Tinnitus and Influencing Comorbidities. / Tinnitus und beeinflussende Komorbiditäten.

Numerous studies show that impairments in chronic tinnitus are closely connected with psychosomatic and other concomitant symptoms. This overview summarizes some of these studies. Beyond hearing loss, individual interactions of medical and psychosocial stress factors as well as resources are of central importance. Tinnitus related distress reflects a large number of intercorrelated, psychosomatic influences - such as personality traits, stress reactivity and depression or anxiety - which can be accompanied by cognitive difficulties and should be conceptualized and assessed within a vulnerability-stress-reaction model. Superordinate factors such as age, gender or education level can increase vulnerability to stress. Therefore, diagnosis and therapy of chronic tinnitus be individualised, multidimensional and interdisciplinary. Multimodal psychosomatic therapy approaches aim to address individually constellated medical, audiological and psychological influences in order to sustainably increase the quality of life of those affected. Counselling in the first contact is also indispensable for diagnosis and therapy.

Prediction of treatment outcome in patients suffering from chronic tinnitus - from individual characteristics to early and long-term change.

BACKGROUND AND OBJECTIVE: Despite the availability of successful treatment approaches for chronic tinnitus, it has proven difficult to predict who profits from treatment and it is still an open question if it is possible at all. We tried to overcome methodological shortcomings and to predict treatment outcome indicated by questionnaires measuring tinnitus distress. METHODS: This is an observational, prospective cohort study. Lasso and post-selection inference methods were used to predict treatment outcome in patients suffering from chronic tinnitus (N = 747). Patients were treated for five consecutive days in an interdisciplinary setting according to guidelines. RESULTS: Early change, i.e. a positive response after the screening day, as well as change due to treatment was predicted by several psychopathological variables, but also tinnitus-related factors. Female gender as an example was a predictor for change due to treatment. In general, therapy success both for early change and change due to treatment cannot be predicted satisfactorily as indicated by a high mean cross-validation error (for early change: 9.83, for change due to treatment: 14.40). Analyzing sub-groups separated by tinnitus severity to reduce heterogeneity did not improve the situation and for patients with high tinnitus severity no predictors at all could be reported (cross-validated error: 11.62 for the low quartile, 13.38 for the low-medium quartile, and 15.61 for the medium-high quartile). CONCLUSION: Several psychopathological and tinnitus-related variables predicted early and long-term change. Nevertheless, also overcoming methodological shortcomings to predict treatment success did not lead to satisfactory results, but rather emphasizes the high heterogeneity of chronic tinnitus.

The Influence of Depression, Anxiety and Cognition on the Treatment Effects of Ginkgo biloba Extract EGb 761® in Patients with Tinnitus and Dementia: A Mediation Analysis.

BACKGROUND: Comorbid occurrence of tinnitus and emotional symptoms of anxiety and depression is highly prevalent. The Ginkgo biloba extract EGb 761® has been shown to be effective in reducing neuropsychiatric symptoms in patients with dementia and tinnitus. METHODS: We performed a mediation analysis to evaluate direct effects of EGb 761® on tinnitus severity, as well as indirect effects mediated by symptoms of depression and anxiety and by changed cognition. We pooled data from subsets of patients suffering from tinnitus that were enrolled in three double-blind, randomized, placebo-controlled clinical trials, which investigated the efficacy of EGb 761® (240 mg/day for 22-24 weeks) in dementia with concomitant neuropsychiatric symptoms. RESULTS: In total, 594 patients suffered from tinnitus (EGb 761®, 289; placebo, 305). Direct effects of EGb 761® on tinnitus severity (p < 0.001) in patients with mild to moderate dementia were found to represent about 60% of the total effect, whereas the indirect effects (p < 0.001) mediated by improvement of anxiety, depression and cognition represented about 40% of the total effect. CONCLUSIONS: EGb 761® could be considered as a supporting treatment for tinnitus in elderly patients suffering from dementia, with added benefit in those with symptoms of depression or anxiety.

[Validation of the German Version of Tinnitus Functional Index (TFI)]. / Validierung der deutschen Version des Tinnitus Functional Index (TFI).

Tinnitus belongs to seriously debilitating auditory conditions and is often complicated by comorbidities such as insomnia, difficulties with concentration, depression, frustration and irritability. To facilitate the grading of symptoms and the effects of therapeutic strategies, we validated a German-version Tinnitus Functional Index (TFI) in 229 subjects suffering from chronic tinnitus. Outcome validity was assessed using the Tinnitus Questionnaire (TQ, German adaptation by Goebel u. Hiller [1998]). Construct validity was assessed using the "Hamburger Allgemeine Depressionsskala" (HADS). The German TFI featured excellent internal consistency (total score Cronbach's α=0.93). Factor analysis disclosed eight TFI subscales as proposed earlier by Meikle et al. [2012]. Intercorrelations were strong both between the TFI and the TQ (r=0.83), and between the TFI and the HADS (depression r=0.49, anxiety r=0.51). The German-version TFI qualifies as a rapid and statistically robust tool for grading the impact of tinnitus on daily living and for the measurements of therapeutic effects. Regarding depressive symptomatology, sensitivity of the TFI was comparable to that of the TQ.

In Patients Undergoing Cochlear Implantation, Psychological Burden Affects Tinnitus and the Overall Outcome of Auditory Rehabilitation.

Cochlear implantation (CI) is increasingly being used in the auditory rehabilitation of deaf patients. Here, we investigated whether the auditory rehabilitation can be influenced by the psychological burden caused by mental conditions. Our sample included 47 patients who underwent implantation. All patients were monitored before and 6 months after CI. Auditory performance was assessed using the Oldenburg Inventory (OI) and Freiburg monosyllable (FB MS) speech discrimination test. The health-related quality of life was measured with Nijmegen Cochlear implantation Questionnaire (NCIQ) whereas tinnitus-related distress was measured with the German version of Tinnitus Questionnaire (TQ). We additionally assessed the general perceived quality of life, the perceived stress, coping abilities, anxiety levels and the depressive symptoms. Finally, a structured interview to detect mental conditions (CIDI) was performed before and after surgery. We found that CI led to an overall improvement in auditory performance as well as the anxiety and depression, quality of life, tinnitus distress and coping strategies. CIDI revealed that 81% of patients in our sample had affective, anxiety, and/or somatoform disorders before or after CI. The affective disorders included dysthymia and depression, while anxiety disorders included agoraphobias and unspecified phobias. We also diagnosed cases of somatoform pain disorders and unrecognizable figure somatoform disorders. We found a positive correlation between the auditory performance and the decrease of anxiety and depression, tinnitus-related distress and perceived stress. There was no association between the presence of a mental condition itself and the outcome of auditory rehabilitation. We conclude that the CI candidates exhibit high rates of psychological disorders, and there is a particularly strong association between somatoform disorders and tinnitus. The presence of mental disorders remained unaffected by CI but the degree of psychological burden decreased significantly post-CI. The implants benefitted patients in a number of psychosocial areas, improving the symptoms of depression and anxiety, tinnitus, and their quality of life and coping strategies. The prevalence of mental disorders in patients who are candidates for CI suggests the need for a comprehensive psychological and psychosomatic management of their treatment.

Genetic susceptibility to bilateral tinnitus in a Swedish twin cohort.

PURPOSE: Genetic contributions to tinnitus have been difficult to determine due to the heterogeneity of the condition and its broad etiology. Here, we evaluated the genetic and nongenetic influences on self-reported tinnitus from the Swedish Twin Registry (STR). METHODS: Cross-sectional data from the STR was obtained. Casewise concordance rates (the risk of one twin being affected given that his/her twin partner has tinnitus) were compared for monozygotic (MZ) and dizygotic (DZ) twin pairs (N = 10,464 concordant and discordant twin pairs) and heritability coefficients (the proportion of the total variance attributable to genetic factors) were calculated using biometrical model fitting procedures. RESULTS: Stratification of tinnitus cases into subtypes according to laterality (unilateral versus bilateral) revealed that heritability of bilateral tinnitus was 0.56; however, it was 0.27 for unilateral tinnitus. Heritability was greater in men (0.68) than in women (0.41). However, when female pairs younger than 40 years of age were selected, heritability of 0.62 was achieved with negligible effects of shared environment. CONCLUSION: Unlike unilateral tinnitus, bilateral tinnitus is influenced by genetic factors and might constitute a genetic subtype. Overall, our study provides the initial evidence for a tinnitus phenotype with a genetic influence.Genet Med advance online publication 23 March 2017.

[Tinnitus - Clinical Symptoms and Therapy]. / Tinnitus ­ Klinik und Therapie.

Tinnitus is a phantom sound that can be a symptom of various disorders such as hearing loss, cardiovascular diseases, neurological disorders, diabetes or tumors. Because of the inability to divert the auditory attention from tinnitus sound, patients suffer with insomnia, problems with concentration and other psychological conditions, in some extreme cases including major depression symptoms. The auditory character of tinnitus induces the patients to seek help predominantly at the otolaryngologist practice. The first aim of a physician is to establish the cause of tinnitus and to measure its audiological properties. The second aim is to estimate the tinnitus-induced distress and to grade its psychological severity. This manuscript is dedicated to describe the audiological as well as psychological properties of tinnitus, its contemporary classification and the therapeutic methods used in the field.

Impact of Multiple Factors on the Degree of Tinnitus Distress.

OBJECTIVE: The primary cause of subjective tinnitus is a dysfunction of the auditory system; however, the degree of distress tinnitus causes depends largely on the psychological status of the patient. Our goal was to attempt to associate the grade of tinnitus-related distress with the psychological distress, physical, or psychological discomfort patients experienced, as well as potentially relevant social parameters, through a simultaneous analysis of these factors. METHODS: We determined the level of tinnitus-related distress in 531 tinnitus patients using the German version of the tinnitus questionnaire (TQ). In addition, we used the Perceived Stress Questionnaire (PSQ); General Depression Scale Allgemeine Depression Skala (ADS), Berlin Mood Questionnaire (BSF); somatic symptoms inventory (BI), and SF-8 health survey as well as general information collected through a medical history. RESULTS: The TQ score significantly correlated with a score obtained using PSQ, ADS, BSF, BI, and SF-8 alongside psychosocial factors such as age, gender, and marital status. The level of hearing loss and the auditory properties of the specific tinnitus combined with perceived stress and the degree of depressive mood and somatic discomfort of a patient were identified as medium-strong predictors of chronic tinnitus. Social factors such as gender, age, or marital status also had an impact on the degree of tinnitus distress. The results that were obtained were implemented in a specific cortical distress network model. CONCLUSIONS: Using a large representative sample of patients with chronic tinnitus permitted a simultaneous statistical measurement of psychometric and audiological parameters in predicting tinnitus distress. We demonstrate that single factors can be distinguished in a manner that explains their causative association and influence on the induction of tinnitus-related distress.