Investigating the association between tinnitus severity and symptoms of depression and anxiety,while controlling for neuroticism,in a large middle-aged UK population

Objective: Clinical studies indicate increased risk for depression and anxiety among tinnitus patients. However population data are scarce, and no studies have controlled for neuroticism. We examined associations between tinnitus and symptoms of depression and anxiety in a large UK population, controlling for neuroticism, to explore whether neuroticism, as previously reported, fully explains the association between symptoms of depression and anxiety, and tinnitus. Design: We used the UK Biobank resource. Study sample: 171 728 participants answered hearing questions. Results: Using generalized linear modelling, we examined associations between tinnitus (mild to severe) and symptoms of depression and anxiety. Controlling for neuroticism, patients with severe tinnitus were at increased risk of depression (odds ratio (OR) = 1.27) and anxiety (OR = 1.11) symptoms, compared to those without tinnitus. Conclusions: Although it is not possible to determine whether tinnitus is a predisposing factor to depression, these results suggest an association. We suggest further exploration to determine the clinical significance of this association. Early psychosocial intervention aimed at reducing anxiety and depression in patients at increased risk might influence the extent to which tinnitus is experienced as troubling, and therefore psychological distress associated with it. Likewise, with tinnitus patients, assessment for anxiety/depression should be considered.     

The impact of tinnitus on cognitive performance in normal-hearing individuals

Objective: The aim of this study was to investigate whether the previously reported differences in cognitive performance as assessed using a Stroop paradigm between individuals with and without tinnitus is present in normal-hearing individuals. Design: Participants completed audiometric evaluation, a visual Stroop test, as well as the Swedish version of the hospital anxiety and depression scale (HADS) questionnaire. In addition individuals with tinnitus participated in a short interview regarding tinnitus characteristics as well as a follow up data collection of the tinnitus questionnaire (TQ). Study sample: Forty individuals participated in this study. Twenty had tinnitus (tinnitus group) and 20 had not (control group). The groups were age- and sex-matched and all participants had normal hearing thresholds (20 dB HL or better). Results: No differences in terms of cognitive performances were found between individuals with tinnitus compared to individuals without tinnitus. Conclusion: In contrast to previous studies of hearing-impaired subjects with tinnitus, the results of the present found no signs of cognitive interference in normal-hearing subjects with tinnitus when assessed using intensive short duration tasks.     

Psychometric properties of a Mandarin version of the tinnitus questionnaire

Objective: To develop a Mandarin version of the tinnitus questionnaire (MTQ) and determine the reliability and validity, and to assess whether it could be used clinically in the Chinese population. Design: The MTQ, short-form (36) health survey, hospital anxiety and depression scale, Mandarin (Chinese) tinnitus handicap inventory, and visual analogue scale were completed by the participants. Study sample: We included 192 adults seeking treatment for primary or secondary tinnitus. Results: Five factors, namely, emotional distress, auditory perceptual difficulties, cognitive distress, sleep disturbance, and intrusiveness, were extracted from the MTQ. Thirty-seven items were included. The MTQ had high test-retest reliability (Spearman correlation coefficients: 0.87–1.00). The MTQ and its subscales had good internal consistency and reliability (total α?=?0.93, subscales α?=?0.71–0.86). A single measure of severity can be acquired by summing the five subscale scores. The MTQ was significantly correlated with psychological distress and tinnitus-related handicap. Conclusion: Our results demonstrated that the MTQ is a reliable and valid measure of tinnitus-related psychopathological symptoms and could be used clinically to evaluate tinnitus-related psychological problems. Questionnaires designed to explore tinnitus-related depression and other symptoms not covered by the scope of the MTQ are needed.     

Cognitive coping and goal adjustment are associated with symptoms of depression and anxiety in people with acquired hearing loss

Objective: The present study examined the joint influence of cognitive coping strategies and goal adjustment on symptoms of depression and anxiety in people with acquired hearing loss (AHL). Design: The study had a cross-sectional design in which participants were asked to fill in written questionnaires. Study sample: The sample consisted of 119 individuals with moderate to profound AHL, acquired in adulthood. Symptoms of depression and anxiety, cognitive coping strategies, and goal-related coping processes were assessed. Results: Relationships between these variables were statistically tested by Pearson correlations and multiple regression analyses. The results showed that ruminative and catastrophizing ways of coping were related to the reporting of more symptoms of depression and/or anxiety. In contrast, refocusing attention to more pleasant issues, disengaging from unattainable goals, and re-engaging in alternative, meaningful goals were related to the reporting of less symptomatology. Conclusions: These results provide us with important targets for prevention and intervention of mental health problems in people with AHL.     

Systematic review on the evidences of an association between tinnitus and depression

Tinnitus has been associated with several psychiatric disorders, however there are still several questions regarding such association.ObjectiveTo assess the scientific evidence on the associations between symptoms of depression, depression, and tinnitus.MethodA systematic review was performed using PubMed, Lilacs, and SciELO scientific databases. This review included studies published in Portuguese, Spanish, or English correlating tinnitus with depression; letters to the editor and case reports were excluded.ResultsA total of 64 studies were identified, of which only 20 met the inclusion criteria and only 2 were case-control clinical trials. The majority of the studies (n = 18) found that depression is associated with tinnitus, either as a predisposition - resulting in poor adaptation to tinnitus or as a consequence of severe disease.ConclusionAn overall assessment of all of the selected studies suggests at least 3 possible associations between depression and tinnitus: depression affecting tinnitus, tinnitus predisposing individuals to depression, and tinnitus appearing as a comorbidity in patients with depression. There is a high prevalence of depressive symptoms in individuals with tinnitus, but the mechanisms by which depression and tinnitus mutually interact, are not fully understood.     

A Russian adaptation of the tinnitus handicap inventory

Objective: To establish a Russian version of the English THI. Design: The English THI (THI-E) was translated into Russian by two bilingual investigators, independently. The final Russian THI version (THI-R) was constructed by a third investigator, from the two translations. This version was administered to fifty consecutive patients at a tinnitus clinic. Participants also assessed the loudness of their tinnitus, and completed the Russian versions of the Beck's depression inventory and the state anxiety Inventory. Study sample: The participants were fifty consecutive patients (older than 18 years of age with a tinnitus lasting over three months) who were treated at a tinnitus clinic. Results: A very good internal consistency was found (α = 0.94), with significant correlation between the THI-R score and the Beck depression inventory score. Factor analysis confirmed a uni-dimensional structure of the inventory. Conclusions: A valid and reliable THI-R questionnaire was constructed.     

Factors related to tinnitus and hyperacusis handicap in older people

Objective: The aim was to assess factors related to tinnitus and hyperacusis handicap in older people. Design: Retrospective cross-sectional. Study sample: Data were gathered for 184 patients with an average age of 69 years. Results: Tinnitus handicap as measured via the Tinnitus Handicap Inventory (THI) was significantly predicted by tinnitus annoyance as measured via the visual analogue scale (VAS) (regression coefficient, b?=?2.9, p?b?=?3.9, p?b?=?0.8, p?b?=?0.07, p?=?0.048). Insomnia scores as measured via the Insomnia Severity Index (ISI) were significantly predicted by scores on the depression subscale of the HADS (b?=?0.46, p?=?0.007). Conclusions: Since tinnitus annoyance significantly predicts tinnitus handicap, it is important to explore factors associated with annoyance that may be useful in designing appropriate rehabilitative interventions aimed at reducing tinnitus handicap in older people. Future studies should explore whether hyperacusis and insomnia in older people with tinnitus need to be managed in conjunction with treatment for depression.     

Systematic review and meta-analyses of randomized controlled trials examining tinnitus management

Objectives/Hypothesis:

To evaluate the existing level of evidence for tinnitus management strategies identified in the UK Department of Health's Good Practice Guideline.

Study Design:

Systematic review of peer‐reviewed literature and meta‐analyses.

Methods:

Searches were conducted in PubMed, Cambridge Scientific Abstracts, Web of Science, and EMBASE (earliest to August 2010), supplemented by hand searches in October 2010. Only randomized controlled trials that used validated questionnaire measures of symptoms (i.e., measures of tinnitus distress, anxiety, depression) were included.

Results:

Twenty‐eight randomized controlled trials met our inclusion criteria, most of which provide moderate levels of evidence for the effects they reported. Levels of evidence were generally limited by the lack of blinding, lack of power calculations, and incomplete data reporting in these studies. Only studies examining cognitive behavioral therapy were numerous and similar enough to perform meta‐analysis, from which the efficacy of cognitive behavioral therapy (moderate effect size) appears to be reasonably established. Antidepressants were the only drug class to show any evidence of potential benefit.

Conclusions:

The efficacy of most interventions for tinnitus benefit remains to be demonstrated conclusively. In particular, high‐level assessment of the benefit derived from those interventions most commonly used in practice, namely hearing aids, maskers, and tinnitus retraining therapy needs to be performed.     

儿童变应性鼻炎对认知功能及情绪的影响

目的探讨儿童变应性鼻炎(AR)对认知功能及情绪的影响,并探索影响认知的危险因素。方法选择该院2018年1月—2020年8月被诊断为AR的患儿223例,并招募220例年龄、性别、受教育程度相匹配的健康体检儿童作为对照组,受试人群均接受神经心理测试：蒙特利尔认知测评量表(MoCA)、言语流畅性、数字广度、木块图、儿童社交焦虑量表(SASC)、儿童抑郁障碍自评量表(DSRSC)。结果AR患儿MoCA、言语流畅性、数字广度、木块图得分均较低(P < 0.05);SASC、DSRSC得分均较高(P < 0.05)。AR组的MoCA得分与SASC、DSRSC及AR严重程度呈负相关(r=-0.346、-0.432、-0.479,P < 0.01)。结论AR患儿的整体认知及言语、记忆、执行功能均受损,并合并焦虑抑郁,较高水平的焦虑、抑郁及中重度鼻炎是影响认知的危险因素。     

Tinnitus impairs cognitive efficiency

Many people who complain of tinnitus say that the noises impair their mental concentration. This complaint was investigated by self-report (primarily the Cognitive Failures Questionnaire) and by means of five cognitive tasks, four presented via laptop computer and one given manually. The tasks measured performance under single and dual-task conditions and included tests of sustained attention, reaction time, verbal fluency and immediate and delayed memory. Two groups of outpatients attending audiological clinics (tinnitus, n?=?43; hearing impairment, n?=?17) were compared with non-clinical volunteers (n?=?32). The results replicated earlier findings that tinnitus outpatients report significantly more everyday cognitive failures than do controls. The tinnitus group responded significantly more slowly than the two control groups on the variable fore-period reaction time task under dual-task conditions. In general, comparisons between the groups on other tasks showed equivalent performance, but both clinical groups performed more poorly than non-clinical controls on verbal fluency. We conclude that cognitive inefficiency in tinnitus participants is related to the control of attentional processes, consistent with our earlier theoretical speculation about the nature of tinnitus complaint and with published findings on the effects of chronic pain on cognitive processes.     

Tinnitus severity and its association with cognitive and somatic anxiety: a critical study

Tinnitus has been defined as a phantom auditory perception. Research indicates the necessity to make a distinction between the physical symptom and the subjective severity of the tinnitus symptom, since especially the latter seems to vary among patients. The relationship between tinnitus severity and psychological variables has been well established. Anxiety is considered to be an important variable for understanding the differences in the subjective tinnitus severity. Although many studies confirm the relationship between anxiety and tinnitus severity, most studies do not take the possibility of shared method variance and content overlap between questionnaires into account. Furthermore, anxiety is a broad concept and contains both a cognitive and somatic dimension. Research including both dimensions of anxiety in tinnitus population is rare. According to us two conditions must be fulfilled before theorization on the relation is useful: (1) the presence of clinically relevant cognitive and/or somatic anxiety, (2) evidence of a substantial or “real” relationship. In our sample, almost 60% reported more than average cognitive anxiety and 40.8% reported clinical relevant somatic anxiety. After controlling for content overlap between the questionnaires used, the relation between tinnitus severity and cognitive and somatic anxiety remains significant. Two hypothetical models concerning this relationship that deserve future research attention are described.     

Electrophysiological and psychological studies in tinnitus

Objectives

Tinnitus can be accompanied by depression, anxiety, insomnia, problems with auditory perception and poor general and mental health. This work was designed to evaluate the cognitive and psychological status in tinnitus patients using different subjective and objective measures.

Methods

This work included 40 patients complaining of tinnitus without any vestibular complaints. Those patients were compared with 40 healthy age and sex matched controls. All subjects were evaluated through: basic audiologic evaluation, electrophysiological test (P300), oculomotor tests (smooth-pursuit, optokinetic, gaze and saccadic eye movements) and psychological evaluation (Hamilton depression and anxiety scales, Mini Mental Status Examination and Trail making tests).

Results

Patients with tinnitus showed abnormalities at both electrophysiological and psychological levels when compared with normal subjects.

Conclusion

This study provides evidences that different pathological mechanisms are involved in tinnitus generation which are more extensive than we thought.     

Children's experience of tinnitus: a preliminary survey of children presenting to a psychology department

Tinnitus has been much researched within adult populations with consideration of prevalence as well as the impact of tinnitus on individual's lives. Although the literature highlights the prevalence of tinnitus in children, there is little information on its effects from a psychological perspective. This small-scale preliminary study looked at 24 children (50% with normal hearing and 50% with a hearing loss) who presented to the Psychology Department with troublesome tinnitus. In line with adult studies, preliminary results suggested that tinnitus can have as marked an effect on children's lives as it is reported to have on adults. Insomnia, emotional distress, listening and attention difficulties are the main psychological factors associated with tinnitus in children. These, in turn, may have an effect upon their school performance. Differences were found between children with normal hearing and those with some degree of hearing loss. Overall, children with normal hearing found tinnitus more troublesome and presented with higher levels of anxiety than those with some level of hearing impairment. The present study suggests that children who complain of tinnitus should be taken seriously. In terms of management, individual intervention packages were found to be useful in alleviating anxiety and other associated factors. Recommendations are made on areas for future research.     

Epidemiology and risk factors for tinnitus after leisure noise exposure in Flemish young adults

Objective: Young people regularly expose themselves to leisure noise and are at risk of acquiring tinnitus. This study examined the prevalence of leisure noise-induced tinnitus among Flemish young adults as well as the relation with sociodemographic factors, health-related variables and attitudes and beliefs towards noise. Design: A self-administered questionnaire was used to evaluate the presence of noise-induced tinnitus, the amount of leisure noise and attitudes towards noise and hearing protection. Study sample: 517 subjects between 18 and 30 years were included. Results: Temporary and chronic tinnitus occurred in 68.5% and 6.4% of the sample, respectively. Chronic tinnitus was more prevalent in male subjects and associated with more hearing-related symptoms. Furthermore, subjects with chronic tinnitus were more aware of the risks of noise and the importance of hearing protection. Finally, higher levels of leisure noise were independently associated with chronic tinnitus. Conclusions: Tinnitus is observed frequently in young adults. Results also indicate that persons with chronic tinnitus were exposed to a higher noise dose during their lives. Longitudinal studies may be useful to evaluate whether the experience of chronic tinnitus has led to behavioural changes. These findings further underpin the importance of educating youth about the risks of leisure noise exposure.     

A Hebrew adaptation of the tinnitus handicap inventory

Abstract

Objective: To establish a Hebrew version of the English THI. Design: The English THI (THI-E) was translated into Hebrew by two bilingual investigators, independently. A third investigator then constructed the final Hebrew THI version (THI-H) from the two translations. This version was administered to fifty consecutive patients at the tinnitus clinic. Participants also assessed tinnitus severity and loudness, and completed the Hebrew versions of the Beck's depression inventory and the state anxiety inventory. Study sample: The participants were fifty consecutive patients (older than 18 years of age, with a tinnitus lasting over three months) who were referred to a tinnitus clinic (none of them declared compensation seeking). Results: A very good internal consistency was found (α = 0.93), with significant correlation between the subscales of the THI-H and the Beck depression inventory score and the state anxiety inventory score. Conclusions: A valid and reliable THI-H questionnaire was constructed.

Sumario

Objetivo: Establecer una versión en Hebreo del THI en Inglés. Diseño: El THI en Inglés (THI-E) fue traducido al Hebreo por dos investigadores bilingües de manera independiente. Un tercer investigador elaboró después la versión final del THI en Hebreo (THI-H) a partir de las dos traducciones. Esta versión se administró a cincuenta pacientes consecutivos en la clínica de acufeno. Los participantes también evaluaron la severidad del acufeno y su intensidad subjetiva y completaron las versiones en Hebreo del Inventario de Depresión de Beck y el Inventario del Estado de Ansiedad. Muestra de Estudio: Los participantes fueron cincuenta pacientes consecutivos (mayores de 18 años con acufeno de duración mayor a 3 meses) que fueron referidos a la clínica de acufeno (ninguno de ellos declaró búsqueda de compensación). Resultados: Se encontró una muy buena consistencia interna (α = 0.93), con correlación significativa entre las subescalas del THI-H y las puntuaciones del Inventario de Depresión de Beck y del Inventario de Estado de Ansiedad. Conclusiones: Se elaboró un Cuestionario de THI-H válido y confiable.     

Anxiety and depression,personality traits relevant to tinnitus: A scoping review

Objective: Scoping reviews of existing literature were conducted to identify key personality traits relevant to tinnitus, and examine the relationship between affective disorders and tinnitus. Design: The methodological framework of Arksey and O’Malley was followed. Study sample: Sixty studies were chosen for charting the data, 14 studies examined personality traits exclusively, 31 studies examined affective disorders exclusively, and 15 studies investigated both. Results: The presence of one or more specific personality traits of high neuroticism, low extraversion, high stress reaction, higher alienation, lower social closeness, lower well-being, lower self control, lower psychological acceptance, presence of a type D personality, and externalized locus of control were associated with tinnitus distress. Anxiety and depression were more prevalent among the tinnitus clinical population and at elevated levels. Conclusions: Personality traits have a consistent association with the distress experienced by adult tinnitus help-seekers, and help-seekers are also more likely to experience affective symptoms and/or disorders.     

Self-reported and behavioral sound avoidance in tinnitus and hyperacusis subjects,and association with anxiety ratings

Abstract

Objective: The purpose of the study was to analyse the role of sound avoidance and anxiety in tinnitus subjects with hyperacusis, defined as hypersensitivity to low to moderate intensity sounds. Design: A group of tinnitus subjects with hyperacusis was compared to tinnitus subjects without hyperacusis, and healthy controls. For assessing noise avoidance, a questionnaire was developed (noise avoidance questionnaire, NAQ) and the duration of self-exposure to a pure tone was assessed as a behavioral index. Different self-rating instruments concerning tinnitus (STI, TF-12), hyperacusis (GÜF), and anxiety (BAI, STAI-T) were used, as well as a psychoacoustic indicator of hyperacusis (ULL). Study sample: Fifty-six tinnitus subjects with/without hyperacusis and 30 controls without tinnitus and hyperacusis participated in the experiment. Results: The findings indicate that subjects with hyperacusis reported significantly more noise-related avoidance in daily life and show significantly shorter exposure to a pure tone than non-hyperacusic subjects, while discomfort was at the same level for each individual. Self-reported avoidance behavior correlated significantly with distress attributed to hyperacusis (r =0.81), and with anxiety ratings. Conclusions: These results suggest that hyperacusis is associated with noise-related avoidance behavior and anxiety. Systematic exposure to sound could play a significant role in the treatment of hyperacusis.     

The suffering of tinnitus in childhood and adolescence

Objectives: Investigate the profile of young patients complaining of tinnitus and study the prevalence and the severity of tinnitus in schoolchildren.

Design: Ninety-five consecutive patients (55 boys), 8–20 years old, seeking help for tinnitus at our clinic were studied using audiometry, structural interviews, Tinnitus Severity Questionnaire (TSQ) and Hospital Anxiety and Depression Scale (HAD), together with Visual Analog Scales (VAS) on tinnitus loudness and annoyance.

Results: The onset of tinnitus was twice as often sudden than gradual. In 54% of the children, tinnitus had started after noise exposure, most commonly listening to music. Correlations were found between the pure-tone average (PTA) of 3, 4, and 6 kHz and TSQ scores; between TSQ and HAD subscales; and between TSQ and VAS. According to the Hospital Anxiety Depression Scale, 32% and 14.5%, respectively, were above the cut level for clinical anxiety and depressive disorders. The girls showed more signs of anxiety disorders than the boys.

Conclusions: The majority of the help seekers had been exposed to noise, mostly music. Predisposing factors for tinnitus severity are high-frequency hearing loss and anxiety and depressive disorders.     

The role of cognition in tinnitus

CONCLUSIONS: The role of cognition in tinnitus is difficult to ignore. First, tinnitus is likely to disrupt cognitive functioning, and there are some indications that tinnitus patients have impaired capacity to perform certain cognitive tasks. Second, evidence is emerging that tinnitus patients show cognitive bias in the way they handle information. Such information processing style suggests either depressive functioning, or anxious vigilance, or both. Finally, self-report measures of tinnitus distress all require conscious recollection of how tinnitus is perceived and the consequences of tinnitus. Such reports necessitate cognitive capacity. OBJECTIVES: To review the literature on the interface between cognitive function and tinnitus, with special regard to the role of different levels of information processing. MATERIALS AND METHODS: A selective systematic literature search was conducted using the search engines of Medline and Psychological Abstracts, and by hand search of conference proceedings. RESULTS: There are yet relatively few published studies on cognitive functioning in tinnitus patients. Most research has been conducted by a few separate research groups. However, the available studies clearly implicate an important role of cognitive processes at different levels from basic cognitive function to more conscious appraisal of the consequences of tinnitus. Finally, a tentative model of the road from tinnitus generation to annoyance via cognitive function is suggested.     

Tinnitus loudness and the severity of insomnia: a mediation analysis

Objective: To assess the relationship between the loudness of tinnitus and insomnia via a mediation analysis.

Design: Retrospective cross-sectional.

Study Sample: 417 consecutive patients seeking treatment for tinnitus in an Audiology Department in the UK.

Results: Mediation analysis showed that the relationship between tinnitus loudness measured using the visual analogue scale (VAS) and insomnia measured using the insomnia severity index was fully mediated via depression measured using the Patient Health Questionnaire, tinnitus handicap measured using the Tinnitus Handicap Inventory and tinnitus annoyance measured using the VAS. The regression coefficients for the indirect effects of tinnitus loudness on insomnia were: via depression b?=?0.53 (95% confidence interval, CI: 0.35–0.71); via the VAS for tinnitus annoyance, b?=?0.33 (95% CI: –0.004–0.66); and via tinnitus handicap, b?=?0.38 (95% CI: 0.16–0.6). The coefficient for the total indirect effect was b?=?1.23 (95% CI: 0.89–1.58). The coefficient for the direct effect of tinnitus loudness on insomnia was b?=?0.11 (95% CI: –0.27–0.51), a non-significant effect.

Conclusions: Insomnia is not directly related to tinnitus loudness. Depression, tinnitus handicap and tinnitus annoyance mediate the relationship between tinnitus loudness and insomnia.