COVID-19 associated anxiety enhances tinnitus

Abstract

<jats:p>Background We investigated how the anxiety associated with COVID 19 impacts the severity of tinnitus and the outcomes of tinnitus therapy. Methods and Findings A retrospective research design was used to compare the clinical characteristics of tinnitus between patients from March to April 2020 under pandemic pressure and those from the matching period in 2019. Tinnitus severity was evaluated using the Tinnitus Handicap Inventory (THI) questionnaire and the minimum masking level (MML) measure while anxiety was quantified using the Zung Self-rating Anxiety Scale (SAS). The assessments were repeated after a 2-month interval, in which sound therapy was applied to a subgroup of patients. In all, 94 and 70 cases were reported in the 2020 and 2019 groups, respectively. The effects of the pandemic on emotional status were evident from a higher incidence of anxiety and much higher SAS scores in the 2020 group. There was also an increase in the THI scores in the 2020 group, but the between-year difference was smaller than that of the SAS score. Moreover, there was no between-year difference in MML or the treatment effect, as measured via both THI and MML. Furthermore, the reduction in SAS score in the second assessment was significantly smaller in the 2020 group. However, a positive correlation between the initial SAS score and the improvement was seen within the 2020 group. Conclusions Anxiety increased greatly in tinnitus subjects due to the COVID 19 pandemic. However, this was not associated with an increase in tinnitus severity in 2020. Instead, there was no between-year difference in the THI score or MML or in the improvement of either measure after treatment. The smaller improvement in SAS score and the positive correlation with the initial SAS score in the 2020 group suggests that the SAS score change in this group might largely be due to the natural relief of pressure as the pandemic decelerated in China. Therefore, the anxiety change induced by the COVID 19 pandemic is not likely to have a strong impact on tinnitus.</jats:p>

The Impact of COVID-19 and the Pandemic on Tinnitus: A Systematic Review

“…As Anzivino et al's study [50] was a letter to the editor, the study was not detailed in terms of describing the age and gender characteristics of participants. In Schlee et al [51] and Xia et al [52], the mean age was similar, 54.0 (SD: 10.9) and 52.6 (SD: 14.7), respectively; however, regarding gender percentages, the male percentage in the participants was greater in Schlee et al [51], at 65.5% and 48.3%, respectively.…”

“…Pandemic Impact Studies: Comparing Tinnitus before and during the Pandemic 3.6.1. Study Characteristics There were three studies comparing tinnitus severity before and during the pandemic performed in Italy [50], Germany [51], and China [52], as summarized in Table 4. The number of participants varied (16, 94, and 122, respectively).…”

“…The study also revealed that the higher the participant's neuroticism score, the more distinct was the worsening of the tinnitus. Xia et al [52] identified significantly higher tinnitus severity during the pandemic (40 out of 100 for the THI for 99 patients) compared to before the pandemic (34 out of 100 for the THI for 89 patients) and that the effect of anxiety (measured by Self-rating Anxiety Scale; SAS) associated with the impact of the pandemic appeared to contribute to elevated tinnitus awareness.…”

“…Xia et al [52] reported that educational counselling resulted in improvements in the SAS, THI score, and tinnitus loudness test before the pandemic, but such treatments were less effective in 2020. The authors concluded that educational counselling was not enough for the stress and anxiety during the COVID-19 pandemic and provided evidence that anxiety is a contributing factor to tinnitus severity.…”

“…[50] study was rated as poor due to the lack of description of the participants (e.g., gender, age, and eligibility criteria), the lack of statistical analysis, lack of repeated outcomes measures, and the small sample size (n = 16). Schlee et al [51] and Xia et al [52] were rated as fair due to providing a relatively good description of the aim, eligibility criteria, outcome measures, and fair sample size.…”