[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.

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.

Maintaining the legacy and moving forward: The new tinnitus questionnaire short form version 2.

OBJECTIVE: The original 52-item version of the Tinnitus Questionnaire (TQ) is a widely applied self-report instrument to measure tinnitus-related distress. One objective of the current study was the validation of the reported five-factor structure of the German TQ in a new, large sample of patients with chronic tinnitus. Since former studies have yielded conflicting results for the factor structure of the 12-item short version (Mini-TQ), analysis of its factor structure and the generation of a new short version were further study aims. METHODS: Data of 7112 subsequent 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 included in the study. Statistical analyses included exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). RESULTS: CFA showed reasonably acceptable fit indices for a five-factor model for the 52-item version of the TQ, at least for RMSEA, one of the three fit indices (RMSEA = 0.059; CFI = 0.871; TLI = 0.861). Factors were called emotional distress, auditory perceptual difficulties, intrusiveness, sleep disturbances, and coping. Another CFA supports a three-factor model of the newly generated 15-item short version (RMSEA = 0.060; CFI = 0.942; TLI = 0.931) with the factors emotional distress, auditory perceptual difficulties, and intrusiveness. CONCLUSION: Validation of the German 52-item version of the TQ in a large, new sample of patients with chronic tinnitus supports the previously reported five-factor structure with slight differences concerning the identified factors. The new three-factorial 15-item short version allows a more rapid and economical assessment of tinnitus-related distress.

A multidisciplinary systematic review of the treatment for chronic idiopathic tinnitus.

The majority of tinnitus patients are affected by chronic idiopathic tinnitus, and almost 60 different treatment modalities have been reported. The present study is a multidisciplinary systematic analysis of the evidence for the different forms of treatment for chronic tinnitus. The results are used to form the basis of an S3 guideline. A systematic search was carried out in PubMed and the Cochrane Library. The basis for presenting the level of evidence was the evidence classification of the Oxford Centre of Evidence-based Medicine. Whenever available, randomised controlled trials were given preference for discussing therapeutic issues. All systematic reviews and meta-analyses were assessed for their methodological quality, and effect size was taken into account. As the need for patient counselling is self-evident, specific tinnitus counselling should be performed. Due to the high level of evidence, validated tinnitus-specific, cognitive behavioural therapy is strongly recommended. In addition, auditory therapeutic measures can be recommended for the treatment of concomitant hearing loss and comorbidities; those should also be treated with drugs whenever appropriate. In particular, depression should be treated, with pharmacological support if necessary. If needed, psychiatric treatment should also be given on a case-by-case basis. With simultaneous deafness or hearing loss bordering on deafness, a CI can also be indicated. For auditory therapeutic measures, transcranial magnetic or direct current stimulation and specific forms of acoustic stimulation (noiser/masker, retraining therapy, music, and coordinated reset) for the treatment of chronic tinnitus the currently available evidence is not yet sufficient for supporting their recommendation.

Does tinnitus distress depend on age of onset?

OBJECTIVES: Tinnitus is the perception of a sound in the absence of any physical source of it. About 5-15% of the population report hearing such a tinnitus and about 1-2% suffer from their tinnitus leading to anxiety, sleep disorders or depression. It is currently not completely understood why some people feel distressed by their tinnitus, while others don't. Several studies indicate that the amount of tinnitus distress is associated with many factors including comorbid anxiety, comorbid depression, personality, the psychosocial situation, the amount of the related hearing loss and the loudness of the tinnitus. Furthermore, theoretical considerations suggest an impact of the age at tinnitus onset influencing tinnitus distress. METHODS: Based on a sample of 755 normal hearing tinnitus patients we tested this assumption. All participants answered a questionnaire on the amount of tinnitus distress together with a large variety of clinical and demographic data. RESULTS: Patients with an earlier onset of tinnitus suffer significantly less than patients with an onset later in life. Furthermore, patients with a later onset of tinnitus describe their course of tinnitus distress as more abrupt and distressing right from the beginning. CONCLUSION: We argue that a decline of compensatory brain plasticity in older age accounts for this age-dependent tinnitus decompensation.

Hypersensitivity to sound in tinnitus patients: an analysis of a construct based on questionnaire and audiological data.

The purpose of this study was to analyse the Questionnaire on Hypersensitivity to Sound (GUF; Nelting & Finlayson, 2004 ) and to improve its validity based on the analysis of intercorrelations (single item level) with other methods of assessing hyperacusis (uncomfortable loudness level, individual loudness function, self-rated severity of hyperacusis). Subjects consisted of 91 inpatients with tinnitus and hyperacusis. The GUF showed a good reliability (alpha = .92). The factorial structure of the questionnaire reported by Nelting et al (2002) was not completely supported by the evidence in this study. The total score and the single items showed small to moderate correlations with the other modes of measuring hyperacusis. Evidence for convergent and discriminant validity were found, but overall the results corroborate the conceptual heterogeneity of the construct hyperacusis and its dependency on the assessment method. Four items of the GUF with particularly low correlations were excluded from the questionnaire. The revised GUF total score showed slightly but not statistically significant higher convergent and discriminant validity.

When tinnitus loudness and annoyance are discrepant: audiological characteristics and psychological profile.

This study evaluates sociodemographic and clinical characteristics of patients reporting discrepant levels of tinnitus loudness and annoyance. 4958 subjects recruited from a national tinnitus association completed a comprehensive screening questionnaire including Klockhoff and Lindblom's loudness grading system and the psychometric Mini-TQ (Tinnitus Questionnaire). There was a moderate correlation of 0.45 between loudness and annoyance. Of the subjects reporting very loud tinnitus, about one third had only mild or moderate annoyance scores. They were not different from those with high annoyance regarding age, gender and tinnitus duration, but annoyance was increased when subjects had additional hearing loss (OR = 1.71), vertigo/dizziness (OR = 1.94) or hyperacusis (OR = 4.96). Another significant predictor was history of neurological disease (OR = 3.16). Subjects reported low annoyance despite high loudness more often if not feeling low/depressed and not considering themselves as victims of their noises. A specific psychological profile was found to characterize annoyed tinnitus sufferers. Permanent awareness of the noises, decreased ability to ignore them and concentration difficulties were reported frequently even when overall annoyance scores were comparatively low. It is concluded that the coexistence of tinnitus with hearing loss, vertigo/dizziness and hyperacusis as complicating otological conditions seems to be of clinical relevance for the prediction of high annoyance levels. Tinnitus loudness and annoyance are not necessarily congruent and should be assessed separately.

Factors influencing tinnitus loudness and annoyance.

OBJECTIVE: To evaluate the 2 major components of tinnitus severity, loudness and annoyance, and their degree of dependence on characteristics of tinnitus manifestation, history, and etiology. DESIGN: Cross-sectional survey performed during the first months of 2004. SETTING: Nonclinical population. PARTICIPANTS: A total of 4995 members of the German Tinnitus League. MAIN OUTCOME MEASURES: Comprehensive screening questionnaire, including the Klockhoff and Lindblom loudness grading system and the miniversion of the Tinnitus Questionnaire. RESULTS: A moderate correlation of 0.45 was found between tinnitus loudness and annoyance. Both factors were generally higher in men, those older than 50 years, those with binaural and centrally perceived tinnitus, those with increased noise sensitivity, and those who had continuous tinnitus without interruptions. Tinnitus that lasted 12 months or less had a stronger influence on annoyance (odds ratio [OR], 1.96) than on loudness (OR, 0.45), whereas the contrary was found for tinnitus of more than 5 years' duration (ORs, 0.72 and 2.11, respectively). Loudness and annoyance were increased in subjects with coexisting hearing loss, vertigo, and hyperacusis. The impact of hyperacusis on annoyance was clearly stronger than on loudness (ORs, 21.91 vs 9.47). CONCLUSIONS: Several clinical factors of tinnitus influence perceived loudness and annoyance. Both are distinguishable components of tinnitus severity.

Rapid assessment of tinnitus-related psychological distress using the Mini-TQ.

The aim of this study was to develop an abridged version of the Tinnitus Questionnaire (TQ) to be used as a quick tool for the assessment of tinnitus-related psychological distress. Data from 351 inpatients and 122 outpatients with chronic tinnitus were used to analyse item statistics and psychometric properties. Twelve items with an optimal combination of high item-total correlations, reliability and sensitivity in assessing changes were selected for the Mini-TQ. Correlation with the full TQ was >0.90, and test-retest reliability was 0.89. Validity was confirmed by associations with general psychological symptom patterns. Treatment effects indicated by the Mini-TQ were slightly greater than those indicated by the full TQ. The Mini-TQ is recommended as a psychometrically approved and solid tool for rapid and economical assessment of subjective tinnitus distress.