Research Article

The relation among tinnitus distress, psychoacoustic parameters and anxiety state in hearing-impaired patients with chronic tinnitus: a pilot study


Background and Aim: Anxiety and depression are prevalent psychological disorders accompany tinnitus that have adverse effects on quality of life of these patients and on the outcomes of rehabilitation programs. The goal of this study was determining and quantifying the relation among perceived tinnitus severity, its psychoacoustic parameters and anxiety symptoms in hearing-impaired individuals with subjective chronic tinnitus and residual inhibition (RI) by using Persian version of Spielberger's State-Trait Anxiety Inventory (STAI), tinnitus handicap inventory-Persian version (THI-P) and visual analogue scale (VAS) besides psychometric evaluations.
Methods: Fourteen patients with chronic tinnitus were enrolled in this cross-sectional study. Conventional psychoacoustic tinnitus evaluations (i.e. determining quality of tinnitus, pitch matching, loudness matching, minimum masking level and RI) were conducted for all subjects, and they also completed the Persian version of STAI and THI-P. For screening of tinnitus perceived loudness and distress, VAS was used.
Results: There was no correlation among THI-P, VAS scores and psychoacoustic parameters. There was a positive significant correlation between THI-P and Persian STAI scores (r = 0.63; p = 0.01). There was not any significant correlation between tinnitus duration and VAS, STAI or THI-P. There also had no significant correlation between VAS and THI-P (r = 0.56; p = 0.2).
Conclusion: The present pilot study showed that Persian version of THI and STAI are correlated questionnaires. Therefore, Persian version of these questionnaires are valuable tools for evaluation of patients with chronic tinnitus.

1. Haider HF, Bojić T, Ribeiro SF, Paço J, Hall DA, Szczepek AJ. Pathophysiology of subjective tinnitus: triggers and maintenance. Front Neurosci. 2018;12:866. doi: 10.3389/fnins.2018.00866
2. Noreña AJ. Revisiting the cochlear and central mechanisms of tinnitus and therapeutic approaches. Audiol Neurootol. 2015;20 Suppl 1:53-9. doi: 10.1159/000380749
3. Han BI, Lee HW, Kim TY, Lim JS, Shin KS. Tinnitus: characteristics, causes, mechanisms, and treatments. J Clin Neurol. 2009;5(1):11-9. doi: 10.3988/jcn.2009.5.1.11
4. Samarei R, Fatholahi N. Causes of tinnitus in patients referred to ENT clinic of Imam Khomeini hospital in Urmia, 2012-2013. Glob J Health Sci. 2014;6(7 Spec No):136-43. doi: 10.5539/gjhs.v6n7p136
5. Bhatt JM, Bhattacharyya N, Lin HW. Relationships between tinnitus and the prevalence of anxiety and depression. Laryngoscope. 2017;127(2):466-9. doi: 10.1002/lary.26107
6. Pattyn T, Van Den Eede F, Vanneste S, Cassiers L, Veltman DJ, Van De Heyning P, et al. Tinnitus and anxiety disorders: A review. Hearing research. 2016;333:255-65. doi: 10.1016/j.heares.2015.08.014
7. Szibor A, Mäkitie A, Aarnisalo AA. Tinnitus and suicide: An unresolved relation. Audiol Res. 2019;9(1):222. doi: 10.4081/audiores.2019.222
8. Meikle MB, Stewart BJ, Griest SE, Henry JA. Tinnitus outcomes assessment. Trends Amplif. 2008;12(3):223-35. doi: 10.1177/1084713808319943
9. Hoare DJ, Gander PE, Collins L, Smith S, Hall DA. Management of tinnitus in English NHS audiology departments: an evaluation of current practice. J Eval Clin Pract. 2012;18(2):326-34. doi: 10.1111/j.1365-2753.2010.01566.x
10. Newman CW, Jacobson GP, Spitzer JB. Development of the tinnitus handicap inventory. Arch Otolaryngol Head Neck Surg. 1996;122(2):143-8. doi:10.1001/archotol.1996.01890140029007
11. Mahmoudian S, Shahmiri E, Rouzbahani M, Jafari Z, Keyhani M, Rahimi F, et al. Persian language version of the "Tinnitus Handicap Inventory": translation, standardization, validity and reliability. Int Tinnitus J. 2011;16(2):93-103.
12. Aksoy S, Firat Y, Alpar R. The Tinnitus Handicap Inventory: a study of validity and reliability. Int Tinnitus J. 2007;13(2):94-8.
13. Baguley DM, Humphriss RL, Hodgson CA. Convergent validity of the tinnitus handicap inventory and the tinnitus questionnaire. J Laryngol Otol. 2000;114(11):840-3. doi: 10.1258/0022215001904392
14. Wrzosek M, Szymiec E, Klemens W, Kotyło P, Schlee W, Modrzyńska M, et al. Polish translation and validation of the tinnitus handicap inventory and the tinnitus functional index. Front Psychol. 2016;7:1871. eCollection 2016. doi: 10.3389/fpsyg.2016.01871
15. Adamchic I, Langguth B, Hauptmann C, Tass PA. Psychometric evaluation of visual analog scale for the assessment of chronic tinnitus. Am J Audiol. 2012;21(2):215-25. doi: 10.1044/1059-0889(2012/12-0010)
16. Raj-Koziak D, Gos E, Swierniak W, Rajchel JJ, Karpiesz L, Niedzialek I, et al. Visual analogue scales as a tool for initial assessment of tinnitus severity: psychometric evaluation in a clinical population. Audiol Neurootol. 2018;23(4):229-37. doi: 10.1159/000494021
17. Spielberger CD, Gorsuch RL, Lushene RE. STAI manual for the State-trait Anxiety Inventory ("Self-evaluation questionnaire"). Palo Alto, CA: Consulting Psychologists Press; 1970.
18. Mahram B. Spielberger anxiety test guidelines and instructions on the administration and interpretation of standardized tests in Mashhad. Mashhad: Ferdowsi University of Mashhad; 1993.
19. Roberts KE, Hart TA, Eastwood JD. Factor structure and validity of the state-trait inventory for cognitive and somatic anxiety. Psychol Assess. 2016;28(2):134-46. doi: 10.1037/pas0000155
20. Santangelo G, Sacco R, Siciliano M, Bisecco A, Muzzo G, Docimo R, et al. Anxiety in Multiple Sclerosis: psychometric properties of the State-Trait Anxiety Inventory. Acta Neurol Scand. 2016;134(6):458-66. doi: 10.1111/ane.12564
21. Gomaa MA, Elmagd MH, Elbadry MM, Kader RM. Depression, Anxiety and Stress Scale in patients with tinnitus and hearing loss. Eur Arch Otorhinolaryngol. 2014;271(8):2177-84. doi: 10.1007/s00405-013-2715-6
22. Li Y, Wang MX, Zhou J, Zhou HF. [Anxiety and depression in patients with idiopathic tinnitus and its relative factors analysis]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2019;33(5):416-21. Chinese. doi: 10.13201/j.issn.1001-1781.2019.05.008
23. Hajebi A, Motevalian SA, Rahimi-Movaghar A, Sharifi V, Amin-Esmaeili M, Radgoodarzi R, et al. Major anxiety disorders in Iran: prevalence, sociodemographic correlates and service utilization. BMC Psychiatry. 2018;18(1):261. doi: 10.1186/s12888-018-1828-2
24. Nascimento IDP, Almeida AA, Diniz J Junior, Martins ML, Freitas TMMWC, Rosa MRDD. Tinnitus evaluation: relationship between pitch matching and loudness, visual analog scale and tinnitus handicap inventory. Braz J Otorhinolaryngol. 2019;85(5):611-6. doi: 10.1016/j.bjorl.2018.05.006
25. Cho CG, Chi JH, Song JJ, Lee EK, Kim BH. Evaluation of anxiety and depressive levels in tinnitus patients. Korean J Audiol. 2013;17(2):83-9. doi: 10.7874/kja.2013.17.2.83
26. Ooms E, Vanheule S, Meganck R, Vinck B, Watelet JB, Dhooge I. Tinnitus severity and its association with cognitive and somatic anxiety: a critical study. Eur Arch Otorhinolaryngol. 2012;269(11):2327-33. doi: 10.1007/s00405-011-1887-1
27. Udupi VA, Uppunda AK, Mohan KM, Alex J, Mahendra MH. The relationship of perceived severity of tinnitus with depression, anxiety, hearing status, age and gender in individuals with tinnitus. Int Tinnitus J. 2013;18(1):29-34. doi: 10.5935/0946-5448.20130005
28. Zachariae R, Mirz F, Johansen LV, Andersen SE, Bjerring P, Pedersen CB. Reliability and validity of a Danish adaptation of the Tinnitus Handicap Inventory. Scand Audiol. 2000;29(1):37-43. doi: 10.1080/010503900424589
29. McCombe A, Baguley D, Coles R, McKenna L, McKinney C, Windle-Taylor P. Guidelines for the grading of tinnitus severity: the results of a working group commissioned by the British Association of Otolaryngologists, Head and Neck Surgeons, 1999. Clin Otolaryngol Allied Sci. 2001;26(5):388-93. doi: 10.1046/j.1365-2273.2001.00490.x
30. Esmaili AA, Renton J. A review of tinnitus. Aust J Gen Pract. 2018;47(4):205-8. doi: 10.31128/AJGP-12-17-4420
31. Leaver AM, Seydell-Greenwald A, Rauschecker JP. Auditory-limbic interactions in chronic tinnitus: Challenges for neuroimaging research. Hear Res. 2016;334:49-57. doi: 10.1016/j.heares.2015.08.005
32. Jastreboff PJ, Jastreboff MM. Tinnitus retraining therapy (TRT) as a method for treatment of tinnitus and hyperacusis patients. J Am Acad Audiol. 2000;11(3):162-77.
33. Chen YC, Xia W, Chen H, Feng Y, Xu JJ, Gu JP, et al. Tinnitus distress is linked to enhanced resting-state functional connectivity from the limbic system to the auditory cortex. Hum Brain Mapp. 2017;38(5):2384-97. doi: 10.1002/hbm.23525
34. Gunbey HP, Gunbey E, Aslan K, Bulut T, Unal A, Incesu L. Limbic-auditory interactions of tinnitus: an evaluation using diffusion tensor imaging. Clin Neuroradiol. 2017;27(2):221-30. doi: 10.1007/s00062-015-0473-0
35. Ziai K, Moshtaghi O, Mahboubi H, Djalilian HR. Tinnitus patients suffering from anxiety and depression: a review. Int Tinnitus J. 2017;21(1):68-73. doi: 10.5935/0946-5448.20170013
36. Meikle MB, Vernon J, Johnson RM. The perceived severity of tinnitus. Some observations concerning a large population of tinnitus clinic patients. Otolaryngol Head Neck Surg. 1984;92(6):689-96. doi: 10.1177/019459988409200617
37. Crocetti A, Forti S, Ambrosetti U, Bo LD. Questionnaires to evaluate anxiety and depressive levels in tinnitus patients. Otolaryngol Head Neck Surg. 2009;140(3):403-5. doi: 10.1016/j.otohns.2008.11.036
IssueVol 29 No 2 (2020) QRcode
SectionResearch Article(s)
Anxiety; tinnitus; tinnitus handicap inventory; state-trait anxiety inventory; visual analog scale; psychoacoustics

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Sharafi MA, Farahani S, Hoseinabadi R, Zamiri Abdollahi F, Jalaie S, Etemadi M. The relation among tinnitus distress, psychoacoustic parameters and anxiety state in hearing-impaired patients with chronic tinnitus: a pilot study. Aud Vestib Res. 2020;29(2):85-92.