Tinnitus: clinical experience of the psychosomatic connection

Exploring the interplay of depression, sleep quality, and hearing in tinnitus-related handicap: insights from polysomnography and pure-tone audiometry

BACKGROUND

Tinnitus affects approximately 740 million adults globally, involving hearing, emotion, and sleep systems. However, studies using polysomnography and pure-tone audiometry (PTA) are limited. We aimed to assess the correlation between tinnitus and hearing, sleep quality, characteristics, and depression using polysomnography and PTA.

METHODS

In this cross-sectional study, we divided participants into tinnitus and non-tinnitus groups. We included 100 outpatients (65 with tinnitus, 35 without) from a medical center in Taiwan, who underwent polysomnography and completed rating scales including the Patient Health Questionnaire-9 (PHQ-9), Chinese version of the Pittsburgh Sleep Quality Index (PSQI), and Chinese-Mandarin version of the Tinnitus Handicap Inventory (THI-CM). We analyzed correlations, conducted group comparisons, assessed factors related to THI-CM scores, constructed ROC curves to predict depression in the tinnitus group, and performed multinomial and logistic regression to explore associations.

RESULTS

Descriptive statistics identified a cohort with mean age 53.9 ± 12.80 years, 63% exhibited PHQ-9 scores ≥ 10, and 66% had Apnea-Hypopnea Index (AHI) > 5. The ratio of rapid eye movement and deep sleep to stage 1 + 2 sleep was relatively low and non-significant. Likewise, leg movements was higher in the tinnitus group but not statistically significant. In the tinnitus group, 63.08% had depression, and 81.54% had AHI > 5. Univariate logistic regression linked tinnitus to AHI > 5 (Odds ratio (OR) 2.67, p = 0.026) and male sex (OR 2.49, p = 0.034). A moderate positive correlation was found between the THI-CM score and PHQ-9 score (rs = 0.50, p < 0.001). Further adjustment for obstructive sleep apnea showed associations between PHQ-9 (total score) or depression and THI-CM Grade 3-5 (OR = 1.28; OR = 8.68). Single- and multifactor regression analyses highlighted significant associations of PSQI scores > 13 (OR 7.06, p = 0.018) and THI-CM scores > 47 (OR 7.43, p = 0.002) with depression.

CONCLUSIONS

Our study recruited tinnitus participants with slight or mild hearing loss and mild tinnitus handicap. Depression was identified as a predominant factor in tinnitus-related handicap. The mild tinnitus handicap in tinnitus participants may explain the lack of significant differences in depression, sleep quality, and polysomnographic sleep characteristics between tinnitus and non-tinnitus groups. Further extensive and prospective studies are needed to elucidate the complex links among depression, sleep, and tinnitus.

Bridging the Gap between Psychophysiological and Audiological Factors in the Assessment of Tinnitus: An EEG Investigation in the Beta Band

BACKGROUND

Despite substantial progress in investigating its psychophysical complexity, tinnitus remains a scientific and clinical enigma. The present study, through an ecological and multidisciplinary approach, aims to identify associations between electroencephalographic (EEG) and psycho-audiological variables.

METHODS

EEG beta activity, often related to stress and anxiety, was acquired from 12 tinnitus patients (TIN group) and 7 controls (CONT group) during an audio cognitive task and at rest. We also investigated psychological (SCL-90-R; STAI-Y; BFI-10) and audiological (THI; TQ12-I; Hyperacusis) variables using non-parametric statistics to assess differences and relationships between and within groups.

RESULTS

In the TIN group, frontal beta activity positively correlated with hyperacusis, parietal activity, and trait anxiety; the latter is also associated with depression in CONT. Significant differences in paranoid ideation and openness were found between groups.

CONCLUSIONS

The connection between anxiety trait, beta activity in the fronto-parietal cortices and hyperacusis provides insights into brain functioning in tinnitus patients, offering quantitative descriptions for clinicians and new multidisciplinary treatment hypotheses.

Cognitive functioning and psychosomatic syndromes in a subjective tinnitus sample

Introduction

Tinnitus is the perception of a sound in the absence of any corresponding external sound source. Current research suggests a relationship among emotional, cognitive, and psychosomatic symptoms and the occurrence or maintenance of chronic tinnitus. This study aimed to detect the prevalence and role of psychosomatic conditions, as defined by the Diagnostic Criteria for Psychosomatic Research (DCPR), and cognitive functioning in a group of patients with tinnitus.

Methods

Sixty-two patients with subjective tinnitus and 62 non-tinnitus controls were recruited from the Otorhinolaryngology Unit of the University of Bari. Pure-tone audiometry was performed in all tinnitus subjects, and sound level tolerance was evaluated. Additionally, tinnitus handicap (Tinnitus Handicap Inventory [THI]), psychopathological symptoms (Symptom Checklist-90, Revised [SCL-90-R]), anxiety (State-Trait Anxiety Inventory [STAI-Y1/2]), depression (Beck Depression Inventory [BDI]), cognitive impairment (Mini-Mental State Examination [MMSE]), executive functions (Frontal Assessment Battery [FAB]), and psychosomatic syndromes (DCPR) were evaluated. Parametric and non-parametric tests were used to detect cognitive and symptomatological differences between patients and controls. The predictivity of these factors for tinnitus severity was studied using multiple regression (Backward Elimination). All tests were considered significant at p < 0.05 (family wise error corrected for each comparison).

Results

69.4% tinnitus patients met multiple DCPR criteria, compared to 32.3% of controls. Tinnitus patients exhibited elevated rates of illness denial (ꭓ2 = 9.02; p < 0.009), demoralization (ꭓ2 = 8.05; p < 0.018), somatization (ꭓ2 = 4.92; p < 0.063) and functional symptoms (ꭓ2 = 5.21; p < 0.06) scoring significantly higher on the BDI, STAI-Y1, and STAI-Y2, and SCL-90-R compared to controls. Patients with tinnitus showed lower MMSE scores, compared to controls (t = -2.282; p < 0.001). No association between tinnitus severity and global cognitive impairment emerged. Conversely, executive function deficits were associated to tinnitus severity. Among the cognitive and psychological factors, only trait anxiety, one or more psychosomatic syndromes, and somatization clusters were strongly correlated with tinnitus severity.

Discussion

Our findings suggest a relationship between tinnitus severity, psychological, psychosomatic symptoms, and frontal impairment. Additionally, the influence of tinnitus on cognitive functions paves the way for integrated, multidisciplinary diagnostic and treatment options for patients. Although preliminary, our findings highlight the importance of early cognitive and psychological screening to improve patients' quality of life.

Association of erectile dysfunction with tinnitus: a nationwide population-based study

With many previous studies indicating a higher prevalence of sexual problems in patients with tinnitus, the association between tinnitus and erectile dysfunction (ED) has become an interesting topic that warrants further research. In our study, we hypothesized that tinnitus may be associated with ED and aimed to further explore the relationship between these two medical conditions using a nationwide population-based database. After retrieving data of 19,329 patients with ED and 19,329 propensity score-matched patients without ED (controls) from Taiwan’s National Health Insurance Dataset, we defined the diagnosis date (the date of the first ED claim) for patients with ED as the index date for cases, and the date of the first utilization of ambulatory care by patients without ED during the index year of their matched case as the index date for controls. We found that 1247 out of 38,658 sampled patients (3.23%) had received a tinnitus diagnosis within the year before the index date, with 792 (4.10%) from cases and 455 (2.35%) from controls. We then utilized multiple logistic regression analysis and observed that cases were more likely to have had a prior tinnitus diagnosis compared to controls (OR 1.772; 95% CI 1.577–1.992; p < 0.001). Lastly, we adjusted the data for co-morbid medical disorders and social economic factors, with the end results showing that cases were more likely than controls to have a prior diagnosis of tinnitus (OR 1.779, 95% CI 1.582–2.001, p < 0.001). Through our investigation, we have ultimately detected a novel association between ED and tinnitus and urge physicians to be alert to the possibility of the development of ED in patients treated for tinnitus.

Neurobiology of Stress-Induced Tinnitus

Emotional stress has accompanied humans since the dawn of time and has played an essential role not only in positive selection and adaptation to an ever-changing environment, but also in the acceleration or even initiation of many illnesses. The three main somatic mechanisms induced by stress are the hypothalamus-pituitary-adrenal axis (HPA axis), the sympathetic-adreno-medullar (SAM) axis, and the immune axis. In this chapter, the stress-induced mechanisms that can affect cochlear physiology are presented and discussed in the context of tinnitus generation and auditory neurobiology. It is concluded that all of the presented mechanisms need to be further investigated. It is advised that clinical practitioners ask patients about stressful events or chronic stress preceding the tinnitus onset and measure the vital signs. Finally, taking into account that tinnitus itself acts as a stressor, the implementation of anti-stress therapies for tinnitus treatment is recommended.

Tinnitus Update

This article provides an update on tinnitus for audiologists and other clinicians who provide tinnitus-specific services. Tinnitus can be attributable to hearing loss, somatosensory system dysfunction, or auditory cortex dysfunction, with hearing loss being the most common cause and serious underlying pathologies being rare. Hearing loss does not always lead to tinnitus, and patients with tinnitus do not always suffer from hearing loss. The first scenario is explained by a so-called inhibitory gating mechanism, whereas the second assumes that all tinnitus sufferers have some degree of hearing impairment, which might not be detected in standard audiological examinations. The treatments should aim at symptomatic relief and management of associated distress. Current treatment options include pharmacotherapy, education, counseling, cognitive behavioral therapy, and sound therapy.

Association between Anatomical Features of Petrotympanic Fissure and Tinnitus in Patients with Temporomandibular Joint Disorder Using CBCT Imaging: An Exploratory Study

Mandible displacement is known to correlate with otological conditions such as pain in the ear canal, hearing loss, or tinnitus. The present work aimed to determine the association between the displacement of the condyle in a temporomandibular joint, the structure and position of the petrotympanic fissure (PTF), and comorbid tinnitus in patients affected by temporomandibular joint and muscle disorder (TMD). We enrolled 331 subjects with TMD (268 women and 63 men). The average age of women was 40.8 ± 16.8 years (range 13–88), whereas the average age of the examined men was 38 ± 14 years (range 13–74). We performed imaging studies of the facial part of the skull in the sagittal plane using a volumetric imaging method and a large imaging field (FOV) of 17 cm × 23 cm. The habitual position of the mandible was determined and used as a reference. Based on the imaging results, we developed a classification for the topography and the structure of the petrotympanic fissure. Thirty-three TMD patients (about 10% of the sample) reported having tinnitus. These patients had PTF configurations characterized by a rear (36.59%) or intracranial-cranial (63.41%) condylar displacement of the temporomandibular joint. Our findings imply that the TMJ- and tinnitus-positive group of patients possibly represents a distinct phenotype of tinnitus. We concluded that for such patients, the therapeutic approach for tinnitus should include TMD treatment.

The Relationship of Tinnitus Distress With Personality Traits: A Systematic Review

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.

Tinnitus-related distress and pain perceptions in patients with chronic tinnitus - Do psychological factors constitute a link?

OBJECTIVE

To investigate the co-occurrence of tinnitus-related distress and pain experiences alongside psychological factors that may underlie their association.

METHOD

Patients with chronic tinnitus (N = 1238) completed a questionnaire battery examining tinnitus-related distress and affective and sensory pain perceptions. A series of simple, parallel- and serial multiple mediator models examined indirect effects of psychological comorbidities as well as -process variables including depressivity, perceived stress and coping attitudes. Moderator and moderated mediation analyses examined differential relational patterns in patients with decompensated vs. compensated tinnitus.

RESULTS

There were significant associations between tinnitus-related distress and pain perceptions. These were partially mediated by most specified variables. Psychological comorbidities appeared to influence tinnitus-pain associations through their impact on depressivity, perceived stress, and coping attitudes. Some specific differences in affective vs. sensory pain perception pathways emerged. Patients with decompensated tinnitus yielded significantly higher symptom burden across all measured indices. Tinnitus decompensation was associated with heightened associations between [1] tinnitus-related distress and pain perceptions, depressivity and negative coping attitudes; and [2] most psychological comorbidities and sensory, but not affective pain perception. Moderated mediation analyses revealed stronger indirect effects of depressivity and anxiety in mediating affective-, and anxiety in mediating sensory pain perception in patients with decompensated tinnitus.

CONCLUSION

Psychological constructs mediate the co-occurrence of tinnitus- and pain-related symptoms across different levels of tinnitus-related distress. Psychological treatment approaches should conceptualize and address individualised interactions of common cognitive-emotional processes in addressing psychosomatic symptom clusters across syndromatic patients with varying distress levels.

Which affective temperaments are most expressed in patients with chronic sub-jective tinnitus?

BACKGROUND

Although chronic subjective tinnitus is one of the most common symptoms, the background of its pathophysiological mechanism and etiology is not fully understood. No studies are exploring various affective temperaments in persons with chronic tinnitus.

METHODS

We included in this study 57 patients with tinnitus who filled out the Serbian 41-item version of the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto questionnaire (TEMPS-A) and a short sociodemographic questionnaire. Patients were assessed using audiometry (measuring the hearing threshold for frequencies of 250, 500, 1,000, 2,000, 4,000, and 8,000 Hz) and tympanometry.

RESULTS

Our research showed that patients with chronic tinnitus predominantly had anxious affective temperament [anxious-cognitive (AnxC): 26.23 %, anxious-somatic (AnxS): 25.6 %). AnxS was dominant in people without hearing loss (46 %) and males (37.39 %). AnxC was dominant in people with a significant hearing loss and females (30.3 %). Both AnxS and AnxC temperaments correlated with hearing loss in the right ear more than in the left one.

CONCLUSION

Our study revealed that anxious temperaments (AnxC and AnxS) were predominant in patients with chronic subjective tinnitus. Affective temperaments could play a significant role in explaining this disorder's currently unclear pathophysiology of, but further research is needed. HIPPOKRATIA 2020, 24(2): 77-83.

[Analysis of comorbid psychiatric disorders in patients with chronic otitis media associated tinnitus]

Objective:To analyze the distribution of comorbid psychiatric disorders in patients with chronic otitis media associated tinnitus. Method:The data of patients with chronic otitis media associated tinnitus who accepted surgical treatments from July 2017 to September 2018 were retrospectively analyzed. All patients accepted pure tone audiometry and acoustic conductance examination and were requested to fill the tinnitus history questionnaire, THI, TEQ, SAS, SDS and PSQI scales before operation. When the SAS or/and SDS score ≥50 the patient was judged as having comorbid psychiatric disorders. When the PSQI score>6 the patient was judged as having comorbid sleep disorder, and then all the results were analyzed. Result:Sixty-two patients were included in the study, 43 cases were diagnosed as chronic suppurative otitis media, and 19 cases were diagnosed as middle ear cholesteatoma. The average course of chronic otitis media or middle ear cholesteatoma was（14.38±14.06） years, while the average course of tinnitus was（8.39±11.69） years. There were 32 cases with mild to moderate tinnitus（gradeⅠ-Ⅱ）（51.61%） and 30 cases with moderate to severe tinnitus（grade Ⅲ-Ⅴ）（48.39%）. Before operation, there were 4 cases（6.45%） with normal hearing, 38 cases（61.29%） with conductive hearing loss, and 20 cases（32.36%） with mixed hearing loss. There was no significant difference in tinnitus severity between different hearing loss degrees and types（P>0.05）. The average SAS score was 45.10±11.61, and the average SDS score was 43.48±14.67, both higher than the normal modulus（30 points）, among which 27 cases（44.00%） comorbid psychiatric disorders. The THI score in patients with comorbid psychiatric disorders（57.85±21.1） was significantly higher than that in patients without comorbid psychiatric disorders（29.2±17.39）（P<0.05）. The PSQI score in patients with comorbid psychiatric disorders（8.86±3.47） was significantly higher than that of those without comorbid psychiatric disorders（6.24±2.54）（P<0.05）. Fifty-three patients were followed up for 0.5 to 1.8 years after operation, and in 43 cases the tinnitus was reduced or disappeared after operation（the effective rate was 81.13%）. There were no significant difference between patients in tinnitus relief group and those in tinnitus without relief group in age, sex, course of the disease, type of the disease, with or without comorbid psychiatric disorders and/or sleep disorder, postoperative hearing improvement. Conclusion:Comorbid psychiatric disorders are common in patients with chronic otitis media associated tinnitus and the tinnitus in patients with comorbid psychiatric disorders is significantly more serious than that those without. For the treatment of chronic otitis media associated tinnitus, besides surgery, the complications such as psychiatric and sleep disorders and so on should be evaluated and treated accordingly.

Tinnitus Among Patients With Anxiety Disorder: A Nationwide Longitudinal Study

OBJECTIVES

The association between tinnitus and anxiety disorder remains debated. We used a retrospective cohort study to investigate the relationship between anxiety disorder and tinnitus, aiming to decipher possible risk factors for tinnitus in patients with anxiety disorder.

METHOD

Data on a total of 7,525 patients with anxiety disorder and 15,050 patients without (comparison cohort) were extracted from the Longitudinal Health Insurance Database 2005 in Taiwan. The Kaplan-Meier estimator with the log rank test and the Cox proportional-hazard regression model were used to compare the incidence of tinnitus in both groups and to identify risk factors that predicted tinnitus.

RESULTS

After adjusting for related covariates, the hazard ratio for the development of tinnitus during the follow-up period was 3.54 (95% confidence interval: 3.11-4.02, P < .001) for anxiety disorder cohort relative to comparison cohort. Age ≧ 60 years, female sex, hypertension, and hyperlipidemia were statistically significant predictive risk factors of tinnitus in patients with anxiety disorder.

CONCLUSION

A significant increase in the lifetime incidence of tinnitus was exhibited in patients with anxiety disorder. Elderly subjects, female sex, hypertension, and hyperlipidemia were risk factors. Clinicians should be alert to the possibility of tinnitus in subjects with anxiety disorder.

Auditory sensation with affective agnosia: A prevalence of alexithymia among tinnitus patients

OBJECTIVES

The aim of the present study was to determine the prevalence and association of alexithymia, depression, and anxiety in patients affected by tinnitus.

METHODS

The study was conducted among the patients referred for audiometric evaluation for tinnitus. They were further evaluated with the Hospital Anxiety and Depression Scale, the Tinnitus Handicap Inventory, and the Toronto Alexithymia Scale. Analysis was done for prevalence and the sample was categorized as high and low tinnitus handicap subgroups, and mean scores of alexithymia, anxiety, and depression were compared.

RESULTS

A total of 70 patients (55.7% - male and 44.3% - female) with a mean age of 33.17 ± 12.24 years were finally analyzed. The severity of tinnitus was most severe (34.3%), followed by moderate (20%), catastrophic (18.6%), mild (17.1%), and slight (10%). The prevalence of alexithymia, anxiety, and depression among patients of tinnitus was found to be 65.7%, 37.1%, and 20%, respectively. The high tinnitus handicap group showed higher scoring on total alexithymia score, anxiety, and depression and higher scoring with describing emotion and identification of emotion, but there was no difference for the subscale of externally oriented thinking.

CONCLUSIONS

The study found a prevalence of alexithymia, anxiety, and depression as 65.7%, 37.1%, and 20%, respectively, among patients of tinnitus, and problem of describing and identification of emotion are associated with higher tinnitus handicap.

A study on the epidemiology of tinnitus in the United Kingdom

PURPOSE

Subjective tinnitus is a common symptom with potentially negative impact on quality of life. More research is required to gain a deeper understanding of the disease and its clinical presentation. To estimate the incidence of tinnitus and to describe patient-related characteristics such as lifestyle factors and comorbidities.

PATIENTS AND METHODS

Using the Clinical Practice Research Datalink, we calculated incidence rates of first-time diagnosed tinnitus in an adult population between 2000 and 2016. We stratified incidence rates by sex, age, and year of diagnosis. Additionally, we performed a 1:1 matched case-control study comparing body mass index, lifestyle factors and selected comorbidities between patients with incident tinnitus and tinnitus-free controls.

RESULTS

We identified 109 783 adults with a first-time diagnosis of tinnitus between 2000 and 2016, yielding an overall age-standardized incidence rate of 25.0 new tinnitus cases per 10,000 person-years (95% CI: 24.6-25.5). There was a steady increase in tinnitus incidence throughout the study period. Approximately 80% of tinnitus cases were diagnosed at age 40 years or older. We observed the highest incidence rate in individuals aged 60-69 years (41.2 per 10,000 person-years, 95% CI: 40.7-41.7). Smokers and alcohol drinkers were at lower risk of being diagnosed with tinnitus compared with non-smokers and non-drinkers, respectively. The occurrence of tinnitus was strongly associated with a recent diagnosis of several otological and vestibular disorders as well as head and neck disorders.

CONCLUSION

The present observational study found an increasing incidence of tinnitus over time, emphasizing the continuously growing health burden. The findings on patient characteristics, lifestyle factors, and selected comorbidities contribute to a better understanding of risk factors for tinnitus.

Prevalence of depression and anxiety among otolaryngology outpatients at Jordan University Hospital

PURPOSE

To determine the prevalence of depression and anxiety among otolaryngology outpatients at Jordan University Hospital.

METHODS

A cross-sectional observational study was conducted between January 2017 and February 2018. The sample included 1328 otolaryngology adult outpatients, who completed (PHQ-9) and (GAD-7) questionnaires for depression and anxiety. Sociodemographic and clinical data were recorded.

RESULTS

Depression and anxiety prevalence rates were 36.1% and 22.9%. The significant risk factors found for them were: age range 30 to 50 years, female sex, divorced status, smoking, alcohol drinking, asthma, family history of psychiatric illness, chronic illnesses, negative life events, secondary education, unemployment, low income, globus pharyngeus, tinnitus, and dizziness.

PRACTICE IMPLICATIONS

Healthcare providers should have the vigilance to suspect and treat these disorders to improve patients' symptoms and quality of life.

Ginkgo biloba extract EGb 761® versus pentoxifylline in chronic tinnitus: a randomized, double-blind clinical trial

Background Ginkgo biloba extract EGb 761^® and pentoxifylline are frequently prescribed for the treatment of tinnitus. Objective To compare the treatment effects of Ginkgo biloba extract EGb 761R and pentoxifylline. Setting The study was performed at Department of Otorhinolaryngology of University Hospital Královské Vinohrady and 3rd Medical Faculty, Charles University in Prague. Method Patients with sub-chronic or chronic tinnitus were enrolled in double-blind trial and randomized to receive 120 mg EGb 761^® or 600 mg pentoxifylline, each twice a day and in double-dummy fashion over a 12-week period. Main outcome measure changes in 11-Point Box Scales for tinnitus loudness and annoyance, the abridged Tinnitus Questionnaire (Mini-TQ), the Hospital Anxiety and Depression Scale (HADS), and the Sheehan Disability Scale (SDS). Results Full analysis set for efficacy analysis comprised 197 patients (EGb 761^®, 99; pentoxifylline 98). For both treatment groups, significant improvements were observed in the Mini-TQ, the 11-Point Box Scales for tinnitus loudness and annoyance, the HADS anxiety score and the SDS. There was no relevant difference with regard to tinnitus-related outcomes between the two treatment groups. 20 adverse events were documented in EGb 761^® group and 36 adverse events were reported for pentoxifylline group. No serious adverse event was reported during the study. Conclusion EGb 761^® and pentoxifylline were similarly effective in reducing the loudness and annoyance of tinnitus as well as overall suffering of the patients. The incidence of adverse events was lower in the EGb 761^® group.

Effects of Anxiety Sensitivity and Hearing Loss on Tinnitus Symptom Severity

OBJECTIVE

The aim of the present study was to examine the relative role of anxiety sensitivity and hearing loss on the tinnitus symptoms severity in a large clinical sample of patients with tinnitus.

METHODS

A total of 1,705 patients with tinnitus who visited the tinnitus clinic underwent the pure-tone audiometric testing and a battery of self-report questionnaires. Multiple linear regression analyses were performed to identify the relationship of anxiety sensitivity and hearing loss to tinnitus symptoms severity.

RESULTS

Both anxiety sensitivity and hearing loss were a significant association with of annoyance (anxiety sensitivity β=0.11, p=0.010; hearing loss β=0.09, p=0.005) and THI score (anxiety sensitivity β=0.21, p<0.001; hearing loss β=0.10, p<0.001) after adjusting for confounding factors. Meanwhile, the awareness time (β=0.19, p<0.001) and loudness (β=0.11, p<0.001) of tinnitus was associated with only the hearing loss but not with anxiety sensitivity.

CONCLUSION

Our results indicate that both hearing loss and anxiety sensitivity were associated with increased tinnitus symptom severity. Furthermore, these associations could be different according to the characteristics of tinnitus symptoms.

Somatoform disorders in patients with chronic subjective tinnitus

This study aimed to investigate the correlation of psychiatric disorders with tinnitus and tinnitus handicap scores. A total of 30 patients and 30 otherwise healthy people were enrolled for the study. Somatoform disorder questionnaire SDQ-20 was filled in by both the study and the control group. Tinnitus handicap scores were filled in study group. Tinnitus handicap scores were 28.1 ± 19.8, and somatoform disorder questionnaire scores were 30.5 ± 7.3 in the tinnitus group. In the control group the somatoform disorder questionnaire scores were 25.4 ± 4.6. (1) We found a statistically significant difference between somatoform disorder questionnaire scores between groups (p < 0.05). (2) There was a statistically significant difference between tinnitus handicap scores and somatoform disorder questionnaire scores in study group (p = 0.0). The correlation between these tests was positively strong (R = 0.782). (3) There was no statistical difference between genders. We recommend investigating patients with long-lasting tinnitus for psychiatric comorbidity in relation to somatoform disorders in cooperation with psychiatric clinics.

The Correlation of the Tinnitus Handicap Inventory with Depression and Anxiety in Veterans with Tinnitus

Objective. The mechanisms of tinnitus are known to alter neuronal circuits in the brainstem and cortex, which are common to several comorbid conditions. This study examines the relationship between tinnitus and anxiety/depression. Subjects and Methods. Ninety-one male veterans with subjective tinnitus were enrolled in a Veterans Affairs Tinnitus Clinic. The Tinnitus Handicap Inventory (THI) was used to assess tinnitus severity. ICD-9 codes for anxiety/depression were used to determine their prevalence. Pure tone averages (PTA) were used to assess hearing status. Results. Descriptive analyses revealed that 79.1% of the 91 tinnitus sufferers had a diagnosis of anxiety, 59.3% had depression, and 58.2% suffered from both anxiety/depression. Patients with anxiety had elevated total THI scores as compared to patients without anxiety (p < 0.05). Patients with anxiety or depression had significantly increased Functional and Emotional THI scores, but not Catastrophic THI score. Significant positive correlations were illustrated between the degree of tinnitus and anxiety/depression (p < 0.05). There were no differences in PTA among groups. Conclusions. A majority of patients with tinnitus exhibited anxiety and depression. These patients suffered more severe tinnitus than did patients without anxiety and depression. The data support the need for multidisciplinary intervention of veterans with tinnitus.

A brain centred view of psychiatric comorbidity in tinnitus: from otology to hodology

Introduction. Comorbid psychiatric disorders are frequent among patients affected by tinnitus. There are mutual clinical influences between tinnitus and psychiatric disorders, as well as neurobiological relations based on partially overlapping hodological and neuroplastic phenomena. The aim of the present paper is to review the evidence of alterations in brain networks underlying tinnitus physiopathology and to discuss them in light of the current knowledge of the neurobiology of psychiatric disorders. Methods. Relevant literature was identified through a search on Medline and PubMed; search terms included tinnitus, brain, plasticity, cortex, network, and pathways. Results. Tinnitus phenomenon results from systemic-neurootological triggers followed by neuronal remapping within several auditory and nonauditory pathways. Plastic reorganization and white matter alterations within limbic system, arcuate fasciculus, insula, salience network, dorsolateral prefrontal cortex, auditory pathways, ffrontocortical, and thalamocortical networks are discussed. Discussion. Several overlapping brain network alterations do exist between tinnitus and psychiatric disorders. Tinnitus, initially related to a clinicoanatomical approach based on a cortical localizationism, could be better explained by an holistic or associationist approach considering psychic functions and tinnitus as emergent properties of partially overlapping large-scale neural networks.