Functional Impact of Tinnitus in Patients with Hearing Loss

THIEME Original Research Functional Impact of Tinnitus in Patients with Hearing Loss Erika Barioni Mantello1 Luciana de Mata Lupoli2 Paula Cantarella de Padua Rodrigues3 Juliana Maria Soares Cavalcante4 Eduardo Tanaka Massuda5 Adriana Ribeiro Tavares Anastasio4 1 Speech, Language and Hearing Department, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil 2 Clinical Speech, Language and Hearing Department, Pontifícia Universidade Católica, São Paulo, SP, Brazil 3 Speech Therapist Graduated, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, SP, Brazil 4 Department of Health Sciences, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, SP, São Paulo, Brazil 5 Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil Address for correspondence Erika Barioni Mantello, PhD, Departamento de Fonoaudiologia, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte (UFRN), Rua General Gustavo Cordeiro de Faria, s/n, Petrópolis, Natal, RN, 59012-570, Brasil (e-mail: ). Int Arch Otorhinolaryngol 2020;24(2):e197–e203. Abstract Keywords ► tinnitus ► hearing loss ► questionnaires ► quality of life received October 30, 2018 accepted August 11, 2019 published online January 28, 2020 Introduction Tinnitus, which is considered the third worst symptom for humans, is a common complaint among people living with hearing loss and may negatively affect the quality of life of those who have it. Objective To analyze the perception of the handicap in patients with tinnitus and hearing loss as well as the possible associations between the variables hearing loss, loudness, onset, frequency and annoyance by tinnitus, and the correlation between the visual analogue scale (VAS) and the Tinnitus Handicap Inventory (THI). Methods A total of 30 patients with complaints of tinnitus and the presence of sensorineural hearing impairment were selected for this cross-sectional, observational, and descriptive study. The loudness of the tinnitus was measured by a VAS and classified as mild, moderate, or severe. The THI was classified as slight, mild, moderate, severe, and catastrophic. Data were submitted to statistical analysis using the Fisher exact test and Spearman correlation coefficient. Results Eleven male (36.7%) and 19 female (63.3%) subjects with a mean age of 56.5 years old were evaluated. There was no significant association between loudness, annoyance, time and frequency of tinnitus, nor between hearing loss and tinnitus. There was a significant association between the variables hearing loss and loudness, and a weak correlation between VAS and THI. Conclusion Tinnitus has a practical impact in the lives of patients with hearing loss in terms of catastrophic, functional, and emotional aspects, regardless of loudness, frequency, or time of onset. Hearing loss was a factor that had an impact on the loudness of tinnitus. There was no statistically significant correlation between VAS and THI. DOI https://doi.org/ 10.1055/s-0039-1697994. ISSN 1809-9777. Copyright © 2020 by Thieme Revinter Publicações Ltda, Rio de Janeiro, Brazil 197 198 Functional Impact of Tinnitus in Patients Mantello et al. Introduction Tinnitus is the sound sensation perceived by a sole individual regardless of the external sound stimulus. Tinnitus is not a disease but a symptom. It is considered the third worst symptom for humans, only surpassed by intense and intractable pain and dizziness.1,2 There is no concrete statistical data about the prevalence of tinnitus in Brazil. However, it is believed that more than 28 million Brazilians experience tinnitus at some stage of their lives.3,4 Several impairments are associated with the presence of tinnitus, such as failure in reasoning, memory, and concentration. These alterations can influence negatively the quality of life of the individuals affected by tinnitus, and there are reports in the literature on the association of these alterations impairing work and leisure activities, rest time, communication, both in the social and domestic environments, with repercussions on the psychic sphere, causing people to be irritable, anxious, distressed, depressed, and insomniac.5–9 The measurement of tinnitus is still a very controversial topic, and there is no standardized measure widely used in the audiological routine. Although otoneurological and psychoacoustic tests may aid in the clinical diagnosis and choice of treatment, they are not sensitive or specific tests to measure the quality of life (QoL) impairment due to tinnitus. However, there are subjective assessment tools available in Portuguese, such as the Hospital Anxiety and Depression Scale (HADS), most commonly used to detect symptoms of depression, due to its easy applicability.10–12 As tinnitus is a subjective symptom, it is difficult to analyze, evaluate and treat. Assessment instruments, such as acuphenometry and, aisual analogue scale (VAS), and questionnaires to determine the impact of tinnitus, such as the Tinnitus Handicap Inventory (THI), are important tools in addition to individual approaches in the treatment of patients afflicted by tinnitus.9,13–15 The THI is a specific questionnaire to evaluate the emotional, functional, and catastrophic aspects triggered by tinnitus.9,16,17 Ferreira et al14 and Schmidt et al18 adapted the THI to the Portuguese language determining its reproducibility and validity. The Brazilian version of the THI was considered a reliable, valid and reproducible instrument for the verification of impairment in the quality of life caused by tinnitus.14 Tinnitus is a constant complaint in the medical and speech-language clinics, and its association with hearing loss is reported by 85 to 96% of patients. Tinnitus from the sensorineural hearing system presents more complex pathophysiology, making it more distressing to the patient and challenging for the clinician.19,20 Some studies show a relationship between the severity of tinnitus and the degree of hearing loss.21,22 Baskill and Coles23 believe that the influence of the degree of hearing loss on the severity of tinnitus is still uncertain, as they found the correlation between auditory thresholds and annoyance by tinnitus to be weak. Numerous authors have described the repercussion of tinnitus on the individual’s quality of life. The adverse effects caused by tinnitus on the quality of life of the subjects may be reduced, even there is no effective cure.24 Scientific knowledge about tinnitus variables is essential to provide subsidies International Archives of Otorhinolaryngology Vol. 24 No. 2/2020 that help the evaluation and decision on the most appropriate clinical treatment; and studies that address the impact of tinnitus are useful for promoting the quality of life of the individuals affected. Thus, the aim of this study was to analyze the perception of the hand (...truncated)