PSYCHOLOGICAL MORBIDITY IN PATIENTS WITH TINNITUS : A HOSPITAL BASED CROSS SECTIONAL STUDY

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DOI: 10.18410/jebmh/2015/749

ORIGINAL ARTICLE

J of Evidence Based Med & Hlthcare, pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 2/Issue 35/Aug. 31, 2015 Page 5383

PSYCHOLOGICAL MORBIDITY IN PATIENTS WITH TINNITUS: A

HOSPITAL BASED CROSS SECTIONAL STUDY

Arti Pandey1_{, Ashutosh Tiwari}2

HOW TO CITE THIS ARTICLE:

Arti Pandey, Ashutosh Tiwari. “Psychological Morbidity in Patients with Tinnitus: A Hospital Based Cross Sectional Study”. Journal of Evidence based Medicine and Healthcare; Volume 2, Issue 35, August 31, 2015; Page: 5383-5386, DOI: 10.18410/jebmh/2015/749

ABSTRACT: INTRODUCTION: Tinnitus is not a disease but a symptom of hearing sound when no external sound is present. Studies have shown that some people, the sound causes anxiety or interferes with concentration, increased awareness of depression and personality disorders. To this purpose we evaluated the prevalence of psychiatric morbidity in chronic tinnitus using MINI interview. METHODS: A sample of 53 male and female patients with tinnitus between the age of 13 and 50 years participated in the study. Patients with ear infections, disease of the heart or blood vessels , Meniere's disease, brain tumors, exposure to certain medications, a previous head injury and earwax were excluded. The subjects so chosen, were explained the nature of the study. Data was collected from outpatient ENT Clinics regarding demographic and clinical profiles from these patients. Each subject was then administered Mini International Neuropsychaitric Interview (M.I.N.I) RESULTS: More numbers of females were there than males and majority were in between 30-39 years. Both married and unmarried people were equally affected. Middle class and upper lower classes were most affected. The prevalence of psychiatric co morbidity in these tinnitus patients follows in descending order: Major depressive disorder>>Social Phobia > Suicide > Panic-disorder > Obsessive – compulsive – disorder > Agarophobia = Dysthymic-disorder=Generalized-anxiety. CONCLUSION: We observed that the prevalence of psychiatric morbidity in chronic tinnitus patients were as follows in descending order Major-depressive-disorder >> Social-Phobia > Suicide > Panic-Major-depressive-disorder > Obsessive - compulsive –disorder > Agarophobia = Dysthymic disorder=Generalized-anxiety. Treatment of this psychiatric morbidity with medications and psychotherapy may likely reduce the severity of tinnitus in many of these patients.

KEYWORDS: Tinnitus, Chronic Tinnitus, Depression, Anxiety, DMS-IV.

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DOI: 10.18410/jebmh/2015/749

ORIGINAL ARTICLE

J of Evidence Based Med & Hlthcare, pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 2/Issue 35/Aug. 31, 2015 Page 5384 METHODS: This hospital based cross sectional descriptive study was conducted at Navjeevan Clinic Bilaspur C. G. between June 2012 to October 2012. Ethical committee has approved the study protocol and obtained informed consent from the study participants. These subjects were then screened using the inclusion and exclusion criteria. A sample of 53 male and female patients with tinnitus between the age of 13 and 50 years participated in the study. Patients with ear infections, disease of the heart or blood vessels, Meniere's disease, brain tumors, exposure to certain medications, a previous head injury and earwax were excluded. The subjects so chosen, were explained the nature of the study. Data was collected from outpatient ENT Clinics regarding demographic and clinical profiles from these patients. Each subject was then administered Mini International Neuropsychaitric Interview (M.I.N.I).(4)_{M.I.N.I. was designed as a brief structured} interview for the means of which a multiaxial diagnosis (Five axes) was expressed, according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and ICD-10. The results of earlier studies showed that the M.I.N.I. has acceptably high validation and reliability scores, but can be administered in a much shorter period of time (Mean 18.7±11.6 minutes, median 15 minutes) than the above referenced instruments. The M.I.N.I. is divided into modules identified by letters, each corresponding to a diagnostic category. Clinical judgment by the rater is used in coding the responses. However, Symptoms better accounted for by an organic cause or by the use of alcohol or drugs are not coded positive in the M.I.N.I.[5]_{The M.I.N.I.} contains interviews for the following disorders such as agoraphobia, alcoholic Dependence/abuse, Anorexia Nervosa, Antisocial Personality Disorder, Bulimia Nervosa Dysthmia, Generalized Anxiety Disorder, (Hypo) Manic Episode/ Bipolar Disorder, Major Depressive Episode, Panic Disorder, Obsessive Compulsive Disorder, Psychotic Disorders, Posttraumatic Stress Disorder, Social Phobia, Substance Dependence and Suicidality.

STATISTICAL ANALYSIS: Data was entered into Excel Spread Sheet 2007. Data was then cleaned, mined and extracted using if and sort functions. Data was described as actual numbers and percentages for categorical variables and Mean & SD for continuo’s variables. Statistical analysis was also performed by using EXCEL spreadsheet only.

RESULTS: A total of 53 patients participated in the study; The Demographic and psychiatric morbidity data was shown in tables-1. More numbers of females were there than males and majority were in between 30-39 years. Both married and unmarried people were equally affected. Middle class and upper lower classes were most affected. The prevalence of psychiatric co morbidity in these tinnitus patients follows in descending order: Major-depressive-disorder>>Social-Phobia>Suicide>Panic-disorder>Obcessive-compulsive-disorder>Agarophobia =Dysthymic disorder= Generalized-anxiety. We have seen a high frequency of somatoform, depression, anxiety in patients with chronic tinnitus.

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DOI: 10.18410/jebmh/2015/749

ORIGINAL ARTICLE

all 12 questions relating to tinnitus severity, suggesting that that depression and tinnitus severity are linked in some patients.[5]_{However, there was no significant difference in reported loudness} of tinnitus between patients with and without depression.[6]_{Studies have shown in tinnitus} patients psychiatric disorders exists on patients even with and without hyperacusis.[7]_{Lewis et al}

reported suicides’ are more in chronic tinnitus patients.[4]_{One study had addressed the presence} of Psychiatric diagnoses in patients with psychogenic dizziness or severe tinnitus.[8]

CONCLUSION: We observed that the prevalence of psychiatric morbidity in chronic tinnitus patients were as follows in descending order Major-depressive-disorder>>Social-Phobia > Suicide > Panic-disorder > Obsessive – compulsive – disorder > Agarophobia = Dysthymic disorder= Generalized-anxiety. Treatment of these psychiatric morbidity with medications and psychotherapy may likely reduce the severity of tinnitus in many of these patients.

Parameter Frequency Percentage

Age group

20-29 7 13.2

30-39 28 52.8

40-49 18 34

Gender

Female 12 22.6

Male 41 77.4

Socio economic status

Lower (V) 3 5.7

Upper Lower (IV) 16 30.2

Lower Middle (III) 13 24.5

Upper Middle (II) 14 26.4

Upper (I) 7 7 13.2

Marital Status

Married 25 47.2

Un married 25 47.2

Widowed 3 5.6

Psychiatric Morbidity

Major depressive disorder 36 67.9

Dysthymic disorder 2 3.8

Generalized-anxiety disorder 2 3.8

Social Phobia 30 56.6

Suicide 15 28.3

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DOI: 10.18410/jebmh/2015/749

ORIGINAL ARTICLE

Obsessive-compulsive disorder 4 7.5

Agarophobia 2 3.8

Table 1: Socio demographic parameters and psychiatric morbidity characteristics of tinnitus patients

REFERENCES:

1. Levine, R.A. and Y. Oron, Tinnitus. Handb Clin Neurol, 2015. 129: p. 409-31.

2. Baguley, D., D. McFerran, and D. Hall, Tinnitus. Lancet, 2013. 382(9904): p. 1600-7.

3. Langguth, B., et al., Tinnitus severity, depression, and the big five personality traits, in Progress in Brain Research, G.H.T.K.A.C. B. Langguth and A.R. Møller, Editors. 2007, Elsevier. p. 221-225.

4. Lewis, J., S. Stephens, and L. McKenna, TINNITUS AND SUCIDE. Clinical Otolaryngology & Allied Sciences, 1994. 19(1): p. 50-54.

5. Lewis, J., S. Stephens, and L. McKenna, TINNITUS AND SUCIDE. Clinical Otolaryngology & Allied Sciences, 1994. 19(1): p. 50-54.

6. Folmer, R.L., et al., Tinnitus severity, loudness, and depression. Otolaryngology-Head and Neck Surgery, 1999. 121(1): p. 48-51.

7. Goebel, G. and U. Floezinger, Pilot study to evaluate psychiatric co-morbidity in tinnitus patients with and without hyperacusis. Audiological Medicine, 2008. 6(1): p. 78-84.

8. Simpson, R., et al., Psychiatric diagnoses in patients with psychogenic dizziness or severe tinnitus. The Journal of otolaryngology, 1988. 17(6): p. 325-330.

NAME ADDRESS EMAIL ID OF THE CORRESPONDING AUTHOR: Dr. Arti Pandey,

# 203, Chandrapark, Brahaspatibazar, Bilaspur, Chhattisgarh.

E-mail: drartipandey@gmail.com

Date of Submission: 17/08/2015. Date of Peer Review: 18/08/2015. Date of Acceptance: 20/08/2015. Date of Publishing: 27/08/2015. AUTHORS:

1. Arti Pandey 2. Ashutosh Tiwari

PARTICULARS OF CONTRIBUTORS: 1. Associate Professor & I/C HOD,

Department of ENT, CIMS, Bilaspur, Chhattisgarh.