Catastrophizing and fear of tinnitus predict quality of life in patients with chronic tinnitus

Objectives: It is well established that catastrophic misinterpretations and fear are involved in the suffering and disability of patients with chronic pain. This study investigated whether similar processes explain suffering and disability in patients with chronic tinnitus. We hypothesized that patients who catastrophically (mis)interpret their tinnitus would be more fearful of tinnitus, more vigilant toward their tinnitus, and report less quality of life. Moreover, tinnitus-related fear was expected to act as a mediator in reduced quality of life. Design: Sixty-one tinnitus patients from an outpatient ENT department of the University Hospital of Antwerp (Belgium) completed a number of questionnaires about their tinnitus. Hierarchical regression analyses were performed to test hypothesized associations and to assess mediation by tinnitus-related fear. Results: Analyses revealed significant associations between catastrophizing and fear and between catastrophizing and increased attention toward the tinnitus. Furthermore, both tinnitus-related catastrophizing and fear were negatively associated with quality of life; moreover, tinnitus-related fear fully mediated the association between catastrophizing about the tinnitus and quality of life. Conclusions: The findings confirm earlier suggestions that tinnitus-related concerns and fears are associated with impaired quality of life, which is in line with a cognitive behavioral account of chronic tinnitus. Future research avenues and clinical applications are discussed

Trauma-Associated Tinnitus: Audiological, Demographic and Clinical Characteristics

Background: Tinnitus can result from different etiologies. Frequently, patients report the development of tinnitus after traumatic injuries. However, to which extent this specific etiologic factor plays a role for the phenomenology of tinnitus is still incompletely understood. Additionally, it remains a matter of debate whether the etiology of tinnitus constitutes a relevant criterion for defining tinnitus subtypes. Objective: By investigating a worldwide sample of tinnitus patients derived from the Tinnitus Research Initiative (TRI) Database, we aimed to identify differences in demographic, clinical and audiological characteristics between tinnitus patients with and without preceding trauma. Materials: A total of 1,604 patients were investigated. Assessment included demographic data, tinnitus related clinical data, audiological data, the Tinnitus Handicap Inventory, the Tinnitus Questionnaire, the Beck Depression Inventory, various numeric tinnitus rating scales, and the World Health Organisation Quality of Life Scale (WHOQoL). Results: Our data clearly indicate differences between tinnitus patients with and without trauma at tinnitus onset. Patients suffering from trauma-associated tinnitus suffer from a higher mental burden than tinnitus patients presenting with phantom perceptions based on other or unknown etiologic factors. This is especially the case for patients with whiplash and head trauma. Patients with posttraumatic noise-related tinnitus experience more frequently hyperacousis, were younger, had longer tinnitus duration, and were more frequently of male gender. Conclusions: Trauma before tinnitus onset seems to represent a relevant criterion for subtypization of tinnitus. Patients with posttraumatic tinnitus may require specific diagnostic and therapeutic management. A more systematic and - at best - standardized assessment for hearing related sequelae of trauma is needed for a better understanding of the underlying pathophysiology and for developing more tailored treatment approaches as well.Fil: Kreuzer, Peter M.. Universitat Regensburg; AlemaniaFil: Landgrebe, Michael. Universitat Regensburg; AlemaniaFil: Schecklmann, Martin. Universitat Regensburg; AlemaniaFil: Staudinger, Susanne. Universitat Regensburg; AlemaniaFil: Langguth, Berthold. Universitat Regensburg; AlemaniaFil: Vielsmeier, Veronika. The TRI Database Study Group; AlemaniaFil: Kleinjung, Tobias. The TRI Database Study Group; AlemaniaFil: Lehner, Astrid. The TRI Database Study Group; AlemaniaFil: Poeppl, Timm B.. The TRI Database Study Group; AlemaniaFil: Figueiredo, Ricardo. The TRI Database Study Group; AlemaniaFil: Azevedo, Andréia. The TRI Database Study Group; AlemaniaFil: Binetti, Ana Carolina. The TRI Database Study Group; AlemaniaFil: Elgoyhen, Ana Belen. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; Argentina. The TRI Database Study Group; AlemaniaFil: Rates, Marcelo. The TRI Database Study Group; AlemaniaFil: Coelho, Claudia. The TRI Database Study Group; AlemaniaFil: Vanneste, Sven. The TRI Database Study Group; AlemaniaFil: de Ridder, Dirk. The TRI Database Study Group; AlemaniaFil: van de Heyning, Paul. The TRI Database Study Group; AlemaniaFil: Zeman, Florian. The TRI Database Study Group; AlemaniaFil: Mohr, Markus. The TRI Database Study Group; AlemaniaFil: Koller, Michael. The TRI Database Study Group; Alemani

Prevalence and characteristics of tinnitus after leisure noise exposure in young adults

The main goal of this study was to assess the prevalence and characteristics of tinnitus among students after exposure to leisure noise. In addition, the effects of tinnitus on otoacoustic emissions (OAEs) in participants suffering from chronic tinnitus were evaluated. The study consisted of two parts. First, a questionnaire regarding leisure noise exposure and tinnitus was completed. Second, the hearing status of the subjects suffering from chronic tinnitus was evaluated and compared with a matched control group (CG). Furthermore, the psychoacoustical characteristics of their tinnitus in the chronic tinnitus group (TG) were established. The questionnaire was answered by 151 respondents. Seven persons suffering from chronic tinnitus were examined further in the second part of the study. Transient tinnitus was observed in 73.5% of the respondents after leisure noise exposure and 6.6% experienced chronic tinnitus. Transient and chronic tinnitus had similar characteristics, as established by the questionnaire. The amplitude of transient evoked otoacoustic emissions and distortion product otoacoustic emissions was reduced and the amount of efferent suppression was smaller in the TG as compared with the CG. Tinnitus induced by leisure noise is observed frequently in young adults. The characteristics of tinnitus cannot predict whether it will have a transient or rather a chronic nature. In subjects suffering from tinnitus, subclinical damage that cannot be detected by audiometry can be demonstrated by measuring OAEs. These findings underpin the importance of educating youth about the risks of noise exposure during leisure activities

Subtyping somatic tinnitus: a cross-sectional UK cohort study of demographic, clinical and audiological characteristics

Somatic tinnitus is the ability to modulate the psychoacoustic features of tinnitus by somatic manoeuvres. The condition is still not fully understood and further identification of this subtype is essential, particularly for the purpose of establishing protocols for both its diagnosis and treatment. This study aimed to investigate the characteristics of somatic tinnitus within a large UK cohort using a largely unselected sample. We believe this to be relatively unique in comparison to current literature on the topic. This was investigated by using a total of 608 participant assessments from a set of recognised tinnitus and audiology measures. Results from a set of chi-square tests of association found that amongst the individuals with somatic tinnitus, a higher proportion had pulsatile tinnitus (different from heartbeat), were under the age of 40, reported variation in the loudness of their tinnitus and reported temporomandibular joint (TMJ) disorder. The same pattern of results was confirmed using a multivariate analysis of the data based on logistic regression. These findings have strong implications towards the profiling of somatic tinnitus as a distinct subtype of general tinnitus

Somatic modulation of tinnitus: a review and some open questions

Tinnitus modulation by movements of the temporomandibular joint, head and neck musculoskeletal structures and the eye, can be found in one to two thirds of tinnitus sufferers; unfortunately this condition is often overlooked by otolaryngologists. Although somatic modulation has been initially hypothesized as a fundamental characteristic of tinnitus, there is increasing evidence of a tight connection with disorders of non-auditory regions. The structure that mostly modulates tinnitus is the temporomandibular joint, which mainly causes an increase in tinnitus loudness, followed by head and neck movements that may result in an increase or decrease of loudness and eye movements (gaze-evoked tinnitus). Besides loudness, somatic movements can also modulate tinnitus pitch and localization. Somatosensory tinnitus is a relatively new nding that leaves several open questions: are there individual predisposing factors to somatic modulation? How strong is the association between the capability to somatically modulate tinnitus and an underlying non-auditory disorder? Changes that occur after somatic maneuvers are only transitory? Why patients that have concomitant hyperacusis also have higher chances of tinnitus modulation? Further basic science and clinical research is required to address these and many other questions about somatosensory tinnitus

Emerging pharmacotherapy of tinnitus

Tinnitus, the perception of sound in the absence of an auditory stimulus, is perceived by about 1 in 10 adults, and for at least 1 in 100, tinnitus severely affects their quality of life. Because tinnitus is frequently associated with irritability, agitation, stress, insomnia, anxiety and depression, the social and economic burdens of tinnitus can be enormous. No curative treatments are available. However, tinnitus symptoms can be alleviated to some extent. The most widespread management therapies consist of auditory stimulation and cognitive behavioral treatment, aiming at improving habituation and coping strategies. Available clinical trials vary in methodological rigor and have been performed for a considerable number of different drugs. None of the investigated drugs have demonstrated providing replicable long-term reduction of tinnitus impact in the majority of patients in excess of placebo effects. Accordingly, there are no FDA or European Medicines Agency approved drugs for the treatment of tinnitus. However, in spite of the lack of evidence, a large variety of different compounds are prescribed off-label. Therefore, more effective pharmacotherapies for this huge and still growing market are desperately needed and even a drug that produces only a small but significant effect would have an enormous therapeutic impact. This review describes current and emerging pharmacotherapies with current difficulties and limitations. In addition, it provides an estimate of the tinnitus market. Finally, it describes recent advances in the tinnitus field which may help overcome obstacles faced in the pharmacological treatment of tinnitus. These include incomplete knowledge of tinnitus pathophysiology, lack of well-established animal models, heterogeneity of different forms of tinnitus, difficulties in tinnitus assessment and outcome measurement and variability in clinical trial methodology. © 2009 Informa UK Ltd.Fil: Langguth, Berthold. Universitat Regensburg; AlemaniaFil: Salvi, Richard. State University of New York; Estados UnidosFil: Elgoyhen, Ana Belen. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres"; Argentin

Somatosensory tinnitus: current evidence and future perspectives

In some individuals, tinnitus can be modulated by specific maneuvers of the temporomandibular joint, head and neck, eyes, and limbs. Neuroplasticity seems to play a central role in this capacity for modulation, suggesting that abnormal interactions between the sensory modalities, sensorimotor systems, and neurocognitive and neuroemotional networks may contribute to the development of somatosensory tinnitus. Current evidence supports a link between somatic disorders and higher modulation of tinnitus, especially in patients with a normal hearing threshold. Patients with tinnitus who have somatic disorders seems to have a higher chance of modulating their tinnitus with somatic maneuvers; consistent improvements in tinnitus symptoms have been observed in patients with temporomandibular joint disease following targeted therapy for temporomandibular disorders. Somatosensory tinnitus is often overlooked by otolaryngologists and not fully investigated during the diagnostic process. Somatic disorders, when identified and treated, can be a valid therapeutic target for tinnitus; however, somatic screening of subjects for somatosensory tinnitus is imperative for correct selection of patients who would benefit from a multidisciplinary somatic approach

Mining and analysis of audiology data to find significant factors associated with tinnitus masker

Objectives: The objective of this research is to find the factors associated with tinnitus masker from the literature, and by using the large amount of audiology data available from a large NHS (National Health Services, UK) hearing aid clinic. The factors evaluated were hearing impairment, age, gender, hearing aid type, mould and clinical comments. Design: The research includes literature survey for factors associated with tinnitus masker, and performs the analysis of audiology data using statistical and data mining techniques. Setting: This research uses a large audiology data but it also faced the problem of limited data for tinnitus. Participants: It uses 1,316 records for tinnitus and other diagnoses, and 10,437 records of clinical comments from a hearing aid clinic. Primary and secondary outcome measures: The research is looking for variables associated with tinnitus masker, and in future, these variables can be combined into a single model to develop a decision support system to predict about tinnitus masker for a patient. Results: The results demonstrated that tinnitus maskers are more likely to be fit to individuals with milder forms of hearing loss, and the factors age, gender, type of hearing aid and mould were all found significantly associated with tinnitus masker. In particular, those patients having Age<=55 years were more likely to wear a tinnitus masker, as well as those with milder forms of hearing loss. ITE (in the ear) hearing aids were also found associated with tinnitus masker. A feedback on the results of association of mould with tinnitus masker from a professional audiologist of a large NHS (National Health Services, UK) was also taken to better understand them. The results were obtained with different accuracy for different techniques. For example, the chi-squared test results were obtained with 95% accuracy, for Support and Confidence only those results were retained which had more than 1% Support and 80% Confidence. Conclusions: The variables audiograms, age, gender, hearing aid type and mould were found associated with the choice of tinnitus masker in the literature and by using statistical and data mining techniques. The further work in this research would lead to the development of a decision support system for tinnitus masker with an explanation that how that decision was obtained

Personality Traits, Perceived Stress, and Tinnitus-Related Distress in Patients With Chronic Tinnitus: Support for a Vulnerability-Stress Model

Background: Despite vulnerability-stress models underlying a variety of distress-related emotional syndromes, few studies have investigated interactions between personality factors and subjectively experienced stressors in accounting for tinnitus-related distress. Aim: The present study compared personality characteristics between patients with chronic tinnitus and the general population. Within the patient sample, it was further examined whether personality dimensions predicted tinnitus-related distress and, if so, whether differential aspects or levels of perceived stress mediated these effects. Method: Applying a cross-sectional design, 100 patients with chronic tinnitus completed the Freiburger Persönlichkeitsinventar (FPI-R) measuring personality, the Perceived Stress Questionnaire (PSQ-20) measuring perceived stress and the German version of the Tinnitus Questionnaire (TQ) measuring tinnitus-related distress. FPI-R scores were compared with normed values obtained from a representative German reference population. Mediation analyses were computed specifying FPI-R scores as independent, PSQ20 scores as mediating and the TQ-total score as dependent variables. Results: Patients with chronic tinnitus significantly differed from the general population across a variety of personality indices. Tinnitus-related distress was mediated by differential interactions between personality factors and perceived stress dimensions. Conclusion: In conceptualizing tinnitus-related distress, idiosyncratic assessments of vulnerability-stress interactions are crucial for devising effective psychological treatment strategies. Patients' somatic complaints and worries appear to be partly informed by opposing tendencies reflecting emotional excitability vs. aggressive inhibition - suggesting emotion-focused treatment strategies as a promising new direction for alleviating distress