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Tinnitus: psychosomatische Aspekte

Tinnitus: psychosomatic aspects

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Zusammenfassung

Tinnitus ist ein häufiges Symptom unklarer Genese, das multifaktoriell bedingt und aufrechterhalten sein kann. Es ist oftmals, aber nicht zwingend, mit Hörverlust assoziiert. Emotionale Belastung oder maladaptive Copingstrategien, die sich in Reaktion auf Tinnitus entwickeln oder durch ihn verstärkt werden können, stellen Schlüsselfaktoren für psychosoziale Interventionen dar. Hierzu eignen sich – nach Abklärung somatischer Einflussfaktoren – entkatastrophisierende Informationsvermittlung und ggf. psychotherapeutische Interventionen. Maßnahmen zur Verbesserung der Hörwahrnehmung (z. B. Hörgeräte oder Cochleaimplantate) können über direkte (Verbesserung der Hörwahrnehmung) oder indirekte Effekte (Verbesserung des emotionalen Befindens oder der Lebensqualität) ebenfalls zur Tinnitushabituation beitragen.

Abstract

Tinnitus is a common symptom of unclear origin that can be multifactorially caused and maintained. It is frequently, but not inevitably, associated with hearing loss. Emotional distress and maladaptive coping strategies – that are associated with or amplified by the tinnitus percept – pose key targets for psychological interventions. Once somatic contributors are identified and treated as applicable, psychological approaches comprise normalizing psychoeducational and psychotherapeutic interventions. Measures to improve hearing perception (e. g., hearing aids or cochlear implants) can also contribute to tinnitus habituation through direct (improvement of hearing perception) or indirect (improvement of emotional wellbeing or quality of life) effects.

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Authors and Affiliations

  1. Tinnituszentrum, Charité – Universitätsmedizin Berlin, Karlplatz 7, 10117, Berlin, Deutschland

    B. Boecking, P. Brueggemann & B. Mazurek

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  1. B. Boecking
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  2. P. Brueggemann
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  3. B. Mazurek
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Correspondence to B. Boecking.

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Interessenkonflikt

B. Boecking, P. Brueggemann und B. Mazurek geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Redaktion

M. Canis, München

T. Hoffmann, Ulm

J. Löhler, Bad Bramstedt

P. Mir-Salim, Berlin

S. Strieth, Mainz

CME-Fragebogen

CME-Fragebogen

Welcher der folgenden Einflussfaktoren ist nicht mit Tinnitus assoziiert?

Depression

Granulomatose mit Polyangiitis

Meningitis

Diabetes mellitus

Leberinsuffizienz

In welchem Fall ist eine weiterführende bildgebende Diagnostik angeraten?

Bei dekompensiertem Tinnitus

Bei chronischem Tinnitus

Bei pulsatilem Tinnitus

Bei einseitigem Tinnitus

Bei knackendem Tinnitus

Welche Aussage hinsichtlich Tinnitus und Stress trifft zu?

Stress verursacht Tinnitus.

Tinnitus verursacht Stress.

Stress sagt Tinnitus voraus.

Stress schützt vor Tinnitus.

Stress muss zunächst definiert werden.

Entsprechend der psychologischen Fallkonzeptualisierung wird Leidensdruck durch Tinnitus am wenigsten beeinflusst durch ...

Lerngeschichte

Copingstrategien

Kulturelle Faktoren

Tinnituslautheit

Umwelteinflüsse

Welche Medikamente sollten bei chronischem Tinnitus verschrieben werden?

Antikonvulsiva

Keine

Neuroleptika

Ginkgo biloba

Kortison

Wie wirken Hörgeräte auf die Tinnitusbelastung?

Indirekt über eine Besserung des Hörvermögens

Direkt über eine Maskierung

Indirekt über eine Erhöhung der Lebensqualität

Direkt über dopaminerge Veränderungen entlang der Hörbahn

Indirekt durch eine Änderung der Tonotopie der Basilarmembran

Eine 45-jährige Patientin stellt sich in Ihrer Praxis mit einem seit 8 Monaten bestehenden Tinnitus links (Wert im Tinnitus-Fragebogen, TF: 46) mit Normakusis vor. Therapeutisch sei bisher lediglich Ginkgo eingenommen worden. Welche Behandlung kommt am ehesten in Betracht?

Akupunktur

Hyperbare Oxygenierung

Systemische Gabe von Hochdosisglukokortikoiden

Tinnitusspezifische Psychotherapie

Hörgeräteverordnung

Welche der folgenden Schritte muss bei Patienten mit einseitigem nichtpulsatilem Tinnitus sowie Hörbeeinträchtigung nicht durchgeführt werden?

Erhebung einer biopsychosozialen Anamnese

HNO-ärztliche und audiologische Untersuchung

Körperliche Untersuchung

Dopplersonographie

Beratung bezüglich Managementstrategien

Welcher der folgenden Fragebögen stellt am wenigsten ein geeignetes Diagnostikum in der Tinnitustherapie dar?

Tinnitus-Handicap-Inventar (THI)

General Anxiety Scale-7 (GAD-7)

Perceived Stress Questionnaire (PSQ)

Insomnia Severity Index (ISI)

Eustachian Tube Dysfunction Questionnaire (ETDQ-7)

Welchen Vorteil bieten psychologische Fallkonzeptualisierungen nicht?

Sie enthalten eindeutige Informationen zur Ätiologie einer Symptomatik.

Sie erlauben die Generierung oder Überprüfung direktionaler Hypothesen.

Sie bilden evidenzbasierte Zusammenhänge ab.

Sie können sowohl konzeptuell als auch individuell angelegt sein.

Sie können dabei helfen, individuelle Behandlungskonzepte zu vermitteln.

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Boecking, B., Brueggemann, P. & Mazurek, B. Tinnitus: psychosomatische Aspekte. HNO 67, 137–152 (2019). https://doi.org/10.1007/s00106-019-0609-7

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  • DOI: https://doi.org/10.1007/s00106-019-0609-7

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