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Langguth B, de Ridder D, Schlee W, Kleinjung T. Tinnitus: Clinical Insights in Its Pathophysiology-A Perspective. J Assoc Res Otolaryngol 2024; 25:249-258. [PMID: 38532055 PMCID: PMC11150221 DOI: 10.1007/s10162-024-00939-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/26/2024] [Indexed: 03/28/2024] Open
Abstract
Tinnitus, the perception of sound without a corresponding external sound source, and tinnitus disorder, which is tinnitus with associated suffering, present a multifaceted clinical challenge due to its heterogeneity and its incompletely understood pathophysiology and especially due to the limited therapeutic options. In this narrative review, we give an overview on various clinical aspects of tinnitus including its heterogeneity, contributing factors, comorbidities and therapeutic pathways with a specific emphasis on the implications for its pathophysiology and future research directions. Tinnitus exhibits high perceptual variability between affected individuals (heterogeneity) and within affected individuals (temporal variability). Hearing loss emerges as predominant risk factor and the perceived pitch corresponds to areas of hearing loss, supporting the compensatory response theory. Whereas most people who have tinnitus can live a normal life, in 10-20% tinnitus interferes severely with quality of life. These patients suffer frequently from comorbidities such as anxiety, depression or insomnia, acting as both risk factors and consequences. Accordingly, neuroimaging studies demonstrate shared brain networks between tinnitus and stress-related disorders shedding light on the intricate interplay of mental health and tinnitus. The challenge lies in deciphering causative relationships and shared pathophysiological mechanisms. Stress, external sounds, time of day, head movements, distraction, and sleep quality can impact tinnitus perception. Understanding these factors provides insights into the interplay with autonomic, sensory, motor, and cognitive processes. Counselling and cognitive-behavioural therapy demonstrate efficacy in reducing suffering, supporting the involvement of stress and anxiety-related networks. Hearing improvement, especially through cochlear implants, reduces tinnitus and thus indirectly validates the compensatory nature of tinnitus. Brain stimulation techniques can modulate the suffering of tinnitus, presumably by alteration of stress-related brain networks. Continued research is crucial for unravelling the complexities of tinnitus. Progress in management hinges on decoding diverse manifestations, identifying treatment-responsive subtypes, and advancing targeted therapeutic approaches.
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Affiliation(s)
- Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
- Interdisciplinary Tinnitus Clinic, University of Regensburg, Regensburg, Germany.
| | - Dirk de Ridder
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- Interdisciplinary Tinnitus Clinic, University of Regensburg, Regensburg, Germany
- Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
| | - Tobias Kleinjung
- Department of Otorhinolaryngology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Chen X, Hu K, Song H, Yin L, Kaijser M, Gurholt TP, Andreassen OA, Valdimarsdóttir U, Fang F, Duan M. Depression, anxiety and brain volume after hearing loss and tinnitus: cohort study in the UK Biobank. BJPsych Open 2024; 10:e37. [PMID: 38297917 PMCID: PMC10897703 DOI: 10.1192/bjo.2023.634] [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] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Hearing loss and tinnitus have been proposed as potential indicators of impaired mental health and brain morphological changes. AIMS To assess the associations of hearing loss and tinnitus with the risk of depression and anxiety and with brain volume. METHOD We conducted a community-based cohort study including 129 610 participants aged 40-69 years at recruitment to the UK Biobank with a follow-up period during 2006-2021 to estimate the risk of depression and anxiety after detection of hearing loss and reported tinnitus. We also assessed the associations of hearing loss and tinnitus with brain volume in a subsample with available brain magnetic resonance imaging data (N = 5222). RESULTS We observed an increased risk of depression among individuals with hearing loss (hazard ratio [HR] 1.14, 95% CI 1.03-1.26), tinnitus (HR 1.30, 95% CI 1.21-1.41) or both (HR 1.32, 95% CI 1.15-1.52), compared with individuals with neither hearing loss nor tinnitus. Similar results were noted for anxiety (HR 1.18, 95% CI 1.07-1.30 for hearing loss; HR 1.32, 95% CI 1.22-1.43 for tinnitus; and HR 1.48, 95% CI 1.30-1.68 for both). Hearing loss was associated with decreased overall brain volume as well as decreased volume of different brain regions. The latter associations disappeared after adjustment for whole intracranial volume. Tinnitus was associated with greater left accumbens and right occipital pole volume after adjustment for the whole intracranial volume. CONCLUSIONS Individuals with tinnitus are at increased risk of depression and anxiety. Hearing loss, on the other hand, is associated with both mood disorders and altered brain morphology.
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Affiliation(s)
- Xiaowan Chen
- Department of Otolaryngology Head and Neck Surgery, the First Hospital of Lanzhou University, Lanzhou, Gansu Province, China; Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Otolaryngology Head and Neck Surgery & Audiology and Neurotology, Karolinska University Hospital, Stockholm, Sweden; and Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Kejia Hu
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Huan Song
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China; and Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Li Yin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Kaijser
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; and Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Tiril P Gurholt
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Unnur Valdimarsdóttir
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maoli Duan
- Department of Otolaryngology Head and Neck Surgery & Audiology and Neurotology, Karolinska University Hospital, Stockholm, Sweden; and Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Fresemann M, Boecking B, Steinmetzger K, Brueggemann P, Rose M, Mazurek B. Aging Makes the Heart Grow Fonder: Age Influences Hearing Ability and Interactions between Psychological Phenomena in Patients with Chronic Tinnitus. J Pers Med 2023; 14:23. [PMID: 38248724 PMCID: PMC10817495 DOI: 10.3390/jpm14010023] [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: 11/13/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
(1) Background: Risk factors for chronic tinnitus comprise interactions of individuals' hearing difficulties and psychological distress-including anxiety, depression, and perceived stress levels. Both groups of factors likely become more pronounced with age, although mixed literature has also suggested increases in psychological resilience over time. To this end, only a few studies have delineated direct and indirect effects of age on audiological and psychological variables that might influence tinnitus-related distress in patients with chronic tinnitus. (2) Methods: N = 678 patients with chronic tinnitus completed audiological assessments alongside self-report measures of psychological and tinnitus-related distress. Path analyses investigated the effect of age on patients' tinnitus-related distress via both audiological and psychological variables. (3) Results: Age was significantly associated with both hearing ability and psychological distress indices, with perceived stress and anxiety decreasing with aging. Different mediation models revealed that the association between age and tinnitus-related distress was mediated completely by hearing ability and partly by perceived stress and anxiety. (4) Conclusions: Whilst interactions of individuals' hearing ability and psychological distress levels maintain tinnitus-related distress across the age span, the weighting of these factors may shift with age. Treatment approaches should consider hearing ability across the lifespan. Psychological factors should be individually conceptualized, considering both distress-related and potential resilience factors in old age.
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Affiliation(s)
| | | | | | | | | | - Birgit Mazurek
- Tinnitus Center, Charité—Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (M.F.); (B.B.); (K.S.); (P.B.); (M.R.)
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Maldonado CJ, White-Phillip JA, Liu Y, Erbele ID, Choi YS. Exposomic Signatures of Tinnitus and/or Hearing Loss. Mil Med 2023; 188:102-109. [PMID: 37948208 DOI: 10.1093/milmed/usad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/24/2023] [Accepted: 02/08/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION We evaluated the risk factors associated with tinnitus and/or hearing loss (THL) among active duty (AD) members of the U.S. Army and Marine Aviation Community (AMAC) using an exposomic approach. Specifically, we aimed to determine the factors associated with the reported THL in the Military Health System. METHODS Longitudinal data were obtained from the Medical Assessment and Readiness System housed at Womack Army Medical Center, Fort Bragg, NC, for a retrospective cohort study that included 78,546 AD AMAC members from October 2015 to December 2019. Multivariable mixed-effects logistic regression was used to assess the relationship between THL and numerous variables to include rank, service time, deployment, tobacco use, alcohol use, age, gender, race, ethnicity, and body mass index. RESULTS Our analysis included a total of 220,044 person-years of observations. The THL incidence rate was 6.7 per 100 person-years, with an 8.1% period prevalence. THL was associated with age, gender, body mass index, race, deployment, service time, marital status, and tobacco use (all P < .05). Service time greater than 16 years had the greatest odds ratio of THL (4.46, 95% CI: 3.58-5.55, P < .001). CONCLUSIONS Our assessment shows the utility of using an exposomic approach to create member-specific personalized clinical algorithms for health outcomes. We examined individuals with THL diagnoses and identified a combination of risk factors from biomedical, lifestyle, environmental, and stochastic sources. Taken together, the risk factors identified across the four exposomic domains could help understand the etiology of THL. Our exposomic methodology could be the foundation for generating predictive models. Finally, a specific evaluation of occupational risk factors may provide insight into aspects not readily available from civilian literature. In upcoming years, as the Medical Assessment and Readiness System matures, we will expand our analyses to include prospective, untargeted metabolites and biomarker data.
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Affiliation(s)
- Carlos J Maldonado
- Department of Clinical Investigation, Womack Army Medical Center, Fort Bragg, NC 28310, USA
| | | | - Yuliang Liu
- Department of Veterans Affairs, Veterans Administration Central Office, Washington, DC 20420, USA
| | - Isaac D Erbele
- Department of Otolaryngology, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Y Sammy Choi
- Department of Clinical Investigation, Womack Army Medical Center, Fort Bragg, NC 28310, USA
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Brueggemann P, Goebel G, Boecking B, Hofrichter N, Rose M, Mazurek B. [Analysis of items on the short forms of the tinnitus questionnaire: Mini-TQ-12 and Mini-TQ-15]. HNO 2023; 71:708-718. [PMID: 37702795 PMCID: PMC10589196 DOI: 10.1007/s00106-023-01365-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND A brief but reliable measurement of tinnitus-related distress is crucial for understanding and treatment options for this often very limiting symptom. Several self-report questionnaires are used in German-speaking countries and several short versions exist for the German translation of the Tinnitus Questionnaire (TQ). OBJECTIVE In the present work, the frequently used Mini-TQ-12 questionnaire and the newly developed Mini-TQ-15 questionnaire will be investigated with regard to reliability, item difficulty, sensitivity (discriminatory power), and predictive power of the items in order to facilitate a decision for one or the other questionnaire in different examination contexts. METHODS Data from 1409 patients with chronic tinnitus who completed the German 52-item version of the TQ and additional psychological tests (ADS‑L, BSF, PHQ, ACSA and SWOP) at the Tinnitus Centre of the Charité Universitaetsmedizin Berlin, Germany, were retrospectively analyzed. We performed external validation of items from different versions of the TQ (original version, Mini-TQ-12, and Mini-TQ-15). RESULTS The items of the Mini-TQ-12 and the Mini-TQ-15 predicted specifically the total score. Both short questionnaires are of comparable quality in terms of reliability and item construction (difficulty, discriminatory power). CONCLUSION Both questionnaires have a very good item quality and are clinically more efficient to use than the long-form TQ. If a similarity of the factor structure to the original questionnaire is required for research questions, the use of the Mini-TQ-15 is recommended.
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Affiliation(s)
- Petra Brueggemann
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Luisenstraße 13, 10117, Berlin, Deutschland
| | - Gerhard Goebel
- Tinnitus- und Hyperakusis-Zentrum, Neurozentrum Prien, Prien am Chiemsee, Deutschland
| | - Benjamin Boecking
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Luisenstraße 13, 10117, Berlin, Deutschland
| | - Nienke Hofrichter
- Klinik für Innere Medizin und Psychosomatik, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Matthias Rose
- Klinik für Innere Medizin und Psychosomatik, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Birgit Mazurek
- Tinnituszentrum, Charité - Universitätsmedizin Berlin, Luisenstraße 13, 10117, Berlin, Deutschland.
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De Meulemeester K, Meeus M, De Pauw R, Cagnie B, Keppler H, Lenoir D. Suffering from chronic tinnitus, chronic neck pain, or both: Does it impact the presence of signs and symptoms of central sensitization? PLoS One 2023; 18:e0290116. [PMID: 37616265 PMCID: PMC10449148 DOI: 10.1371/journal.pone.0290116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Chronic subjective tinnitus is a prevalent symptom, which has many similarities with chronic pain. Central sensitization is considered as a possible underlying mechanism of both symptoms. Central sensitization has already been investigated in chronic pain populations but not in patients with chronic subjective tinnitus. Therefore, the main objective of this cross-sectional study was to compare signs and symptoms, indicative for central sensitization, in tinnitus patients with and without chronic idiopathic neck pain, patients with chronic idiopathic neck pain only, and healthy controls. Also, differences in psychological and lifestyle factors, possibly influencing the association between central sensitization and tinnitus, were examined as well as correlations between signs and symptoms of central sensitization, and tinnitus, pain, psychological and lifestyle factors. Differences in signs and symptoms of central sensitization were examined using the self-report Central Sensitization Inventory and QST protocol (local and distant mechanical and heat hyperalgesia, conditioned pain modulation). Tinnitus, pain, psychological and lifestyle factors were evaluated using self-report questionnaires. Symptoms of central sensitization and local mechanical hyperalgesia were significantly more present in both tinnitus groups, compared to healthy controls, but were most extensive in the group with chronic tinnitus+chronic idiopathic neck pain. Distant mechanical hyperalgesia, indicative for central sensitization, was only observed in the group with both chronic tinnitus+chronic idiopathic neck pain. This group also displayed a significantly higher psychological burden and poorer sleep than patients with chronic tinnitus only and healthy controls. Signs and symptoms of central sensitization were also shown to be associated with tinnitus impact, pain-related disability, psychological burden and sleep disturbances. This study shows preliminary evidence for the presence of central sensitization in patients with chronic tinnitus+chronic idiopathic neck pain. This could be explained by the higher perceived tinnitus impact, psychological burden and sleep problems in this group. Trial registration: This study is registered as NCT05186259 (www.clinicaltrials.gov).
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Affiliation(s)
- Kayleigh De Meulemeester
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, The Netherlands
| | - Mira Meeus
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, The Netherlands
- MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Robby De Pauw
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Lifestyle and Chronic Diseases, Department of Epidemiology and Public Health, Sciensano, Belgium
| | - Barbara Cagnie
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Hannah Keppler
- Audiology Research Group, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Oto-Rhino-Laryngology, Ghent University Hospital, Ghent, Belgium
| | - Dorine Lenoir
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, The Netherlands
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Majno M. “The two voices,” or more? Music and gender from myth and conquests to the neurosciences. J Neurosci Res 2023; 101:604-632. [PMID: 36971041 DOI: 10.1002/jnr.25175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 11/18/2022] [Accepted: 01/20/2023] [Indexed: 03/29/2023]
Abstract
Music is a unique phenomenon, constantly eliciting interest from a variety of viewpoints, several of which intersect the universal trait of musicality with sex/gender studies and the neurosciences. Its unparalleled power and physical, social, aesthetic, as well as cognitive, emotional and clinical ramifications make it a specially promising terrain for studies and reflections on sex and gender differences and their impact. This overview wishes to enhance awareness of such issues, also fostering an interdisciplinary exchange between the natural sciences, the humanities, and the arts. Over the centuries, different associations of music with the feminine gender have contributed to a pendulum between progressive recognition and stereotypical setbacks requiring to be overcome. Against this backdrop, music-related neurophysiological and psychological studies on sex and gender specificities are reviewed in their multiple approaches and results, exposing or questioning differences in structural, auditory, hormonal, cognitive, and behavioral areas, also in relation to abilities, treatment, and pedagogy. Thus, the bridging potential of music as universal yet diverse language, art, and practice, recommends its gender-aware integration into education, protective endeavors, and therapeutic interventions, to promote equality and well-being.
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Affiliation(s)
- Maria Majno
- Mariani Foundation for Child Neurology, Milan, Italy
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Low Evidence for Tinnitus Risk Factors: A Systematic Review and Meta-analysis. J Assoc Res Otolaryngol 2023; 24:81-94. [PMID: 36380120 PMCID: PMC9971395 DOI: 10.1007/s10162-022-00874-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
AIMS/HYPOTHESIS Identifying risk factors for tinnitus could facilitate not only the recommendations for prevention measures, but also identifying potential pathways for new interventions. This study reports the first comprehensive systematic review of analytical observational studies able to provide information about causality (i.e., case-control and cohort designs). METHODS A literature search of four electronic databases identified epidemiological studies published on tinnitus and different exposures. Independent raters screened all studies, extracted data, and evaluated study quality using the Newcastle-Ottawa Scale. Reported relative risks (RR), hazard ratios (HR), odds ratios (OR), and prevalence ratios (PR) with 95% confidence intervals (CI) were used to compute crude estimates of RR for tinnitus risk factors. RESULTS From 2389 records identified, a total of 374 articles were read as full text (24 reviews, 301 cross-sectional studies, 42 cohort studies, and 7 case-control studies). However, from 49 case-control and cohort studies, only 25 adequately reported risk ratios. Using the findings from these studies, positive causal associations were found for various hearing-related factors (i.e., unspecified hearing loss, sensorineural hearing loss, occupational noise exposure, ototoxic platinum therapy, and otitis media). Evidence was also found for a number of non-otological risk factors including temporo-mandibular joint disorder, depression, chronic obstructive pulmonary disease, and hyperlipidemia. Negative associations indicating preventative effects were found for diabetes and high alcohol consumption. No associations were found for low alcohol consumption, body mass index, head injury, heart failure, hypertension, leisure noise exposure, migraine, rheumatoid arthritis, sex, smoking, stroke, and whiplash. However, with the exception of unspecified hearing loss, these findings resulted from pooling no more than 4 studies, illustrating that the vast majority of the associations still remain inconclusive. CONCLUSIONS These systematic review and meta-analysis confirm a number of otological and non-otological risk factors for tinnitus. By highlighting major gaps in knowledge, our synthesis can help provide direction for future research that will shed light on the pathophysiology, improve management strategies, and inform more effective preventions.
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Rademaker MM, Meijers SM, Smit AL, Stegeman I. Prediction Models for Tinnitus Presence and the Impact of Tinnitus on Daily Life: A Systematic Review. J Clin Med 2023; 12:jcm12020695. [PMID: 36675624 PMCID: PMC9861218 DOI: 10.3390/jcm12020695] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/27/2022] [Accepted: 01/03/2023] [Indexed: 01/17/2023] Open
Abstract
The presence of tinnitus does not necessarily imply associated suffering. Prediction models on the impact of tinnitus on daily life could aid medical professionals to direct specific medical resources to those (groups of) tinnitus patients with specific levels of impact. Models of tinnitus presence could possibly identify risk factors for tinnitus. We systematically searched the PubMed and EMBASE databases for articles published up to January 2021. We included all studies that reported on multivariable prediction models for tinnitus presence or the impact of tinnitus on daily life. Twenty-one development studies were included, with a total of 31 prediction models. Seventeen studies made a prediction model for the impact of tinnitus on daily life, three studies made a prediction model for tinnitus presence and one study made models for both. The risk of bias was high and reporting was poor in all studies. The most used predictors in the final impact on daily life models were depression- or anxiety-associated questionnaire scores. Demographic predictors were most common in final presence models. No models were internally or externally validated. All published prediction models were poorly reported and had a high risk of bias. This hinders the usability of the current prediction models. Methodological guidance is available for the development and validation of prediction models. Researchers should consider the importance and clinical relevance of the models they develop and should consider validation of existing models before developing new ones.
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Affiliation(s)
- Maaike M. Rademaker
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Sebastiaan M. Meijers
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Adriana L. Smit
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Inge Stegeman
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Correspondence:
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Panahi R, Jalali MM, Joukar F, Maroufizadeh S, Naghipour M, Mansour-Ghanaei F. Prevalence of Tinnitus and Its Associated Factors in the PERSIAN Guilan Cohort Study. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2023; 35:29-38. [PMID: 36721416 PMCID: PMC9872267 DOI: 10.22038/ijorl.2022.63809.3187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 10/26/2022] [Indexed: 02/02/2023]
Abstract
Introduction Tinnitus can be associated with many auditory and non-auditory factors, and its prevalence varies widely in the literature. There is no large sample of published data on tinnitus prevalence and its associated factors in Iran. Here, we analyzed the PERSIAN Guilan Cohort Study (PGCS) data and reported the prevalence of tinnitus and some of the risk factors related to tinnitus in the Iranian population. Materials and Methods This cross-sectional study was conducted on 10520 men and women between 35 and 70 years old. The prevalence of tinnitus and associations between tinnitus and age, sex, habitat, marital status, employment status, socioeconomic status, educational level, lifestyle habits, and comorbid diseases were examined using simple and multiple logistic regression analyses. Results The prevalence of tinnitus was 6.4% in this study. Based on the adjusted analysis, only older age (odds ratio: 2.60, 95% confidence interval: 1.88 - 3.60), residency in a rural area (odds ratio: 1.22, 95% confidence interval: 1.03 - 1.44), cigarette smoking (odds ratio:1.33, 95% confidence interval: 1.04 - 1.72), and having other comorbidities (odds ratio: 2.75, 95% confidence interval: 2.19 - 3.44) were related to tinnitus. In addition, the results of subgroup analyses by sex were mostly consistent with the overall analysis. Conclusions Our results revealed that the prevalence of tinnitus in the north of Iran is comparable with other communities. Age and other comorbidities were among the most related factors to tinnitus.
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Affiliation(s)
- Rasool Panahi
- Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Mir Mohammad Jalali
- Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Farahnaz Joukar
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
| | - Saman Maroufizadeh
- Department of Biostatistics, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.
| | - Mohammadreza Naghipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
| | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran. ,Corresponding Author: Professor of Medicine, Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Razi Hospital, Sardar-Jangle Ave, Rasht, Iran. E-mail: ,
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Grundfast KM, Jamil TL. Evaluation and Management of Tinnitus: Are There Opportunities for Improvement? Otolaryngol Head Neck Surg 2023; 168:45-58. [PMID: 35349391 DOI: 10.1177/01945998221088286] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/02/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review current information about diagnosis and management of tinnitus aiming to identify opportunities for achieving a cost-effective, efficient, evidence-based approach that meets the needs of tinnitus sufferers. DATA SOURCES PubMed/MEDLINE. REVIEW METHODS In total, 249 relevant published reports were reviewed. Pertinent keywords and MeSH terms identified reports via PubMed and EMBASE. Acknowledged experts were consulted on ways to improve tinnitus management. CONCLUSIONS There may be opportunities to improve evaluation and management of patients with tinnitus using modern modes of communication and a multidisciplinary therapeutic approach. IMPLICATIONS FOR PRACTICE Tinnitus can adversely affect quality of life while being time-consuming and costly to evaluate and manage. Based on both personal experience and the reports of others, patients with tinnitus who choose to see a physician primarily want to know two things: (1) that the tinnitus that is so distressing will not remain at the same level of severity forever and (2) that something can be done to help cope with the tinnitus that is so annoying. Recent advancements in internet communications, social media, information technology, artificial intelligence, machine learning, holistic medical care, mind-body integrative health care, and multidisciplinary approaches in medical therapeutics may be possibly making new ways of meeting the needs of patients with tinnitus.
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Affiliation(s)
- Kenneth M Grundfast
- Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
- Otology Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Taylor L Jamil
- Boston University School of Medicine, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, Massachusetts, USA
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Yuan H, Lu PH, Chen JW, Ma PW, Wang WL, Ding XR, Lun YQ, Gao W, Lu LJ. Correlation between clinical characteristics and tinnitus severity in tinnitus patients of different sexes: an analytic retrospective study. Eur Arch Otorhinolaryngol 2023; 280:167-173. [PMID: 35701540 DOI: 10.1007/s00405-022-07480-x] [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: 04/04/2022] [Accepted: 05/30/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE This study aimed to explore whether sex is influences tinnitus severity and whether the risk factors for tinnitus severity are the same in tinnitus patients of different sexes. METHODS This was a retrospective study of data from 1427 patients complaining of tinnitus in a local hospital otolaryngology clinic from November 2019 to January 2022. All patients were interviewed and assessed by otoscopy, pure-tone audiometry, tinnitus handicap inventory (THI), visual analogue scale (VAS), and tinnitus refinement test. RESULTS THI values were higher in females than in males (P = 0.00). Types of tinnitus sounds (OR 0.667, P = 0.000) and degree of hearing loss (OR 1.318, P = 0.000) were risk factors for tinnitus severity in males. Types of tinnitus sounds (OR 0.789, P = 0.005), sensation level (OR 1.023, P = 0.037), tinnitus types (OR 1.163, P = 0.041), tinnitus location (OR 1.198, P = 0.026), and the degree of hearing loss (OR 1.303, P = 0.000) were risk factors for tinnitus severity in females. Sex was an influencing factor for tinnitus severity. There were different risk factors for the tinnitus severity in different sexes. CONCLUSION The risk factors for tinnitus severity differed according to sex in tinnitus patients, and the risk factors for tinnitus severity were greater in women than in men. These findings add to the literature on sex differences in tinnitus and suggest that medical and psychological screening of affected individuals and customized tinnitus treatment for each individual with tinnitus are needed. TRIAL REGISTRATION NUMBER/DATE OF REGISTRATION ChiCTR2200057958, 2022/3/24 (retrospectively registered trials).
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Affiliation(s)
- Hao Yuan
- Department of Otolaryngology Head and Neck Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Pei-Heng Lu
- Department of Otolaryngology Head and Neck Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jia-Wei Chen
- Department of Otolaryngology Head and Neck Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Peng-Wei Ma
- Department of Otolaryngology Head and Neck Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Wei-Long Wang
- Department of Otolaryngology Head and Neck Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Xue-Rui Ding
- Department of Otolaryngology Head and Neck Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yu-Qiang Lun
- Department of Otolaryngology Head and Neck Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Wei Gao
- Department of Otolaryngology Head and Neck Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Lian-Jun Lu
- Department of Otolaryngology Head and Neck Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
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Deshpande SB, Deshpande AK. Race/Ethnicity, Gender, and Socioeconomic Status Representation in U.S.-Based Randomized Controlled Trials of Tinnitus: A Systematic Review. Am J Audiol 2022; 31:1320-1333. [PMID: 36170574 DOI: 10.1044/2022_aja-21-00244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate if peer-reviewed randomized controlled trials (RCTs) for the management/treatment of tinnitus conducted in the United States include diverse participants in terms of gender, race/ethnicity, education, occupation, and income. METHOD We performed a comprehensive and systematic literature search via PubMed, Web of Science, Clinical-Trials.gov, and the Cochrane Central Register of Controlled Trials. Our goal was to identify prospective RCTs of tinnitus intervention conducted in the United States from January 1994 to September 2021 and published in peer-reviewed journals. RESULTS A total of 2,584 studies were retrieved. Thirty-two peer-reviewed articles met all inclusion criteria. Of the included studies, approximately 96% reported participants' gender. Approximately 15% studies reported race/ethnicity information in alignment with the U.S. Census Bureau. However, an underrepresentation of both females and people of color was evident across studies. Reporting of socioeconomic status information of participants was also scarce, with only 25% studies reporting education and/or occupation of participants and 0% reporting income levels. CONCLUSIONS This study indicates underrepresentation and underreporting of diverse participant pools in tinnitus research. Reasons for such underrepresentation are explored. Additionally, this systematic review indicates that recent research in tinnitus portrays an optimistic trend in terms of reporting and recruitment of diverse participant groups. Sustainable strategies for including diverse research participants are essential for hearing health care equity. Research and strategies to promote this goal are discussed.
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Affiliation(s)
- Shruti Balvalli Deshpande
- Department of Communication Sciences and Disorders, St. John's University, Queens, NY.,Long Island Doctor of Audiology Consortium, Garden City, NY
| | - Aniruddha K Deshpande
- Long Island Doctor of Audiology Consortium, Garden City, NY.,The Hear-Ring Lab, Department of Speech-Language-Hearing Sciences, Hofstra University, Hempstead, NY
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14
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Miwa T, Yamaguchi T, Kita SI, Osaka K, Kanai R, Maetani T, Kanemaru SI. Predictive factors of acute sensorineural hearing loss in adult Japanese patients for clinical application by primary care doctors: a cross-sectional study. BMC PRIMARY CARE 2022; 23:219. [PMID: 36042422 PMCID: PMC9429655 DOI: 10.1186/s12875-022-01830-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022]
Abstract
Background Several methods are used for hearing loss screening; however, their benefits are uncertain. In this study, we aimed to determine the predictive factors of acute sensorineural hearing loss for clinical application by primary care doctors. Methods This retrospective, cross-sectional study included 365 patients with acute sensorineural hearing loss without prior therapy. The patients’ clinical data, demographic information, and medical histories were obtained, and they were asked about comorbidities. In addition, we assessed lifestyle factors such as stress level, alcohol consumption, marital status, and socioeconomic level. Logistic regression analysis was performed to investigate the diagnostic predictive ability of the selected factors associated with acute sensorineural hearing loss. The hearing levels of all patients were evaluated using pure tone audiometry. Results We identified significant predictive factors for acute sensorineural hearing loss. The absence of hyperacusis was a predictive factor for sudden sensorineural hearing loss. Younger age, female sex, and marital status were predictive factors for acute low-tone hearing loss. High body mass index, high socioeconomic level, low alcohol consumption, high stress level, hyperacusis, and vertigo/dizziness were predictive factors for Ménière’s disease. High body mass index and ear fullness were predictive factors for perilymph fistula. Low stress level was a predictive factor for acoustic tumours. Conclusions Our findings can be used to distinguish between the types of acute sensorineural hearing loss. Symptoms, physical status, and lifestyle factors identified during this study are useful markers for predicting acute sensorineural hearing loss occurrence. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01830-8.
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15
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Wang S, Cha X, Li F, Li T, Wang T, Wang W, Zhao Z, Ye X, Liang C, Deng Y, Liu H. Associations between sleep disorders and anxiety in patients with tinnitus: A cross-sectional study. Front Psychol 2022; 13:963148. [PMID: 35992459 PMCID: PMC9389284 DOI: 10.3389/fpsyg.2022.963148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo investigate the characteristics of sleep disorders and anxiety in patients with tinnitus, their influencing factors, and the role of sleep disorders as mediators.MethodsThe general conditions and disease characteristics of 393 patients with tinnitus presented to the Changzheng Hospital of the Naval Medical University from 2018 to 2021 were collected. All patients accepted questionnaires such as Tinnitus Handicap Inventory (THI), Pittsburgh Sleep Quality Index (PSQI) and Self-rating Anxiety Scale (SAS), and then the characteristics and the influencing factors of sleep disorders and anxiety were analyzed.ResultsAmong the 393 tinnitus patients, 213 cases (54.19%) were diagnosed with sleep disorders, and 78 cases (19.85%) were diagnosed with anxiety, including 25 men (32.1%) and 53 women (67.9%). Binary regression showed that gender, hearing loss, tinnitus severity, and sleep disorders severity were positively associated with anxiety. Multiple logistic regression analysis showed that female gender (OR = 2.526, P = 0.008), hearing loss (OR = 2.901, P = 0.003, tinnitus severity (OR = 1.863, P = 0.003) and sleep disorders (OR = 2.510, P = 0.001) were the independent risk factors of anxiety. The mediating effect of sleep disorders between tinnitus severity and anxiety accounted for 27.88% of the total effect size.ConclusionFemales patients with hearing loss, moderate to severe tinnitus, and sleep disorders were at greater risk for anxiety, with sleep disorders partially mediating the anxiety associated with tinnitus.
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Affiliation(s)
- Shenglei Wang
- Department of Otolaryngology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Xudong Cha
- Department of Otolaryngology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Fengzhen Li
- Department of Otolaryngology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Tengfei Li
- Department of Otolaryngology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Tianyu Wang
- Department of Otolaryngology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Wenwen Wang
- Department of Neurology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Zhengqing Zhao
- Department of Neurology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Xiaofei Ye
- Department of Health Statistics, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Caiquan Liang
- Department of Otolaryngology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
- *Correspondence: Caiquan Liang
| | - Yue Deng
- Department of Otolaryngology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
- Yue Deng
| | - Huanhai Liu
- Department of Otolaryngology, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, China
- Huanhai Liu
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Allgaier J, Schlee W, Probst T, Pryss R. Prediction of Tinnitus Perception Based on Daily Life MHealth Data Using Country Origin and Season. J Clin Med 2022; 11:jcm11154270. [PMID: 35893370 PMCID: PMC9331976 DOI: 10.3390/jcm11154270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/01/2022] [Accepted: 07/08/2022] [Indexed: 02/01/2023] Open
Abstract
Tinnitus is an auditory phantom perception without external sound stimuli. This chronic perception can severely affect quality of life. Because tinnitus symptoms are highly heterogeneous, multimodal data analyses are increasingly used to gain new insights. MHealth data sources, with their particular focus on country- and season-specific differences, can provide a promising avenue for new insights. Therefore, we examined data from the TrackYourTinnitus (TYT) mHealth platform to create symptom profiles of TYT users. We used gradient boosting engines to classify momentary tinnitus and regress tinnitus loudness, using country of origin and season as features. At the daily assessment level, tinnitus loudness can be regressed with a mean absolute error rate of 7.9% points. In turn, momentary tinnitus can be classified with an F1 score of 93.79%. Both results indicate differences in the tinnitus of TYT users with respect to season and country of origin. The significance of the features was evaluated using statistical and explainable machine learning methods. It was further shown that tinnitus varies with temperature in certain countries. The results presented show that season and country of origin appear to be valuable features when combined with longitudinal mHealth data at the level of daily assessment.
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Affiliation(s)
- Johannes Allgaier
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, 97070 Würzburg, Germany;
- Correspondence:
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy, University of Regensburg, 93053 Regensburg, Germany;
| | - Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, University for Continuing Education Krems, 3500 Krems, Austria;
| | - Rüdiger Pryss
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, 97070 Würzburg, Germany;
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17
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Sex Differences in Comorbidity Combinations in the Swedish Population. Biomolecules 2022; 12:biom12070949. [PMID: 35883505 PMCID: PMC9313065 DOI: 10.3390/biom12070949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/23/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
High comorbidity rates, especially mental–physical comorbidity, constitute an increasing health care burden, with women and men being differentially affected. To gain an overview of comorbidity rates stratified by sex across a range of different conditions, this study examines comorbidity patterns within and between cardiovascular, pulmonary, skin, endocrine, digestive, urogenital, musculoskeletal, neurological diseases, and psychiatric conditions. Self-report data from the LifeGene cohort of 31,825 participants from the general Swedish population (62.5% female, 18–84 years) were analyzed. Pairwise comorbidity rates of 54 self-reported conditions in women and men and adjusted odds ratios (ORs) for their comparison were calculated. Overall, the rate of pairwise disease combinations with significant comorbidity was higher in women than men (14.36% vs. 9.40%). Among psychiatric conditions, this rate was considerably high, with 41.76% in women and 39.01% in men. The highest percentages of elevated mental–physical comorbidity in women were found for musculoskeletal diseases (21.43%), digestive diseases (20.71%), and skin diseases (13.39%); in men, for musculoskeletal diseases (14.29%), neurological diseases (11.22%), and digestive diseases (10%). Implications include the need for integrating mental and physical health care services and a shift from a disease-centered to an individualized, patient-centered focus in clinical care.
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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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Arnold ML, Dhar S, Lee DJ, Perreira KM, Pupo D, Tsalatsanis A, Sanchez VA. Sex-Specific Prevalence, Demographic Characteristics, and Risk Factors of Tinnitus in the Hispanic Community Health Study/Study of Latinos. Am J Audiol 2022; 31:78-90. [PMID: 34990560 DOI: 10.1044/2021_aja-21-00138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The aim of this study was to determine the prevalence of any and chronic tinnitus among female and male individuals from varied Hispanic/Latino backgrounds and to estimate associations between risk factors for chronic tinnitus. METHOD Our analysis used cross-sectional baseline data collected from 2008 to 2011 from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Prevalence estimates and multivariable logistic regression were conducted using survey methodology. Participants included 15,768 adults (8,229 women and 7,539 men) aged 18-76 years. The primary outcome of interest was chronic tinnitus, defined as self-reported tinnitus lasting ≥ 5 min at a time and at least once per week. We hypothesized that after adjusting for covariates, the risk factors of depressed and anxious symptoms, smoking history, hypertension, and noise exposure history would be associated with higher odds of chronic tinnitus. RESULTS Unstratified prevalence for any tinnitus was 32.9%, and for chronic tinnitus, it was 12.1%. Sex-stratified results demonstrated that 2,995 female individuals (36.4%) and 2,187 male individuals (29.0%) reported any tinnitus, and of these, 1,043 female individuals (12.7%) and 870 male individuals (11.5%) reported chronic tinnitus. In the fully adjusted model, depressed and anxious symptoms as well as recreational noise exposure were associated with higher odds of chronic tinnitus in female individuals (odds ratios [ORs] = 1.06, confidence interval [CI; 1.04, 1.07]; 1.02, CI [1.01, 1.04]; and 1.40, CI [1.20, 1.62]) and in male individuals (ORs = 1.06, CI [1.03, 1.08]; 1.05, CI [1.02, 1.08]; and 1.30, CI [1.05, 1.65]). Current smoking was a risk factor for chronic tinnitus in male individuals (OR = 1.53, CI [1.16, 2.02]). CONCLUSIONS Prevalence of any and chronic tinnitus in the HCHS/SOL baseline cohort is higher than that reported in previous studies, particularly among female individuals. Understanding risk factors associated with tinnitus is important for the development of culturally and linguistically appropriate public health programs that consider sex differences and promote lifestyle modifications known to lower the odds of experiencing tinnitus.
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Affiliation(s)
- Michelle L. Arnold
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
| | - Sumitrajit Dhar
- School of Communication, Northwestern University, Evanston, IL
| | - David J. Lee
- Department of Health Sciences, University of Miami Miller School of Medicine, FL
| | - Krista M. Perreira
- Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill
| | - Daniel Pupo
- School of Aging Studies, University of South Florida, Tampa
| | - Athanasios Tsalatsanis
- Department of Otolaryngology–Head and Neck Surgery, Morsani College of Medicine, University of South Florida, Tampa
| | - Victoria A. Sanchez
- Department of Otolaryngology–Head and Neck Surgery, Morsani College of Medicine, University of South Florida, Tampa
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Deshpande AK, Bhatt I, Rojanaworarit C. Virtual reality for tinnitus management: a randomized controlled trial. Int J Audiol 2021; 61:868-875. [PMID: 34550862 DOI: 10.1080/14992027.2021.1978568] [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: 10/20/2022]
Abstract
OBJECTIVE Sound therapy (ST) and stress reduction regimens have been successfully used to manage tinnitus. Virtual reality (VR) has been used to manage chronic conditions like intractable pain. The aim of the present study was to investigate whether the use of VR in conjunction with ST revealed additional improvements in tinnitus attributes as compared to ST alone. DESIGN This study was a randomised controlled trial (RCT) with a cross-over design. All participants received two interventions - ST alone (control) and ST with VR stimuli (experimental). ST consisted of fractal tones while VR stimuli comprised of nature videos presented via VR goggles. A multilevel mixed-effects linear regression model was used to estimate the intervention effect. STUDY SAMPLE Twenty adults with subjective, continuous, chronic tinnitus participated in the study. RESULTS After adjusting for period and baseline tinnitus loudness, significant improvements were observed in tinnitus loudness and Tinnitus Functional Index scores. Although not statistically significant, mean minimum masking levels were lower after the experimental intervention. CONCLUSIONS Study participants benefitted from the use of VR in conjunction with ST in a laboratory setting. Additional effectiveness trials and blinded RCTs will be needed before validating the use of VR for tinnitus management in clinical settings.
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Affiliation(s)
- Aniruddha K Deshpande
- The Hear-Ring Lab, Department of Speech-Language-Hearing Sciences, Hofstra University, Hempstead, NY, USA.,The Long Island AuD Consortium, Garden City, NY, USA
| | - Ishan Bhatt
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA
| | - Chanapong Rojanaworarit
- Department of Health Professions, School of Health Professions and Human Services, Hofstra University, Hempstead, NY, USA
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Allgaier J, Schlee W, Langguth B, Probst T, Pryss R. Predicting the gender of individuals with tinnitus based on daily life data of the TrackYourTinnitus mHealth platform. Sci Rep 2021; 11:18375. [PMID: 34526553 PMCID: PMC8443560 DOI: 10.1038/s41598-021-96731-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 08/12/2021] [Indexed: 02/08/2023] Open
Abstract
Tinnitus is an auditory phantom perception in the absence of an external sound stimulation. People with tinnitus often report severe constraints in their daily life. Interestingly, indications exist on gender differences between women and men both in the symptom profile as well as in the response to specific tinnitus treatments. In this paper, data of the TrackYourTinnitus platform (TYT) were analyzed to investigate whether the gender of users can be predicted. In general, the TYT mobile Health crowdsensing platform was developed to demystify the daily and momentary variations of tinnitus symptoms over time. The goal of the presented investigation is a better understanding of gender-related differences in the symptom profiles of users from TYT. Based on two questionnaires of TYT, four machine learning based classifiers were trained and analyzed. With respect to the provided daily answers, the gender of TYT users can be predicted with an accuracy of 81.7%. In this context, worries, difficulties in concentration, and irritability towards the family are the three most important characteristics for predicting the gender. Note that in contrast to existing studies on TYT, daily answers to the worst symptom question were firstly investigated in more detail. It was found that results of this question significantly contribute to the prediction of the gender of TYT users. Overall, our findings indicate gender-related differences in tinnitus and tinnitus-related symptoms. Based on evidence that gender impacts the development of tinnitus, the gathered insights can be considered relevant and justify further investigations in this direction.
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Affiliation(s)
- Johannes Allgaier
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany.
| | - Winfried Schlee
- Department for Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Berthold Langguth
- Department for Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems an der Donau , Austria
| | - Rüdiger Pryss
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
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孙 慧, 冯 国, 高 志. [Key factors of the severity of chronic subjective tinnitus: a complex network analysis]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:586-592. [PMID: 34304485 PMCID: PMC10127896 DOI: 10.13201/j.issn.2096-7993.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Indexed: 06/13/2023]
Abstract
Objective:To investigate the key factors related to the severity of chronic subjective tinnitus through a complex network analysis. Methods:A retrospective study about patients with chronic subjective tinnitus presented to Peking Union Medical College Hospital from December 2019 to October 2020 was conducted. The demographic information, audiometric and tinnitus-related tests, and scores of Tinnitus Handicap Inventory(THI), Hospital Anxiety and Depression Scale(HADS), Pittsburgh Sleep Quality Index(PSQI) and Visual Analogue Scale(VAS) of tinnitus loudness and annoyance were set as nodes in a complex network which was conducted and analyzed through the R package. Results:A total of 183 patients were enrolled, including 99(54.1%) males and 84(45.9%) females, with an average age of(41.65±1.05) years. The results of the complex network analysis showed that anxiety and sleep disorder were closely related to THI score, and anxiety was more important than sleep disorder. There was a strong correlation between self-reported anxiety and insomnia. Demographic characteristics, audiologic and tinnitus-associated tests were not significantly related to THI score. Conclusion:Anxiety and sleep disturbance were key factors related to tinnitus severity, and anxiety played a more important role. There was an obvious correlation between sleep disorder and anxiety, and they might have a superimposed effect on tinnitus severity. Future therapies of tinnitus should pay more attention on releasing anxiety and insomnia.
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Affiliation(s)
- 慧颖 孙
- 北京协和医学院 中国医学科学院 北京协和医院耳鼻咽喉头颈外科(北京, 100730)Department of Otolaryngology Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - 国栋 冯
- 北京协和医学院 中国医学科学院 北京协和医院耳鼻咽喉头颈外科(北京, 100730)Department of Otolaryngology Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - 志强 高
- 北京协和医学院 中国医学科学院 北京协和医院耳鼻咽喉头颈外科(北京, 100730)Department of Otolaryngology Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
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Boecking B, Biehl R, Brueggemann P, Mazurek B. Health-Related Quality of Life, Depressive Symptoms, Anxiety, and Somatization Symptoms in Male and Female Patients with Chronic Tinnitus. J Clin Med 2021; 10:jcm10132798. [PMID: 34202097 PMCID: PMC8267833 DOI: 10.3390/jcm10132798] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 12/19/2022] Open
Abstract
Objective: To investigate the joint impact of tinnitus-related distress (TRD), anxiety, depressive symptoms, and other somatization symptoms on health-related quality of life (HRQoL) in female vs. male patients with chronic tinnitus. Method: Three-hundred-and-fifty-two patients with chronic tinnitus completed audiological testing and a psychological assessment battery that comprised—among other measures—German versions of the Tinnitus Questionnaire, Hospital Anxiety and Depression Scale, Somatic Symptom Scale-8, and Health-Related Quality of Life scale. Descriptive analyses examined associations as well as within- and between-gender differences of the measured variables. Gender-specific serial indirect effects analyses aimed to explain the impact of TRD on HRQoL through psychological processes, notably anxiety, depressive symptoms, and somatization symptoms. Results: Both female and male patients yielded lower mental than physical HRQoL and negative associations between the measured psychological variables and HRQoL. Compared to male patients, female patients reported higher levels of tinnitus-related- and wider psychological distress, other somatization symptoms (e.g., headaches), and impairments in mental and physical HRQoL. For each gender, depressive symptoms, anxiety, and somatization symptoms fully mediated the effect of TRD on mental and physical HRQoL. A double-dissociation revealed an interaction of somatization symptoms and depression on the TRD-HRQoL association in women, and of somatization symptoms and anxiety in men. Conclusions: In patients with chronic tinnitus, psychological constructs account for reported impairments in both mental and physical HRQoL. To improve patients’ HRQoL, treatment conceptualizations should consider gender-specific psychological expressions of low mood or anxiety.
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Affiliation(s)
| | | | | | - Birgit Mazurek
- Correspondence: ; Tel.: +49-30-450-009; Fax: +49-30-450-555-907
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Ausland JHL, Engdahl B, Oftedal B, Steingrímsdóttir ÓA, Nielsen CS, Hopstock LA, Johnsen M, Friborg O, Rosenvinge JH, Eggen AE, Krog NH. Tinnitus and associations with chronic pain: The population-based Tromsø Study (2015-2016). PLoS One 2021; 16:e0247880. [PMID: 33651844 PMCID: PMC7924755 DOI: 10.1371/journal.pone.0247880] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/16/2021] [Indexed: 11/18/2022] Open
Abstract
Tinnitus and pain have many similarities. Both are subjective sensations that may turn chronic, they are often accompanied by hypersensitivity in their respective sensory system, and overlapping brain changes have been observed. Since no population study has examined the empirical association between chronic pain and tinnitus, the present study aimed to explore the relationship in a general adult population. We used data from the seventh survey of the Tromsø Study (2015–2016). Participants (aged ≥40) responded to questions about pain and tinnitus. Using multiple logistic regression, we analysed the adjusted relationship between chronic pain and tinnitus in the full sample (n = 19,039), using several tinnitus definitions ranging from tinnitus >5 minutes within the past 12 months (broadest definition) to at least weekly and highly bothersome tinnitus (strictest definition). We also analysed relationships between number of body regions with pain, pain intensity and bothering, and tinnitus >5 minutes, among participants with chronic pain (n = 11,589). We found an association between chronic pain and tinnitus that was present irrespective of tinnitus definition, but was stronger with more bothersome tinnitus. With chronic pain, the odds of tinnitus >5 minutes was 64% higher, while odds of at least weekly, highly bothersome tinnitus was 144% higher than without chronic pain. Among participants with chronic pain, the number of pain regions was the pain variable most strongly associated with tinnitus >5 minutes (OR = 1.17 (95% CI: 1.14–1.20) for an increase of one region), whereas the other pain variables (intensity and bothering) showed weaker associations. All chronic pain variables had significant interactions with age, with the strongest associations for the youngest individuals (40–54 years). Our findings support the existence of an association between chronic pain and tinnitus and emphasises the importance of examining for comorbid pain in tinnitus patients to provide a more comprehensive treatment of tinnitus.
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Affiliation(s)
- Jannike H-L Ausland
- Department of Environmental Health, Norwegian Institute of Public Health, Skøyen, Oslo, Norway
- * E-mail:
| | - Bo Engdahl
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Skøyen, Oslo, Norway
| | - Bente Oftedal
- Department of Environmental Health, Norwegian Institute of Public Health, Skøyen, Oslo, Norway
| | - Ólöf A. Steingrímsdóttir
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Skøyen, Oslo, Norway
| | - Christopher S. Nielsen
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Skøyen, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Nydalen, Oslo, Norway
| | - Laila A. Hopstock
- Department of Community Medicine, UiT The Arctic University of Norway, Langnes, Tromsø, Norway
| | - Magnar Johnsen
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Oddgeir Friborg
- Department of Psychology, UiT The Arctic University of Norway, Langnes, Tromsø, Norway
| | - Jan H. Rosenvinge
- Department of Psychology, UiT The Arctic University of Norway, Langnes, Tromsø, Norway
| | - Anne E. Eggen
- Department of Community Medicine, UiT The Arctic University of Norway, Langnes, Tromsø, Norway
| | - Norun H. Krog
- Department of Environmental Health, Norwegian Institute of Public Health, Skøyen, Oslo, Norway
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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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Lan T, Cao Z, Zhao F, Perham N. The Association Between Effectiveness of Tinnitus Intervention and Cognitive Function-A Systematic Review. Front Psychol 2021; 11:553449. [PMID: 33488438 PMCID: PMC7815700 DOI: 10.3389/fpsyg.2020.553449] [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: 04/18/2020] [Accepted: 11/27/2020] [Indexed: 11/13/2022] Open
Abstract
Tinnitus refers to the perception of sound in the absence of an external stimulus. This can be problematic and can lead to health problems in some sufferers, including effects on cognitive functions such as attention and memory. Although several studies have examined the effectiveness of tinnitus interventions, e.g., cognitive behavioral therapy and sound therapy, it is still unclear as to the overall quality and limitations of these studies and whether their results could be generalized. Clarification is also needed as to whether poor cognitive function will lead to a less favorable intervention outcome in tinnitus patients. The present systematic review was therefore designed to critically appraise and synthesize findings from randomized controlled trials (RCTs) of tinnitus intervention and its effects on cognition. The methodology followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Medline (PubMed), Embase, and PsycINFO were searched. Only RCTs that compared the effectiveness of a tinnitus intervention and a measure of cognitive function in adult participants with tinnitus were included. A total of 8 studies involving 610 participants tested using 11 cognitive function assessment tools (e.g., Stroop Color and Word Test and Visual Continuous Performance Task) and 5 tinnitus intervention outcome measurements (e.g., Tinnitus Handicap Inventory and Tinnitus Questionnaire) were included and analyzed. The outcomes of the review suggest that tinnitus intervention not only facilitates tinnitus management but also improves cognitive functions. It is likely that cognition and emotion play an important role in a patient's adjustment to tinnitus. Whether cognition can predict treatment outcomes is unclear due to insufficient evidence. Future research is needed using a standardized assessment protocol focusing on the effect of sound-based interventions on tinnitus severity and cognitive functions. Studies on whether cognitive function measurement can be used as a predictor for the effectiveness of tinnitus therapy are also needed.
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Affiliation(s)
- Tianxiang Lan
- Centre for Speech and Language Therapy and Hearing Sciences, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Zuwei Cao
- Center for Rehabilitative Auditory Research, Guizhou Provincial People's Hospital, Guiyang, China
| | - Fei Zhao
- Centre for Speech and Language Therapy and Hearing Sciences, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
- Department of Hearing and Speech Science, Xinhua College, Sun Yat-sen University, Guangzhou, China
| | - Nick Perham
- Department of Applied Psychology, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
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Wang TC, Chiu CJ, Chen PC, Chang TY, Tyler RS, Rojas-Roncancio E, Coelho CB, Mancini PC, Lin CL, Lin CD, Tsai MH. Increased Incidence of Tinnitus Following a Hyperthyroidism Diagnosis: A Population-Based Longitudinal Study. Front Endocrinol (Lausanne) 2021; 12:741719. [PMID: 34803911 PMCID: PMC8595298 DOI: 10.3389/fendo.2021.741719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND An association between thyroid disease and tinnitus has been described previously but further longitudinal, population-based studies are limited. OBJECTIVE To investigate the incidence of tinnitus in patients with hyperthyroidism in a national sample, and to identify risk level and associated factors for tinnitus in hyperthyroidism patients. DESIGN Retrospective cohort study. Patient data were collected from the Longitudinal Health Insurance Database (LHID 2000), which includes national claims data of patient expenditures for admissions or ambulatory care from 1996 to 2011. SETTING Taiwan hospitals and clinics providing healthcare nationwide. PARTICIPANTS Patients aged 20 years and older with newly diagnosed hyperthyroidism (ICD-9-CM code 242) between 2000-2010 were selected as the study cohort. Hyperthyroidism patient cohort were identified from the LHID2000. Those with tinnitus history (ICD-9-CM code 388.3) before the index date (first hyperthyroidism diagnosis), younger than 20 years, and with incomplete demographic data were excluded. The non-hyperthyroidism cohort included patients with no history of hyperthyroidism and no documented tinnitus. MAIN OUTCOMES AND MEASURES Incidence of tinnitus was the primary outcome. Baseline demographic factors and comorbidities possibly associated with tinnitus, including age, sex, and comorbidities of hearing loss, vertigo, insomnia and anxiety, were retrieved from the LHID 2000. Patients were followed until end of 2011. RESULTS During the study period, 780 (4.9%) hyperthyroidism patients and 2007 (3.2%) non-hyperthyroidism controls developed tinnitus. Incidence rate of tinnitus in the hyperthyroidism cohort was significantly higher in hyperthyroidism cohort (7.86 vs. 5.05 per 1000 person-years) than that in non-hyperthyroidism cohort. A higher proportion of patients with hyperthyroidism had comorbid insomnia (45.1% vs. 30.9%) and anxiety (14.0% vs. 5.73%) than those without hyperthyroidism. After adjusting for age, gender and comorbidities (vertigo, insomnia, anxiety, hearing loss), hyperthyroidism patients had 1.38-fold higher risk of tinnitus (95% CI = 1.27-1.50) than those without hyperthyroidism. CONCLUSIONS This large population-based study suggests patients with diagnosed hyperthyroidism was more prone to develop tinnitus. Our findings suggest evaluation for comorbid vertigo, insomnia, anxiety and/or hearing loss may identify patients who are at high risk of developing tinnitus in patients with hyperthyroidism.
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Affiliation(s)
- Tang-Chuan Wang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Chien-Jen Chiu
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Pei-Chun Chen
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Ta-Yuan Chang
- Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung, Taiwan
- *Correspondence: Ta-Yuan Chang,
| | - Richard S. Tyler
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, IA, United States
| | - Eveling Rojas-Roncancio
- Otorrinolaringóloga, Universidad Nacional-Universidad Militar, Miembro Asociación Colombiana de Otorrinolaringología, Cirugía de Cabeza y Cuello, Maxilofacial y Estética Facial (ACORL), Bogotá, Colombia
| | - Claudia Barros Coelho
- College of Medicine, University of Vale do Taquari (UNIVATES), Center of Medical Sciences, Rio Grande do Sul, Brazil
| | - Patricia C. Mancini
- Department of Speech-Language Pathology and Audiology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Cheng-Li Lin
- Management Office for Health Data (DryLab), Clinical Trial Center (CTC), China Medical University Hospital, Taichung, Taiwan
| | - Chia-Der Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ming-Hsui Tsai
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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