Tinnitus: Distinguishing between Subjectively Perceived Loudness and Tinnitus-Related Distress

Abstract

ObjectivesOverall success of current tinnitus therapies is low, which may be due to the heterogeneity of tinnitus patients. Therefore, subclassification of tinnitus patients is expected to improve therapeutic allocation, which, in turn, is hoped to improve therapeutic success for the individual patient. The present study aims to define factors that differentially influence subjectively perceived tinnitus loudness and tinnitus-related distress.MethodsIn a questionnaire-based cross-sectional survey, the data of 4705 individuals with tinnitus were analyzed. The self-report questionnaire contained items about subjective tinnitus loudness, type of onset, awareness and localization of the tinnitus, hearing impairment, chronic comorbidities, sleep quality, and psychometrically validated questionnaires addressing tinnitus-related distress, depressivity, anxiety, and somatic symptom severity. In a binary step-wise logistic regression model, we tested the predictive power of these variables on subjective tinnitus loudness and tinnitus-related distress.ResultsThe present data contribute to the distinction between subjective tinnitus loudness and tinnitus-related distress. Whereas subjective loudness was associated with permanent awareness and binaural localization of the tinnitus, tinnitus-related distress was associated with depressivity, anxiety, and somatic symptom severity.ConclusionsSubjective tinnitus loudness and the potential presence of severe depressivity, anxiety, and somatic symptom severity should be assessed separately from tinnitus-related distress. If loud tinnitus is the major complaint together with mild or moderate tinnitus-related distress, therapies should focus on auditory perception. If levels of depressivity, anxiety or somatic symptom severity are severe, therapies and further diagnosis should focus on these symptoms at first.

Acceptance of Tinnitus As an Independent Correlate of Tinnitus Severity

“…In the conservative regression model in which all the variables that were significantly associated with the criterion were accounted for, TAQ still had a variance increment of almost 13% (compared with 4% for HADS scales in the model in which order of entry was reversed). Interestingly, self-rated loudness of tinnitus was significantly correlated with tinnitus severity, but, in-line with earlier findings (e.g., Wallhäusser-Franke et al 2012), all the psychological variables (acceptance, anxiety, and depression) accounted for unique variance beyond self-rated characteristics of the sounds. Furthermore, mediation analysis showed that acceptance of tinnitus mediated the association between self-rated loudness and tinnitus severity.…”

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

“…Three factors were identified to have a unique significant effect on tinnitus severity when measured on both the TQ and THI: (1) percentage of tinnitus awareness during the day, (2) self-reported depression and/or anxiety, and (3) tinnitus loudness. A close relationship between tinnitus and depression and/or anxiety has been demonstrated multiple times [9][10][11][12][13][14]. Other studies did not show a positive correlation between anxiety or depression and tinnitus [10,15].…”

A confirmatory factor analytic validation of the Tinnitus Handicap Inventory

“…For this purpose, scales that only assess the subjective loudness or intensity of the tinnitus are not sufficient, in particular because tinnitus loudness itself is rather moderately or lowly correlated with the experienced distress [16][17][18][19]. Instead measures that directly assess different dimensions of the impairment and distress associated with tinnitus are necessary.…”