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Smith LJ, Wilkinson D, Bodani M, Surenthiran SS. Cognition in vestibular disorders: state of the field, challenges, and priorities for the future. Front Neurol 2024; 15:1159174. [PMID: 38304077 PMCID: PMC10830645 DOI: 10.3389/fneur.2024.1159174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 01/05/2024] [Indexed: 02/03/2024] Open
Abstract
Vestibular disorders are prevalent and debilitating conditions of the inner ear and brain which affect balance, coordination, and the integration of multisensory inputs. A growing body of research has linked vestibular disorders to cognitive problems, most notably attention, visuospatial perception, spatial memory, and executive function. However, the mechanistic bases of these cognitive sequelae remain poorly defined, and there is a gap between our theoretical understanding of vestibular cognitive dysfunction, and how best to identify and manage this within clinical practice. This article takes stock of these shortcomings and provides recommendations and priorities for healthcare professionals who assess and treat vestibular disorders, and for researchers developing cognitive models and rehabilitation interventions. We highlight the importance of multidisciplinary collaboration for developing and evaluating clinically relevant theoretical models of vestibular cognition, to advance research and treatment.
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Affiliation(s)
- Laura J. Smith
- Centre for Preventative Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- School of Psychology, Keynes College, University of Kent, Kent, United Kingdom
| | - David Wilkinson
- School of Psychology, Keynes College, University of Kent, Kent, United Kingdom
| | - Mayur Bodani
- School of Psychology, Keynes College, University of Kent, Kent, United Kingdom
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Freiherr von Schoenhueb D, Boecking B, Mazurek B. Alexithymia in Patients with Somatization Difficulties and Tinnitus-Related Distress: A Systematic Review. J Clin Med 2023; 12:6828. [PMID: 37959295 PMCID: PMC10649228 DOI: 10.3390/jcm12216828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 11/15/2023] Open
Abstract
Chronic tinnitus, the perception of sound without an external source, can significantly affect individuals' well-being. As an often medically unexplained symptom, chronic tinnitus can present as a "somatoform" or "functional" difficulty. Some evidence has pointed to alexithymia as a transdiagnostically relevant risk factor for both symptom clusters. Using a two-part rapid review-searching within EBSCO, Embase by Ovid, PubMed, Web of Science-we summarize psychological studies regarding alexithymia, i.e., difficulties in recognizing and expressing emotions and (1) somatoform conditions and (2) chronic tinnitus. For the former (inclusion criteria: (1) adult human beings with different kinds of somatization, (2) longitudinal study designs, (3) publication between 2001 and 2021, (4) full-text in English or German) we identified eight studies that revealed significant links between alexithymia and somatoform conditions. Psychotherapy improved alexithymia in most studies. Additionally, alexithymia was associated with broader treatment outcomes such as improvements in pain intensity, gastrointestinal symptoms, and patient-therapist alliance. The 'Risk Of Bias In Non-randomized Studies-of Interventions' tool (ROBINS-I) and 'Revised Cochrane risk-of-bias tool for randomized trials' (RoB 2) were used for risk of bias assessment. Summarizing all available studies on alexithymia and chronic tinnitus, we identified three studies. Inclusion criteria were: (1) adult human beings with chronic tinnitus, (2) publication between 2001 and 2021, (3) full-text in English or German. Risk of bias was assessed by the 'JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies'. The available studies suggested a high rate of alexithymia (65.7%) in patients with chronic tinnitus. Tinnitus-related distress was significantly associated with alexithymia in two studies, one of which, however, found no differences in alexithymia between patients with bothersome versus non-bothersome tinnitus. Conversely, one study reported high levels of alexithymia in patients with low levels of tinnitus-related distress. Overall, alexithymia may be a transdiagnostic psychological indicator of somatization phenomena, which might include some chronic tinnitus presentations. Psychotherapy likely improves alexithymia as well as somatoform symptom presentations.
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Affiliation(s)
| | | | - Birgit Mazurek
- Tinnitus Center, Charité—Universitatsmedizin Berlin, 10117 Berlin, Germany; (D.F.v.S.); (B.B.)
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Functional ear symptoms referred to an otology clinic: incidence, co-morbidity, aetiological factors and a new experience-driven clinical model. J Laryngol Otol 2023; 137:143-150. [PMID: 35801310 DOI: 10.1017/s0022215122001530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study aimed to review the incidence and co-morbidity of functional ear symptoms in new referrals to an adult otology clinic and present a clinical model based on neuroscientific concepts. METHOD This was a retrospective review of 1000 consecutive new referrals to an adult otology clinic. RESULTS Functional disorder was the primary diagnosis in 346 patients (34.6 per cent). Functional ear symptoms included tinnitus (69.7 per cent), imbalance (23.7 per cent), otalgia (22.8 per cent) and aural fullness (19.1 per cent), with more than one symptom occurring in 25.1 per cent of patients. Co-morbidities included sensorineural hearing loss (39 per cent), emotional stress (30 per cent) and chronic illness (22 per cent). CONCLUSION Functional disorders commonly present to the otology clinic, often in the presence of emotional stress or chronic illness. They occur because of adaptation of brain circuitry to experience, including adverse events, chronic illness and fear learning. This study presented an experience-driven clinical model based on these concepts. An understanding of these principles will significantly aid otolaryngologists who encounter patients with functional ear symptoms.
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Patil JD, Alrashid MA, Eltabbakh A, Fredericks S. The association between stress, emotional states, and tinnitus: a mini-review. Front Aging Neurosci 2023; 15:1131979. [PMID: 37207076 PMCID: PMC10188965 DOI: 10.3389/fnagi.2023.1131979] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Extensive literature supporting the view of tinnitus induced stress in patients is available. However, limited evidence has been produced studying the opposite, that is, does stress cause tinnitus? The hypothalamus pituitary adrenal axis, one of the main neuroendocrine systems involved in stress response, is commonly disturbed in tinnitus patients. Patients with chronic tinnitus have been shown to develop abnormal responses to psycho-social stress, where the hypothalamus pituitary adrenal axis response is weaker and delayed, suggesting chronic stress contributes to the development of chronic tinnitus. The sympathetic branch of the autonomic nervous system also plays a major role in stress response and its chronic hyperactivity seems to be involved in developing tinnitus. Psycho-social stress has been shown to share the same probability of developing tinnitus as occupational noise and contributes to worsening tinnitus. Additionally, exposure to high stress levels and occupational noise doubles the likelihood of developing tinnitus. Interestingly, short-term stress has been shown to protect the cochlea in animals, but chronic stress exposure has negative consequences. Emotional stress also worsens pre-existing tinnitus and is identified as an important indicator of tinnitus severity. Although there is limited body of literature, stress does seem to play a vital role in the development of tinnitus. This review aims to highlight the association between stress, emotional states, and the development of tinnitus while also addressing the neural and hormonal pathways involved.
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Affiliation(s)
- Jayaditya Devpal Patil
- Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
- *Correspondence: Jayaditya Devpal Patil,
| | | | - Ayah Eltabbakh
- Royal College of Surgeons in Ireland, Al Muharraq, Bahrain
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Zhang L, Monacelli G, Vashisht H, Schlee W, Langguth B, Ward T. The Effects of Tinnitus in Probabilistic Learning Tasks: Protocol for an Ecological Momentary Assessment Study. JMIR Res Protoc 2022; 11:e36583. [PMID: 36367761 PMCID: PMC9700237 DOI: 10.2196/36583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 07/26/2022] [Accepted: 07/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic tinnitus is an increasing worldwide health concern, causing a significant burden to the health care system each year. The COVID-19 pandemic has seen a further increase in reported cases. For people with tinnitus, symptoms are exacerbated because of social isolation and the elevated levels of anxiety and depression caused by quarantines and lockdowns. Although it has been reported that patients with tinnitus can experience changes in cognitive capabilities, changes in adaptive learning via decision-making tasks for people with tinnitus have not yet been investigated. OBJECTIVE In this study, we aim to assess state- and trait-related impairments in adaptive learning ability on probabilistic learning tasks among people with tinnitus. Given that performance in such tasks can be quantified through computational modeling methods using a small set of neural-informed model parameters, such approaches are promising in terms of the assessment of tinnitus severity. We will first examine baseline differences in the characterization of decision-making under uncertainty between healthy individuals and people with tinnitus in terms of differences in the parameters of computational models in a cross-sectional experiment. We will also investigate whether these computational markers, which capture characteristics of decision-making, can be used to understand the cognitive impact of tinnitus symptom fluctuations through a longitudinal experimental design. METHODS We have developed a mobile app, AthenaCX, to deliver e-consent and baseline tinnitus and psychological assessments as well as regular ecological momentary assessments (EMAs) of perceived tinnitus loudness and a web-based aversive version of a probabilistic decision-making task, which can be triggered based on the participants' responses to the EMA surveys. Computational models will be developed to fit participants' choice data in the task, and cognitive parameters will be estimated to characterize participants' current ability to adapt learning to the change of the simulated environment at each session when the task is triggered. Linear regression analysis will be conducted to evaluate the impacts of baseline tinnitus severity on adapting decision-making performance. Repeated measures linear regression analysis will be used to examine model-derived parameters of decision-making in measuring real-time perceived tinnitus loudness fluctuations. RESULTS Ethics approval was received in December 2020 from Dublin City University (DCUREC/2021/070). The implementation of the experiments, including both the surveys and the web-based decision-making task, has been prepared. Recruitment flyers have been shared with audiologists, and a video instruction has been created to illustrate to the participants how to participate in the experiment. We expect to finish data collection over 12 months and complete data analysis 6 months after this. The results are expected to be published in December 2023. CONCLUSIONS We believe that EMA with context-aware triggering can facilitate a deeper understanding of the effects of tinnitus symptom severity upon decision-making processes as measured outside of the laboratory. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/36583.
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Affiliation(s)
- Lili Zhang
- Insight Science Foundation Ireland Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
| | - Greta Monacelli
- Insight Science Foundation Ireland Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
| | | | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Tomas Ward
- Insight Science Foundation Ireland Research Centre for Data Analytics, Dublin City University, Dublin, Ireland
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Idriss SA, Reynard P, Marx M, Mainguy A, Joly CA, Ionescu EC, Assouly KKS, Thai-Van H. Short- and Long-Term Effect of Cochlear Implantation on Disabling Tinnitus in Single-Sided Deafness Patients: A Systematic Review. J Clin Med 2022; 11:5664. [PMID: 36233532 PMCID: PMC9572534 DOI: 10.3390/jcm11195664] [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: 08/06/2022] [Revised: 09/12/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Patients with single-sided deafness can experience an ipsilateral disabling tinnitus that has a major impact on individuals' social communication and quality of life. Cochlear implants appear to be superior to conventional treatments to alleviate tinnitus in single-sided deafness. We conducted a systematic review to evaluate the effectiveness of cochlear implants in single-sided deafness with disabling tinnitus when conventional treatments fail to alleviate tinnitus (PROSPERO ID: CRD42022353292). All published studies in PubMed/MEDLINE and SCOPUS databases until December 2021 were included. A total of 474 records were retrieved, 31 studies were included and were divided into two categories according to whether tinnitus was assessed as a primary complaint or not. In all studies, cochlear implantation, evaluated using subjective validated tools, succeeded in reducing tinnitus significantly. Objective evaluation tools were less likely to be used but showed similar results. A short-(3 months) and long-(up to 72 months) term tinnitus suppression was reported. When the cochlear implant is disactivated, complete residual tinnitus inhibition was reported to persist up to 24 h. The results followed a similar pattern in studies where tinnitus was assesed as a primary complaint or not. In conclusion, the present review confirmed the effectiveness of cochlear implantation in sustainably reducing disabling tinnitus in single-sided deafness patients.
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Affiliation(s)
- Samar A. Idriss
- Department of Audiology and Otoneurological Evaluation, Edouard Herriot Hospital, Hospices Civils de Lyon, 69002 Lyon, France
- Department of Otorhinolaryngology and Head and Neck Surgery, Eye and Ear University Hospital, Holy Spirit University of Kaslik, Beirut 1202, Lebanon
| | - Pierre Reynard
- Department of Audiology and Otoneurological Evaluation, Edouard Herriot Hospital, Hospices Civils de Lyon, 69002 Lyon, France
- Institut de l’Audition, Institut Pasteur, University of Paris, INSERM, 75012 Paris, France
- Faculty of Medicine, University Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Mathieu Marx
- Department of Otology, Otoneurology and Pediatric Otolaryngology, Pierre-Paul Riquet Hospital, Toulouse Purpan University Hospital, 31300 Toulouse, France
- Brain and Cognition Laboratory, UMR 5549, Toulouse III University, 31062 Toulouse, France
| | - Albane Mainguy
- National Commission for the Evaluation of Medical Devices and Health Technologies, Haute Autorité de Santé, 93210 La Plaine St Denis, France
| | - Charles-Alexandre Joly
- Department of Audiology and Otoneurological Evaluation, Edouard Herriot Hospital, Hospices Civils de Lyon, 69002 Lyon, France
- Institut de l’Audition, Institut Pasteur, University of Paris, INSERM, 75012 Paris, France
- Faculty of Medicine, University Claude Bernard Lyon 1, 69100 Villeurbanne, France
| | - Eugen Constant Ionescu
- Department of Audiology and Otoneurological Evaluation, Edouard Herriot Hospital, Hospices Civils de Lyon, 69002 Lyon, France
- Institut de l’Audition, Institut Pasteur, University of Paris, INSERM, 75012 Paris, France
| | - Kelly K. S. Assouly
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Cochlear Technology Centre, 2800 Mechelen, Belgium
| | - Hung Thai-Van
- Department of Audiology and Otoneurological Evaluation, Edouard Herriot Hospital, Hospices Civils de Lyon, 69002 Lyon, France
- Institut de l’Audition, Institut Pasteur, University of Paris, INSERM, 75012 Paris, France
- Faculty of Medicine, University Claude Bernard Lyon 1, 69100 Villeurbanne, France
- National Commission for the Evaluation of Medical Devices and Health Technologies, Haute Autorité de Santé, 93210 La Plaine St Denis, France
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Milinski L, Nodal FR, Vyazovskiy VV, Bajo VM. Tinnitus: at a crossroad between phantom perception and sleep. Brain Commun 2022; 4:fcac089. [PMID: 35620170 PMCID: PMC9128384 DOI: 10.1093/braincomms/fcac089] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/31/2021] [Accepted: 03/31/2022] [Indexed: 11/25/2022] Open
Abstract
Sensory disconnection from the environment is a hallmark of sleep and is crucial
for sleep maintenance. It remains unclear, however, whether internally generated
percepts—phantom percepts—may overcome such disconnection and, in
turn, how sleep and its effect on sensory processing and brain plasticity may
affect the function of the specific neural networks underlying such phenomena. A
major hurdle in addressing this relationship is the methodological difficulty to
study sensory phantoms, due to their subjective nature and lack of control over
the parameters or neural activity underlying that percept. Here, we explore the
most prevalent phantom percept, subjective tinnitus—or tinnitus for
short—as a model to investigate this. Tinnitus is the permanent
perception of a sound with no identifiable corresponding acoustic source. This
review offers a novel perspective on the functional interaction between brain
activity across the sleep–wake cycle and tinnitus. We discuss
characteristic features of brain activity during tinnitus in the awake and the
sleeping brain and explore its effect on sleep functions and homeostasis. We ask
whether local changes in cortical activity in tinnitus may overcome sensory
disconnection and prevent the occurrence of global restorative sleep and, in
turn, how accumulating sleep pressure may temporarily alleviate the persistence
of a phantom sound. Beyond an acute interaction between sleep and neural
activity, we discuss how the effects of sleep on brain plasticity may contribute
to aberrant neural circuit activity and promote tinnitus consolidation. Tinnitus
represents a unique window into understanding the role of sleep in sensory
processing. Clarification of the underlying relationship may offer novel
insights into therapeutic interventions in tinnitus management.
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Affiliation(s)
- Linus Milinski
- University of Oxford, Department of Physiology, Anatomy and Genetics, Sherrington Building, Parks Road, Oxford OX1 3PT, UK
| | - Fernando R. Nodal
- University of Oxford, Department of Physiology, Anatomy and Genetics, Sherrington Building, Parks Road, Oxford OX1 3PT, UK
| | - Vladyslav V. Vyazovskiy
- University of Oxford, Department of Physiology, Anatomy and Genetics, Sherrington Building, Parks Road, Oxford OX1 3PT, UK
| | - Victoria M. Bajo
- University of Oxford, Department of Physiology, Anatomy and Genetics, Sherrington Building, Parks Road, Oxford OX1 3PT, UK
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Vladimirova TY, Aizenshtadt LV. [Features of tinnitus in older patients with autonomic dysfunction]. Vestn Otorinolaringol 2021; 86:9-13. [PMID: 34269017 DOI: 10.17116/otorino2021860319] [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: 11/18/2022]
Abstract
OBJECTIVE To establish the features of tinnitus in older age patients with autonomic dysfunction. MATERIAL AND METHODS We examined 94 patients aged 60 to 93 years (average age is 75.4±3.2 years). Patients with an imbalance of the autonomic nervous system were identified according to the questionnaire of A.M. Wayne and Kerdo's autonomic index. The questionnaires assessing the strength of subjective ear noise, the psychoemotional state of patients, the impact of tinnitus on various spheres of life were used in this study. RESULTS It was revealed that more than 50% of patients of older age groups with tinnitus had a dysfunction of the autonomic nervous system. Patients with parasympathicotonia more often noted bilateral persistent subjective ear noise than patients with sympathicotonia. CONCLUSIONS Autonomic dysfunction could be the cause of sleep disturbances, psychoemotional disorders and a decrease in the quality of life.
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de Matos IL, Ferreira MC, Mondelli MFCG. Development and Evaluation of Portal do Zumbido : A Novel Telehealth Approach to Tinnitus. Int Arch Otorhinolaryngol 2021; 25:e258-e266. [PMID: 33968230 PMCID: PMC8096511 DOI: 10.1055/s-0040-1709113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/11/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction Tinnitus is a prevalent symptom in audiological clinics, and the speech therapist participates in the assessment, diagnosis, and intervention of tinnitus. A range of studies have been developed with the aim to promote auditory health, and telehealth is an option for this purpose. Objective The aim of the present study was to develop and assess a virtual platform for tinnitus management for speech therapists. Methods The present study provided a distance-learning-course, with the aid of Portal do Zumbido , available in the following electronic address: zumbido.fob.usp.br. Infographics were available for download, and modules were made to comprise the introduction to the symptoms, assessment, and intervention for tinnitus. Results Speech therapists of different regions of Brazil received an e-mail invitation to participate and to assess the platform, 46 of whom registered. From the 46 speech therapists registered, 38 assessed the virtual platform with the aid of a questionnaire about the theoretical content and then answered a motivational research sheet (MRS). The speech therapists correctly answered 90% and 100% of the questions in the questionnaire and in the MRS, respectively, which may indicate that the professionals positively absorbed the content; thus, the content was considered to be impressive when the MRS was analyzed. Conclusion Portal do Zumbido was developed and is available for access in the following electronic address: zumbido.fob.usp.br. Furthermore, the platform received a positive assessment by the speech therapists who participated in the present study.
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Affiliation(s)
- Izabella Lima de Matos
- Speech TherapyProgram, Faculdade de Odontologia de Bauru (FOB), Universidade de São Paulo (USP), Bauru, São Paulo, Brazil
| | - Maria Carolina Ferreira
- Speech TherapyProgram, Faculdade de Odontologia de Bauru (FOB), Universidade de São Paulo (USP), Bauru, São Paulo, Brazil
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Abstract
In this chapter, I address the topic of tinnitus in the context of the patient's trajectory of care, with special attention to psychological comorbidities. Although most patients will cope with tinnitus and need no more than information and reassurance from professionals, a proportion of patients will need more supportive management. Assessment of psychological comorbidities is important to determine how urgent they should be seen in the clinic and their specific needs. The most frequent complaints are stress, depression, and anxiety. Although the direction of this relationship is still unclear (are comorbidities at the origin of tinnitus or are they a consequence of it), it is evident that the more serious comorbidities are at the onset of tinnitus, the worse the prognosis. Therefore, an assessment at the initial visit in the clinic is of utmost importance. There are valid and reliable psychometric tools to quickly draw a portrait of the psychological state of patients that can be used by audiologists, psychologists, or doctors. Therapeutic avenues can then be discussed with the patients to ensure them the best support possible.
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Subjective hearing ability, physical and mental comorbidities in individuals with bothersome tinnitus in a Swedish population sample. PROGRESS IN BRAIN RESEARCH 2021; 260:51-78. [PMID: 33637232 DOI: 10.1016/bs.pbr.2020.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study investigates associations of subjective hearing ability, physical comorbidities, and mental comorbidities with bothersome (vs. non-bothersome) tinnitus and mediating effects between these influences. METHODS The Swedish LifeGene cohort was used to sample cross-sectional survey data (collected 2009-2016) of 7615 participants with tinnitus, 697 (9.2%) of whom rated their tinnitus as bothersome. Associations between bothersome tinnitus and subjective hearing ability, physical and mental comorbidities were investigated by separate age- and gender-adjusted multiple logistic regression models. Interrelationships between these associations were investigated by logistic mediation models. RESULTS Compared to non-bothersome tinnitus, bothersome tinnitus was associated with higher age, reduced subjective hearing ability, hearing-related difficulties in social situations, cardiovascular disease, chronic shoulder pain, thyroid disease, Ménière's disease, depression, anxiety syndrome, and social anxiety. Subjective hearing impairment or hearing-related difficulties mediated 13-36% of the effects of mental comorbidities on bothersome tinnitus. Depression or anxiety syndrome mediated 5-8% of most relationships between physical comorbidities and bothersome tinnitus. Depression, anxiety syndrome, or social anxiety mediated 2-4% of the effects of subjective hearing impairment or hearing-related difficulties on bothersome tinnitus. CONCLUSION Psychological factors, subjective hearing impairment, and hearing-related difficulties in social situations play key roles in predicting bothersome (vs. non-bothersome) tinnitus in a large population sample. Psychological factors contribute to explaining the impact of physical comorbidities and hearing-related effects on bothersome tinnitus. This highlights their transdiagnostic importance for aggravating varied physical symptom clusters. Interventions to improve or prevent high tinnitus burden should be interdisciplinary/multimodal and target auditory, physical, and psychological factors.
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Elarbed A, Fackrell K, Baguley DM, Hoare DJ. Tinnitus and stress in adults: a scoping review. Int J Audiol 2020; 60:171-182. [PMID: 33000672 DOI: 10.1080/14992027.2020.1827306] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Tinnitus and stress are recurrently reported together. The strength and direction of this relationship is not clear. The aim of this review is to catalogue the evidence of this relationship, how it has been described in adults and which instruments were used. DESIGN Five-stage framework was followed. An online search of databases and published journals were conducted. The main inclusion criteria were original studies published in English and conducted in an adult human population, in which both tinnitus and stress were measured using different instruments. STUDY SAMPLES 5699 records were identified in the searching stage and 50 studies were eligible for data extraction. RESULTS Measurements of perceived stress were most frequently used. Tinnitus patients tend to report louder and more bothersome tinnitus when they are stressed, but not all tinnitus patients associated stress with the onset or the severity of their tinnitus. Any positive correlation reported between stress and tinnitus levels varied in strength according to the used instrument. Post-intervention changes in stress and tinnitus levels showed inconsistency. CONCLUSION There is considerable room for further research to study the relationship between stress and tinnitus. We highlight principal issues that should be considered in future studies.
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Affiliation(s)
- Asma Elarbed
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK.,Hearing Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Kathryn Fackrell
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK.,Hearing Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - David M Baguley
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK.,Hearing Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Derek J Hoare
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK.,Hearing Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
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Boecking B, von Sass J, Sieveking A, Schaefer C, Brueggemann P, Rose M, Mazurek B. Tinnitus-related distress and pain perceptions in patients with chronic tinnitus - Do psychological factors constitute a link? PLoS One 2020; 15:e0234807. [PMID: 32584841 PMCID: PMC7316290 DOI: 10.1371/journal.pone.0234807] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/02/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the co-occurrence of tinnitus-related distress and pain experiences alongside psychological factors that may underlie their association. METHOD Patients with chronic tinnitus (N = 1238) completed a questionnaire battery examining tinnitus-related distress and affective and sensory pain perceptions. A series of simple, parallel- and serial multiple mediator models examined indirect effects of psychological comorbidities as well as -process variables including depressivity, perceived stress and coping attitudes. Moderator and moderated mediation analyses examined differential relational patterns in patients with decompensated vs. compensated tinnitus. RESULTS There were significant associations between tinnitus-related distress and pain perceptions. These were partially mediated by most specified variables. Psychological comorbidities appeared to influence tinnitus-pain associations through their impact on depressivity, perceived stress, and coping attitudes. Some specific differences in affective vs. sensory pain perception pathways emerged. Patients with decompensated tinnitus yielded significantly higher symptom burden across all measured indices. Tinnitus decompensation was associated with heightened associations between [1] tinnitus-related distress and pain perceptions, depressivity and negative coping attitudes; and [2] most psychological comorbidities and sensory, but not affective pain perception. Moderated mediation analyses revealed stronger indirect effects of depressivity and anxiety in mediating affective-, and anxiety in mediating sensory pain perception in patients with decompensated tinnitus. CONCLUSION Psychological constructs mediate the co-occurrence of tinnitus- and pain-related symptoms across different levels of tinnitus-related distress. Psychological treatment approaches should conceptualize and address individualised interactions of common cognitive-emotional processes in addressing psychosomatic symptom clusters across syndromatic patients with varying distress levels.
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Affiliation(s)
- Benjamin Boecking
- Tinnitus Center, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | | | - Antonia Sieveking
- Tinnitus Center, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | | | - Petra Brueggemann
- Tinnitus Center, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Rose
- Division of Psychosomatic Medicine, Medical Department, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Birgit Mazurek
- Tinnitus Center, Charité–Universitätsmedizin Berlin, Berlin, Germany
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