Tinnitus and anxiety disorders: A review.
BACKGROUND
The most common form of tinnitus is a subjective, auditory, and distressing phantom phenomenon. Comorbidity with depression is high but other important psychiatric disorders such as anxiety disorders have received less attention. The current paper reviews the literature on the associations between tinnitus and anxiety disorders and the underlying pathophysiology, and discusses the clinical implications.


METHODS
PubMed and Web of Science were searched for all articles published up until October 2014 using combinations of the following search strings "Tinnitus", "Anxiety disorder", "Panic Disorder", "Generalized Anxiety Disorder", "Post traumatic stress disorder", "PTSD" "Social Phobia", "Phobia Disorder", "Obsessive Compulsive Disorder", "Agoraphobia".


RESULTS
A total of 117 relevant papers were included. A 45% lifetime prevalence of anxiety disorders is reported in tinnitus populations, while an important overlap in associated (sub)cortical brain areas and cortico-subcortical networks involved in attention, distress, and memory functions is suggested. A disturbed hypothalamic-pituitary-adrenal axis function can be found in tinnitus and in anxiety disorders but, in comorbidity, the direction of the dysfunction is unclear.


CONCLUSIONS
Comorbidity is high and screening for and treatment of anxiety disorders is recommended in moderate to severe tinnitus, as, given the overlap in the structural and functional brain circuitries involved, theoretically, their management could improve (subjective) levels of tinnitus although further empirical research on this topic is required.
University of Antwerp, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp, Belgium; University Department of Psychiatry, Campus Antwerp University Hospital, Antwerp, Belgium. Electronic address: thomas.pattyn@uantwerpen.be.
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Pattyn
University Department of Psychiatry, Campus Antwerp University Hospital, Antwerp, Belgium; University of Antwerp, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp, Belgium.
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Van Den Eede
University of Antwerp, Department of Translational Neuroscience, Faculty of Medicine, Antwerp, Belgium; University of Texas, School of Behavioral and Brain Sciences, Dallas, Richardson, TX, United States.
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Vanneste
University of Antwerp, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp, Belgium; University Department of Psychiatry, Campus Antwerp University Hospital, Antwerp, Belgium.
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Cassiers
VU University Medical Centre, Department of Psychiatry and EMGO Institute of Health and Care Research and Neuroscience Campus Amsterdam, Amsterdam, The Netherlands.
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Veltman
University of Antwerp, Department of Translational Neuroscience, Faculty of Medicine, Antwerp, Belgium; Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Antwerp, Belgium.
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Van De Heyning
University of Antwerp, Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp, Belgium; University Department of Psychiatry, Campus Psychiatric Hospital Duffel, Duffel, Belgium.
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Sabbe
D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D001307:Auditory Perception; D015897:Comorbidity; D006801:Humans; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D014012:Tinnitus / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy
Epidemiology; Generalized anxiety disorder; Neurobiology; PTSD; Panic disorder; Phobia; Treatment