Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 16, 2023; 11(14): 3211-3223
Published online May 16, 2023. doi: 10.12998/wjcc.v11.i14.3211
Evaluation of chronic idiopathic tinnitus and its psychosocial triggers
Sherifa Ahmed Hamed, Fadia Ahmed Attiah, Mohamed Fawzy, Mohamed Azzam
Sherifa Ahmed Hamed, Fadia Ahmed Attiah, Mohamed Fawzy, Department of Neurology and Psychiatry, Assiut University, Faculty of Medicine, Assiut 71516, Egypt
Mohamed Azzam, Department of Otolaryngology, Assiut University, Faculty of Medicine, Assiut 71516, Egypt
Author contributions: Hamed SA was the guarantor and designed the study, conducted the data collection and neurologic evaluation of the patients, applied the diagnostic work-up questionnaires on the patients, and contributed to the statistical analyses and manuscript drafting; Attiah FA and Fawzy M conducted the psychiatric interviewing, and participated in the acquisition, analysis, and interpretation of the data; Azzam M did the ENT evaluation, and participated in the acquisition, analysis, and interpretation of the data; Attiah FA, Fawzy M, and Azzam M revised the article critically for important intellectual content.
Institutional review board statement: The Ethics Committees of Faculty of Medicine of Assiut University, Assiut Governorate, Egypt, approved the study protocol.
Informed consent statement: All study participants, or their guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sherifa Ahmed Hamed, MD, Professor, Department of Neurology and Psychiatry, Assiut University, Faculty of Medicine, Assiut University Street, Nayla Khatoun, Gharb District, Assiut 71516, Egypt. hamedsherifa@aun.edu.eg
Received: December 27, 2022
Peer-review started: December 27, 2022
First decision: February 2, 2023
Revised: February 18, 2023
Accepted: April 10, 2023
Article in press: April 10, 2023
Published online: May 16, 2023
Processing time: 139 Days and 12.5 Hours
Abstract
BACKGROUND

The tinnitus susceptibility patterns in relation to different psychological and life stressors are unknown in different cultures.

AIM

To determine the comorbid psychosocial factors and behaviors associated with tinnitus and the predictors for the increase in its severity.

METHODS

Participants were 230 adults (males = 70; females = 160; mean age = 38.6 ± 3.3). They underwent audiograms, speech discrimination and masking testing, and neuropsychiatric evaluation. Measures used for assessment included tinnitus handicap inventory, depression anxiety stress scale 21 (DASS-21), perceived stress scale (PSS), and insomnia severity index (ISI).

RESULTS

Patients had mean duration of tinnitus of 11.5 ± 2.5 mo. They had intact hearing perception at 250-8000 Hz and 95 (41.3%) had aggravation of tinnitus loudness by masking noise. Decompensated tinnitus was reported in 77% (n = 177). The majority had clinically significant insomnia (81.3%), somatic symptoms (75%) other than tinnitus and perceived moderate (46.1%) and high (44.3%) stress to tinnitus. The severe/extremely severe symptoms of depression, anxiety and stress were reported in 17.4%, 35.7% and 44.3%, respectively. Patients with decom-pensated type had significantly higher scores for ISI (P = 0.001) and DASS-21 (depression = 0.02, anxiety = 0.01, stress = 0.001) compared to those with compensated tinnitus. Psychiatric interviewing showed that 35.7% had non-specific anxiety disorder, 17.4% had major depression, and 19.6% fulfilled the criteria of somatization disorder. Multivariate analysis showed that the only independent predictors for tinnitus severity were the duration of tinnitus [odd ratios (OR) = 0.832, 95%CI: 0.640-1.158; P = 0.001] and PSS (OR = 0.835, 95%CI: 0.540-1.125; P = 0.001) scores.

CONCLUSION

To the best of our knowledge, this is the first study in our culture to evaluate the causal relationship between psychological factors and tinnitus onset, severity and persistence. Tinnitus could be the earliest and dominant somatic symptom induced by life stressors and psychological vulnerabilities. Therefore, multidisciplinary consultation (psychologists, psychiatrists, and neurologists) is important to acknowledge among the audiologists and otolaryngologists who primarily consult patients.

Keywords: Chronic tinnitus; Idiopathic; Stress; Anxiety; Insomnia; Somatization; Psychosocial factors

Core Tip: Tinnitus is a frequent subjective symptom in adults. About 15%-30% of patients with tinnitus have no clinically manifested hearing loss or no subclinical sensorineural hearing loss when evaluated using advanced auditory testing. There are several comorbid psychiatric conditions and disorders in sufferers of tinnitus, which may contribute to its persistence and increased severity. They include stress, anxiety, depression, sleep disturbance, increased forgetfulness, major depression and anxiety, and somatoform disorders. However, the relationship of these comorbidities with tinnitus onset is unclear. Also the psychosocial triggers for initiation, increased severity, and chronicity of tinnitus are understudied in many areas of the world.