Tinnitus: clinical experience of the psychosomatic connection

European Archives of Oto-Rhino-Laryngology, 2007

The aim of present study was to determine the psychiatric symptoms and comorbidities in patients affected by tinnitus. The study sample, between June 2004 and September 2005, consisted of 180 Turkish adults living in Elazıg. Ninety consecutive tinnitus patients were enrolled on their first visit to the outpatients clinic. Control subjects were recruited partly from the social surroundings of the authors. All subjects with significant medical and/or psychiatric pathologies, such as schizophrenia, manicdepressive psychosis, dementia, and behavioural disorders with social withdrawal or suicidal risk, were excluded, as were those unwilling to take part in the study. For the psychopathological examination, patients underwent the Structured Clinical Interview for DSM-III-R (SCID-I, SCID-II). Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Symptom Check list-90 (Revised) (SCL-90-R) were also administered to patients with tinnitus and control subjects. SCL-90-R subscales scores, Beck Anxiety Inventory and Beck Depression Inventory scores were significantly higher in tinnitus patients than in normal control subjects. Twenty-four patients (26.70%) with tinnitus had at least one psychiatric diagnosis. Five control subjects (5.60%) had at least one psychiatric diagnosis. There were significant differences between the two groups (P \ 0.001). Anxiety disorders and somatoform disorders were significantly higher in tinnitus patients than in normal control subjects. We conclude that psychiatric symptoms (such as symptoms of anxiety, depression or somatization) among patients with tinnitus should alert clinicians for the presence of a chronic and complex psychiatric condition (Axis-I and Axis-II disorders).

Journal Riphah College of Rehabilitation Sciences, 2024

Objectives: To determine the characteristics of tinnitus and its association with clinical and demographic variables including psychological health. Methodology: This cross-sectional study recruited 80 tinnitus cases from ENT outpatients of District Head Quarter Hospital Chakwal from over a period of 6 months from 1st Jan 2019 to 31st June, 2019, using convenience sampling. Sample included both genders, aged 18-75 years with tinnitus for at least three months. Tinnitus Handicap Inventory (THI) & Depression Anxiety and Stress Scale 21 (DASS-21) were used for data collection & analysis done using SPSS-version 20. Anova statistics & Pearsons correlation was determined for THI and DASS-21. Chi-square test was used to see any association with clinic-demographic variables. P<0.05 was considered significant. Results: Study revealed 30(37.5%) cases with mild, 20(25%) each with moderate and severe while least 4(5%) catastrophic tinnitus. Tinnitus severity was significant associated with gender (p=0.005), age (p=0.035), educational level (p=0.049), occupation (p=0.002), duration of tinnitus (p=0.038), site of tinnitus (P<0.001) and type of tinnitus sound (P=0.003). Duration of tinnitus was associated with anxiety (p=0.024), site of tinnitus was associated with THI (p=0.016), anxiety (p=0.021), stress (p<0.001) and depression (p=0.02) and total DASS-21 (p=0.005). A significant positive correlation was present between tinnitus handicap, Anxiety, stress, depression and DASS-21 total score (P<0.001). Conclusion: Mild tinnitus was most prevalent (37.5%) with Tinnitus severity having significant association with gender, age, educational level, occupation, duration of tinnitus, site of tinnitus, and type of tinnitus sound. Duration of tinnitus was also associated with anxiety while site of tinnitus has association with THI, anxiety, stress, depression and total DASS-21. Significant positive correlation is present between THI and Anxiety, stress, depression and DASS-21 total score.

https://www.ijrrjournal.com/IJRR_Vol.7_Issue.1_Jan2020/Abstract_IJRR0082.html, 2020

Introduction- Tinnitus is perceived as a continuous buzzing, hissing or ringing in the ears and in some cases in head. One of common cause of subjective tinnitus is psychogenic. The high prevalence of anxiety and depression in patients of tinnitus warrants a review of literature to shed light on the link between these diseases. Despite theoretical suggestions of a link between stress and tinnitus, this notion has received little empirical support. We conducted this study with aim to find out the psychological factors in patients suffering from psychogenic tinnitus. Methodology- Fifty patients with diagnosis of psychogenic tinnitus referred to psychiatry outpatient department underwent detailed psychiatric evaluation by a consultant psychiatrist. Psychiatric diagnoses were considered as per ICD-10 DCR criteria. Hamilton Depression rating scale (HAM-D) was used to assess Depressive symptoms and Hamilton Anxiety Rating scale (HAM-A) was used to asses anxiety symptoms. Perceived Stress scale (PSS) was used to assess the perception of stress. Visual Analog Scale (VAS) was used asses the severity of Tinnitus. The statistical analyses were conducted using Statistical package for the social sciences (SPSS version 16) software. Results- Majority of patients reported difficulty in falling asleep (28%), Dizziness was reported by 20% of patients , 20% reported Headache, 16% reported Irritability, 8% reported difficulty in concentrating due to tinnitus, 3% patients were fearful about their illness. Most common psychiatric diagnosis in our study was anxiety disorders (18%), followed by Depressive disorder (14%). 3 (6%) Tinnitus patients also suffered from Somatoform Disorders. Correlation analysis showed significant correlation between visual analog scale annoyance, coping, distress, loudness scores and perceived stress scores Conclusion- This study has revealed significant psychological stress and psychiatric comorbidity associated with psychogenic tinnitus patients. Stress can be particularly related to aetiology as well as morbidity of psychogenic tinnitus. Keywords: Tinnitus, psychiatric comorbidity, HAM-D, HAM-A, Stress

Quality of Life Research, 2013

Purpose Known association between tinnitus and psychological distress prompted us to examine patients with chronic tinnitus by using the Composite International Diagnostic Interview (CIDI), which is a standardized and reliable method used for the diagnosis of mental disorders. Methods One hundred patients with chronic tinnitus admitted to the Tinnitus Center, Charité-Universitätsmedizin Berlin, were included in this study. Data were collected between February 2008 and February 2009. Besides CIDI, the Tinnitus Questionnaire according to Goebel and Hiller, the Hospital Anxiety Depression Scale, and the General Anxiety Disorder-7 were used. Results Using CIDI, we have identified one or more mental disorders in 46 tinnitus patients. In that group, we found persistent affective disorders (37 %), anxiety disorders (32 %), and somatoform disorders (27 %). Those patients who had affective or anxiety disorders were more distressed by tinnitus and were more anxious and more depressed than tinnitus patients without mental disorders. Psychological impairment positively correlated with tinnitus distress: Patients with decompensated tinnitus had significantly more affective and anxiety disorders than patients with compensated tinnitus. Conclusions In the present study, we have detected a high rate (almost half of the cases) of psychological disorders occurring in patients with chronic tinnitus. The patients diagnosed with psychological disorders were predominantly affected by affective and anxiety disorders. Psychological disorders were associated with severity of tinnitus distress. Our findings imply a need for routine comprehensive screening of mental disorders in patients with chronic tinnitus.

… international tinnitus …, 2010

Journal of Experimental Psychopathology

The current study is the first substantial investigation to determine whether tinnitus perception mediates the relationship between physiological and psychological problems (PP). Simple random sampling, with a cross-sectional design, was used to collect data from 100 adult patients (males = 60; females = 40) diagnosed with chronic tinnitus. Subjects were approached through various public and private hospitals, at their respective Audiology and Ear, Nose, and Throat departments in Rawalpindi and Lahore, Pakistan. Participants underwent complete physiological and psychological tinnitus evaluations, such as tinnitus matching and audiometry, as well as assessments using standardized tinnitus instruments. The mediation analyses revealed an indirect relationship with hearing loss (HL) and PP (e.g., anxiety, stress, depression, mood swings) in tinnitus patients. These findings suggest that physiological problems such as tinnitus and HL might contribute to the development of psychological s...

European Archives of Oto-Rhino-Laryngology, 2012

The study was carried out to determine the impact of some co-morbid otological symptoms and demographic factors on the emotional distress and cognitive functioning in patients with tinnitus. One hundred consecutive patients, complaining of constant idiopathic tinnitus, were enrolled into the study. Four tests were administered: Beck Depression Inventory, Hospital Anxiety Depression Scale (HADS, A-anxiety, D-depression), Mini-Mental State Examination (MMSE) and Trail Making Test (TMT). A multivariate stepwise linear regression analysis was performed to estimate the relationship between the results of each of the tests and following co-morbid factors: age, sex, tinnitus duration, tinnitus laterality, hearing status (normal hearing, unilateral hearing loss and bilateral hearing loss) and vertigo/dizziness. It was found that the scores of MMSE and TMT were negatively correlated with age and with hearing status and the scores of HADS-A were slightly correlated with sex. In regression analysis, in HADS-A, sex and to a lesser extent tinnitus duration, in MMSE and TMT age and to a lesser extent tinnitus laterality were the variables that were comprised in the final model. Demographic factors had contributed more than overlapping otological symptoms to the psychological outcome in tinnitus patients.

Journal of Psychosomatic Research, 2010

Clinical studies indicate a strong association between tinnitus and mental health, but results from general population data are missing. The purpose of the study was to examine the association between tinnitus, mental health, and wellbeing in the general adult population and to identify factors that might mediate and moderate this association. Methods: Data from 51,574 adults participating in the Nord-Trøndelag Hearing Loss Study (1995)(1996)(1997), part of the Nord-Trøndelag Health Study (HUNT-2), were analyzed. The association between tinnitus symptom intensity and symptoms of depression, anxiety, selfesteem, and subjective well-being was examined by multivariate ANOVA, stratified by age group and sex. Explanatory variables were age, marital status, education, hearing, dizziness, vision, physical disability, and somatic illness. In a subsample of participants with tinnitus, the effects of "time since onset," "predictability of tinnitus episodes," and "noise sensitivity" were tested. Results: Participants with tinnitus scored significantly higher on anxiety and depression and lower on self-esteem and well-being than people without tinnitus. The effect sizes were small and quite similar across levels of tinnitus symptom intensity. No significant effect of time since onset was found. A significant effect of predictability of tinnitus episodes and noise sensitivity was found in some groups. Conclusion: A weak association between tinnitus and mental health was found in this general population study.

The International Tinnitus Journal, 2016

Introduction: tinnitus patients have higher risk of developing anxiety-depressive disorders and decreased quality of life. The reasons why selected patients are able to cope with chronic tinnitus, whereas it represents a disabling symptom for others remain under discussion. Objectives: the objective of the study was to determine the tinnitus-related degree of distress along with the prevalence of anxiety-depression disorders in a sample of eighty patients referring for chronic tinnitus at the Department of Otolaryngology of Catholic University of Rome from March to September 2015. Materials and Methods: we administered to all patients the Italian versions of Tinnitus Handicap Inventory (THI) and Hospital Anxiety and Depression Scale (HADS). Furthermore we investigated the correlation among patient's discomfort, severity of hearing loss and age. Results: average THI score was 40.85, meaning moderate degree of discomfort; 57.5% of the patients showed HADS scores consistent with high risk of psychiatric comorbidities. A significant linear correlation between THI and HADS scores was demonstrated. Conclusion: we suggest that patients with severe tinnitus-related distress are routinely invited to accomplish psychometric questionnaires, to assess the possibility of a neuropsychiatric evaluation and/or specific pharmacological planning. At this purpose we recommend the administration of HADS, as a reliable and quick instrument.

Neuropsychiatry, 2018

Evaluate the presence of psychopathological symptoms and quality of life in patients with bothersome tinnitus and correlate it with tinnitus annoyance. Study design A cross-sectional study was performed. Setting: Ambulatory of Tinnitus-UNIFESP/EPM. Subjects and methods Group A included 40 patients with persistent and bothersome tinnitus and hearing loss; Group B had 26 patients with persistent and bothersome tinnitus without hearing loss; Group C (control group) had 26 individuals without either tinnitus or hearing loss. Each participant completed the BECK depression and anxiety scales, the Obsessions and Compulsions Inventory-Revised, the Tinnitus Handicap Inventory and Medical Outcomes Study Short Form-36. Results Psychopathological symptoms were more present in the patients than in controls (p<0.05); 37.9% had depression, 47% anxiety and 40% obsessive-compulsive disorder. Positive associations between the degree of discomfort and depression, anxiety and the concurrence of more than one psychopathological symptoms were observed. The degree of tinnitus discomfort showed a strong correlation (r>0.40) with anxiety and depression; physical, social and mental health quality of life domains and obsessive symptoms. Conclusion Depression, anxiety and OCD are related to tinnitus annoyance. These patients showed impairment in "social aspect", "emotional aspect" and "functional capacity". The presence of more than one psychopathological disorder was responsible for a worsening in the degree of tinnitus. The concomitance of anxiety and depression, depression and obsessive symptoms (OCD) or depression and lack of social interactions, were able to predict an increased discomfort of tinnitus in these patients.