Auckland, New Zealand; Center for Brain Research, University of Auckland, Auckland, New Zealand
| | - Mary G O'Keeffe
- Department of Audiology, University of Auckland, Auckland, New Zealand
| | - Grant D Searchfield
- Department of Audiology, University of Auckland, Auckland, New Zealand; Center for Brain Research, University of Auckland, Auckland, New Zealand.
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Kim SY, Jeon YJ, Lee JY, Kim YH. Characteristics of tinnitus in adolescents and association with psychoemotional factors. Laryngoscope 2016; 127:2113-2119. [DOI: 10.1002/lary.26334] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 12/20/2022]
Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center; CHA University; Seongnam South Korea
| | - Yung Jin Jeon
- Department of Otorhinolaryngology; Seoul National University Boramae Medical Center; Seoul South Korea
| | - Jun-Young Lee
- Department of Psychiatry; Seoul National University Boramae Medical Center; Seoul South Korea
| | - Young Ho Kim
- Department of Otorhinolaryngology; Seoul National University Boramae Medical Center; Seoul South Korea
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Durai M, Searchfield G. Anxiety and depression, personality traits relevant to tinnitus: A scoping review. Int J Audiol 2016; 55:605-15. [DOI: 10.1080/14992027.2016.1198966] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Mithila Durai
- School of Population Health - Audiology, University of Auckland, New Zealand
| | - Grant Searchfield
- School of Population Health - Audiology, University of Auckland, New Zealand
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McCormack A, Edmondson-Jones M, Somerset S, Hall D. A systematic review of the reporting of tinnitus prevalence and severity. Hear Res 2016; 337:70-9. [DOI: 10.1016/j.heares.2016.05.009] [Citation(s) in RCA: 282] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/19/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
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Seimetz BM, Teixeira AR, Rosito LPS, Flores LS, Pappen CH, Dall'igna C. Pitch and Loudness Tinnitus in Individuals with Presbycusis. Int Arch Otorhinolaryngol 2016; 20:321-326. [PMID: 27746834 PMCID: PMC5063743 DOI: 10.1055/s-0035-1570311] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 10/04/2015] [Indexed: 10/25/2022] Open
Abstract
Introduction Tinnitus is a symptom that is often associated with presbycusis. Objective This study aims to analyze the existence of association among hearing thresholds, pitch, and loudness of tinnitus in individuals with presbycusis, considering the gender variable. Methods Cross-sectional, descriptive, and prospective study, whose sample consisted of individuals with tinnitus and diagnosis of presbycusis. For the evaluation, we performed anamnesis along with otoscopy, pure tone audiometry, and acuphenometry to analyze the psychoacoustic characteristics of tinnitus individuals. Results The sample consisted of 49 subjects, with a mean age of 69.57 ± 6.53 years, who presented unilateral and bilateral tinnitus, therefore, a sample of 80 ears. In analyzing the results, as for acuphenometry, the loudness of tinnitus was more present at 0dB and the pitch was 6HKz and 8HKz. Regarding the analysis of the association between the frequency of greater hearing threshold and tinnitus pitch, no statistical significance (p = 0.862) was found. As for the association between the intensity of greater hearing threshold and tinnitus loudness, no statistical significance (p = 0.115) was found. Conclusion There is no significant association between the hearing loss of patients with presbycusis and the pitch and loudness of tinnitus.
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Affiliation(s)
- Bruna Macangnin Seimetz
- Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Adriane Ribeiro Teixeira
- Department of Developmental Psychology and Personality, Universidade Federal do Rio Grande do Sul, Instituto de Psicologia da UFRGS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Leticia Petersen Schmidt Rosito
- Department of Otolaryngology - Head and Neck Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Carlos Henrique Pappen
- Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Celso Dall'igna
- Department of Otolaryngology - Head and Neck Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Kehrle HM, Sampaio ALL, Granjeiro RC, de Oliveira TS, Oliveira CACP. Tinnitus Annoyance in Normal-Hearing Individuals: Correlation With Depression and Anxiety. Ann Otol Rhinol Laryngol 2015; 125:185-94. [PMID: 26424781 DOI: 10.1177/0003489415606445] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess and correlate tinnitus annoyance in normal-hearing patients with auditory brainstem response and with anxiety/depression. METHODS A sample of 84 individuals with tinnitus and normal hearing levels (pure-tone thresholds ≤25 dB HL) was compared to a matched control group of 47 normal-hearing individuals without tinnitus. All participants underwent auditory brainstem response testing. Tinnitus annoyance was assessed using the Tinnitus Handicap Inventory and depression and anxiety using the Beck Depression Inventory and Beck Anxiety Inventory, respectively. We compared auditory brainstem response and anxiety/depression symptoms between groups. In the study group, we correlated the degree of tinnitus annoyance with normal/abnormal auditory brainstem response and presence/level of anxiety/depression symptoms. RESULTS All controls had normal auditory brainstem response; 30 patients with tinnitus had abnormal results. Thirty-five patients with tinnitus had depression and 41 anxiety, while only 2 controls had depression and none had anxiety, with a significant between-group difference (P < .001). Normal/abnormal auditory brainstem response showed no association with tinnitus annoyance, anxiety, or depression. A higher degree of tinnitus annoyance was associated with severity of depression and anxiety. CONCLUSIONS Increased tinnitus annoyance was positively correlated with greater severity of anxiety and depression in normal-hearing patients but was unrelated to normal/abnormal auditory brainstem response.
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Affiliation(s)
- Helga Moura Kehrle
- Department of Otolaryngology, Hospital de Base do Distrito Federal, State Department of Health of the Federal District, Brasília, DF, Brazil
| | | | - Ronaldo Campos Granjeiro
- Department of Otolaryngology, Hospital de Base do Distrito Federal, State Department of Health of the Federal District, Brasília, DF, Brazil
| | - Taciana Sarmento de Oliveira
- Department of Otolaryngology, Hospital de Base do Distrito Federal, State Department of Health of the Federal District, Brasília, DF, Brazil
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Searchfield GD. Tinnitus what and where: an ecological framework. Front Neurol 2014; 5:271. [PMID: 25566177 PMCID: PMC4266022 DOI: 10.3389/fneur.2014.00271] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 12/01/2014] [Indexed: 01/04/2023] Open
Abstract
Tinnitus is an interaction of the environment, cognition, and plasticity. The connection between the individual with tinnitus and their world seldom receives attention in neurophysiological research. As well as changes in cell excitability, an individual's culture and beliefs, and work and social environs may all influence how tinnitus is perceived. In this review, an ecological framework for current neurophysiological evidence is considered. The model defines tinnitus as the perception of an auditory object in the absence of an acoustic event. It is hypothesized that following deafferentation: adaptive feature extraction, schema, and semantic object formation processes lead to tinnitus in a manner predicted by Adaptation Level Theory (1, 2). Evidence from physiological studies is compared to the tenants of the proposed ecological model. The consideration of diverse events within an ecological context may unite seemingly disparate neurophysiological models.
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Affiliation(s)
- Grant D. Searchfield
- Section of Audiology, School of Population Health, Centre for Brain Research, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Tinnitus Research Initiative, Regensburg, Germany
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Mucci S, Geocze L, Abranches DC, Antúnez AEA, Penido NDO. Systematic review of evidence on the association between personality and tinnitus. Braz J Otorhinolaryngol 2014; 80:441-7. [PMID: 25303821 PMCID: PMC9444609 DOI: 10.1016/j.bjorl.2014.05.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 11/07/2013] [Indexed: 11/30/2022] Open
Abstract
Introduction Objective Methods Results Conclusion
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Affiliation(s)
- Samantha Mucci
- Department of Psychiatry, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP-EPM), São Paulo, SP, Brazil.
| | - Luciana Geocze
- Department of Psychiatry, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP-EPM), São Paulo, SP, Brazil
| | - Denise Caluta Abranches
- Department of Psychiatry, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP-EPM), São Paulo, SP, Brazil
| | | | - Norma de Oliveira Penido
- Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP-EPM), São Paulo, SP, Brazil
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Tinnitus-related distress and the personality characteristic resilience. Neural Plast 2014; 2014:370307. [PMID: 25120934 PMCID: PMC4121180 DOI: 10.1155/2014/370307] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 06/13/2014] [Accepted: 06/20/2014] [Indexed: 11/17/2022] Open
Abstract
It has been suggested that personality traits may be prognostic for the severity of suffering from tinnitus. Resilience as measured with the Wagnild and Young resilience scale represents a positive personality characteristic that promotes adaptation to adverse life conditions including chronic health conditions. Aim of the study was to explore the relation between resilience and tinnitus severity. In a cross-sectional study with a self-report questionnaire, information on tinnitus-related distress and subjective tinnitus loudness was recorded together with the personality characteristic resilience and emotional health, a measure generated from depression, anxiety, and somatic symptom severity scales. Data from 4705 individuals with tinnitus indicate that tinnitus-related distress and to a lesser extent the experienced loudness of the tinnitus show an inverse correlation with resilience. A mediation analysis revealed that the relationship between resilience and tinnitus-related distress is mediated by emotional health. This indirect effect indicates that high resilience is associated with better emotional health or less depression, anxiety, and somatic symptom severity, which in turn is associated with a less distressing tinnitus. Validity of resilience as a predictor for tinnitus-related distress is supported but needs to be explored further in longitudinal studies including acute tinnitus patients.
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Lee JH, Ra JJ, Kim YH. Adequacy of the Simplified Version of the Tinnitus Handicap Inventory (THI-S) to Measure Tinnitus Handicap and Relevant Distress. KOREAN JOURNAL OF AUDIOLOGY 2014; 18:19-27. [PMID: 24782947 PMCID: PMC4003733 DOI: 10.7874/kja.2014.18.1.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 03/15/2014] [Accepted: 03/20/2014] [Indexed: 11/22/2022]
Abstract
Background and Objectives The Tinnitus Handicap Inventory (THI) often requires patients to devote their time to complete the questionnaire than they expect. Given that it limits the effectiveness of THI in a busy clinical practice that desires a quick and easy assessment of tinnitus handicap, this study evaluated clinical usefulness of a Simplified version of Tinnitus Handicap Inventory (THI-S) in measuring the severity of tinnitus handicap as well as predicting the psychological distress associated with tinnitus. Subjects and Methods A total of 129 outpatients suffering from tinnitus (61 with normal hearing and 68 with hearing loss) participated in this study. The responses of THI-S (10 items) and THI (25 items) were evaluated to quantify the subjective handicap of tinnitus. The self-perceived level of stress, anxiety, and depression of all participants was measured with a series of self-report questionnaires such as Korean version of Brief Encounter Psychosocial Instrument (BEPSI), State Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI), respectively. All the questionnaire responses were analyzed using non-parametric analyses to examine the convergence, comparability, internal consistency reliability and validity of THI-S. Results The severity of tinnitus handicap and the relevant psychological distress greatly varied across individuals. The THI-S responses were comparable to original THI responses, regardless of hearing status of patients. The internal consistency of THI-S responses was found to be good for total score (Cronbach's α=0.83-0.91), with moderately high consistency for the emotional, functional, and catastrophic subscales. Significant (p<0.01) correlations of the THI-S with the THI (rs=0.95) as well as with the BEPSI, STAI, BDI questionnaires (rs=0.40-0.45) suggest that the THI-S questionnaire appeared to be useful to provide objective data of subjective tinnitus handicap as well as predict psychological distress. Three factors were extracted through factor analysis, which explained 73% of the total variance. Conclusions Despite reducing the length of 25 items of THI to 10 items, the THI-S can be used as s a simple but reliable and valid tool for evaluating severity of tinnitus handicap as well as detecting its negative impact on psychological functioning.
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Affiliation(s)
- Jae Hee Lee
- Department of Audiology, Hallym University of Graduate Studies, Seoul, Korea
| | - Jin-Ju Ra
- Department of Audiology, Hallym University of Graduate Studies, Seoul, Korea. ; Department of Otolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul, Korea
| | - Young Ho Kim
- Department of Otolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul, Korea
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McCormack A, Edmondson-Jones M, Fortnum H, Dawes P, Middleton H, Munro KJ, Moore DR. The prevalence of tinnitus and the relationship with neuroticism in a middle-aged UK population. J Psychosom Res 2014; 76:56-60. [PMID: 24360142 DOI: 10.1016/j.jpsychores.2013.08.018] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 08/23/2013] [Accepted: 08/26/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND Previous research has suggested that a substantial proportion of the population are severely affected by tinnitus, however recent population data are lacking. Furthermore, there is growing evidence that the perception of severity is closely related to personality factors such as neuroticism. OBJECTIVE In a subset (N=172,621) of a large population sample of >500,000 adults aged 40 to 69years, (from the UK Biobank dataset) we calculated the prevalence of tinnitus and that which is perceived as bothersome, and examined the association between tinnitus and a putative predisposing personality factor, neuroticism. METHOD Participants were recruited through National Health Service registers and aimed to be inclusive and as representative of the UK population as possible. The assessment included subjective questions concerning hearing and tinnitus. Neuroticism was self-rated on 13 questions from the Eysenck Personality Inventory. Associations between neuroticism and tinnitus were tested with logistic regression analyses. RESULTS Prevalence of tinnitus was significantly higher for males, and increased with age, doubling between the youngest and oldest age groups (males 13% and 26%; females 9% and 19% respectively). Of those with tinnitus, females were more likely to report bothersome tinnitus. Neuroticism was associated with current tinnitus and bothersome tinnitus, with the items: 'loneliness', 'mood swings', 'worrier/anxious' and 'miserableness', as the strongest associations of bothersome tinnitus. CONCLUSIONS Neuroticism was identified as a novel association with tinnitus. Individuals with tinnitus and higher levels of neuroticism are more likely to experience bothersome tinnitus, possibly as a reflection of greater sensitivity to intrusive experiences.
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Affiliation(s)
- Abby McCormack
- NIHR Nottingham Hearing Biomedical Research Unit, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU, UK; School of Clinical Sciences, University of Nottingham, UK; MRC Institute of Hearing Research, University Park, Nottingham NG7 2RD, UK.
| | - Mark Edmondson-Jones
- NIHR Nottingham Hearing Biomedical Research Unit, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU, UK; School of Clinical Sciences, University of Nottingham, UK.
| | - Heather Fortnum
- NIHR Nottingham Hearing Biomedical Research Unit, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU, UK; School of Clinical Sciences, University of Nottingham, UK.
| | - Piers Dawes
- School of Psychological Sciences, University of Manchester, UK.
| | - Hugh Middleton
- School of Sociology and Social Policy, University of Nottingham, UK; Nottinghamshire Healthcare NHS Trust, UK.
| | - Kevin J Munro
- School of Psychological Sciences, University of Manchester, UK; Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK.
| | - David R Moore
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45213, USA.
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McNeill C, Távora-Vieira D, Alnafjan F, Searchfield GD, Welch D. Tinnitus pitch, masking, and the effectiveness of hearing aids for tinnitus therapy. Int J Audiol 2012; 51:914-9. [PMID: 23126317 DOI: 10.3109/14992027.2012.721934] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the benefits of hearing aids on tinnitus according to the tinnitus reaction questionnaire (TRQ; Wilson et al, 1991), to verify whether the degree of masking provided by the hearing aid influenced the TRQ score, to examine whether the matched tinnitus pitch predicted the effectiveness of hearing aids in masking tinnitus, and to determine whether prescription of high-frequency amplification might be desirable in tinnitus management when tinnitus pitch is high. DESIGN AND STUDY SAMPLE A retrospective evaluation of the clinical outcomes of 70 tinnitus patients fitted with hearing aids was undertaken. The primary outcome measure was the TRQ, with a secondary subjective measure of tinnitus masking. RESULTS Participants who achieved masking with their hearing aids had greater reduction in TRQ scores. Masking was more likely to be achieved when participants had good low-frequency hearing and tinnitus pitch fell into the frequency range of the hearing aids. CONCLUSIONS The results support the use of hearing aids for tinnitus management, and suggest that masking may be a significant contributor to hearing aid success, implying that high-frequency amplification may be effective in high-pitch tinnitus.
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Affiliation(s)
- Celene McNeill
- Audiology Department, Mcquarie University, Healthy Hearing and Balance Care, Sydney, Australia.
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Searchfield GD, Kobayashi K, Sanders M. An adaptation level theory of tinnitus audibility. Front Syst Neurosci 2012; 6:46. [PMID: 22707935 PMCID: PMC3374480 DOI: 10.3389/fnsys.2012.00046] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 05/24/2012] [Indexed: 11/20/2022] Open
Abstract
Models of tinnitus suggest roles for auditory, attention, and emotional networks in tinnitus perception. A model of tinnitus audibility based on Helson’s (1964) adaptation level theory (ALT) is hypothesized to explain the relationship between tinnitus audibility, personality, memory, and attention. This theory attempts to describe how tinnitus audibility or detectability might change with experience and context. The basis of ALT and potential role of auditory scene analysis in tinnitus perception are discussed. The proposed psychoacoustic model lends itself to incorporation into existing neurophysiological models of tinnitus perception. It is hoped that the ALT hypothesis will allow for greater empirical investigation of factors influencing tinnitus perception, such as attention and tinnitus sound therapies.
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Affiliation(s)
- Grant D Searchfield
- Audiology Section and Centre for Brain Research, The University of Auckland Auckland, New Zealand
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HILGENBERG PB, SALDANHA ADD, CUNHA CO, RUBO JH, CONTI PCR. Temporomandibular disorders, otologic symptoms and depression levels in tinnitus patients. J Oral Rehabil 2011; 39:239-44. [DOI: 10.1111/j.1365-2842.2011.02266.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dawes PJD, Welch D. Childhood hearing and its relationship with tinnitus at thirty-two years of age. Ann Otol Rhinol Laryngol 2010; 119:672-6. [PMID: 21049852 DOI: 10.1177/000348941011901005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Tinnitus is associated with hearing loss in adulthood, often resulting from noise or age, but it is not known whether children's hearing and/or middle ear health predispose them to tinnitus in adulthood. METHODS The participants were members of the Dunedin Multidisciplinary Health and Development Study, born in Dunedin, New Zealand, between April 1972 and March 1973. The base sample consisted of 1,037 children. Otitis media was assessed at 5, 7, and 9 years of age; audiometry and tympanometry findings were recorded at 11 years of age, and a detailed description of the tympanic membrane was made at 15 years of age. At 32 years of age, 970 of the 1,015 living study members (96%) answered questions about tinnitus. RESULTS Children who had otitis media and a raised audiometric threshold went on to experience more tinnitus in adulthood than did those without middle ear disease or those who had otitis media without a raised threshold. In those who had recovered from otitis media, audiometric threshold elevation at lower and higher frequencies was associated with experiencing tinnitus in adulthood. Neither childhood otitis media alone nor elevated thresholds alone predicted adult tinnitus. CONCLUSIONS Childhood otitis media with an associated hearing loss in the low and high frequencies was associated with a greater probability of experiencing tinnitus in adulthood.
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Affiliation(s)
- Patrick J D Dawes
- Dept of Otorhinolaryngology-Head and Neck Surgery, Dunedin Hospital, 201 Great King St, Dunedin, New Zealand
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Nondahl DM, Cruickshanks KJ, Wiley TL, Klein BEK, Klein R, Chappell R, Tweed TS. The ten-year incidence of tinnitus among older adults. Int J Audiol 2010; 49:580-5. [PMID: 20560859 DOI: 10.3109/14992021003753508] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
As part of a population-based study in Beaver Dam, Wisconsin, we estimated the 10-year cumulative incidence of tinnitus and its risk factors. Participants (n = 2922, aged 48-92 years) not reporting tinnitus at baseline (1993-1995) were followed for up to ten years. In addition to audiometric testing and anthropometric measures, data on tinnitus, health, and other history were obtained via questionnaire. Potential risk factors were assessed with discrete-time proportional hazards models. The 10-year cumulative incidence of tinnitus was 12.7%. The risk of developing tinnitus was significantly associated with: history of arthritis (hazard ratio (HR = 1.37), history of head injury (HR = 1.76), history of ever smoking (HR = 1.40), and among women, hearing loss (HR = 2.59). Alcohol consumption (HR = 0.63 for > or = 141 grams/week vs. <15 grams/week), age (among women, HR = 0.90 for each five-year increase in age), and among men, obesity (HR = 0.55), were associated with decreased risk. The risk of developing tinnitus was high for older adults, and associated with modifiable health and behavioral factors.
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Affiliation(s)
- David M Nondahl
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, USA.
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Krog NH, Engdahl B, Tambs K. The association between tinnitus and mental health in a general population sample: results from the HUNT Study. J Psychosom Res 2010; 69:289-98. [PMID: 20708451 DOI: 10.1016/j.jpsychores.2010.03.008] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 03/16/2010] [Accepted: 03/16/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Clinical studies indicate a strong association between tinnitus and mental health, but results from general population data are missing. The purpose of the study was to examine the association between tinnitus, mental health, and well-being in the general adult population and to identify factors that might mediate and moderate this association. METHODS Data from 51,574 adults participating in the Nord-Trøndelag Hearing Loss Study (1995-1997), part of the Nord-Trøndelag Health Study (HUNT-2), were analyzed. The association between tinnitus symptom intensity and symptoms of depression, anxiety, self-esteem, and subjective well-being was examined by multivariate ANOVA, stratified by age group and sex. Explanatory variables were age, marital status, education, hearing, dizziness, vision, physical disability, and somatic illness. In a subsample of participants with tinnitus, the effects of "time since onset," "predictability of tinnitus episodes," and "noise sensitivity" were tested. RESULTS Participants with tinnitus scored significantly higher on anxiety and depression and lower on self-esteem and well-being than people without tinnitus. The effect sizes were small and quite similar across levels of tinnitus symptom intensity. No significant effect of time since onset was found. A significant effect of predictability of tinnitus episodes and noise sensitivity was found in some groups. CONCLUSION A weak association between tinnitus and mental health was found in this general population study.
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