Mithila Durai

Anxiety and depression, personality traits relevant to tinnitus: A scoping review

Abstract Objective: Scoping reviews of existing literature were conducted to identify key personality traits relevant to tinnitus, and examine the relationship between affective disorders and tinnitus. Design: The methodological framework of Arksey and O’Malley was followed. Study sample: Sixty studies were chosen for charting the data, 14 studies examined personality traits exclusively, 31 studies examined affective disorders exclusively, and 15 studies investigated both. Results: The presence of one or more specific personality traits of high neuroticism, low extraversion, high stress reaction, higher alienation, lower social closeness, lower well-being, lower self control, lower psychological acceptance, presence of a type D personality, and externalized locus of control were associated with tinnitus distress. Anxiety and depression were more prevalent among the tinnitus clinical population and at elevated levels. Conclusions: Personality traits have a consistent association with the distress experienced by adult tinnitus help-seekers, and help-seekers are also more likely to experience affective symptoms and/or disorders.

A State-of-the-Art Review: Personalization of Tinnitus Sound Therapy

Background: There are several established, and an increasing number of putative, therapies using sound to treat tinnitus. There appear to be few guidelines for sound therapy selection and application. Aim: To review current approaches to personalizing sound therapy for tinnitus. Methods: A “state-of-the-art” review (Grant and Booth, 2009) was undertaken to answer the question: how do current sound-based therapies for tinnitus adjust for tinnitus heterogeneity? Scopus, Google Scholar, Embase and PubMed were searched for the 10-year period 2006–2016. The search strategy used the following key words: “tinnitus” AND “sound” AND “therapy” AND “guidelines” OR “personalized” OR “customized” OR “individual” OR “questionnaire” OR “selection.” The results of the review were cataloged and organized into themes. Results: In total 165 articles were reviewed in full, 83 contained sufficient details to contribute to answering the study question. The key themes identified were hearing compensation, pitched-match therapy, maskability, reaction to sound and psychosocial factors. Although many therapies mentioned customization, few could be classified as being personalized. Several psychoacoustic and questionnaire-based methods for assisting treatment selection were identified. Conclusions: Assessment methods are available to assist clinicians to personalize sound-therapy and empower patients to be active in therapy decision-making. Most current therapies are modified using only one characteristic of the individual and/or their tinnitus.

The Personality Profile of Tinnitus Sufferers and a Nontinnitus Control Group.

Background: Chronic tinnitus (phantom perception of sound) significantly disrupts quality of life in 15‐20% of those who experience it. Understanding how certain personality traits impact tinnitus perception and distress can be beneficial for the development of interventions to improve the lives of tinnitus sufferers. Purpose: Four key self‐reported personality traits (social closeness, stress reaction, alienation, and self‐control) were identified from previous research as being associated with tinnitus. These were compared between tinnitus and age‐, gender‐, and hearing level‐matched nontinnitus controls to see whether underlying profile differences exist, and if personality traits levels correlate with various tinnitus characteristics assessed in typical clinical questionnaires. Research Design: A Web‐based personality survey was administered comprising of self‐control, stress reaction, alienation, and social closeness subscale questions of the Multidimensional Personality Questionnaire, the Hearing Handicap Inventory‐Screening Version, TFI, and the Tinnitus Case History Questionnaire. Study Sample: A total of 154 participants with tinnitus (81 males, 73 females, mean age = 62.6 yr) and 61 control (32 males, 29 females, mean age = 59.62 yr) participants were recruited via e‐mail invitations to a tinnitus research clinic database, poster, and social media Web site advertising. Data Collection and Analysis: Statistical analysis was conducted using parametric statistics and IBM SPSS® Version 22 software. Results: Tinnitus sufferers displayed higher levels of stress reaction, lower social closeness, lower self‐control, and higher alienation than the control group (p < 0.05). Alienation was related to tinnitus pitch and self‐reported hyperacusis measured using the Tinnitus Case History Questionnaire (p < 0.05). Stress reaction correlated with self‐reported hyperacusis, whether tinnitus sufferers had sought other treatments, and whether loud sounds make the tinnitus worse (p < 0.05). Conclusions: The four personality traits examined in this study exhibited a consistent association with tinnitus perception and distress, and differentiated tinnitus sufferers from nontinnitus control. Some of the traits also correlated significantly with certain characteristics measured in tinnitus history questionnaires. Personality traits are described in relation to “maladaptive” residuals under the Adaptation Level Theory model of tinnitus. The results of the study suggest that certain personality traits correlate with the clinical presentation of tinnitus.

Examining the short term effects of emotion under an Adaptation Level Theory model of tinnitus perception

Objectives: Existing evidence suggests a strong relationship between tinnitus and emotion. The objective of this study was to examine the effects of short‐term emotional changes along valence and arousal dimensions on tinnitus outcomes. Emotional stimuli were presented in two different modalities: auditory and visual. The authors hypothesized that (1) negative valence (unpleasant) stimuli and/or high arousal stimuli will lead to greater tinnitus loudness and annoyance than positive valence and/or low arousal stimuli, and (2) auditory emotional stimuli, which are in the same modality as the tinnitus, will exhibit a greater effect on tinnitus outcome measures than visual stimuli. Study design: Auditory and visual emotive stimuli were administered to 22 participants (12 females and 10 males) with chronic tinnitus, recruited via email invitations send out to the University of Auckland Tinnitus Research Volunteer Database. Emotional stimuli used were taken from the International Affective Digital Sounds‐ Version 2 (IADS‐2) and the International Affective Picture System (IAPS) (Bradley and Lang, 2007a, 2007b). The Emotion Regulation Questionnaire (Gross and John, 2003) was administered alongside subjective ratings of tinnitus loudness and annoyance, and psychoacoustic sensation level matches to external sounds. Results: Males had significantly different emotional regulation scores than females. Negative valence emotional auditory stimuli led to higher tinnitus loudness ratings in males and females and higher annoyance ratings in males only; loudness matches of tinnitus remained unchanged. The visual stimuli did not have an effect on tinnitus ratings. The results are discussed relative to the Adaptation Level Theory Model of Tinnitus. Conclusions: The results indicate that the negative valence dimension of emotion is associated with increased tinnitus magnitude judgements and gender effects may also be present, but only when the emotional stimulus is in the auditory modality. Sounds with emotional associations may be used for sound therapy for tinnitus relief; it is of interest to determine whether the emotional component of sound treatments can play a role in reversing the negative responses discussed in this paper. HighlightsOnly auditory emotional stimuli priming affects tinnitus judgments.Lower valence sounds results in increased tinnitus magnitude estimates.Males and females significantly differ in emotional regulation levels.Gender differences exist in emotional stimuli priming and tinnitus judgments.

A feasibility study of predictable and unpredictable surf-like sounds for tinnitus therapy using personal music players

Abstract Objective: To evaluate the feasibility of predictable or unpredictable amplitude-modulated sounds for tinnitus therapy. Design: The study consisted of two parts. (1) An adaptation experiment. Loudness level matches and rating scales (10-point) for loudness and distress were obtained at a silent baseline and at the end of three counterbalanced 30-min exposures (silence, predictable and unpredictable). (2) A qualitative 2-week sound therapy feasibility trial. Participants took home a personal music player (PMP). Study sample: Part 1: 23 individuals with chronic tinnitus and part 2: seven individuals randomly selected from Part 1. Results: Self-reported tinnitus loudness and annoyance were significantly lower than baseline ratings after acute unpredictable sound exposure. Tinnitus annoyance ratings were also significantly lower than the baseline but the effect was small. The feasibility trial identified that participant preferences for sounds varied. Three participants did not obtain any benefit from either sound. Three participants preferred unpredictable compared to predictable sounds. Some participants had difficulty using the PMP, the average self-report hours of use were low (less <1 h/day). Conclusions: Unpredictable surf-like sounds played using a PMP is a feasible tinnitus treatment. Further work is required to improve the acceptance of the sound and ease of PMP use.

Sound therapy and aural rehabilitation for tinnitus: a person centred therapy framework based on an ecological model of tinnitus

Abstract Purpose: Tinnitus is a common oto-neurological complaint often accompanying hearing loss. In this perspective on rehabilitation we describe a framework for sound therapy and aural rehabilitation of tinnitus based on the ecological model of tinnitus. Method: A thematic network analysis-based approach was used to relate aural rehabilitation methods to the ecological model of tinnitus and the client-oriented scale of improvement in tinnitus. Results: Aural rehabilitation methods were mapped to concepts of: (1) Context, (2) presence of sound and (3) reaction to sound. A global theme was: adaptation to sound. The framework is the result of an iterative and cumulative research program exploring tinnitus as the outcome of the relationship between individual psychoacoustics and psychosocial factors including context of perception. Conclusions: The intent of this framework is to help guide audiologists managing tinnitus. The framework has been useful in our clinic as illustrated by a case study. The benefits of this approach relative to standard care needs to be independently ascertained. Implications for Rehabilitation Tinnitus is a common oto-neurological complaint that when severe can be very disabling. Tinnitus is very heterogeneous as a consequence of this no one treatment is suitable for everyone. The sound therapy and aural rehabilitation for tinnitus framework is designed to assist audiologists in clinical planning that addresses individual needs. The framework is the result of an iterative and cumulative research program exploring tinnitus as the outcome of the relationship between individual psychoacoustics and psychosocial factors including context of perception.

A survey and clinical evaluation of hearing aid data-logging: a valued but underutilized hearing aid fitting tool

ABSTRACT Objectives: Data-logging is a feature in hearing aids with little empirical evidence as to its use and relationship to outcomes in adults. Two studies were undertaken to evaluate data-logging use. Methods: Study 1: a 27-question web-based survey was developed in consultation with hearing aid manufacturers and distributors, and sent to 358 members of the New Zealand Audiological Society (NZAS). Study 2: data-logging results and hearing aid features from 44 clients were related to the Modified Abbreviated Profile of Hearing Aid Benefit (MAPHAB). Results: Study 1 had 108 respondents to the survey (30% response rate); 88% of audiologists found data-logging to be a useful clinical tool in the overall hearing aid fitting process and 94% found it to be a useful tool in participant counselling. Most audiologists reported data-logging use in the first follow-up appointment and often (but not always) in subsequent appointments. Study 2 found data-logging agreed with self-reported patterns of use. The participants found significant benefit in hearing aids according to the MAPHAB, but data-logging results provided little insight into MAPHAB outcomes. Participants used hearing aids for over 8 h per day, with aids in ‘speech-in-quiet’ modes 67% of the time. Clients fitted to the NAL-NL2 prescription had greater benefit than those fitted to NAL-NL1. The trial audiologists seldom used data-logging to assist fitting. Conclusions: Audiologists self-reported that data-logging was a useful clinical tool for assisting in the hearing aid fitting process, however in practice audiologists did not appear to be using many of the data-logging features.

A Review of Auditory Prediction and Its Potential Role in Tinnitus Perception

BACKGROUND The precise mechanisms underlying tinnitus perception and distress are still not fully understood. A recent proposition is that auditory prediction errors and related memory representations may play a role in driving tinnitus perception. It is of interest to further explore this. PURPOSE To obtain a comprehensive narrative synthesis of current research in relation to auditory prediction and its potential role in tinnitus perception and severity. RESEARCH DESIGN A narrative review methodological framework was followed. DATA COLLECTION AND ANALYSIS The key words Prediction Auditory, Memory Prediction Auditory, Tinnitus AND Memory, Tinnitus AND Prediction in Article Title, Abstract, and Keywords were extensively searched on four databases: PubMed, Scopus, SpringerLink, and PsychINFO. All study types were selected from 2000-2016 (end of 2016) and had the following exclusion criteria applied: minimum age of participants <18, nonhuman participants, and article not available in English. Reference lists of articles were reviewed to identify any further relevant studies. Articles were short listed based on title relevance. STUDY SAMPLE After reading the abstracts and with consensus made between coauthors, a total of 114 studies were selected for charting data. RESULTS The hierarchical predictive coding model based on the Bayesian brain hypothesis, attentional modulation and top-down feedback serves as the fundamental framework in current literature for how auditory prediction may occur. Predictions are integral to speech and music processing, as well as in sequential processing and identification of auditory objects during auditory streaming. Although deviant responses are observable from middle latency time ranges, the mismatch negativity (MMN) waveform is the most commonly studied electrophysiological index of auditory irregularity detection. However, limitations may apply when interpreting findings because of the debatable origin of the MMN and its restricted ability to model real-life, more complex auditory phenomenon. Cortical oscillatory band activity may act as neurophysiological substrates for auditory prediction. Tinnitus has been modeled as an auditory object which may demonstrate incomplete processing during auditory scene analysis resulting in tinnitus salience and therefore difficulty in habituation. Within the electrophysiological domain, there is currently mixed evidence regarding oscillatory band changes in tinnitus. CONCLUSIONS There are theoretical proposals for a relationship between prediction error and tinnitus but few published empirical studies.