Clinical and audiologic characteristics of patients with sensorineural tinnitus and its association with psychological aspects: an analytic retrospective study

Abstract

This study was performed to analyze clinical and audiologic characteristics of sensorineural tinnitus and to investigate the associating factors reflecting psychological aspects of stress and depression of the patients. This is a retrospective analytical study conducted in a tinnitus clinic of a tertiary referral center of a university hospital. The medical records of 216 patients suffering from sensorineural tinnitus were thoroughly evaluated to determine correlations between clinical and audiological characteristics, including age, sex, predisposing or etiologic factors, hearing levels up to extended high frequencies, and tinnitus severity. Psychological aspects of stress and depression were also evaluated and analyzed to seek the associations with tinnitus severity. All data were stored in our database bank and were statistically analyzed. Our study subjects showed a slight male predominance. The highest percentage of tinnitus was found in patients of 60-80 years old. Only 32.5 % of tinnitus patients were subjectively aware of their hearing loss, whereas 73 % of subjects had hearing deficits in some frequencies in their audiogram. Hearing impairments were of the low-frequency sensorineural type in 18.2 % of patients and were limited to the high frequencies in 77.9 % of patients. Tinnitus was unilateral in 51 % of patients and had a tonal nature in 45 % of patients. In total, 45.8 % of patients with high-frequency sensorineural hearing loss had high-pitched tinnitus. There were significant correlations between tinnitus severity, loudness and annoyance. Correlations with THI (Tinnitus Handicap Inventory) and Beck depression index scores were also found. Sensorineural tinnitus was related with hearing loss in some frequencies nevertheless of patients' own awareness of hearing loss. Loudness and annoyance of tinnitus seems to be two important factors reflecting psychological problems of patients' stress and depression.

Aplicabilidade da orientação fonoaudiológica associada ao uso de aparelho de amplificação sonora individual na redução do zumbido

“…Epidemiological studies have indicated that approximately 20% of individuals with tinnitus suffer from changes in sleep quality and concentration, causing negative emotional reactions (1,2) . The same was observed by other researchers (3) , who reported the prevalence of 7% to 19% of adult individuals with tinnitus as an otological symptom, as well as important associated complaints, such as insomnia, problems in social interaction, life, emotional difficulties, health changes in general, and problems at work.…”

Perfil clínico e implicações do zumbido em indivíduos com e sem perda auditiva

“…Researchers, even in the 1990s, reported little relation between these factors, as well as correlation of loudness with the stress and handicap caused by tinnitus (27) . More recent studies point to the intensity of tinnitus as a possible predictor of perception of the symptom's severity (2,28) , as well as moderate correlations between intensity and degree of annoyance (17) .…”

“…The absence of objective data regarding intensity in an evaluation process may favor the strengthening of the complaint, a factor that promotes the development of psychosocial barriers associated with the symptom. Since there is no consensus that the severity of tinnitus is necessarily associated with its intensity (17,27,28) , this information can also be understood as a tool with which to guide patients and plan at least part of treatment. Regardless of whether it is associated with hearing loss or not, the severity of tinnitus may also be related to the degree of discomfort in daily tasks and other functional impairments, which could lead to mental disorders such as difficulty concentrating, sleep disorders, anxiety, mood swings and even social isolation (5,17) .…”

“…In a study cited above (30) , the authors argue that subjective measures obtained with questionnaires may show better results and higher rates in the pre-and post-treatment comparison of tinnitus subjects than psychoacoustic measures, being more suitable for use in clinical practice. However, considering that MML reflects the ease with which tinnitus can be masked by environmental sounds (28) , it is believed that this measure may help evaluate the benefit of using noise masking in the treatment of tinnitus, also being an important parameter for establishing the adjustments needed to adapt these devices to patients with or without associated hearing loss. In addition, specifically for subjects with hearing loss and tinnitus, the risk of discomfort caused by the masking noise is higher, as the intensity required to change these subjects' perception of tinnitus is lower, and therefore should be taken into account when adapting any type of resource, be it hearing aid or tinnitus masking.…”

Differences in Clinical Characteristics and Brain Activity between Patients with Low- and High-Frequency Tinnitus

“…Tinnitus is a highly heterogeneous condition with respect to the characteristics of the perceived sound, and it is associated with various degrees of associated awareness and distress, duration, and comorbidities [56,57]. This variability would be expected in clinical presentation to be reflected by a similar variability in the structures and functions of neuronal correlates.…”