The impact of co-morbid factors on the psychological outcome of tinnitus patients

The impact of tinnitus distress on cognition

Tinnitus is the chronic perception of a phantom sound with different levels of related distress. Past research has elucidated interactions of tinnitus distress with audiological, affective and further clinical variables. The influence of tinnitus distress on cognition is underinvestigated. Our study aims at investigating specific influences of tinnitus distress and further associated predictors on cognition in a cohort of n = 146 out-ward clinical tinnitus patients. Age, educational level, hearing loss, Tinnitus Questionnaire (TQ) score, tinnitus duration, speech in noise (SIN), stress, anxiety and depression, and psychological well-being were included as predictors of a machine learning regression approach (elastic net) in three models with scores of a multiple choice vocabulary test (MWT-B), or two trail-making tests (TMT-A and TMT-B), as dependent variables. TQ scores predicted lower MWT-B scores and higher TMT-B test completion time. Stress, emotional, and psychological variables were not found to be relevant predictors in all models with the exception of small positive influences of SIN and depression on TMT-B. Effect sizes were small to medium for all models and predictors. Results are indicative of specific influence of tinnitus distress on cognitive performance, especially on general or crystallized intelligence and executive functions. More research is needed at the delicate intersection of tinnitus distress and cognitive skills needed in daily functioning.

An Effective Treatment for Tinnitus and Hyperacusis Based on Cognitive Behavioral Therapy in an Inpatient Setting: A 10-Year Retrospective Outcome Analysis

AIM

Tinnitus and hyperacusis are phenomena with a considerable prevalence in the general population, leading to high levels of suffering. It is a symptom that can present itself comorbidly with a variety of psychiatric and medical illnesses. We established a treatment of tinnitus and hyperacusis, which is based on a multimodal approach including a specific cognitive behavioral therapy (CBT) method in an inpatient setting. This approach includes education on tinnitus and hyperacusis, applying coping strategies and techniques of relaxation, directed attention, and music therapy. We aim to evaluate the efficacy of this treatment approach.

MATERIALS AND METHODS

We included retrospective data of 268 patients who underwent tinnitus treatment throughout the 10-year existence of the treatment program. We assessed routine clinical data pretreatment and posttreatment with parameters concerning tinnitus-distress, hyperacusis, and psychological well-being. To determine these variables, we used validated instruments including the Tinnitus Questionnaire (TQ), Questionnaire on Hypersensitivity to Sound (QHS), Brief Symptom Inventory (BSI), and the Beck Depression Inventory (BDI-II).

RESULTS

Patients showed highly significant reduction in all of the examined clinical outcomes. Reduction of TQ, the primary outcome measure, was 15.39 (SD 21.88) from a mean baseline value of 35.72 (p < 0.001). The QHS showed a reduction of 6.72 (SD 8.23) from a mean baseline value of 18.98 (p < 0.001). Moreover, psychological strain was also reduced with high significance, as illustrated in reduction of BSI and BDI-II; reduction in BSI from 49.63 by 24.41 (SD 26.88; p < 0.001) and BDI-II from 16.89 by 7.47 (SD 8.76; p < 0.001).

DISCUSSION

The multimodal treatment program for tinnitus and hyperacusis including a specific CBT method proves to be a highly effective means of significantly reducing not only tinnitus and hyperacusis but also accompanying distress. Furthermore, it also enables considerable reduction of concomitant psychiatric symptoms such as depression.

CONCLUSIONS

Our results underline the importance of intensive and multimodal approaches to the treatment of tinnitus and hyperacusis.

Self-reported participation restrictions in normal hearing individuals in thyroid ontogeny: Evidence of subclinical changes

Purpose

To verify evidence of subclinical alterations through self-reported participation restrictions in normal hearing individuals and congenital hypothyroidism patients.

Methods

An analytical, quantitative, cross-sectional exploratory study with a 1:1 ratio, consisting of a convenience sample of 86 normal hearing individuals with (n = 42) and without (n = 44) congenital hypothyroidism diagnosis. All participants underwent tonal and speech audiometry, immitance and distortion product otoacoustic emissions. The researchers excluded people with hearing loss, genetic syndromes and metabolic diseases. The instrument used for evaluate of self-reported participation restrictions was the HHIE-adapted questionnaire, composed of 25 questions, 12 of which were social domain and 13 emotional domain. Student's t-test and chi-square test were used for statistical analysis at a significance level of 5%.

Results

There was a significant (p < 0.001) self-reported participation restrictions in CH (61.9%), with a greater relevance for the social domain (p = 0.002). There was a greater frequency of mild/moderate (40.5%) and higher prevalence of association with clinical factors and adherence to treatment.

Conclusion

The findings indicate that self-reported participation restrictions in normal hearing individuals with congenital hypothyroidism was more significant than in the non-exposed group, suggesting evidence of subclinical auditory abnormalities in this population.

The Effect of Comorbidity between Tinnitus and Dizziness on Perceived Handicap, Psychological Distress, and Quality of Life

Tinnitus and dizziness are common complaints encountered in the department of otolaryngology. We hypothesized that when patients complain of both tinnitus and dizziness, perceived handicap, impairment of quality of life, and emotional distress are more severe than the patient who complain of either tinnitus or dizziness. The subjects for this study were 736 patients who visited Hino Municipal Hospital between August 2010 and March 2012, complaining of tinnitus or dizziness. The subjects were divided into three groups depending upon their chief complaints-group B had patients with both tinnitus and dizziness (N = 75), group T had patients with tinnitus (N = 145), and group D had patients with dizziness (N = 516). Assessments were performed using Tinnitus Handicap Inventory (THI) for groups B and T, Dizziness Handicap Inventory (DHI) for groups B and D, Medical Outcomes Study 8-items Short-Form Health Survey (SF-8), and Hospital Anxiety and Depression Scale (HADS). The THI score of group B was higher than that of group T. The scores of PCS (physical component of SF-8) of groups B and D were lower than that of group T. However, there were no significant differences in the DHI scores of groups B and D, and the HADS scores of the three groups. While the physical quality of life was found to vary depending on the presence of dizziness in patients with tinnitus, it was not found to vary depending on the presence of tinnitus in patients with dizziness. It is therefore important to consider the functional impact resulting from dizziness in patients with tinnitus.

Tinnitus: Prospects for Pharmacological Interventions With a Seesaw Model

Chronic tinnitus, the perception of lifelong constant ringing in ear, is one capital cause of disability in modern society. It is often present with various comorbid factors that severely affect quality of life, including insomnia, deficits in attention, anxiety, and depression. Currently, there are limited therapeutic treatments for alleviation of tinnitus. Tinnitus can involve a shift in neuronal excitation/inhibition (E/I) balance, which is largely modulated by ion channels and receptors. Thus, ongoing research is geared toward pharmaceutical approaches that modulate the function of ion channels and receptors. Here, we propose a seesaw model that delineates how tinnitus-related ion channels and receptors are involved in homeostatic E/I balance of neurons. This review provides a thorough account of our current mechanistic understanding of tinnitus and insight into future direction of drug development.

Association between sleep quality and psychiatric disorders in patients with subjective tinnitus in China

The study aimed to investigate the relationship between quality of sleep and psychiatric disorders including anxiety and depression in patients with subjective tinnitus. Early intervention is associated with improved therapeutic outcomes. We used Pittsburgh sleep quality index (PSQI), self-rating anxiety scale (SAS), self-rating depression scale (SDS) and tinnitus handicap inventory (THI) in 543 patients [224 male (41.3 %); 319 female (58.7 %)] with subjective tinnitus enrolled in the ENT outpatient clinic from 2013 to 2015. Tinnitus characteristics and hearing status were recorded. A binary step-wise logistic regression analysis was performed. Two hundred cases (36.8 %) including 65 men (32.5 %) and 135 women (67.5 %) were diagnosed with sleep disorders. The PSQI score was the highest in patients with anxiety plus depression. Prolonged sleep latency and daytime dysfunction were positively associated with anxiety and depression. Increased sleep latency score was associated with 1.521- and 1.667-fold increased risk of anxiety and depression. Increase in the daytime dysfunction score was associated with 1.941- and 1.477-fold increases in the risk of anxiety and depression, respectively. Psychiatric and sleep disorders are highly prevalent in patients with subjective tinnitus. The most severe sleep impairment was found in patients with anxiety plus depression, resulting from prolonged sleep latency and severe daytime dysfunction. Acute duration, young people, hearing loss, impaired sleep, and severity of tinnitus were the major risk factors for tinnitus accompanied with anxiety symptoms. Severity of tinnitus and sleep impairment appeared to be the major risk factors of tinnitus accompanied with depression symptoms.

Biological correlates of tinnitus-related distress: an exploratory study

During the process of tinnitus diagnostics, various psychometric instruments are used to measure tinnitus-related distress. The aim of present work was to explore whether candidates for biological correlates of the tinnitus-related distress could be found in peripheral blood of patients and if so, whether there was association between them and psychometric scores that reflect tinnitus-related distress. The concentrations of interleukin-1β (IL1β), interleukin-6 (IL6), tumor necrosis factor-α (TNFα) and a brain-derived neutrotrophic factor (BDNF) were measured in serum of 30 patients diagnosed with chronic tinnitus and tested for correlation with psychometric scores collected on the same day. Spearman's correlation analyses detected significant positive association between the concentrations of tumor necrosis factor α and tinnitus loudness, total perceived stress, tension and depression and a negative association between tumor necrosis factor α and a psychometric score "joy". Concentrations of interleukin-1β correlated with the awareness grade of tinnitus. The correlation between visual analogue scale (VAS) "loudness" and tumor necrosis factor α as well as between "joy" and tumor necrosis factor α retained their significance (p < 0.00167) after the application of Bonferroni correction for multiple testing. Partial correlations removing the effects of age, hearing loss and the duration of tinnitus verified the results obtained using Spearman correlation. We conclude that measuring the concentrations of selected circulating cytokines could possibly become an additional objective element of tinnitus diagnostics in the future.