Evaluation of chronic idiopathic tinnitus and its psychosocial triggers

Table 1 Characteristics of tinnitus in the studied patients, n (%)

Characteristics	Patients, n = 230	Compensated tinnitus, n = 53	Decompensated tinnitus, n = 177	P value
Duration of tinnitus in mo	6-24 (11.5 ± 2.5)	10.6 ± 2.2	14.3 ± 2.3	0.03
≥ 6 to ≤ 12	55 (23.9)	8 (15.1)	47 (26.6)
> 12 to ≤ 18	127 (55.2)	7 (13.2)	120 (67.8)
> 18	48 (20.9)	38 (71.7)	10 (5.7)
Origin of sound
Ear	147 (63.9)	38 (71.7)	109 (61.6)
Ear and head	83 (36.1)	15 (28.3)	68 (38.4)
Description
Ringing	32 (14)	14 (26.4)	18 (10.2)
Whistling	76 (33)	14 (26.4)	62 (35)
Roaring	34 (14.8)	13 (24.5)	21 (11.9)
Clicking	17 (7.4)	0	17 (9.6)
Sound echo	9 (4)	0	9 (5.1)
Different descriptions	62 (27)	12 (22.6)	50 (28.3)
Laterality
Unilateral, either right or left	63 (27.4)	3 (5.7)	60 (33.9)
Bilateral	132 (57.4)	38 (71.7)	94 (53.1)
Equal intensity	98 (43.6)	30 (56.6)	68 (38.4)
Unequal intensity	34 (14.8)	8 (15.1)	26 (14.7)
Alternating	35 (15.2)	12 (22.6)	23 (13)
Pattern
Continuous	120 (52.2)	28 (42.8)	92 (52)
Periodic	110 (47.8)	25 (47.2)	85 (48)
Time of occurrence
In silence, e.g., at bed time	140 (60.8)	25 (47.2)	115 (65)
In presence of noise or silence	90 (39.1)	28 (42.8)	62 (35)

Significance: Compensated vs decompensated tinnitus.

Table 2 Results of the diagnostic work-up questionnaires and psychiatric interviewing, n (%)

Characteristics	Patients, n = 230	Compensated, n = 53	Decompensated, n = 177	P value
Type of insomnia
Sub-threshold insomnia	43 (18.7)	10 (18.9)	33 (18.6)
Moderately severe clinical insomnia	129 (52.2)	25 (47.2)	104 (58.8)
Severe clinical insomnia	58 (23.2)	18 (34)	40 (22.6)
ISI score	20.6 ± 5.3	14.3 ± 2.4	28.6 ± 2.3	0.001
DASS-21
Depression
No, score: 0-9	45 (19.6)	14 (26.4)	31 (17.5)
Mild, score: 10-13	85 (37)	23 (43.4)	62 (35)
Moderate, score: 14-20	60 (26.1)	12 (22.6)	48 (27.1)
Severe, score: 21-27	28 (12.2)	4 (7.6)	24 (13.6)
Extremely severe, score: 28+	12 (5.2)	0	12 (6.8)
Score	15.88 ± 3.26	14.08 ± 2.46	22.68 ± 2.26	0.02
Anxiety
No, score: 0-7	12 (5.2)	12 (22.6)	0
Mild, score: 8-9	16 (7)	14 (26.4)	2 (1.1)
Moderate, score: 10-14	120 (52.2)	8 (15.1)	112 (63.3)
Severe, score: 15-19	58 (25.2)	19 (35.9)	39 (22)
Extremely severe, score: 20+	24 (10.4)	0	24 (13.6)
Score	28.65 ± 2.80	22.42 ± 2.33	30.55 ± 2.08	0.01
Stress
No, score: 0-14	10 (4.4)	2 (3.8)	8 (4.5)
Mild, score: 15-18	12 (5.2)	3 (5.7)	9 (5.1)
Moderate, score: 19-25	106 (46.1)	40 (75.5)	66 (37.3)
Severe, score: 26-33	60 (26.1)	8 (26.1)	52 (29.4)
Extremely severe, score: 34+	42 (18.3)	0	42 (23.7)
Score	38.32 ± 3.86	23.82 ± 2.40	42.88 ± 2.23	0.001
PSS
Perceived low stress	12 (5.2)	3 (5.7)	9 (5.1)
Perceived moderate stress	106 (46.1)	30 (56.6)	76 (42.9)
Perceived high stress	112 (48.7)	20 (37.7)	92 (51.98)
Comorbid physical and psychiatric conditions
Major depression	40 (17.4)	8 (26.1)	32 (18.1)
Non-specific anxiety disorder	82 (35.7)	18 (34)	64 (35)
Somatization disorder	45 (19.6)	3 (5.7)	42 (23.7)
Poor concentration	88 (38.3)	23 (43.4)	65 (36.7)
Non-specific headache	110 (47.9)	32 (60.4)	78 (44.1)
Gastrointestinal tract symptoms	95 (41.3)	20 (37.7)	75 (42.4)
Sexual dysfunction	73 (31.7)	26 (49.1)	47 (26.6)
Family history of psychiatric disorders	18 (7.8)	6 (11.3)	12 (6.8)

P value: Compensated vs decompensated tinnitus. DASS21: Depression, anxiety, stress scale 21; ISI: Insomnia severity index; PSS: Perceived stress scale.

Table 3 Life stressors of studied patients, n (%)

No.	Most stressful life events or changes	Total, n = 230	Compensated, n = 53	Decompensated, n = 177
1	Financial issues: Change in financial state; Accumulation of loans; Stopped work or fired at work (either subject or a spouse)	178 (77.39)	27 (50.94)	151 (85.31)
2	Marital issues: Trouble with spouse; Marital separation; Divorce; Death of spouse	168 (73.04)	3 (5.66)	165 (93.22)
3	Siblings' issues: Change in health; Death; Left home; Poor achievement at school or college or work; Stopped work	160 (69.57)	20 (37.74)	140 (79.10)
4	Change in personal issues: Lower home daily activities; Lower work activities; Poor social activities; Change in personal habits; Change in religion habits	120 (52.17)	0	120 (67.80)
5	Work or home activities' issues: Work readjustment; Change in work hours or conditions; Change to a different line of work; Change a different responsibility at work; Change in sleeping habits or frequent daytime shifts	63 (27.39)	0	63 (35.59)
6	Trouble with law issues	0	0	0
7	A close relatives' or a friends' issues: Change in health; Death	50 (21.74)	3 (5.66)	47 (26.55)
8	None	18 (8.83)	0	18 (10.17)

Table 4 Results of correlation analysis between tinnitus and psychological variables, r (P value)

Parameter	Duration	THI	ISI	PSS
Duration
THI	0.358 (0.01)
ISI	0.520 (0.001)	0.653 (0.001)
DASS-21
Depression	0.362 (0.04)	0.325 (0.033)	0.350 (0.02)	0.358 (0.01)
Anxiety	0.540 (0.001)	0.386 (0.02)	0.520 (0.001)	0.626 (0.001)
Stress	0.565 (0.001)	0.543 (0.001)	0.624 (0.001)	0.580 (0.001)
PSS	0.338 (0.01)	0.545 (0.001)	0.545 (0.001)

DASS-21: Depression, anxiety, stress scale 21; ISI: Insomnia severity index; PSS: Perceived stress scale; THI: Tinnitus handicap inventory.