PERCEIVED SEVERITY AND ITS RELATIONSHIP TO THE PSYCHOACOUSTIC CHARACTERISTICS OF TINNITUS - Christina M. Dambra

PERCEIVED SEVERITY AND ITS
    RELATIONSHIP TO THE
     PSYCHOACOUSTIC
CHARACTERISTICS OF TINNITUS

    Christina M. Dambra

SPECIFIC AIMS
   Elucidate the relationship between the Tinnitus
    Handicap Questionnaire and the psychoacoustic
    properties of tinnitus

   Determine whether or not questionnaires such as
    these are useful clinical tools

BACKGROUND AND SIGNIFICANCE
   What is tinnitus and how is it assessed?
     Concentration,   sleep, and hearing difficulties may result

     Attempts   at treating the disorder are limited by an
      inability to accurately assess the condition

     Currently   both subjective and objectives have been
      used

BACKGROUND AND SIGNIFICANCE
Sample of THQ Items
I do not enjoy life because of tinnitus.
I feel uneasy in social situations because of tinnitus.
Tinnitus affects the quality of my relationships.
I am unable to follow conversation during meetings
   because of tinnitus.
I have trouble falling asleep at night because of
   tinnitus.

BACKGROUND AND SIGNIFICANCE
   Herraiz et. al (2002) found that psychoacoustic
    characteristics such as pitch, minimal masking levels,
    and residual inhibition could be correlated with
    tinnitus severity

   Herraiz et. al (2002) also noted that the presence
    of hearing loss, hyperacusis, and anxiety was
    related to a higher severity score

BACKGROUND AND SIGNIFICANCE
   Kuk et al. (1990) found no significant relationship
    between scores of severity and loudness or MML
   Also noted a strong correlation between subjective
    judgments of loudness and tinnitus handicap
   When correlated with the objective measurement of
    loudness, subjective measurements were much higher
   Similarly, Henry et al. (1996) failed to find a
    relationship between subjective and objective
    loudness ratings

BACKGROUND AND SIGNIFICANCE

   Tyler (1983) found high correlations between
    the objective measurement of loudness and the
    level of noise required to cover it up

   Evidence that a relationship between the
    loudness and MML does not exist (Burns, 1984)

RESEARCH DESIGN AND METHODS
   PARTICIPATION
     20  subjects
     Recruited via postings at UB’s Speech-Language
      and Hearing Clinic as well as through mailings to
      the Tinnitus Support Group of Western New York
     Must have had tinnitus for a minimum of 6 months in
      at least one ear
     No history of otologic disorders

     Required to pass tympanometric screening

RESEARCH DESIGN AND METHODS

   METHOD
     Completion   of questionnaires
     Informal interview
     Otoscopic examination
     Tympanometric screening
     Pure tone audiometry (0.25-8 kHz)
     High frequency audiometry (9-16 kHz)
     Pitch and Loudness matching
     Minimum masking levels
     Loudness discomfort levels

HYPOTHESES
1. The loudness of tinnitus will be directly related to self-
   perceived handicap.
2. Subjects who require higher levels of masking will
   experience greater handicap.
3. Subjects with reduced sound tolerance will indicate
   greater handicap on the THQ.
4. The degree of hearing loss will be positively
   correlated with perceived handicap.
5. Tinnitus pitch will be positively correlated with
   perceived handicap.

RESULTS: Participant Characteristics
   Subject Characteristics
     Meanage=63. 7 years (50-82)
     85% male

   Hearing Loss
     95%   of participants had some degree of hearing loss
      in the 0.25-8 kHz range
   Loudness Discomfort Levels
     Mean LDL for 40 ears = 96. 2
     10% had abnormal LDLs

RESULTS: Participant Characteristics
   Tinnitus Laterality and Quality
     85%   reported bilateral tinnitus
     “Hissing” tinnitus was most commonly reported (35%)

   THQ
     Mean score=29.87
     45% scored a 30 or higher

RESULTS: Perceptual Characteristics
   Pitch
     Mean  subjective rating = 8.0
     Mean objective rating=6 kHz

     No significant relationship between the two

   Loudness
     Mean   subjective rating=6.4
     Mean objective rating=9.2 dB SL

     Significant relationship found between the two

Figure 3.
                                  Subjective vs. Objective Loudness Rating
                                  30

      Measured Loudness (dB SL)
                                  20

                                  10

                                  0
                                       0      2       4       6       8       10
                                           Subjective Loudness (1-10 scale)

RESULTS: Perceptual Characteristics
r=0.29, p=.014

RESULTS: Perceptual Characteristics
   Minimum Masking Levels
     Average MML for BBN=30 dB SL
     Average MML for NBN=20 dB SL

     Difference was statistically significant
                  Figure 6.
                                      BBN vs NBN
                           40
                           35          *
                           30
                           25
                   dB SL

                           20
                           15
                           10
                            5
                            0
                                      L)

                                                             L)
                                  (S

                                                          (S
                                  N

                                                      BN
                                BB

                                                      N

                                           Stimulus

Figure 7.                                            Figure 8.

                        Loudness vs. NBN SL                               Loudness vs. BBN SL
               80                                                80

               60                                                60
   NBN dB SL

                                                     BBN dB SL
               40                                                40

               20                                                20

               0                                                 0
                    0      10          20     30                      0      10          20     30
                          Loudness (dB SL)                                  Loudness (dB SL)

               RESULTS: Perceptual Characteristics
               Significant relationship between loudness and NBN MML

RESULTS
   Psychoacoustic Measures and their Relationship to
    THQ
     No  significant relationships between hearing loss,
      loudness, pitch, LDLs, or MMLs and the THQ score
     Subjective ratings of loudness were related to THQ
      score

DISCUSSION
   Subjective and objective ratings of loudness were
    correlated, yet the same was not true for pitch
     Conceptof pitch is difficult for patients to understand
     May be due to the limited frequency resolution of the
      audiometer
   Effectiveness of the NBN masker as opposed to the
    BBN not surprising

DISCUSSION
   Results of this study conflict with previous reports
    which suggest that perceived handicap is related to
    the psychoacoustic properties of tinnitus
   Our data suggests that tinnitus handicap is
    INDEPENDENT of tinnitus pitch, loudness, masking
    level, or degree of hearing loss
   This may be useful if the goal of treatment is to
    improve the patient’s reaction; cannot be used if the
    goal is improve the actual properties of tinnitus
    (loudness, maskability, etc.)

DISCUSSION
   Although this questionnaire was not useful in
    predicting the characteristics of tinnitus, it may be
    helpful in identifying patients who are in need of
    further psychological care
   Future studies should examine the relationship
    between assessment tools other than the THQ
   Bridging the gap between subjective and objective
    measures may help in placing patients into distinct
    treatment categories

ACKNOWLEDGMENTS
 A special thanks to the following members of my
                      committee:

                 Richard Salvi, PhD
               Edward Lobarinas, PhD
                    Wei Sun, PhD
                   Bohua Hu, PhD
               Christina Stocking, AuD

References
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   Bauer, C.A., Brozoski, T.J. 2001. Assessing tinnitus and prospective tinnitus therapeutics using a psychophysical animal model. J Assoc Res Otolaryngol 2, 54-64.
   Burns, E.M. 1984. A comparison of variability among measurements of subjective tinnitus and objective stimuli. Audiology 23, 426-40.
   Erlandsson, S., Hallberg, L., Axelsson, A. 1992. Psychological and audiological correlates of perceived tinnitus severity. Audiology: official organ of the International
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