Tinnitus severity and its association with cognitive and somatic anxiety: a critical study.
From: Eur Arch Otorhinolaryngol. 2011 Dec 23. [Epub ahead of print]
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 the authors 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 this 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 in this article.
Tinnitus is a common problem in the population. With the aging of the population, the prevalence of tinnitus will increase. The prevention of tinnitus should focus on hearing impairment screening, otitis media treatment, and noise exposure reduction.
Does tinnitus distress depend on age of onset?
From: PLoS One. 2011;6(11):e27379
Tinnitus is the perception of sound in the absence of an auditory stimulus. Averaged over all age groups 5–15% of the western population experience some form of tinnitus. Many people can cope with chronic tinnitus, but about 1–2% of the population experience significant impairments in their quality of life due to their tinnitus.
The prevalence of chronic tinnitus increases with increasing age, peaking at 14.3% in people between 60 and 69 years of age. The increase in tinnitus prevalence with age is at least partly explained by the fact that hearing loss is an important risk factor for tinnitus and hearing loss prevalence also increases with age.
Neuroplastic processes play a crucial role both in the generation of tinnitus and in the amount of suffering. Imaging studies reveal that neuroplastic changes in the central auditory system are generating the tinnitus percept and that coactivation of nonauditory structures in the frontal cortex and the limbic system are involved in tinnitus related distress.
Studies in animals and humans have shown that the mechanisms of cortical plasticity change over the lifetime with a tendency of decreased and less efficient neuroplastic potential as demonstrated by decreased induction and maintenance of long-term-potentiation and reduced long-term depression-like effects with advancing age.
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A review of tinnitus symptoms beyond ‘ringing in the ears’: a call to action
From: Curr Med Res Opin. 2011 Jun 23. [Epub ahead of print]
About 10% of the population experiences tinnitus, a common and distressing symptom characterized by the perception of sound in the absence of external stimuli. There is, however, marked heterogeneity in etiology, perception, and extent of distress among those who experience tinnitus. Reactions to tinnitus vary from simple awareness to severe irritation; some people have difficulty in hearing because of the loudness of the noise. Severe tinnitus causes many, often psychological, symptoms (e.g., tension, frustration, impaired concentration, disrupted sleep). For some, tinnitus is temporary, for others it is longstanding. Although many people adjust successfully, others are disabled by tinnitus; approximately 5% experience persistent and severe symptoms affecting their lifestyle and significantly reducing their quality of life. Because tinnitus is poorly understood and no single therapeutic approach is effective for all patients, many patients are told that ”nothing can be done” and they must ”learn to live with it.”
Tinnitus, often referred to as ‘ringing in the ears’, is highly prevalent. However, patients may also present with a number of other symptoms.
To review the broad range of symptoms of tinnitus, to evaluate their impact on patient quality of life and to explore methods of diagnosis and assessment. An electronic literature search was performed in PubMed between September and December 2010.
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Tinnitus and depression
From: World J Biol Psychiatry. 2011 May 13. [Epub ahead of print]
Depressive symptoms are common in individuals with tinnitus and may substantially aggravate their distress. The mechanisms, however, by which depression and tinnitus mutually interact are still not fully understood.
Here the authors review neurobiological knowledge relevant for the interplay between depression and tinnitus. Neuroimaging studies confirm the existence of neural circuits that are activated both in depression and tinnitus. Studies of neuroendocrine function demonstrate alterations of the HPA-axis in depression and, more recently, in tinnitus.
Studies addressing neurotransmission suggest that the dorsal cochlear nucleus that is typically hyperactive in tinnitus, is also involved in the control of attention and emotional responses via projections to the locus coeruleus, the reticular formation and the raphe nuclei. Impaired hippocampal neurogenesis has been documented in animals with tinnitus after noise trauma, as in animal models of depression.
Finally, from investigations of human candidate genes, there is some evidence to suggest that variant BDNF may act as a common susceptibility factor in both disorders.
These parallels in the pathophysiology of tinnitus and depression argue against comorbidity by chance and against depression as pure reaction on tinnitus. Instead, they stand for a complex interplay between tinnitus and depression. Implications for tinnitus treatment are discussed
Self-reported tinnitus and ototoxic exposures among deployed Australian Defence Force personnel
From: Mil Med. 2011 Apr;176(4):461-7.
The association between military service and symptoms of hearing loss including tinnitus is well known, with a number of countries strengthening hearing conservation programs for their serving defense personnel. In many cases of occupation related hearing loss, the problem is attributed to noise exposure alone. Although noise is the most common preventable cause of irreversable sensorineural hearing loss in the general population, focusing solely on noise ignores a number of other potential causes of ototoxicity. A number of chemical compounds are known or suspected to have the ability induce ototoxic effects, including solvents, heavy metals, pesticides and asphyxiants such as carbon monoxide.
Although many occupational studies indicate a possible likely relationship between chemical exposures and hearing impairment, the exact nature of any effects in humans has proved difficult to establish. In particular, the impact of nonwork factors such as the ageing process and noisy recreation activities is difficult to assess. Tobacco smoking is a further confounding factor as cigarette smoke contains a number of known or suspected ototoxic chemicals, including hydrogen cyanide, carbon monoxide, cadmium and lead. A substantial body of research demonstrates that smoking behaviors impact negatively on hearing, particularly at high frequencies, although there is no clear relationship between tinnitus and smoking.
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Similarities between severe tinnitus and chronic pain
From: J Am Acad Audiol. 2000 Mar;11(3):115-24
The symptoms and signs of severe tinnitus and chronic pain have many similarities and similar hypotheses have been presented regarding how the symptoms are generated. Pain and tinnitus have many different forms. The severity of the symptoms of both varies within wide limits, and it is not likely that all forms have the same pathology. Some individuals with severe tinnitus perceive sounds to be unpleasant or painful. This may be similar to what is known as allodynia, which is a painful sensation of normally innocuous stimulation of the skin. Many individuals with chronic pain experience a worsening of their pain from repeated stimulation (the “wind-up” phenomenon). This is similar to the increasingly unpleasant feeling from sounds that are repeated that many individuals with severe tinnitus experience. There are also similarities in the hypotheses about the generation of pain and tinnitus. Although less severe tinnitus may be generated in the ear, it is believed that severe tinnitus in many cases is caused by changes in the nervous system that occur as a result of neural plasticity. Acute pain caused by tissue injury is generated at the site of injury but chronic pain is often generated in the central nervous system, yet another similarity between chronic pain and severe tinnitus. The changes in the nervous system consist of altered synaptic efficacy including opening of dormant synapses. For pain, this is believed to occur in the wide dynamic range neurons of the spinal cord and brain stem. Less is known about the anatomic location of the changes that cause severe tinnitus but there are indications that it may be the inferior colliculus. It is also possible that other auditory systems than the classical ascending pathways may be involved in severe tinnitus.
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Tinnitus and its risk factors in the Beaver Dam Offspring Study
From: Int J Audiol. 2011 Feb 10. [Epub ahead of print]
To assess the prevalence of tinnitus along with factors potentially associated with having tinnitus. Data were from the Beaver Dam Offspring Study, an epidemiological cohort study of aging. After a personal interview and audiometric examination, 3267 participants were classified as having tinnitus if in the past year they reported having tinnitus of at least moderate severity or that caused difficulty in falling asleep.
The prevalence of tinnitus was 10.6%. In a multivariable logistic regression model adjusting for age and sex, the following factors were associated with having tinnitus: hearing impairment, currently having a loud job, history of head injury, depressive symptoms, history of ear infection, history of target shooting, arthritis, and use of NSAID medications. For women, ever drinking alcohol in the past year was associated with a decreased risk of having tinnitus.
These results suggest that tinnitus is a common symptom in this cohort and may be associated with some modifiable risk factors.
The more the worse: the grade of noise-induced hearing loss associates with the severity of tinnitus
From: Int J Environ Res Public Health. 2010 Aug;7(8):3071-9. Epub 2010 Aug 4.
Tinnitus is a perception of sound without an external source. This perception can be induced by various dysfunctions on several levels of the peripheral or central auditory pathway. Regardless of the original cause, all patients complain of hearing a tinnitus tone on either one (unilateral) or both sides (bilateral) of the head or ears. Depending on the case, tinnitus tone may have low, medium or high frequency and be either relatively quiet (0–3 dB), going up to relatively loud (more than 16 dB). Tinnitus may take acute (up to 3 months), sub-acute (4–12 months) or a chronic turn (longer than a year). Regarding the level of disturbance, tinnitus can be classified as compensated (low-level distress) or decompensated (high-level distress). The major problem in patients with decompensated tinnitus is sleep interference, because the tinnitus tone keeps the patients awake. Other diseases that follow include depression, a variety of phobias, anxiety disorders, problems with concentration and in extreme cases—suicide. In other words, decompensated tinnitus seriously reduces the quality of life. Approximately 30 per 100 adults experience tinnitus, whereas about 1–5 persons per 100 suffer from tinnitus and seek medical help. In the Western world, tinnitus has a big economic impact.
The onset of tinnitus can have various basis such as neurologic, traumatic, infectious or drug-related, however, the major cause of tinnitus is a hearing loss. Hearing loss is usually caused by the aging process (presbycusis) or by the overexposure to noise (noise-induced hearing loss). Occupational noise, together with environmental noise pollution, are two major factors contributing to the noise-induced hearing loss. Newly emerging noise-induced hearing loss victims are adolescents who inappropriately use MP3 or MP3-like personal players (too long/too loud, using earphone-insert type headphones). Between 57% and 76% of tinnitus patients were shown to have noise-induced hearing loss. These, and a lot of other data, strongly indicate coexistence of both hearing dysfunctions. Based on the above data the authors put forward a hypothesis that the degree of hearing loss could negatively influence the severity of tinnitus. To test the hypothesis we used a retrospective study using data acquired from 531 tinnitus patients. This data were randomly collected on the admission of patients who reported to the day ward of Tinnitus Center at the Charité – Universitätsmedizin in Berlin between January 2008 and March 2010. The authors have analyzed general audiometric and tinnitus-oriented psychometric parameters.
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Prevalence and Characteristics of Tinnitus among US Adults
From: Am J Med. 2010 Aug;123(8):711-8
Tinnitus, derived from the Latin word tinnire meaning “to ring,” is the perception of noise in the absence of an acoustic stimulus. It is a common condition that is usually subjective, perceived only by the patient, and therefore diagnosis and monitoring rely on self-report. Data from the 1996 National Health Interview Survey (NHIS) showed tinnitus was experienced by approximately 35-50 million adults in the US, with 12 million seeking medical care, and 2-3 million reporting symptoms that were severely debilitating. Cases and proposed etiologies of tinnitus are clinically heterogeneous and, although several treatment options have been tried, no single cure exists for the condition.
Patients who experience tinnitus often report significant associated morbidities. Lifestyle detriment, emotional difficulties, sleep deprivation, work hindrance, interference with social interaction, and decreased overall health have been attributed to tinnitus. Although causative relations are yet unknown, patients with tinnitus can have increased risk for depression, anxiety, and insomnia.
A limited number of risk factors for tinnitus have been suggested, the best described of which include increasing age, hearing loss, and loud noise exposure. These associations merit further exploration in a large cohort. Furthermore, the relations between tinnitus and other demographic and health factors are minimally characterized in the current literature. Therefore, the authors examined the relation between tinnitus and several potential risk factors using data from the National Health and Nutrition Examination Survey (NHANES), a large nationally representative survey.
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Assessing audiological, pathophysiological and psychological variables in tinnitus patients with or without hearing loss.
From: Eur Arch Otorhinolaryngol. 2010 Jun 25. [Epub ahead of print]
The aim of this work is to study the characteristics of tinnitus both in normal hearing subjects and in patients with hearing loss. The study considered tinnitus sufferers, ranging from 21 to 83 years of age, who were referred to the Audiology Section of Palermo University in the years 2006-2008. The following parameters were considered: age, sex, hearing threshold, tinnitus laterality, tinnitus duration, tinnitus measurements and subjective disturbance caused by tinnitus. The sample was divided into Group1 (G1), 115 subjects with normal hearing, and Group2 (G2), 197 subjects with hearing loss. Especially for G2, there was a predominance of males compared to females; the highest percentage of tinnitus resulted in the decades 61-70 and >70 with a significant difference for G2 demonstrating that the hearing status and the elderly represent the principal tinnitus-related factors.
The hearing impairment resulted in most cases of sensorineural hearing loss type and was limited to the high frequencies; the 72.1% of the patients with sensorineural hearing loss had a high-pitched tinnitus, while the 88.4% of the patients with a high-frequency sensorineural hearing loss had a high-pitched tinnitus. As to the subjective discomfort, the catastrophic category was the most representative among G1 with a significant difference between the two groups; no correlation was found between the level of tinnitus intensity and the tinnitus annoyance confirming the possibility that tinnitus discomfort is elicited by a certain degree of psychological distress as anxiety, depression, irritability and phobias.
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