"I feel [so alone] nothing" - emotional vulnerability and detachment as transdiagnostic key characteristics of patients with chronic tinnitus: a schema mode model approach.

Background: Gold-standard approaches for chronic tinnitus involve hearing amplification measures and psychological therapy, where applicable. Whilst schema therapy is accumulating evidence as a transdiagnostically useful treatment framework, its applicability for patients with chronic tinnitus has not yet been examined. The present study (a) explores latent dimensions of psychological distress in a sample of chronic tinnitus patients, and (b) examines whether the schema mode model might explain these dimensions - thus constituting a potentially helpful conceptualization and treatment framework. Methods: N = 696 patients with chronic tinnitus completed the Tinnitus Questionnaire, Tinnitus Handicap Inventory, Hospital Anxiety and Depression Scale, Perceived Stress Questionnaire and ICD-10 Symptom Rating. As criterion, patients further completed the Schema Mode Inventory (SMI-r) - which assesses psychological constructs linked to negative self-beliefs ("parent modes"), primary emotions resulting from unmet psychological needs ("child modes"), and secondary emotional or behavioral attempts to reinstate or maintain psychological equilibrium ("coping modes"). A varimax-rotated principal axis factor analysis grouped the primary item pool. Factor scale scores were then correlated with the SMI-r. Results: A three-factor solution explained 37.4% of variance and represented 78% of the included items. Following item content examination, the factors represented (1) General emotional distress, (2) Tinnitus-attributed emotional distress, and (3) Socio-audiological impairment. Factors 1|2 correlated highly (r = 0.70), Factors 2|3 moderately (r = 0.62). Linked to the schema mode model, Factor 1 correlated highly with the "vulnerable child" (r = 0.78), and moderately with the "parent", "angry child", and "detached protector" modes (0.53 < r < 0.65). Factor 2 correlated moderately with the "vulnerable child" (r = 0.53). Factor 3 was largely uncorrelated with SMI-r scores - although a low correlation with the "detached protector" warrants further examination. Conclusion: "General" and "tinnitus-attributed" emotional distress correlate highly - warranting holistic (not symptom-specific) psychological case conceptualization and treatment planning. Viewed from a schema mode perspective, the "vulnerable child" explains substantial variance across both dimensions. Consequently, autobiographically anchored, unmet emotional needs and emotional detachment constitute key treatment targets. Social-audiological impairment should be multimodally conceptualised and treated with hearing aids and psychological support measures, as applicable.

[Rational timepoint of medical rehabilitation in chronic tinnitus : Applying for rehabilitation options for a chronic course]. / Sinnvoller Zeitpunkt medizinischer Rehabilitation bei Tinnitus : Beantragung von Rehabilitationsmöglichkeiten bei chronischem Verlauf.

Chronic tinnitus is a common symptom of the auditory system. A causal therapy does not yet exist. The recommended treatment includes expert counseling, psychotherapeutic interventions, particularly cognitive behavioral therapy, and measures to improve hearing. The treatment modules are multimodal and can be combined individually. Depending on the severity of the different disease dimensions (tinnitus and comorbidities), a rehabilitative approach may be useful for maintaining health and occupational ability. In addition to a thorough and well-founded diagnosis and counseling, specific cognitive behavioral therapy and non-specific psychotherapeutic interventions (mindfulness/relaxation) on an individual or group basis, physiotherapy, and exercise, as well as auditory rehabilitation measures (hearing aids, auditory therapy) in the context of multimodal therapy approaches are necessary.

Emotional self-states and coping responses in patients with chronic tinnitus: a schema mode model approach.

Background: Amongst "third-wave" cognitive behavioural therapies, schema therapy demonstrates encouraging efficacy across various mental health conditions. Within this field, clinical interest has begun to converge on the "schema-mode-model" - a conceptualization framework for affective, cognitive and behavioral states that guide individuals' perceptions and behaviours at a given point in time. Schema mode expressions in patients with chronic tinnitus are as-yet unexamined. Methods: The present study reports self-report data from N = 696 patients with chronic tinnitus who completed the Schema Mode- and Tinnitus Handicap Inventories alongside measures of perceived stress, anxiety and depression. The Schema Mode Inventory assesses so-called maladaptive "parent", "child" and "coping" modes. Parent modes can be understood as self-states which are characterized by self-critical and hostile beliefs; child modes are characterized by biographically unmet emotional needs; and coping modes by inflexible attempts to regulate emotion and stabilize one's sense of self. Descriptive, correlational and mediation analyses investigated schema mode expressions (1) in patients with chronic tinnitus, (2) as compared to published reference values from a healthy control sample, (3) in their relation to other psychological constructs, and (4) regarding their potential role in driving tinnitus-related distress. Results: Patients reported mild-to-moderate levels of emotional distress. Compared to healthy controls, patients showed (1) high relative expressions of child-, detachment and compliant coping modes and (2) a conspicuously low relative expression of the 'punitive parent' mode. Correlational patterns suggested strong associations of (1) parent as well as angry child modes with perceived stress and anxiety, (2) the vulnerable child mode with all measured constructs and (3) emotional distress with - intrapersonally - emotional detachment as well as - interpersonally - alleged compliance. Mediation analyses demonstrated that tinnitus-related distress was driven by significant interactions between child and coping modes. Conclusions: The study provides initial clinical evidence for the relevance and applicability of schema-mode based formulation and treatment planning in patients with chronic tinnitus.

Lipid parameters and depression in patients with chronic tinnitus: A cross-sectional observation.

BACKGROUND: Pathophysiological theories assume importance of metabolic abnormalities in patients with major depression - and possibly chronic tinnitus. Although chronic tinnitus frequently correlates with depression, links between high-density lipoprotein (HDL) and depression are uninvestigated. METHODS: Two-hundred patients with chronic tinnitus (Mage = 55; 51% female) were examined. Serum levels of total cholesterol (TC), triglycerides (TGs), HDL, low-density lipoprotein cholesterol (LDL), non-HDL, as well as LDL/HDL and TC/HDL ratios were analysed. Questionnaires included depression subscales of the ICD-10 Symptom Rating, the Hospital Anxiety and Depression Scale (HADS_D), and the Berlin Mood Questionnaire (BSF). Multivariate analyses of covariance and linear regression models - which controlled age, tinnitus-related distress and perceived stress - investigated between-subgroup differences (p < 0.05) and linear associations between HDL indices and depression (p < 0.01). RESULTS: HDL levels did not differ for tinnitus-symptom durations, smoking and alcohol use levels, statin or antihypertensive drug use, and body-mass indices. Relative to non-to-mildly depressed patients with chronic tinnitus, patients with moderate-to-severe depression (n = 45; 23%) had significantly lower HDL levels (d = -0.35) and higher LDL/HDL (d = 0.39) and TC/HDL ratios (d = 0.40). Across participants, HDL-levels were negatively associated with depression as measured by the HADS_D and BSF_indifference scales. CONCLUSIONS: In keeping with general depression research, low serum HDL levels correlate with depressive symptomatology in patients with chronic tinnitus. This association may be influenced by proximal (e.g. modulations of HPA-axis activity) or distal factors (e.g. maladaptive coping behaviours) - both of which should be conceptualized within psychological stimulus-processing frameworks.

Heterogeneity in response to treatment across tinnitus phenotypes.

The clinical heterogeneity of chronic tinnitus poses major challenges to patient management and prompts the identification of distinct patient subgroups (or phenotypes) that respond more predictable to a particular treatment. We model heterogeneity in treatment response among phenotypes of tinnitus patients concerning their change in self-reported health burden, psychological characteristics, and tinnitus characteristics. Before and after a 7-day multimodal treatment, 989 tinnitus patients completed 14 assessment questionnaires, from which 64 variables measured general tinnitus characteristics, quality of life, pain experiences, somatic expressions, affective symptoms, tinnitus-related distress, internal resources, and perceived stress. Our approach encompasses mechanisms for patient phenotyping, visualizations of the phenotypes and their change with treatment in a projected space, and the extraction of patient subgroups based on their change with treatment. On average, all four distinct phenotypes identified at the pre-intervention baseline showed improved values for nearly all the considered variables following the intervention. However, a considerable intra-phenotype heterogeneity was noted. Five clusters of change reflected variations in the observed improvements among individuals. These patterns of treatment effects were identified to be associated with baseline phenotypes. Our exploratory approach establishes a groundwork for future studies incorporating control groups to pinpoint patient subgroups that are more likely to benefit from specific treatments. This strategy not only has the potential to advance personalized medicine but can also be extended to a broader spectrum of patients with various chronic conditions.

[Analysis of items on the short forms of the tinnitus questionnaire: Mini-TQ-12 and Mini-TQ-15]. / Itemanalyse der Kurzformen des Tinnitusfragebogens: Mini-TF-12 und Mini-TF-15.

BACKGROUND: A brief but reliable measurement of tinnitus-related distress is crucial for understanding and treatment options for this often very limiting symptom. Several self-report questionnaires are used in German-speaking countries and several short versions exist for the German translation of the Tinnitus Questionnaire (TQ). OBJECTIVE: In the present work, the frequently used Mini-TQ-12 questionnaire and the newly developed Mini-TQ-15 questionnaire will be investigated with regard to reliability, item difficulty, sensitivity (discriminatory power), and predictive power of the items in order to facilitate a decision for one or the other questionnaire in different examination contexts. METHODS: Data from 1409 patients with chronic tinnitus who completed the German 52-item version of the TQ and additional psychological tests (ADS­L, BSF, PHQ, ACSA and SWOP) at the Tinnitus Centre of the Charité Universitaetsmedizin Berlin, Germany, were retrospectively analyzed. We performed external validation of items from different versions of the TQ (original version, Mini-TQ-12, and Mini-TQ-15). RESULTS: The items of the Mini-TQ-12 and the Mini-TQ-15 predicted specifically the total score. Both short questionnaires are of comparable quality in terms of reliability and item construction (difficulty, discriminatory power). CONCLUSION: Both questionnaires have a very good item quality and are clinically more efficient to use than the long-form TQ. If a similarity of the factor structure to the original questionnaire is required for research questions, the use of the Mini-TQ-15 is recommended.

[Chronic tinnitus: An interplay between somatic and psychological factors]. / Chronischer Tinnitus im Wechselspiel somatischer und psychischer Faktoren.

Chronic tinnitus is a common, sometimes highly distressing phenomenon that can be triggered and maintained by an interplay of physical and psychological factors. Partnering with clinical psychology and psychosomatic medicine, modern otolaryngology integrates both medical (e.g., hearing loss) and psychological influences (e.g., interactions between biographical experiences, personality traits, subjective evaluation of intrapsychic and interpersonal stimuli, emotional states, and intrapsychic or interpersonal emotion regulation strategies). Both groups of variables can influence the intensity and course of chronic tinnitus symptomatology both directly and indirectly, whereby the quality and relative degrees of psychological and physical components in a person's self-experience can fluctuate. With this in mind, the present article distinguishes between chronic tinnitus symptomatology with or without hearing loss-and strongly advocates for an integrated understanding of the symptomatology within a holistic psychological frame of reference. After a brief introduction to the principles of psychosomatic medicine and psychotherapy, the article discusses psychological case conceptualization using a vulnerability-stress-coping (VSC) model as an example, outlines clinical aspects and diagnostics of chronic tinnitus symptomatology, and concludes with a conceptualization of chronic tinnitus-related distress as a function of person-centered VSC interactions.

Limited Link of Common Blood Parameters with Tinnitus.

Background: Tinnitus severity is generally assessed by psychometric and audiological instruments. However, no objective measure exists to evaluate the subjective discomfort and suffering caused by this hearing phenomenon. The objective of this work was to determine the possible blood parameters for diagnostics and therapy. Methods: We measured tinnitus distress by using the Tinnitus Questionnaire (TQ) and collected tinnitus-related audiological measures, namely the hearing threshold (HT), tinnitus loudness (TL), and sensation level (SL, i.e., the tinnitus loudness/hearing threshold at a tinnitus frequency). Blood samples were taken from 200 outpatients of the Tinnitus Centre of the Charité, and 46 routine blood count parameters were examined. The possible interactions were determined by (robust) linear models. Results: Tinnitus distress and audiological measurements were largely uncorrelated but could partly be predicted by selected blood parameters. First, the erythrocyte counts predicted tinnitus distress to a small extent. Second, the levels of vitamin D3 explained about 6% of tinnitus loudness and, age-dependently, the hearing threshold variability. Last, the levels of uric acid explained about 5% of the sensation level variability. Conclusions: Tinnitus is a multidimensional phenomenon. The marginal influences of blood markers suggest the possible roles of inflammation and oxidative stress produced by psychological or somatic burdens. Clinically, a vitamin D substitution (in older patients) might have a hearing-protective effect.

Aging Makes the Heart Grow Fonder: Age Influences Hearing Ability and Interactions between Psychological Phenomena in Patients with Chronic Tinnitus.

(1) Background: Risk factors for chronic tinnitus comprise interactions of individuals' hearing difficulties and psychological distress-including anxiety, depression, and perceived stress levels. Both groups of factors likely become more pronounced with age, although mixed literature has also suggested increases in psychological resilience over time. To this end, only a few studies have delineated direct and indirect effects of age on audiological and psychological variables that might influence tinnitus-related distress in patients with chronic tinnitus. (2) Methods: N = 678 patients with chronic tinnitus completed audiological assessments alongside self-report measures of psychological and tinnitus-related distress. Path analyses investigated the effect of age on patients' tinnitus-related distress via both audiological and psychological variables. (3) Results: Age was significantly associated with both hearing ability and psychological distress indices, with perceived stress and anxiety decreasing with aging. Different mediation models revealed that the association between age and tinnitus-related distress was mediated completely by hearing ability and partly by perceived stress and anxiety. (4) Conclusions: Whilst interactions of individuals' hearing ability and psychological distress levels maintain tinnitus-related distress across the age span, the weighting of these factors may shift with age. Treatment approaches should consider hearing ability across the lifespan. Psychological factors should be individually conceptualized, considering both distress-related and potential resilience factors in old age.

Hearing Aid Use Time Is Causally Influenced by Psychological Parameters in Mildly Distressed Patients with Chronic Tinnitus and Mild-to-Moderate Hearing Loss.

BACKGROUND: Hearing aids (HAs) can improve tinnitus-related distress (TRD) and speech-comprehension (SC) in silence or at 55 dB noise-interference (SC_55 dB) in patients with chronic tinnitus and mild-to-moderate hearing loss. However, the role of HA use time in relation to psychological, audiological, or self-reported tinnitus characteristics is under-investigated. METHODS: We examine 177 gender-stratified patients before (t1) and after an intervention comprising binaural DSLchild algorithm-based HA fitting and auditory training (t2) and at a 70-day follow up [t3]. HA use time was retrospectively retrieved (at t2) for the pre-post- and (at t3) post-follow up periods. General linear models investigated HA use time in relation to (1) general audiological, (2) tinnitus-related audiological, (3) tinnitus-related self-report, and (4) distress-related self-report indices before and after treatment, where applicable. Receiver operator characteristic analyses identified optimal HA use time for hereby-mediated treatment changes. RESULTS: At t1 and t2, psychological, but not audiological indices causally influenced prospective HA use time-except for SC_55 dB at t1, which, however, correlated with patients' anxiety, depressivity, and psychological distress levels. Correlations did not differ between patient subgroups defined by categorical tinnitus-related audiological or self-report indices. HA use time partly mediated treatment-related improvement in TRD, but not SC. Optimal use amounted to 9.5-10.5 h/day. CONCLUSIONS: An awareness of psychological influences may help clinicians facilitate HA use and, thereby, TRD improvement with hearing amplification.

DSLchild-Algorithm-Based Hearing Aid Fitting Can Improve Speech Comprehension in Mildly Distressed Patients with Chronic Tinnitus and Mild-to-Moderate Hearing Loss.

BACKGROUND: Patients with chronic tinnitus and mild-to-moderate hearing loss (HL) can experience difficulties with speech comprehension (SC). The present study investigated SC benefits of a two-component hearing therapy. METHODS: One-hundred-seventy-seven gender-stratified patients underwent binaural DSLchild-algorithm-based hearing aid (HA) fitting and conducted auditory training exercises. SC was measured at four timepoints under three noise interference conditions each (0, 55, and 65 dB): after screening (t0; without HAs), HA- fitting (t1), additional auditory training (t2), and at 70-day follow-up (t3). Repeated-measure analyses of covariance investigated the effects of HAs (t0-t1), auditory training (t1-t2), and the stability of the combined effect (t2-t3) on SC per noise interference level and HL subgroup. Correlational analyses examined associations between SC, age, and psychological indices. RESULTS: Patients showed mildly elevated tinnitus-related distress, which was negatively associated with SC in patients with mild but not moderate HL. At 0 dB, the intervention lastingly improved SC for patients with mild and moderate HL; at 55 dB, for patients with mild HL only. These effects were mainly driven by HAs. CONCLUSIONS: The here-investigated treatment demonstrates some SC-benefit under conditions of no or little noise interference. The auditory training component warrants further investigation regarding non-audiological treatment outcomes.

Estimation of Tinnitus-Related Socioeconomic Costs in Germany.

Despite the high prevalence of tinnitus in Germany of nearly 12% of the general population, there have been no systematic studies on the socioeconomic costs for German society caused by tinnitus so far. Here we analyzed data from 258 chronic tinnitus patients-namely tinnitus severity and health utility index (HUI)-and correlated them with their tinnitus-related public health care costs, private expenses, and economic loss due to their tinnitus percept as assessed by questionnaires. We found correlations of the HUI with health care costs and calculated the mean socioeconomic costs per tinnitus patient in Germany. According to our most conservative estimate, these sum up to EUR 4798.91 per year. Of that EUR 2206.95 account for the public health care, EUR 290.45 are carried by the patient privately and the remaining EUR 2301.51 account for economical loss due to sick leave. With a prevalence of 5.5% with at least bothersome tinnitus, this sums up to 21.9 billion Euro per year and with 25.82 sick leave days; tinnitus patients miss work more than double the time of the average German employee (10.9 days). The findings fit within the cost ranges of studies from other European countries and the USA and show that the socioeconomic burden of this disease-like symptom is a global problem. In comparison with the costs of other major chronic diseases in Germany-such as chronic obstructive pulmonary diseases (ca. 16 billion Euro) or diabetes mellitus (ca. 42 billion Euro)-the relevance of the 'symptom' tinnitus for the German social economy becomes even more obvious.

Negative Associations of Stress and Anxiety Levels With Cytotoxic and Regulatory Natural Killer Cell Frequency in Chronic Tinnitus.

Background: Depression and anxiety are known to be associated with stress-induced changes in the immune system. Bothersome tinnitus can be related to stress and often co-occurs with depression and anxiety. This study investigates associations of psychological and audiological tinnitus-related factors with inflammatory parameters and immune cell subsets in chronic tinnitus patients as well as treatment-related effects. Methods: This longitudinal study of inpatients treated with compact multimodal tinnitus-specific cognitive behavioral therapy included four repeated measurement sessions: baseline (N = 41), treatment end, 7.8-week (N = 35), and 13.8-week follow-up (N = 34). Data collection included audiometric testing, blood sampling, and psychometric questionnaires: Tinnitus Handicap Inventory (THI), Perceived Stress Questionnaire (PSQ-20), and Hospital Anxiety Depression Scale (HADS). Flow cytometry was used to analyze immune cell subsets. Statistical analyses comprised correlation and network analysis (cross-sectional), and linear mixed effect models (longitudinal). Results: Bootstrapped network analysis showed negative averaged cross-sectional associations of cytotoxic natural killer (NKc) cell frequency (CD56 + CD16+) and PSQ-20 (-0.21 [-0.48, 0]) and of regulatory natural killer (NKreg) cell frequency (CD56 + CD16dim/-) and HADS anxiety (-0.14 [-0.38, 0]). No significant treatment effects were found. A negative predictive effect of baseline PSQ-20 scores (ß = -6.22 [-12.18, -0.26], p = 0.041) and a positive predictive effect of baseline ferritin levels (ß = 8.90 [2.76, 15.03], p = 0.004) on NKc cell frequency across the repeated measurement sessions were observed. Conclusion: We observed negative relationships between perceived stress levels and NKc cell frequency and between anxiety levels and NKreg cell frequency in chronic tinnitus patients. These exploratory results suggest stress-/anxiety-related immune alterations in bothersome tinnitus but need to be tested in further confirmatory studies with larger sample sizes. The potential of NK cells as biomarkers of emotional distress in chronic tinnitus should be further investigated.

Sex Differences in Comorbidity Combinations in the Swedish Population.

High comorbidity rates, especially mental-physical comorbidity, constitute an increasing health care burden, with women and men being differentially affected. To gain an overview of comorbidity rates stratified by sex across a range of different conditions, this study examines comorbidity patterns within and between cardiovascular, pulmonary, skin, endocrine, digestive, urogenital, musculoskeletal, neurological diseases, and psychiatric conditions. Self-report data from the LifeGene cohort of 31,825 participants from the general Swedish population (62.5% female, 18-84 years) were analyzed. Pairwise comorbidity rates of 54 self-reported conditions in women and men and adjusted odds ratios (ORs) for their comparison were calculated. Overall, the rate of pairwise disease combinations with significant comorbidity was higher in women than men (14.36% vs. 9.40%). Among psychiatric conditions, this rate was considerably high, with 41.76% in women and 39.01% in men. The highest percentages of elevated mental-physical comorbidity in women were found for musculoskeletal diseases (21.43%), digestive diseases (20.71%), and skin diseases (13.39%); in men, for musculoskeletal diseases (14.29%), neurological diseases (11.22%), and digestive diseases (10%). Implications include the need for integrating mental and physical health care services and a shift from a disease-centered to an individualized, patient-centered focus in clinical care.

Vascular-Metabolic Risk Factors and Psychological Stress in Patients with Chronic Tinnitus.

Little is known about molecular correlates of chronic tinnitus. We examined interrelationships between vascular−metabolic risk factors, perceived stress, and other routine blood values in patients with chronic tinnitus. Two-hundred patients (51% female) were screened for 49 blood parameters pertaining to vascular−metabolic risk, immune function, and redox processes. They further completed perceived stress- and tinnitus-related distress questionnaires. Following descriptive analyses, gender-specific sets of age- and tinnitus-severity-adjusted regression models investigated associations between perceived stress and blood parameters. Patients reported mildly elevated levels of perceived stress. Elevated levels of total cholesterol (65% and 61% of female and male patients, respectively), non-HDL-c (43/50%), LDL-c (56/59%), and lipoprotein_a (28/14%) were accompanied by high rates of overweight (99/100%) and smoking (28/31%). A low-level inflammatory state was accompanied by reduced reactive oxygen species (ROS)-neutralizing capacity (reduced co-enzyme Q10 and SOD1 levels). Most vascular risk factors were not correlated with perceived stress, except for fibrinogen (ß = −0.34) as well as C-reactive protein (ß = −0.31, p < 0.05) in men, and MCV (ß = −0.26, p < 0.05) in women. Interrelations between blood parameters and stress levels need to be investigated within psychobehavioural frameworks across varying distress levels. Alongside psychological interventions, a low-level inflammatory state may be a route for pharmacological therapeutics.

Hearing Therapy Improves Tinnitus-Related Distress in Mildly Distressed Patients with Chronic Tinnitus and Mild-to-Moderate Hearing Loss: A Randomized-Controlled Cross-Over Design.

BACKGROUND: The psychological effects of hearing aids and auditory training are underinvestigated. OBJECTIVE: To assess the short- and long-term effects of an industry-developed auditory training on tinnitus-related distress, perceived stress, and psychological epiphenomena in patients with chronic tinnitus and mild-to-moderate hearing loss. METHOD: One-hundred-seventy-seven gender-stratified patients were randomized to an immediate [IIG] or delayed [DIG] intervention group. Following binaural hearing aid fitting, participants completed a CD-enhanced 14-days self-study program. Applying a randomized-controlled cross-over design, psychological measures were obtained at four times: pre-treatment/wait [IIG: t1; DIG: wait], post-treatment/pre-treatment [IIG: t2; DIG: t1], follow-up/post-treatment [IIG: t3; DIG: t2], and follow-up [DIG: t3]. Between- and within-group analyses investigated treatment-related effects and their stability at a 70-day follow-up. RESULTS: Overall, distress symptom severity was mild. Unlike the DIG, the IIG showed significant improvements in tinnitus-related distress. Some psychological epiphenomena, notably anxiety, slightly improved in both groups. Within-group analyses demonstrated the stability of the tinnitus-distress-related effects, alongside uncontrolled improvements of perceived stress and mood-related symptoms at follow-up. CONCLUSIONS: The investigated hearing therapy lastingly improves tinnitus-related distress in mildly distressed patients with chronic tinnitus and mild-to-moderate hearing loss. Beneficial psychological knock-on effects deserve further investigation.

Juxtaposing Medical Centers Using Different Questionnaires Through Score Predictors.

Background: Chronic tinnitus is a clinically multidimensional phenomenon that entails audiological, psychological and somatosensory components. Previous research has demonstrated age and female gender as potential risk factors, although studies to this regard are heterogeneous. Moreover, whilst recent research has begun to identify clinical "phenotypes," little is known about differences in patient population profiles at geographically separated and specialized treatment centers. Identifying such differences might prevent potential biases in joint randomized controlled trials (RCTs) and allow for population-specific treatment adaptations. Method: Two German tinnitus treatment centers were compared regarding pre-treatment data distributions of their patient population bases. To identify overlapping as well as center-specific factors, juxtaposition-, similarity-, and meta-data-based methods were applied. Results: Between centers, significant differences emerged. One center demonstrated some predictive power of the patients of the other center with regard to questionnaire score after treatment, indicating similarities in treatment response across center populations. Furthermore, adherence to the completion of the questionnaires was found to be an important factor in predicting post-treatment data. Discussion: Differential age and gender distributions per center should be considered as regards RCT design and individualized treatment planning.

Psychological Treatment Effects Unrelated to Hair-Cortisol and Hair-BDNF Levels in Chronic Tinnitus.

BACKGROUND: Currently, there are no objective markers to measure treatment efficacy in chronic (distressing) tinnitus. This study explores whether stress-related biomarkers cortisol and brain-derived neurotrophic factor (BDNF) measured in hair samples of chronic tinnitus patients change after compact multimodal tinnitus-specific cognitive behavioral therapy. METHODS: In this longitudinal study, hair-cortisol and hair-BDNF levels, self-reported tinnitus-related distress (Tinnitus Questionnaire; TQ), and perceived stress (Perceived Stress Questionnaire; PSQ-20) were assessed before and 3 months after 5 days of treatment in N = 80 chronic tinnitus patients. Linear mixed-effects models with backward elimination were used to assess treatment-induced changes, and a cross-lagged panel model (structural equation model) was used for additional exploratory analysis of the temporal associations between TQ and hair-BDNF. RESULTS: At follow-up, a reduction in TQ (p < 0.001) and PSQ-20 scores (p = 0.045) was observed, which was not influenced by baseline hair-cortisol or hair-BDNF levels. No changes in biomarker levels were observed after treatment. The exploratory analysis tentatively suggests that a directional effect of baseline TQ scores on hair-BDNF levels at follow-up (trend; p = 0.070) was more likely than the opposite directional effect of baseline hair-BDNF levels on TQ scores at follow-up (n.s.). DISCUSSION: While the treatment effectively reduced tinnitus-related distress and perceived stress in chronic tinnitus patients, this effect was not mirrored in biological changes. However, the lack of changes in hair-cortisol and hair-BDNF levels might have been influenced by the treatment duration, follow-up interval, or confounding medical factors, and therefore must be interpreted with caution. The relationship between tinnitus-related distress and hair-BDNF levels should be explored further to obtain a better understanding of stress-related effects in chronic tinnitus.

Construct validity of the Mini-TQ-15 for a rapid and differentiated assessment of tinnitus-related distress.

OBJECTIVE: Different domains of tinnitus-related distress can be assessed by self-report questionnaires, such as the original 52-item version of the Tinnitus Questionnaire (TQ). Short forms of the TQ allow a more rapid assessment. For this purpose, a new 15-item short form (Mini-TQ-15) has been previously developed. In the present retrospective cohort study, we aimed to compare construct validity of the Mini-TQ-15 and the original TQ. METHODS: Data of 7112 patients with chronic tinnitus that filled out the German 52-item version of the TQ at the Tinnitus Center at Charité University Hospital Berlin, Germany were retrospectively analyzed. 1409 of the 7112 patients completed additional psychological tests (ADS-L, BSF, PHQ, ACSA, SWOP) before starting therapy. Data of these 1409 patients with higher tinnitus distress on average were included in the present study. We compared convergent and discriminant validity of the TQ and the Mini-TQ-15 by calculating Spearman's rank correlation between their different factors and the results of further self-report questionnaires. RESULTS: The factor emotional and cognitive distress of the original TQ and of the Mini-TQ-15 showed specific high correlations with depression scales (correlation coefficients between 0.50 and 0.60) and considerably lower correlations with the other scales. CONCLUSION: Results of the present study indicate good convergent and discriminant validity of the Mini-TQ-15 and of the original TQ. The three factorial Mini-TQ-15 represents a promising short version with good construct validity for a rapid and differentiated assessment of tinnitus-related distress.

Dimensions of Tinnitus-Related Distress.

OBJECTIVES: (1) To determine which psychosocial aspects predict tinnitus-related distress in a large self-reported dataset of patients with chronic tinnitus, and (2) to identify underlying constructs by means of factor analysis. METHODS: A cohort of 1958 patients of the Charité Tinnitus Center, Berlin completed a large questionnaire battery that comprised sociodemographic data, tinnitus-related distress, general psychological stress experience, emotional symptoms, and somatic complaints. To identify a construct of "tinnitus-related distress", significant predictive items were grouped using factor analysis. RESULTS: For the prediction of tinnitus-related distress (linear regression model with R2 = 0.7), depressive fatigue symptoms (concentration, sleep, rumination, joy decreased), the experience of emotional strain, somatization tendencies (pain experience, doctor contacts), and age appeared to play a role. The factor analysis revealed five factors: "stress", "pain experience", "fatigue", "autonomy", and low "educational level". CONCLUSIONS: Tinnitus-related distress is predicted by psychological and sociodemographic indices. Relevant factors seem to be depressive exhaustion with somatic expressions such as sleep and concentration problems, somatization, general psychological stress, and reduced activity, in addition to higher age.