title: Tinnitus: distinguishing between subjectively perceived loudness and tinnitus-related distress.
abstract: OBJECTIVE
  Overall success of current tinnitus therapies is low, which may be due to the heterogeneity of tinnitus patients. Therefore, subclassification of tinnitus patients is expected to improve therapeutic allocation, which, in turn, is hoped to improve therapeutic success for the individual patient. The present study aims to define factors that differentially influence subjectively perceived tinnitus loudness and tinnitus-related distress.
  
  
  METHODS
  In a questionnaire-based cross-sectional survey, the data of 4705 individuals with tinnitus were analyzed. The self-report questionnaire contained items about subjective tinnitus loudness, type of onset, awareness and localization of the tinnitus, hearing impairment, chronic comorbidities, sleep quality, and psychometrically validated questionnaires addressing tinnitus-related distress, depressivity, anxiety, and somatic symptom severity. In a binary step-wise logistic regression model, we tested the predictive power of these variables on subjective tinnitus loudness and tinnitus-related distress.
  
  
  RESULTS
  The present data contribute to the distinction between subjective tinnitus loudness and tinnitus-related distress. Whereas subjective loudness was associated with permanent awareness and binaural localization of the tinnitus, tinnitus-related distress was associated with depressivity, anxiety, and somatic symptom severity.
  
  
  CONCLUSIONS
  Subjective tinnitus loudness and the potential presence of severe depressivity, anxiety, and somatic symptom severity should be assessed separately from tinnitus-related distress. If loud tinnitus is the major complaint together with mild or moderate tinnitus-related distress, therapies should focus on auditory perception. If levels of depressivity, anxiety or somatic symptom severity are severe, therapies and further diagnosis should focus on these symptoms at first.
authors.affiliation: Department of Phoniatrics and Audiology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. elisabeth.wallhaeusser@medma.uni-heidelberg.de
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Wallhäusser-Franke
authors.forename: Joachim
authors.initials: J
authors.lastname: Brade
authors.forename: Tobias
authors.initials: T
authors.lastname: Balkenhol
authors.forename: Roberto
authors.initials: R
authors.lastname: D'Amelio
authors.forename: Andrea
authors.initials: A
authors.lastname: Seegmüller
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Delb
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D016015:Logistic Models; D008144:Loudness Perception; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013312:Stress, Physiological; D011795:Surveys and Questionnaires; D014012:Tinnitus / Q000175:diagnosis*; D055815:Young Adult