Published online May 16, 2023. doi: 10.12998/wjcc.v11.i14.3211
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
Tinnitus is the most common auditory symptom with an estimated prevalence of 8%-40% and life-long disabling problem in ~2.5%. Tinnitus is an aberrant sound heard in the ears or in both ears and head. It is believed to be a symptom of hearing impairment. However, many audiologists observed that approximately 15%-30% of subjects with tinnitus had neither manifest nor subclinical hearing impairment. Research studies have indicated that psychosocial factors as stress, anxiety, depression and insomnia are strong risks for the chronic and severe tinnitus. They also reported comorbid psychiatric disorders as anxiety, somatization and major depressive disorders in 23%-35% of patients with tinnitus. Others reported improvement of tinnitus after the use of antidepressant or anxiolytic medications. Many audiologist and otolaryngologist believe that tinnitus requires multidisciplinary evaluation and management. As chronic idiopathic tinnitus and evaluation of its psychosocial triggers is an understudied topic in many parts of the world, therefore, it has to be addressed in different populations.
The research hotspots include determination of: (1) Characteristics of chronic tinnitus in group of patients with no obvious hearing loss as a cause; (2) comorbid psychosocial stressors and psychiatric conditions and disorders which are associated with tinnitus initiation, aggravation and chronicity; and (3) predictors that are independently associated with increase in the severity of tinnitus.
This study systematically assessed patients with chronic idiopathic tinnitus and the psychosocial factors associated with its onset, increased severity and chronicity.
Tinnitus handicap inventory, depression anxiety stress scale 21, perceived stress scale, insomnia severity index, and a designed questionnaire for determination of life stressors.
This study included 230 adult patients from both sex. They had chronic tinnitus with a mean duration of approximately 11 mo. Their previous ear, nose and throat and audiology evaluations including pure tone audiometry at frequencies ranged from 250 to 8000 Hz did not reveal obvious cause for tinnitus. Decompensated tinnitus was reported in 77%. The characters of tinnitus in many patients are distinguished from that of tinnitus due to pure auditory pathway lesions, which included being originated from ears and/or head, bilateral or alternate ear side, described as whistling, roaring, clicking, or combined sound, aggravated by ear plugging, stress, anxiety and insomnia and absence of hearing deterioration overtime. Psychiatric evaluation revealed frequent comorbid conditions and disorders including stress, anxiety, somatic problems, depression, enhanced perceived stress towards tinnitus and anxiety, somatization and major depressive disorders. We also reported that the variables which were highly significant and independently associated with tinnitus were its duration and increased stress perception towards tinnitus.
Tinnitus was a common and predominant somatic symptom in response to severe life stressors and psychological susceptibility. The tinnitus variables showed distinct characteristics which differentiate it from tinnitus caused by pure auditory system lesions. Psychiatric interviewing revealed that the majority of patients had symptoms of stress, anxiety, depression, and sleep disturbance of variable severities. Anxiety and somatization disorders were reported in 35.7% and 19.6% of patients, respectively. Major depressive disorder was reported in 17.4%. The interindividual variability to stress perception and anxiety were strong triggers for tinnitus, its severity and chronicity.
In our locality, the importance of the psychosocial factors for the initiation, aggravation and chronicity of tinnitus are understudied. Multidisciplinary consultation (psychologists, psychiatrists and neurologists) is important to acknowledge among the audiologists and otolaryngologists who primarily consult patients. Also future longitudinal studies are required to determine the tinnitus outcomes before and after treatment with psychotropic medications.