Tinnitus Related Distress

[Ali]

The following paper looks at predictors for tinnitus related distress:

Psychosocial and personality predictors of tinnitus-related distress.

Langenbach M, Olderog M, Michel O, Albus C, Kohle K.

Gen Hosp Psychiatry. 2005 Jan-Feb;27(1):73-7.

Abstract:
We set out to determine predisposing psychosocial and personality factors of experienced distress in chronic, decompensating tinnitus by a prospective investigation of 48 patients at two points: within 4 weeks of first tinnitus symptoms, and 6 months later, by sociodemographic, otological and psychological findings in a test battery [Symptom Checklist-90-Revised, Freiburger Personlichkeitsinventar, Tinnitus Questionnaire]. Data were processed by multiple regression analysis. Forty-four patients (92%) returned complete data sets. Thirty-four patients displayed chronic tinnitus. The factors sleeping disturbance attributed to tinnitus, anxiousness and satisfaction with own life, each at the time of the first investigation, could explain 56% of variance of tinnitus distress at the time of the second investigation. Our results suggest that patients with psychological disturbances and sleeping difficulties at first presentation shortly after the onset of tinnitus have a higher risk of developing tinnitus-related distress. We suggest that our results support the fact that early psychosocial intervention in patients at risk may prevent development of chronic tinnitus with high psychological distress.

[Dr Ross Dineen]

The following paper looks at predictors for tinnitus related distress:

Psychosocial and personality predictors of tinnitus-related distress.

Langenbach M, Olderog M, Michel O, Albus C, Kohle K.

Gen Hosp Psychiatry. 2005 Jan-Feb;27(1):73-7.

Abstract:
We set out to determine predisposing psychosocial and personality factors of experienced distress in chronic, decompensating tinnitus by a prospective investigation of 48 patients at two points: within 4 weeks of first tinnitus symptoms, and 6 months later, by sociodemographic, otological and psychological findings in a test battery [Symptom Checklist-90-Revised, Freiburger Personlichkeitsinventar, Tinnitus Questionnaire]. Data were processed by multiple regression analysis. Forty-four patients (92%) returned complete data sets. Thirty-four patients displayed chronic tinnitus. The factors sleeping disturbance attributed to tinnitus, anxiousness and satisfaction with own life, each at the time of the first investigation, could explain 56% of variance of tinnitus distress at the time of the second investigation. Our results suggest that patients with psychological disturbances and sleeping difficulties at first presentation shortly after the onset of tinnitus have a higher risk of developing tinnitus-related distress. We suggest that our results support the fact that early psychosocial intervention in patients at risk may prevent development of chronic tinnitus with high psychological distress.

Tinnitus distress appears to be a symptom of increased arousal bought about by high levels of general life stress, rather than tinnitus being the cause of the high levels of arousal. Heightened arousal levels appear to influence a number of other hearing related pathologies, such as hyperacusis, acoustic shock injury, and posttraumatic stress disorder, and may be influencing the nature of the reported symptoms. In part these conditions appear to involve a heightened sensitivity of centrally mediated protective reflexes in the middle ear. The major influence appears to be anticipatory anxiety, initiated by an extremely distressing acoustic event or repeated exposure to a noxious acoustic stressor, causing a. conditioned association to develop between an auditory stimulus and distress, which in these conditions appears to lead to a lowering of the threshold of the acoustic startle response. The fluttering sensation, feelings of fullness and sometimes ear pain, described by people with hypersensitivity to normal environmental sounds, or those exposed to repeated acoustic shocks, may be a physical correlate of the lowered threshold of the startle response.

What are the implications of these studies for our understanding of tinnitus?
• Firstly nearly everybody has noises in their auditory system, and given certain circumstances nearly everyone can become aware of their presence.
• There are no scientifically proven treatments that can eradicate tinnitus.
• Awareness of the presence of tinnitus does not necessarily lead to people becoming distressed.
• People who become distressed by tinnitus do not have a quality to their noises that is significantly different from people who are not distressed.
• People who become distressed have more stress in their lives, and it is the presence of this life stress that has a major influence on development of tinnitus related distress.
• People who are distressed by tinnitus may have catastrophic beliefs about the significance of these noises to their physical and mental health.
• People who are distressed apply a range of coping strategies, some which appear more successful than others.

What do these findings imply for the content of tinnitus management programs?
• Information and understanding helps facilitate tinnitus management
• Counselling is necessary to identify and challenge inaccurate and at times catastrophic beliefs about the perception of noise in the auditory system.
• Training in coping strategies has a significant benefit.
• Therapeutic noise helps in some cases, but as a management strategy rather than a form of treatment.
• Subjects reporting extreme distress require referral for in depth psychological or psychiatric counselling.

In general there is no cure for tinnitus, so the tinnitus sufferer has to adjust to the presence of tinnitus. Tinnitus management therapy can be described as a combination of cognitive and behavioural strategies. Cognitive, in the sense that maladaptive beliefs about the nature and meaning of tinnitus are being identified and challenged, and behavioural, in the sense that strategies are being learned which enable the individual to inhibit the distress responses, which have become associated with perception of tinnitus. The successful outcome of tinnitus therapy can more realistically be described as learned inhibition, as what is being modified through therapy is the association between the perception of tinnitus and the distress reaction, not the perception of tinnitus itself.