Zusammenfassung
Hintergrund
Tinnitus wird oft in eine akute und eine chronische Form eingeteilt. Allerdings ergaben epidemiologische Studien als häufigste Form intermittierenden Tinnitus (IT), der keiner dieser Kategorien eindeutig zugehört.
Ziel der Arbeit
Ziel war eine weitergehende empirische Beschreibung des IT.
Material und Methoden
In einer exploratorischen Querschnittstudie wurden 320 Tinnitusbetroffene zu Soziodemografie, Tinnitusmerkmalen, begleitenden Beschwerden, wahrgenommenen Auslösern und hilfesuchendem Verhalten befragt. Sie wurden eingeteilt in: chronischer Tinnitus (CT), wenn sie den Tinnitus in den letzten 12 Monaten ständig bemerkten, IT, wenn sie den Tinnitus nur zeitweise wahrnahmen, oder Einzelepisode (SET), wenn der Tinnitus nur einmal, aber für mehrere Tage aufgetreten war.
Ergebnisse
Von 62 % der Stichprobe wurde IT angegeben, von 23 % SET und von 16 % CT. Der Beginn lag im Mittel 36 (CT), 28 (IT) bzw. 19 Monate (SET) zurück. Dabei dauerten IT-Episoden bei den meisten Betroffenen wenige Tage, bei 25 % 1–4 Wochen, im Durchschnitt 1,6 Wochen. Sie traten in einer Häufigkeit zwischen alle paar Tage und halbjährlich auf, im Mittel alle 7 Wochen. Führende Auslöser waren beruflicher oder privater Stress. Abnahme der Leistungsfähigkeit, Depression, soziale Isolation, psychiatrische Störungen und Innenohrerkrankungen waren bei CT häufiger als bei IT. Hilfesuchendes Verhalten war zwischen CT und IT vergleichbar.
Schlussfolgerung
Emotionale Reaktionen und situative Beeinträchtigung führen bei IT zu multiplen Behandlungsversuchen, i. Allg. aber nicht zu schwerer Beeinträchtigung. Innenohrerkrankungen und psychische Veränderungen sind seltener als bei CT, daher könnten Therapieansprechen und Prognose besser sein. Die Autoren schlagen eine Einteilung in akute Einzelepisode (<3 Monate), intermittierende und chronisch persistierende Form (>3 Monate) vor.
Abstract
Background
Tinnitus is often classified into acute or chronic persistent forms. However, epidemiologic studies have shown that intermittent tinnitus (IT), which does not clearly belong to either category, is the most common form.
Objective
The aim of this study was to further characterize IT empirically.
Materials and methods
We conducted an exploratory cross-sectional interview study among 320 subjects with tinnitus. Sociodemographic and tinnitus characteristics, concomitant complaints, perceived triggers, and help-seeking behavior were assessed. Subjects were classified into continuous (CT), IT, or single-episode tinnitus (SET) if they had experienced tinnitus “continuously,” “temporarily time and again,” or “only once but for several days,” respectively, during the past 12 months.
Results
Of the sample, 62% reported IT, 23% SET, and 16% CT. Mean time since onset was 36 (CT), 28 (IT), and 19 months (SET), respectively. Most subjects with IT experienced episodes lasting a few days, whereas in 25%, episodes lasted 1–4 weeks. Mean duration was 1.6 weeks. The frequency of IT episodes ranged from every few days to half-yearly; mean frequency was every 7 weeks. Leading triggers were occupational and private stress. Asthenia, depression, social isolation, psychiatric disorders, and inner ear disorders were more prevalent among CT than IT subjects. Help-seeking behavior was comparable between CT and IT.
Conclusion
IT is associated with emotional reactions and situational impairment severe enough to trigger multiple treatment attempts, but usually does not result in severe impairment. Inner ear disorders and psychological changes are less frequent than in CT; therefore, treatment response and prognosis might be better. We suggest classification of tinnitus into acute single-episode (<3 months), intermittent, or chronic persistent (>3 months) forms.
Literatur
Andersson G, Vretblad P, Larsen HC et al (2001) Longitudinal follow-up of tinnitus complaints. Arch Otolaryngol Head Neck Surg 127:175–179
Auerbach BD, Rodrigues PV, Salvi RJ (2014) Central gain control in tinnitus and hyperacusis. Front Neurol 5:206
Bhatt JM, Lin HW, Bhattacharyya N (2016) Prevalence, severity, exposures, and treatment patterns of tinnitus in the United States. Jama Otolaryngol Head Neck Surg 142:959–965
Bruggemann P, Szczepek AJ, Rose M et al (2016) Impact of multiple factors on the degree of tinnitus distress. Front Hum Neurosci 10:341
Cima RF, Maes IH, Joore MA et al (2012) Specialised treatment based on cognitive behaviour therapy versus usual care for tinnitus: a randomised controlled trial. Lancet 379:1951–1959
Cornwell BR, Baas JM, Johnson L et al (2007) Neural responses to auditory stimulus deviance under threat of electric shock revealed by spatially-filtered magnetoencephalography. Neuroimage 37:282–289
Creswell JD, Taren AA, Lindsay EK et al (2016) Alterations in resting-state functional connectivity link mindfulness meditation with reduced Interleukin-6: a randomized controlled trial. Biol Psychiatry 80:53–61
Drew S, Davies E (2001) Effectiveness of Ginkgo biloba in treating tinnitus: double blind, placebo controlled trial. BMJ 322:73
Flores LS, Teixeira AR, Rosito LP et al (2016) Pitch and loudness from tinnitus in individuals with noise-induced hearing loss. Int Arch Otorhinolaryngol 20:248–253
Hall DA, Haider H, Kikidis D et al (2015) Toward a global consensus on outcome measures for clinical trials in tinnitus: report from the first international meeting of the COMiT initiative, November 14, 2014, Amsterdam, the Netherlands. Trends Hear 19:1–7. https://doi.org/10.1177/2331216515580272
Hall DA, Haider H, Szczepek AJ et al (2016) Systematic review of outcome domains and instruments used in clinical trials of tinnitus treatments in adults. Trials 17:270
Hoekstra CE, Wesdorp FM, Van Zanten GA (2014) Socio-demographic, health, and tinnitus related variables affecting tinnitus severity. Ear Hear 35:544–554
Knippers M, Van DP, Nunes I et al (2013) Advances in the neurobiology of hearing disorders: recent developments regarding the basis of tinnitus and hyperacusis. Prog Neurobiol 111:17–33
Krauss P, Tziridis K, Metzner C et al (2016) Stochastic resonance controlled upregulation of internal noise after hearing loss as a putative cause of tinnitus-related neuronal hyperactivity. Front Neurosci 10:597
Landgrebe M, Azevedo A, Baguley D et al (2012) Methodological aspects of clinical trials in tinnitus: a proposal for an international standard. J Psychosom Res 73:112–121
Leaver AM, Turesky TK, Seydell-Greenwald A et al (2016) Intrinsic network activity in tinnitus investigated using functional MRI. Hum Brain Mapp 37:2717–2735
Maron-Katz A, Vaisvaser S, Lin T et al (2016) A large-scale perspective on stress-induced alterations in resting-state networks. Sci Rep 6:21503
Mazurek B, Haupt H, Olze H et al (2012) Stress and tinnitus-from bedside to bench and back. Front Syst Neurosci 6:47
Mazurek B, Szczepek AJ, Hebert S (2015) Stress and tinnitus. HNO 63:258–265
Mccormack A, Edmondson-Jones M, Somerset S et al (2016) A systematic review of the reporting of tinnitus prevalence and severity. Hear Res 337:70–79
Moller AR (2011) Introduction. In: Moller AR, Langguth B, DeRidder D, Kleinjung T (Hrsg) Textbook of tinnitus. Springer, New York, S 3–7
Oiticica J, Bittar RS (2015) Tinnitus prevalence in the city of Sao Paulo. Braz J Otorhinolaryngol 81:167–176
Probst T, Pryss R, Langguth B et al (2016) Emotional states as mediators between tinnitus loudness and tinnitus distress in daily life: results from the “TrackYourTinnitus” application. Sci Rep 6:20382
Rauschecker JP, Leaver AM, Muhlau M (2010) Tuning out the noise: limbic-auditory interactions in tinnitus. Neuron 66:819–826
Seydel C, Haupt H, Szczepek AJ et al (2010) Long-term improvement in tinnitus after modified tinnitus retraining therapy enhanced by a variety of psychological approaches. Audiol Neurootol 15:69–80
Shargorodsky J, Curhan GC, Farwell WR (2010) Prevalence and characteristics of tinnitus among US adults. Am J Med 123:711–718
Shore SE, Roberts LE, Langguth B (2016) Maladaptive plasticity in tinnitus – triggers, mechanisms and treatment. Nat Rev Neurol 12:150–160
Simonetti P, Oiticica J (2015) Tinnitus neural mechanisms and structural changes in the brain: the contribution of neuroimaging research. Int Arch Otorhinolaryngol 19:259–265
Stein A, Wunderlich R, Lau P et al (2016) Clinical trial on tonal tinnitus with tailor-made notched music training. Bmc Neurol 16:38
Tunkel DE, Bauer CA, Sun GH et al (2014) Clinical practice guideline: tinnitus. Otolaryngol Head Neck Surg 151:S1–S40
Zenner HP (2015) S3-Leitlinie 017/064: Chronischer Tinnitus. In: AdWMF e. V. (Hrsg) https://www.awmf.org/uploads/tx_szleitlinien/017-064l_S3_Chronischer_Tinnitus_2015-02.pdf (open access)
Zenner HP, Vonthein R, Zenner B et al (2013) Standardized tinnitus-specific individual cognitive-behavioral therapy: a controlled outcome study with 286 tinnitus patients. Hear Res 298:117–125
Förderung
Diese Studie wurde von der Fa. Dr. Willmar Schwabe GmbH & Co. KG, Karlsruhe, finanziert.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
B. Mazurek ist Direktor, M. Burkart, P. Brueggemann und A. J. Szczepek sind Ganztagsbeschäftigte bei Institutionen, die Tinnitusbehandlungen anbieten. D. Frank ist Managing Director der Fa. ISM Global Dynamics, Bad Homburg, der Organisation, welche die Studie durchgeführt hat.
Die Studie wurde im Einklang mit dem International Code on Market and Social Research der International Chamber of Commerce/European Society for Opinion and Market Research und aktuellen Richtlinien des BVM (Berufsverband Deutscher Markt- und Sozialforscher e. V.) durchgeführt. Von allen Befragten liegt eine Einwilligung vor.
Rights and permissions
About this article
Cite this article
Burkart, M., Brueggemann, P., Szczepek, A.J. et al. Intermittierender Tinnitus – eine empirische Beschreibung. HNO 67, 440–448 (2019). https://doi.org/10.1007/s00106-019-0622-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00106-019-0622-x