Tinnitus: distinguishing between subjectively perceived loudness and tinnitus-related distress

Abstract

Objectives: Overall success of current tinnitus therapies is low, which may be due to the heterogeneity of tinnitus patients. Therefore, subclassification of tinnitus patients is expected to improve therapeutic allocation, which, in turn, is hoped to improve therapeutic success for the individual patient. The present study aims to define factors that differentially influence subjectively perceived tinnitus loudness and tinnitus-related distress.

Methods: In a questionnaire-based cross-sectional survey, the data of 4705 individuals with tinnitus were analyzed. The self-report questionnaire contained items about subjective tinnitus loudness, type of onset, awareness and localization of the tinnitus, hearing impairment, chronic comorbidities, sleep quality, and psychometrically validated questionnaires addressing tinnitus-related distress, depressivity, anxiety, and somatic symptom severity. In a binary step-wise logistic regression model, we tested the predictive power of these variables on subjective tinnitus loudness and tinnitus-related distress.

Results: The present data contribute to the distinction between subjective tinnitus loudness and tinnitus-related distress. Whereas subjective loudness was associated with permanent awareness and binaural localization of the tinnitus, tinnitus-related distress was associated with depressivity, anxiety, and somatic symptom severity.

Conclusions: Subjective tinnitus loudness and the potential presence of severe depressivity, anxiety, and somatic symptom severity should be assessed separately from tinnitus-related distress. If loud tinnitus is the major complaint together with mild or moderate tinnitus-related distress, therapies should focus on auditory perception. If levels of depressivity, anxiety or somatic symptom severity are severe, therapies and further diagnosis should focus on these symptoms at first.

Figure 1. Comorbidity of depressivity, anxiety, and somatic symptom severity derived from scores of the Patient Health Questionnaire (PHQ).

A: Somatic symptom severity was most common (13.1% of whole sample) followed by depressivity (10.6%) and anxiety (7.3%). 3.6% of the whole sample were affected by elevated levels of depressivity, anxiety and somatic symptom severity at the same time, and an additional 4.5% showed elevated levels in two scales. B: The 726 participants with scores of 15 or above in at least one of the three PHQ scales (1/3) were set to 100%. Of these, 318 (43.8%) exhibited severe levels in at least 2 PHQ-scales (2/3), while 142 (19.6%) had severe levels in all scales (3/3). The percentage of participants with scores of 15 and above in all three scales (3/3) was least common in the subgroup with mild tinnitus-related distress (2.9%), while it was most common in the subgroup with severe tinnitus-related distress with 39.8%. Differences between subgroups with low and high subjective loudness had the same direction, but were less pronounced. PHQ scales: PHQ-9 – depressivity, GAD-7 – anxiety, PHQ-15 – somatic symptom severity.