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Hearing Aid Use Time Is Causally Influenced by Psychological Parameters in Mildly Distressed Patients with Chronic Tinnitus and Mild-to-Moderate Hearing Loss

Tinnitus Centre, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
Terzo Institute, ISMA AG, 96515 Sonneberg, Germany
Division of Psychosomatic Medicine, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
Author to whom correspondence should be addressed.
J. Clin. Med. 2022, 11(19), 5869;
Submission received: 8 September 2022 / Revised: 30 September 2022 / Accepted: 1 October 2022 / Published: 4 October 2022
(This article belongs to the Section Otolaryngology)


Background: Hearing aids (HAs) can improve tinnitus-related distress (TRD) and speech-comprehension (SC) in silence or at 55 dB noise-interference (SC_55 dB) in patients with chronic tinnitus and mild-to-moderate hearing loss. However, the role of HA use time in relation to psychological, audiological, or self-reported tinnitus characteristics is under-investigated. Methods: We examine 177 gender-stratified patients before (t1) and after an intervention comprising binaural DSLchild algorithm-based HA fitting and auditory training (t2) and at a 70-day follow up [t3]. HA use time was retrospectively retrieved (at t2) for the pre-post- and (at t3) post-follow up periods. General linear models investigated HA use time in relation to (1) general audiological, (2) tinnitus-related audiological, (3) tinnitus-related self-report, and (4) distress-related self-report indices before and after treatment, where applicable. Receiver operator characteristic analyses identified optimal HA use time for hereby-mediated treatment changes. Results: At t1 and t2, psychological, but not audiological indices causally influenced prospective HA use time—except for SC_55 dB at t1, which, however, correlated with patients’ anxiety, depressivity, and psychological distress levels. Correlations did not differ between patient subgroups defined by categorical tinnitus-related audiological or self-report indices. HA use time partly mediated treatment-related improvement in TRD, but not SC. Optimal use amounted to 9.5–10.5 h/day. Conclusions: An awareness of psychological influences may help clinicians facilitate HA use and, thereby, TRD improvement with hearing amplification.

1. Introduction

Tinnitus denotes “the conscious awareness of a tonal or composite noise for which there is no identifiable corresponding external acoustic source” [1]. While psychological, audiological, or medical factors can facilitate tinnitus onset or maintenance, hearing loss (HL) is an important risk factor for many—though not all—tinnitus presentations [2,3,4]. Accordingly, current guidelines suggest the provision of hearing aids (HAs) as first-line intervention for individuals with HL and chronic tinnitus, alongside psychological interventions for those who experience high levels of psychological distress preceding or following symptom onset [5].
Both HL [6] and chronic tinnitus can contribute to difficulties with speech comprehension (SC), especially in contexts involving noise distractors [7]. Initial evidence suggests that HA use may benefit SC over time [8,9], potentially through individual levels of hearing loss linearly influencing HA use as a mediator of benefit [10]. However, neuropsychological mechanisms underlying these effects are likely complex [7,11,12,13,14,15,16,17], and research findings in this regard are limited to date.
Despite its putative importance and comparatively easy influenceability, research at the junction of HA use time and associated psychological influences in adults is sparse [18]. The majority of studies focuses on audiological predictors of HA use [19] oand psychological influences on HL that are either unsusceptible to HA use [20] or improve following hearing amplification [21]. “Previously identified psychological predictors of HA nonuse include ‘perceived stigma’, ‘cosmetic concerns’, ‘disappointment with HA’, ‘oversold expectations’, or ‘family pressure to get HAs’ [22]. By contrast, HA use is influenced by ‘[positive] attitudes towards HAs’, ‘[realistic] expectations of benefit’, and individuals’ ‘perception- and acceptance of their hearing difficulties’ [23].” Only one study specifically examines the impact of psychological factors on HA use time - and reported a negative association between depressivity and HA use time [24]. Dawes et al. [25], however, failed to find such an association in a large cross-sectional sample.
Against the background of interacting influences of HL, chronic tinnitus symptomatology, psychological distress, and SC difficulties, few studies have investigated the effectiveness of HAs on tinnitus-related distress (TRD) or SC in silence or noise in patients with chronic tinnitus and mild-to-moderate HL. Two recent studies from our group aimed to fill this gap and reported beneficial effects of a 21-day hearing therapy on TRD [26] and SC in silence for patients with mild or moderate, and 55 dB noise-interference for patients with mild HL only [27]. Treatment involved binaural Desired Sensation Level (DSL)child algorithm-based HA fittings and auditory self-study training. At 65 dB noise-interference, SC did not improve with treatment in either patient group.
Expanding these investigations, the present study has two aims: First, to examine psychological distress levels across general audiological (hearing ability, speech comprehension in silence and at 55 dB or 65 dB noise-interference), tinnitus-related audiological (tinnitus type, location, pitch), and tinnitus-related self-report data (perceived pitch, onset, duration, as well as perceived fluctuations of sound and loudness). Second, to examine HA use time in relation to these four variable groups and herewith-associated treatment benefits on TRD or SC, respectively. We hypothesized that both audiological and psychological variables would influence HA use time and, thereby, the intervention’s benefit.

2. Materials and Methods

2.1. Participants

Expanding on the above-reported results [26,27,28], we use data from the original randomized controlled crossover study that investigated the effects of a hearing therapy protocol on TRD and SC. The present study examines pooled data from the crossover study’s two intervention arms and includes N = 177 patients with chronic tinnitus and mild-to-moderate HL (agemean = 59.61 years; SD = 7.46) who were examined at screening (t0), pre- and post-treatment (t1 − t2), and at a 70-day follow up timepoint (t3) (see also [27]). The study was conducted according to the principles of the Declaration of Helsinki and approved by the Charité’s Ethics Committee (EA1/114/17).

2.2. Data and Measures

Briefly, obtained data comprised four groups of variables: (1) general audiological data (hearing ability [Pure-Tone-Audiometry, PTA, t0]; SC in silence and at 55 and 65 dB noise-interference, t1, t2, t3); (2) tinnitus-related audiological data (tinnitus type, location, pitch, t0); (3) tinnitus-related self-report indices (perceived pitch, onset, duration, as well as perceived sound-and loudness fluctuations, t0); and (4) distress-related self-report data (Tinnitus Questionnaire, TQ, [29]; Tinnitus Handicap Inventory, THI [30]; Tinnitus Functional Index, TFI [31], Perceived Stress Questionnaire, PSQ [32]; Hospital Anxiety and Depression Scale, HADS [33]; and ICD-10 Symptom Rating, ISR [34,35], t1, t2, t3).
Overall, the sample was characterized by low-to-mild (TFI) or mild-to-moderate levels of TRD (TQ, THI), respectively; normal levels of perceived stress (PSQ), anxiety, and depression (HADS), and mildly elevated general psychological distress (ISR).

2.2.1. Hearing Therapy

The hearing therapy combined binaural DSLchild algorithm-based HA fittings and a 14-day auditory self-study program (terzo© Hearing Therapy). For detailed information on sample characteristics at screening [28] as well as study design, sample characteristics at baseline, the examined hearing therapy, and the obtained self-report measures, readers are referred to the current study’s predecessor papers [26,27].

2.2.2. Hearing Aid Use Time

The present study used Mood 16 G4 HAs. HA use time (h/day) was retrospectively retrieved (at t2) for the pre-post- and (at t3) for the post-follow up periods, thus allowing for a causal interpretation of correlation coefficients at pre- or post-treatment respectively.

2.3. Statistical Analyses

First, descriptive analyses and univariate comparisons (independent-samples t tests and analyses of variance, ANOVAs) examined tinnitus-related audiological and tinnitus-related self-report indices relative to general audiological- and distress-related self-report variables.
Second, Pearson correlation coefficients r investigated (1) associations between general audiological as well as distress-related self-report data at pre- and post-treatment and HA use time, as well as (2) possible differences in any such associations for patient subgroups who differed on factors identified in Step 1. Here, similar to our approach in [27], coefficients were compared using MedCalc (; accessed on 19 August 2022), where applicable. Correlational effects were interpreted according to Cohen [36] (r ≥ 0.10 = small effect, r ≥ 0.30 = moderate effect, r ≥ 0.50 = strong effect).
Third, Hayes’ PROCESS macro [37] calculated simple mediation models that examined ‘true’ mediation [38] of pre (x)-to-post (y)-treatment changes in SC or distress-related variables via (retrospectively quantified) HA use time (m). For significant indirect effects, Receiver operator characteristic (ROC) analyses further aimed to quantify the optimal HA use time associated with treatment-related ‘improvement’ (vs. ‘no improvement’), pragmatically defined as any pre-to-post-treatment change to the positive (SC) or negative (TQ, THI, TFI, PSQ, HADS_a, HADS_d, ISR), respectively. Here, the ‘area under the curve’ statistic (AUC) reflects HA use time’s poor (0.50 < AUC < 0.70), acceptable (0.71 < AUC < 0.90), or outstanding ability (AUC > 0.91) to perform this distinction [39,40].
All analyses were computed using SPSS statistical software version 27 (SPSS Inc., Chicago, IL, USA). Of note, analyses revealed no significant effects for the post- to follow up period—likely owing to the relative stability of all treatment-related effects (cf. [26,27]). The present paper thus limits itself to reporting findings for the t1-t2 intervention period.

3. Results

3.1. Tinnitus-Related Audiological and Tinnitus-Related Self-Report Indices in Relation to General Audiological and Distress-Related Self-Report Data

Table 1 reports between-group differences in general audiological- (Panel a) and distress-related (Panels b and c) variables across categorical tinnitus-related audiological and tinnitus-related self-report indices, where applicable.
Results revealed that patients’ PTA-measured hearing ability was lower for patients reporting previous hearing aid use and gradual tinnitus onset.
SC in silence was aggravated for patients reporting previous hearing aid use and narrow-band tinnitus perception. At medium noise-interference (SC_55 dB), patients with a history of psychotherapeutic support reported higher SC difficulties. At 55 and 65 dB noise-interference, higher SC difficulties were further accompanied by a ‘very high’ (vs. high) self-reported tinnitus pitch.
Significantly higher levels of psychological distress were reported by patients who were female (TFI, PSQ, HADS_a, ISR), had a history of psychotherapeutic support (TQ, THI, TFI, PSQ, HADS_a, HADS_d, ISR), described a ‘very high’ (vs. middle: TQ, HADS_a; or vs. high vs. middle: THI, TFI, HADS_d, ISR) self-reported tinnitus pitch, reported sudden tinnitus onset (THI, PSQ), experienced no intermittence (TFI), and reported fluctuations in perceived loudness (PSQ, HADS_a).
The majority of patients reported a ‘high’ tinnitus pitch. Yet, despite comparable proportions of patients in PTA-measured vs. self-reported tinnitus frequency ranges, statistical agreement between the two variables was only “slight” (Cohen’s κ = 0.12; p < 0.05, [41]), indicating an importance of independent measurement and conceptualization.

3.2. Hearing Aid Use Time and General Audiological, Tinnitus-Related Audiological, Tinnitus-Related Self-Report-, and Distress-Related Self-Report Data

Participants’ average daily HA use time amounted to 9.26 (SD = 4.14) for the t1−t2 period and 9.49 (SD = 4.25) h for the t2−t3 period, respectively. It did not differ between any patient subgroups who were characterized by differences in categorical tinnitus-related audiological or tinnitus-related self-report indices.
Table 2 reports Pearson’s r correlations between general audiological as well as distress-related self-report indices and subsequent HA use time. At pre-treatment, small-to-moderate causal effects emerged for psychological, but not audiological variables. An exception was found for SC_55 dB, which was further associated with both patients’ hearing ability, r = −0.40, p < 0.001 (‘moderate’), and indices of anxiety, r = −0.18, p < 0.05; depression, r = −0.20, p < 0.01; and general psychological-, but not tinnitus-related distress, r = −0.26, p < 0.01 (‘small’). At post-treatment, psychological variables continued to causally influence prospective HA use time during the follow up period in the small-to-moderate range.
SC in silence and at 65 dB noise-interference did not influence HA use time. SC_0 dB was associated with patients’ hearing ability, r = −0.19, p < 0.05, TRD (THI: r = −0.16, p < 0.05; TFI: r = −0.19, p < 0.05) and perceived stress, r = −0.17, p < 0.05 (‘small’). SC_65 dB was associated with patients’ hearing ability, r = −0.28, p < 0.001, depression, r = −0.17, p < 0.05, and general psychological distress, r = −0.17, p < 0.05 (‘small’).
Linking findings from Section 3.1 and Section 3.2, additional analyses investigated, whether correlation coefficients between HA use time and influencing parameters (cf. Table 2) differed between patient subgroups who were characterized by differences in categorical tinnitus-related audiological or tinnitus-related self-report indices (cf. Table 1). For example, because (1) TQ-measured TRD causally influenced subsequent HA use time (cf. Table 2), and (2) TQ scores significantly differed for participants with vs. without previous psychotherapy (cf. Table 1), correlation coefficients rTQ HA use time were compared between these patient subgroups.
Overall, results revealed no between-subgroup differences in correlational strengths. An exception was found for rSC_55 dB_HA use time, which only emerged in patients with a ‘high’, r = −0.31, p < 0.01 (but not ‘very high’, r = 0.10, n.s.) tinnitus pitch (z = 2.07, p < 0.05).

3.3. Mediation Analyses

Simple mediation analyses examined effects of HA use time (m) on treatment-related changes in SC and distress-related variables between t1 (x) and t2 (y). Results indicated that HA use time partly mediated pre- to post-treatment change in TRD as measured by the TQ (path a: −0.07, SE = 0.02, p < 0.001; path b: −0.36, SE = 0.16, p < 0.05; ab = 0.03, SE = 0.02) and TFI (path a: −0.05, SE = 0.015, p < 0.001; path b: −0.85, SE = 0.28, p < 0.01; ab = 0.05, SE = 0.02). Here, higher TRD levels at baseline negatively affected subsequent HA use time and, thereby, TRD-related improvement with treatment. By contrast, HA use time did not mediate changes in THI scores, SC indices, or other distress-related variables.

Receiver Operator Characteristics Analyses

Following up on the identified indirect effects, ROC analyses aimed to identify the optimal HA use time that distinguished pre- to post-treatment ‘improvement’ (from ‘no improvement’) on the TQ or TFI. While point estimates were not significant, trend significant AUC statistics within poor-to-acceptable confidence intervals suggested minima of 9.5 (TQ; 0.47–0.75, p < 0.10) and 10.5 h/day respectively (TFI; 0.48–0.77, p < 0.10).

4. Discussion

The present study demonstrated that HA use time (1) is causally influenced by psychological parameters and (2) partly mediates tinnitus distress-related, but not speech comprehension improvements in mildly distressed patients with chronic tinnitus and mild-to-moderate hearing loss.
One-hundred seventy-seven gender-stratified patients with chronic tinnitus and mild-to-moderate HL were binaurally fitted with DSLchild algorithm-based HAs and completed auditory training exercises over a 21-day period. Measurements in TRD, anxiety, depressivity, general psychological distress, and SC in silence as well as at 55 or 65 dB noise-interference were obtained at screening (t0), before (t1) and after the intervention (t2), and at a 70-day follow up (t3). Previously published studies that examined this dataset reported controlled improvements in TRD (TQ, THI, TFI) alongside uncontrolled small improvements in anxiety and psychological distress levels (HADS_a, ISR) [26], as well as HA-related improvements in SC in silence (for patients with mild or moderate HL) and at 55 dB noise-interference (for patients with mild HL only) [27].

4.1. Patients’ Self-Report and Audiological Data

First, the present study examined differences in general audiological ([PTA-measured] hearing ability, SC) or psychological distress indices (TQ, THI, TFI, PSQ, HADS, ISR) across patient subgroups characterized by tinnitus-related audiological (tinnitus type, location, pitch) or tinnitus-related self-report indices (perceived tinnitus pitch, onset, duration, as well as perceived sound- and loudness fluctuations).
Here, self-reported ‘sudden’ tinnitus onset was associated with proportionately higher levels of perceived stress and THI-measured TRD. Previous research has highlighted links between sudden tinnitus and ‘stress’ or, relatedly [42,43], sudden hearing loss in patients’ own tinnitus narratives [44] as well as emotional difficulties in patients with experiences of traumatization [45]. By contrast, a reported history of ‘gradual’ onset was associated with lower PTA-measured hearing ability. For some patients, gradually developing hearing loss might parallel the perception of tinnitus [46], emphasizing a need for preventative or early-onset hearing protection measures that might delay both clusters of difficulty [47,48,49] alongside associated broader emotional difficulties [50,51].
The dissociation between self-reported sudden vs. gradual tinnitus onset and observed psychological vs. hearing ability-related influences may reflect a particular importance of stress-related factors for the former type of onset [52,53], particularly within a broader psychological context of pre-existing vulnerability [54,55]. For the chronification or maintenance of TRD, however, psychological factors may contribute to the appraisal of the tinnitus sound regardless of onset trajectory, potentially explaining varying TRD levels across both psychologically or audiologically mediated onset patterns [56].
Moreover, patients with higher levels of perceived stress and anxiety reported fluctuations in perceived tinnitus loudness, and patients with higher psychological distress levels or SC-in-noise difficulties reported a ‘very high’ tinnitus pitch. In keeping with some previous findings, audiometric frequency matching did not mirror this association [57,58]. Thus, rather than high-pitched noise being perceived as aversive, psychological distress likely shapes the appraisal and experience of the tinnitus sound [59]. Previous research has suggested ‘emotional tension’ or ‘worry’ as transdiagnostic factors that potentially underlie TRD [60]. Because patients’ emotional states likely mediate the appraisal and experience of the tinnitus sound [61,62], it is crucially important to understand and conceptualize patients’ distress experiences holistically, i.e., beyond the influence of the tinnitus symptom [63]. Any such accounts, however, are necessarily complex and idiosyncratic, thus necessitating person- (not symptom-) focused psychological formulations and treatment plans [64,65,66]. Clinically, patients who report sudden tinnitus onset or loudness fluctuations may particularly benefit from clinicians’ awareness and consideration of psychological influences beyond tinnitus as the presenting index symptom, as well as their own emotional reactions to respective patient presentations [67,68,69,70]. Ideographic associations between patients’ psychological distress levels and experienced characteristics of the tinnitus sound remain uninvestigated.
Patients’ PTA-measured hearing ability correlated moderately with their SC abilities. Interestingly, SC_55 dB further correlated with patients’ anxiety, depressivity, and general psychological, but not tinnitus-related distress levels. By contrast, SC_0 dB yielded a roughly inverse pattern. Moreover, SC_55 dB was lower in patients with a history of psychotherapeutic support, who further reported higher levels of distress across all psychological indices.
Patients with chronic tinnitus commonly report difficulties with SC, which can (but does not have to) be associated with hearing difficulties, potentially reflecting a ‘functional’ component in some patients [71]. Psychologically, SC is underlain by a multitude of cognitive processes such as inhibitory control, processing speed, allocation of attentional resources, or working memory [72,73], all of which are also known to interact with affective states such as anxiety or mood [13,74,75,76,77,78,79,80,81,82]. In a recent study, Tai and Husain [83] suggested that SC in noise may be influenced by interactions of ongoing tinnitus perception, cognitive control of emotion (involving the perception of, orientation towards, appraisal of, and reaction to the tinnitus sound), and cognitive control of attention.
Speculatively, SC might follow an inverse U-curve characterized by inversely proportional ratios of hearing- vs. emotion-related influences under circumstances of increasing noise-interference [84,85,86,87], with emotion-related influences reaching their proportionate maximum at medium noise-interference. Future studies might wish to test this possibility by measuring patients’ SC across linearly increased noise-interference levels in patients at varying levels of HL and psychological distress.
In keeping with previous findings, female patients reported higher levels of tinnitus-related [88,89,90,91] and general psychological distress [92,93,94,95,96]. Studies aiming to explain this gender discrepancy suspect the existence of gender-specific (hormonal [97]) phenotype clusters [98] or high numbers of emotionally stressed men who do not access available support options, potentially influenced by masculine gender norms [99,100,101,102,103,104].
Moreover, intermittent perception of the tinnitus sound was associated with lower levels of TFI-measured TRD, supporting some [105,106], but not all previous findings [107]. Underlying factors likely include both cognitive or behavioral processes such as higher attentional control [108], or individuals’ distress-related (in)abilities to distract themselves from the tinnitus percept [56,109]. Alternatively, however, the finding may reflect an artifact owed to some of the TFI’s item phrasings (e.g., “What percentage of your time awake were you consciously aware of your tinnitus?”).

4.2. Hearing Aid Use Time

Second, we examined the four obtained variable groups (general audiological, tinnitus-related audiological, tinnitus-related self-report, and distress-related self-report indices) in relation to HA use time and associated treatment benefit. Owing to the retrospective retrieval of HA use time, correlation coefficients could be interpreted causally. Results revealed small yet significant causal influences of both tinnitus-related and broader psychological distress on HA use time at both pre- and post-treatment.
Relatedly, HA use time partly mediated treatment-related change in TRD as measured by the TQ and TFI, with higher TRD levels at baseline reducing prospective HA use time - thereby lowering treatment benefit as measured by these indices. According to Van der Wal et al. [110], the TQ captures the “psychological“, and the TFI the “body functions” and “activity and participation”-related impact of chronic tinnitus symptomatology. A similar suggestion was made by Boecking et al. [111], who discussed “psychological” vs. “audiological” characteristics of TRD as measured by the TQ or TFI, respectively. Associations between pre-existing psychological distress, HA use, HA use time, and subsequent psychological, hearing-related or participation-based benefits are, however, likely bidirectional and closely interrelated. Notwithstanding, while HA-related benefits on TRD have been previously demonstrated in patients with chronic tinnitus and HL [5,112,113,114,115], our study is the first to demonstrate a vicious cycle wherein TRD at baseline likely decreases the use of the very intervention likely to benefit it.
Supplementary analyses revealed at trend level that an average use time of 9.5-to-10.5 h/day best distinguished between patients who showed improvement (vs. no improvement) on the TQ or TFI, respectively. Although these results necessitate replication due to a lenient definition of ’improvement’ and rather broad confidence intervals around the AUC statistics, they do suggest that HA use time partly influences TRD improvement (in context of DSLchild algorithm-based HA fittings for patients with mild-to-moderate HL) – yet by no means exclusively so. Clinicians may wish to emphasize or review associations between baseline TRD, likely effects on HA use time, and resulting improvements for individuals with chronic tinnitus and mild-to-moderate HL.
By contrast, HA use did not mediate changes in anxiety, depressivity, or general psychological distress. Mirroring previous observations [116], this finding likely reflects the multifactorial, non-audiological origin and breadth of peoples’ emotional experiences [117] as well as the overall only mild distress levels in the present sample [26].
Interestingly, HA use time did not mediate changes in patients’ SC levels either: Neither patients’ PTA-measured hearing ability nor SC levels at 0 or 65 dB noise-interference causally influenced prospective HA use time. By contrast, SC_55 dB did do so; however, HA use time did not predict treatment-related change on this index—which was therefore influenced by other, unmeasured variables. We further observed indications of a double dissociation wherein SC_55 dB was associated with general psychological, but not tinnitus-related distress, and a roughly inverse pattern emerged for SC_0 dB. Future studies might wish to experimentally study the effects of people’s affective states on SC at varying levels of HL, noise-interference, or amplification.
Overall, the observed mediation pattern appears to reflect both the psycho-audiological nature of TRD in patients with chronic tinnitus and HL [5] and the clinical need to conceptualize and address psychological influences on hearing- as well as SC difficulties beyond amplification alone [118].

4.3. Limitations

The present study has important limitations. Most notably, the interpretability and generalizability of results is inconclusive, owing to overall ‘mild’ psychological distress levels, a primarily amplification-based treatment protocol, and dual ‘index symptoms’ (chronic tinnitus symptomatology and mild-to-moderate HL) that may independently or interactionally affect both SC and psychological distress as outcomes of interest. Future studies might wish to examine chronic tinnitus patient samples with dimensionally distributed rates of hearing loss, speech comprehension difficulties, noise-interference levels, and psychological distress levels.

4.4. Conclusions

In summary, the present study highlights the importance of psychological factors in motivating HA use time for patients with chronic tinnitus and mild-to-moderate HL, with direct effects on TRD-improvements following amplification-based hearing therapy. To this end, certain self-reported tinnitus characteristics may serve as tentative markers of psychological distress that ought to be conceptualized holistically within patients’ broader life contexts [54,64,119,120,121]. Clinicians might wish to counsel individuals sensitively about links between baseline TRD, HA use time, and realistically expectable amplification benefits. The influence of psychological factors on SC difficulties is currently unclear and warrants further examination, particularly in circumstances of medium noise-interference.

Author Contributions

Conceptualization, B.B., S.P., A.N., J.D.-P., C.F., P.B. and B.M.; Data curation, S.P., A.N. and B.M.; Formal analysis, B.B.; Funding acquisition, B.M. and K.O.; Methodology, B.B., J.D.-P. and C.F.; Resources, B.M.; Supervision, B.M. and M.R.; Writing—original draft, B.B.; Writing—review and editing, B.B. All authors have read and agreed to the published version of the manuscript.


This research was funded by Terzo Institute, ISMA AG, Sonneberg, Germany.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the ethics committee of the Charité Universitaetsmedizin Berlin (EA1/114/17).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

As per Charité—Universitätsmedizin Berlin’s ethics committee, unfortunately, we cannot make the data public without restrictions, because we did not obtain patients’ consent to do so at the time. Nevertheless, interested researchers can contact the directorate of the Tinnitus Center at the Charité—Universitätsmedizin Berlin with data access requests ([email protected]).

Conflicts of Interest

All authors complied with APA ethical standards in the treatment of participants and in the setup of the study. The developers and distributors of the here-investigated intervention funded the study and were partly responsible for audiological data collection. Data analyses were performed independently. This important potential conflict of interest is transparently addressed throughout the manuscript.


  1. De Ridder, D.; Schlee, W.; Vanneste, S.; Londero, A.; Weisz, N.; Kleinjung, T.; Shekhawat, G.S.; Elgoyhen, A.B.; Song, J.-J.; Andersson, G.; et al. Tinnitus and Tinnitus Disorder: Theoretical and Operational Definitions (an International Multidisciplinary Proposal). In Progress Brain Research; Elsevier: Amsterdam, The Netherlands, 2021; Volume 260, pp. 1–25. [Google Scholar]
  2. Langguth, B.; Kreuzer, P.M.; Kleinjung, T.; De Ridder, D. Tinnitus: Causes and Clinical Management. Lancet Neurol. 2013, 12, 920–930. [Google Scholar] [CrossRef]
  3. Baguley, D.; McFerran, D.; Hall, D. Tinnitus. Lancet 2013, 382, 1600–1607. [Google Scholar] [CrossRef] [Green Version]
  4. Shargorodsky, J.; Curhan, G.C.; Farwell, W.R. Prevalence and Characteristics of Tinnitus among US Adults. Am. J. Med. 2010, 123, 711–718. [Google Scholar] [CrossRef] [PubMed]
  5. Cima, R.F.F.; Mazurek, B.; Haider, H.; Kikidis, D.; Lapira, A.; Noreña, A.; Hoare, D.J. A Multidisciplinary European Guideline for Tinnitus: Diagnostics, Assessment, and Treatment. Hno 2019, 67, 10–42. [Google Scholar] [CrossRef] [Green Version]
  6. Peelle, J.E.; Troiani, V.; Grossman, M.; Wingfield, A. Hearing Loss in Older Adults Affects Neural Systems Supporting Speech Comprehension. J. Neurosci. 2011, 31, 12638–12643. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  7. Ivansic, D.; Guntinas-Lichius, O.; Müller, B.; Volk, G.F.; Schneider, G.; Dobel, C. Impairments of Speech Comprehension in Patients with Tinnitus—A Review. Front. Aging Neurosci. 2017, 9, 224. [Google Scholar] [CrossRef] [Green Version]
  8. Wendt, D.; Kollmeier, B.; Brand, T. How Hearing Impairment Affects Sentence Comprehension: Using Eye Fixations to Investigate the Duration of Speech Processing. Trends Hear. 2015, 19, 2331216515584149. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  9. Habicht, J.; Kollmeier, B.; Neher, T. Are Experienced Hearing Aid Users Faster at Grasping the Meaning of a Sentence than Inexperienced Users? An Eye-Tracking Study. Trends Hear. 2016, 20, 2331216516660966. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  10. Vogelzang, M.; Thiel, C.M.; Rosemann, S.; Rieger, J.W.; Ruigendijk, E. Effects of Age-Related Hearing Loss and Hearing Aid Experience on Sentence Processing. Sci. Rep. 2021, 11, 5994. [Google Scholar] [CrossRef]
  11. Fitzhugh, M.C.; LaCroix, A.N.; Rogalsky, C. Distinct Contributions of Working Memory and Attentional Control to Sentence Comprehension in Noise in Persons With Stroke. J. Speech Lang. Hear. Res. 2021, 64, 3230–3241. [Google Scholar] [CrossRef]
  12. Xie, Z.; Zinszer, B.D.; Riggs, M.; Beevers, C.G.; Chandrasekaran, B. Impact of Depression on Speech Perception in Noise. PLoS ONE 2019, 14, e0220928. [Google Scholar] [CrossRef]
  13. Nikolin, S.; Tan, Y.Y.; Schwaab, A.; Moffa, A.; Loo, C.K.; Martin, D. An Investigation of Working Memory Deficits in Depression Using the N-Back Task: A Systematic Review and Meta-Analysis. J. Affect. Disord. 2021, 284, 1–8. [Google Scholar] [CrossRef]
  14. Rose, E.J.; Ebmeier, K.P. Pattern of Impaired Working Memory during Major Depression. J. Affect. Disord. 2006, 90, 149–161. [Google Scholar] [CrossRef]
  15. Moran, T.P. Anxiety and Working Memory Capacity: A Meta-Analysis and Narrative Review. Psychol. Bull. 2016, 142, 831. [Google Scholar] [CrossRef] [Green Version]
  16. Derryberry, D.; Reed, M.A. Anxiety-Related Attentional Biases and Their Regulation by Attentional Control. J. Abnorm. Psychol. 2002, 111, 225. [Google Scholar] [CrossRef]
  17. Alexander, E.J. Speech-in-Noise Perception in Older Adults: Impact of Emotional Semantic Valence and Clinical Depression. Ph.D. Thesis, University of Toronto, Toronto, ON, Canada, 2019. [Google Scholar]
  18. Broome, E.; Meyer, C.; Church, P.; Henshaw, H. What Factors Are Important to Whom in What Context, When Adults Are Prescribed Hearing Aids for Hearing Loss? A Realist Review Protocol. BMJ Open 2022, 12, e059836. [Google Scholar] [CrossRef]
  19. Christensen, J.H.; Saunders, G.H.; Havtorn, L.; Pontoppidan, N.H. Real-World Hearing Aid Usage Patterns and Smartphone Connectivity. Front. Digit. Health 2021, 3, 722186. [Google Scholar] [CrossRef]
  20. Keidser, G.; Seeto, M.; Rudner, M.; Hygge, S.; Rönnberg, J. On the Relationship between Functional Hearing and Depression. Int. J. Audiol. 2015, 54, 653–664. [Google Scholar] [CrossRef]
  21. Brewster, K.K.; Pavlicova, M.; Stein, A.; Chen, M.; Chen, C.; Brown, P.J.; Roose, S.P.; Kim, A.H.; Golub, J.S.; Brickman, A.; et al. A Pilot Randomized Controlled Trial of Hearing Aids to Improve Mood and Cognition in Older Adults. Int. J. Geriatr. Psychiatr. 2020, 35, 842–850. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  22. McCormack, A.; Fortnum, H. Why Do People Fitted with Hearing Aids Not Wear Them? Int. J. Audiol. 2013, 52, 360–368. [Google Scholar] [CrossRef]
  23. Knudsen, L.V.; Öberg, M.; Nielsen, C.; Naylor, G.; Kramer, S.E. Factors Influencing Help Seeking, Hearing Aid Uptake, Hearing Aid Use and Satisfaction with Hearing Aids: A Review of the Literature. Trends Amplif. 2010, 14, 127–154. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  24. Gatehouse, S. Components and Determinants of Hearing Aid Benefit. Ear Hear. 1994, 15, 30–49. [Google Scholar] [CrossRef] [PubMed]
  25. Dawes, P.; Emsley, R.; Cruickshanks, K.J.; Moore, D.R.; Fortnum, H.; Edmondson-Jones, M.; McCormack, A.; Munro, K.J. Hearing Loss and Cognition: The Role of Hearing Aids, Social Isolation and Depression. PLoS ONE 2015, 10, e0119616. [Google Scholar] [CrossRef] [Green Version]
  26. Boecking, B.; Rausch, L.; Psatha, S.; Nyamaa, A.; Dettling-Papargyris, J.; Funk, C.; Brueggemann, P.; Rose, M.; Mazurek, B. Hearing Therapy Improves Tinnitus-Related Distress in Mildly Distressed Patients with Chronic Tinnitus and Mild-to-Moderate Hearing Loss: A Randomized-Controlled Cross-Over Design. J. Clin. Med. 2022, 11, 1764. [Google Scholar] [CrossRef] [PubMed]
  27. Boecking, B.; Rausch, L.; Psatha, S.; Nyamaa, A.; Dettling-Papargyris, J.; Funk, C.; Oppel, K.; Brueggemann, P.; Rose, M.; Mazurek, B. DSLchild-Algorithm-Based Hearing Aid Fitting Can Improve Speech Comprehension in Mildly Distressed Patients with Chronic Tinnitus and Mild-to-Moderate Hearing Loss. J. Clin. Med. 2022, 11, 5244. [Google Scholar] [CrossRef] [PubMed]
  28. Neff, P.; Simões, J.; Psatha, S.; Nyamaa, A.; Boecking, B.; Rausch, L.; Dettling-Papargyris, J.; Funk, C.; Brueggemann, P.; Mazurek, B. The Impact of Tinnitus Distress on Cognition. Sci. Rep. 2021, 11, 2243. [Google Scholar] [CrossRef] [PubMed]
  29. Goebel, G.; Hiller, W. Tinnitus-Fragebogen:(TF): Ein Instrument Zur Erfassung von Belastung Und Schweregrad Bei Tinnitus, Handanweisung; Hogrefe, Verlag für Psychologie: Göttingen, Germany, 1998. [Google Scholar]
  30. Kleinjung, T.; Fischer, B.; Langguth, B.; Sand, P.G.; Hajak, G.; Dvorakova, J.; Eichhammer, P. Validierung Einer Deutschsprachigen Version Des “Tinnitus Handicap Inventory”. Psychiatr. Prax. 2007, 34, S140–S142. [Google Scholar] [CrossRef]
  31. Brueggemann, P.; Szczepek, A.; Kleinjung, T.; Ojo, M.; Mazurek, B. Validierung Der Deutschen Version Des Tinnitus Functional Index (TFI). Laryngo-Rhino-Otol. 2017, 96, 615–619. [Google Scholar] [CrossRef] [PubMed]
  32. Fliege, H.; Rose, M.; Arck, P.; Walter, O.B.; Kocalevent, R.-D.; Weber, C.; Klapp, B.F. The Perceived Stress Questionnaire (PSQ) Reconsidered: Validation and Reference Values from Different Clinical and Healthy Adult Samples. Psychosom. Med. 2005, 67, 78–88. [Google Scholar] [CrossRef]
  33. Herrmann, C.; Buss, U.; Snaith, R.P. HADS-D: Hospital Anxiety and Depression Scale (German Version). Bern Hans Huber 1995, 1, 995. [Google Scholar]
  34. Tritt, K.; von Heymann, F.; Zaudig, M.; Zacharias, I.; Söllner, W.; Loew, T. Entwicklung Des Fragebogens» ICD-10-Symptom-Rating «(ISR). Z. Psychosom. Med. Psychother. 2008, 54, 409–418. [Google Scholar] [CrossRef] [PubMed]
  35. Fischer, H.F.; Schirmer, N.; Tritt, K.; Klapp, B.F.; Fliege, H. Retest-Reliabilität Und Änderungssensitivität Des ICD-10-Symptom-Rating (ISR) in Verschiedenen Stichproben. PPmP-Psychother. Psychosom. Med. Psychol. 2011, 61, 162–169. [Google Scholar] [CrossRef]
  36. Cohen, J. Statistical Power Analysis for the Behavioral Sciences, 2nd ed.; Routledge: Oxford, UK, 1988. [Google Scholar]
  37. Hayes, A.F. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach, 2nd ed.; The Guilford Press: New York, NY, USA, 2018. [Google Scholar]
  38. Kraemer, H.C. Toward Non-Parametric and Clinically Meaningful Moderators and Mediators. Stat. Med. 2008, 27, 1679–1692. [Google Scholar] [CrossRef] [PubMed]
  39. Pintea, S.; Moldovan, R. The Receiver-Operating Characteristic (ROC) Analysis: Fundamentals and Applications in Clinical Psychology. J. Cogn. Behav. Psychother. 2009, 9, 49–66. [Google Scholar]
  40. Streiner, D.L.; Cairney, J. What’s under the ROC? An Introduction to Receiver Operating Characteristics Curves. Can. J. Psychiatr. 2007, 52, 121–128. [Google Scholar] [CrossRef] [Green Version]
  41. Landis, J.R.; Koch, G.G. The Measurement of Observer Agreement for Categorical Data. Biometrics 1977, 33, 159–174. [Google Scholar] [CrossRef] [Green Version]
  42. Chung, S.-D.; Hung, S.-H.; Lin, H.-C.; Sheu, J.-J. Association between Sudden Sensorineural Hearing Loss and Anxiety Disorder: A Population-Based Study. Eur. Arch. Otorhinolaryngol. 2015, 272, 2673–2678. [Google Scholar] [CrossRef]
  43. Chen, J.; Liang, J.; Ou, J.; Cai, W. Mental Health in Adults with Sudden Sensorineural Hearing Loss: An Assessment of Depressive Symptoms and Its Correlates. J. Psychosom. Res. 2013, 75, 72–74. [Google Scholar] [CrossRef]
  44. Wallhäusser-Franke, E.; Brade, J.; Balkenhol, T.; D’Amelio, R.; Seegmüller, A.; Delb, W. Tinnitus: Distinguishing between Subjectively Perceived Loudness and Tinnitus-Related Distress. PLoS ONE 2012, 7, e34583. [Google Scholar]
  45. Fagelson, M.A. The Association between Tinnitus and Posttraumatic Stress Disorder. Am. J. Audiol. 2007, 16, 107–117. [Google Scholar] [CrossRef]
  46. Langguth, B.; Landgrebe, M.; Schlee, W.; Schecklmann, M.; Vielsmeier, V.; Steffens, T.; Staudinger, S.; Frick, H.; Frick, U. Different Patterns of Hearing Loss among Tinnitus Patients: A Latent Class Analysis of a Large Sample. Front. Neurol. 2017, 8, 46. [Google Scholar] [CrossRef] [Green Version]
  47. Griest, S.E.; Bishop, P.M. Tinnitus as an Early Indicator of Permanent Hearing Loss: A 15 Year Longitudinal Study of Noise Exposed Workers. AAOHN J. 1998, 46, 325–329. [Google Scholar] [CrossRef]
  48. Fausti, S.A.; Wilmington, D.J.; Helt, P.V.; Helt, W.J.; Konrad-Martin, D. Hearing Health and Care: The Need for Improved Hearing Loss Prevention and Hearing Conservation Practices. J. Rehabil. Res. Dev. 2005, 42, 45–62. [Google Scholar] [CrossRef] [PubMed]
  49. Martin, W.H.; Griest, S.E.; Sobel, J.L.; Howarth, L.C. Randomized Trial of Four Noise-Induced Hearing Loss and Tinnitus Prevention Interventions for Children. Int. J. Audiol. 2013, 52, S41–S49. [Google Scholar] [CrossRef]
  50. Tambs, K. Moderate Effects of Hearing Loss on Mental Health and Subjective Well-Being: Results from the Nord-Trøndelag Hearing Loss Study. Psychosom. Med. 2004, 66, 776–782. [Google Scholar] [CrossRef] [PubMed]
  51. Davis, A.; McMahon, C.M.; Pichora-Fuller, K.M.; Russ, S.; Lin, F.; Olusanya, B.O.; Chadha, S.; Tremblay, K.L. Aging and Hearing Health: The Life-Course Approach. Gerontologist 2016, 56, S256–S267. [Google Scholar] [CrossRef] [PubMed]
  52. Heinecke, K.; Weise, C.; Schwarz, K.; Rief, W. Physiological and Psychological Stress Reactivity in Chronic Tinnitus. J. Behav. Med. 2008, 31, 179–188. [Google Scholar] [CrossRef]
  53. Budd, R.J.; Pugh, R. The Relationship between Locus of Control, Tinnitus Severity, and Emotional Distress in a Group of Tinnitus Sufferers. J. Psychosom. Res. 1995, 39, 1015–1018. [Google Scholar] [CrossRef]
  54. Biehl, R.; Boecking, B.; Brueggemann, P.; Grosse, R.; Mazurek, B. Personality Traits, Perceived Stress, and Tinnitus-Related Distress in Patients with Chronic Tinnitus: Support for a Vulnerability-Stress Model. Front. Psychol. 2020, 10, 3093. [Google Scholar] [CrossRef]
  55. Wallhäusser-Franke, E.; D’Amelio, R.; Glauner, A.; Delb, W.; Servais, J.J.; Hörmann, K.; Repik, I. Transition from Acute to Chronic Tinnitus: Predictors for the Development of Chronic Distressing Tinnitus. Front. Neurol. 2017, 8, 605. [Google Scholar] [CrossRef] [Green Version]
  56. Colagrosso, E.M.; Fournier, P.; Fitzpatrick, E.M.; Hébert, S. A Qualitative Study on Factors Modulating Tinnitus Experience. Ear Hear. 2019, 40, 636–644. [Google Scholar] [CrossRef] [PubMed]
  57. Meikle, M.B.; Vernon, J.; Johnson, R.M. The Perceived Severity of Tinnitus: Some Observations Concerning a Large Population of Tinnitus Clinic Patients. Otolaryngol. Neck Surg. 1984, 92, 689–696. [Google Scholar] [CrossRef] [PubMed]
  58. Ibraheem, O.A.; Hassaan, M.R. Psychoacoustic Characteristics of Tinnitus versus Temporal Resolution in Subjects with Normal Hearing Sensitivity. Int. Arch. Otorhinolaryngol. 2017, 21, 144–150. [Google Scholar] [CrossRef]
  59. De Ridder, D.; Vanneste, S.; Weisz, N.; Londero, A.; Schlee, W.; Elgoyhen, A.B.; Langguth, B. An Integrative Model of Auditory Phantom Perception: Tinnitus as a Unified Percept of Interacting Separable Subnetworks. Neurosci. Biobehav. Rev. 2014, 44, 16–32. [Google Scholar] [CrossRef] [PubMed]
  60. Boecking, B.; Rose, M.; Brueggemann, P.; Mazurek, B. Two Birds with One Stone.–Addressing Depressive Symptoms, Emotional Tension and Worry Improves Tinnitus-Related Distress and Affective Pain Perceptions in Patients with Chronic Tinnitus. PLoS ONE 2021, 16, e0246747. [Google Scholar]
  61. Probst, T.; Pryss, R.; Langguth, B.; Schlee, W. Emotional States as Mediators between Tinnitus Loudness and Tinnitus Distress in Daily Life: Results from the “TrackYourTinnitus” Application. Sci. Rep. 2016, 6, 20382. [Google Scholar] [CrossRef] [Green Version]
  62. Probst, T.; Pryss, R.; Langguth, B.; Schlee, W. Emotion Dynamics and Tinnitus: Daily Life Data from the “TrackYourTinnitus” Application. Sci. Rep. 2016, 6, 31166. [Google Scholar] [CrossRef] [Green Version]
  63. Houben, M.; Van Den Noortgate, W.; Kuppens, P. The Relation between Short-Term Emotion Dynamics and Psychological Well-Being: A Meta-Analysis. Psychol. Bull. 2015, 141, 901. [Google Scholar] [CrossRef] [Green Version]
  64. Frank, R.I.; Davidson, J. The Transdiagnostic Road Map to Case Formulation and Treatment Planning: Practical Guidance for Clinical Decision Making; New Harbinger Publications: Oakland, CA, USA, 2014. [Google Scholar]
  65. Maunder, R.; Hunter, J. An Integrated Approach to the Formulation and Psychotherapy of Medically Unexplained Symptoms: Meaning-and Attachment-Based Intervention. Am. J. Psychother. 2004, 58, 17–33. [Google Scholar] [CrossRef] [Green Version]
  66. Cox, L.A. Use of Individual Formulation in Mental Health Practice. Ment. Health Pract. 2021, 24, 33–41. [Google Scholar]
  67. Monzoni, C.M.; Duncan, R.; Grünewald, R.; Reuber, M. Are There Interactional Reasons Why Doctors May Find It Hard to Tell Patients That Their Physical Symptoms May Have Emotional Causes? A Conversation Analytic Study in Neurology Outpatients. Patient Educ. Couns. 2011, 85, e189–e200. [Google Scholar] [CrossRef] [PubMed]
  68. Reid, S.; Whooley, D.; Crayford, T.; Hotopf, M. Medically Unexplained Symptoms—GPs’ Attitudes towards Their Cause and Management. Fam. Pract. 2001, 18, 519–523. [Google Scholar] [CrossRef] [Green Version]
  69. Burbaum, C.; Stresing, A.-M.; Fritzsche, K.; Auer, P.; Wirsching, M.; Lucius-Hoene, G. Medically Unexplained Symptoms as a Threat to Patients’ Identity?: A Conversation Analysis of Patients’ Reactions to Psychosomatic Attributions. Patient Educ. Couns. 2010, 79, 207–217. [Google Scholar] [CrossRef] [PubMed]
  70. Monzoni, C.M.; Duncan, R.; Grünewald, R.; Reuber, M. How Do Neurologists Discuss Functional Symptoms with Their Patients: A Conversation Analytic Study. J. Psychosom. Res. 2011, 71, 377–383. [Google Scholar] [CrossRef] [PubMed]
  71. Austen, S.; Lynch, C. Non-Organic Hearing Loss Redefined: Understanding, Categorizing and Managing Non-Organic Behaviour. Int. J. Audiol. 2004, 43, 449–457. [Google Scholar] [CrossRef] [PubMed]
  72. Tegg-Quinn, S.; Bennett, R.J.; Eikelboom, R.H.; Baguley, D.M. The Impact of Tinnitus upon Cognition in Adults: A Systematic Review. Int. J. Audiol. 2016, 55, 533–540. [Google Scholar] [CrossRef] [PubMed]
  73. Dryden, A.; Allen, H.A.; Henshaw, H.; Heinrich, A. The Association between Cognitive Performance and Speech-in-Noise Perception for Adult Listeners: A Systematic Literature Review and Meta-Analysis. Trends Hear. 2017, 21, 2331216517744675. [Google Scholar] [CrossRef] [Green Version]
  74. Cisler, J.M.; Koster, E.H. Mechanisms of Attentional Biases towards Threat in Anxiety Disorders: An Integrative Review. Clin. Psychol. Rev. 2010, 30, 203–216. [Google Scholar] [CrossRef] [Green Version]
  75. Ansari, T.L.; Derakshan, N. Anxiety Impairs Inhibitory Control but Not Volitional Action Control. Cogn. Emot. 2010, 24, 241–254. [Google Scholar] [CrossRef]
  76. Fales, C.L.; Barch, D.M.; Burgess, G.C.; Schaefer, A.; Mennin, D.S.; Gray, J.R.; Braver, T.S. Anxiety and Cognitive Efficiency: Differential Modulation of Transient and Sustained Neural Activity during a Working Memory Task. Cogn. Affect. Behav. Neurosci. 2008, 8, 239–253. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  77. Ansari, T.L.; Derakshan, N. The Neural Correlates of Cognitive Effort in Anxiety: Effects on Processing Efficiency. Biol. Psychol. 2011, 86, 337–348. [Google Scholar] [CrossRef]
  78. Quinn, C.R.; Harris, A.; Kemp, A.H. The Impact of Depression Heterogeneity on Inhibitory Control. Aust. N. Z. J. Psychiatr. 2012, 46, 374–383. [Google Scholar] [CrossRef]
  79. Nuño, L.; Gómez-Benito, J.; Carmona, V.R.; Pino, O. A Systematic Review of Executive Function and Information Processing Speed in Major Depression Disorder. Brain Sci. 2021, 11, 147. [Google Scholar] [CrossRef] [PubMed]
  80. Dennis-Tiwary, T.A.; Roy, A.K.; Denefrio, S.; Myruski, S. Heterogeneity of the Anxiety-Related Attention Bias: A Review and Working Model for Future Research. Clin. Psychol. Sci. 2019, 7, 879–899. [Google Scholar] [CrossRef]
  81. Suslow, T.; Husslack, A.; Kersting, A.; Bodenschatz, C.M. Attentional Biases to Emotional Information in Clinical Depression: A Systematic and Meta-Analytic Review of Eye Tracking Findings. J. Affect. Disord. 2020, 274, 632–642. [Google Scholar] [CrossRef]
  82. Lukasik, K.M.; Waris, O.; Soveri, A.; Lehtonen, M.; Laine, M. The Relationship of Anxiety and Stress with Working Memory Performance in a Large Non-Depressed Sample. Front. Psychol. 2019, 10, 4. [Google Scholar] [CrossRef] [Green Version]
  83. Tai, Y.; Husain, F.T. The Role of Cognitive Control in Tinnitus and Its Relation to Speech-in-Noise Performance. J. Audiol. Otol. 2019, 23, 1–7. [Google Scholar] [CrossRef]
  84. Murray, D.C. Talk, Silence and Anxiety. Psychol. Bull. 1971, 75, 244. [Google Scholar] [CrossRef]
  85. Bulsara, A.R.; Gammaitoni, L. Tuning in to Noise. Phys. Today 1996, 49, 39–47. [Google Scholar] [CrossRef] [Green Version]
  86. Hillier, A.; Alexander, J.K.; Beversdorf, D.Q. The Effect of Auditory Stressors on Cognitive Flexibility. Neurocase 2006, 12, 228–231. [Google Scholar] [CrossRef]
  87. Degeest, S.; Kestens, K.; Keppler, H. Investigation of the Relation Between Tinnitus, Cognition, and the Amount of Listening Effort. J. Speech Lang. Hear. Res. 2022, 65, 1988–2002. [Google Scholar] [CrossRef] [PubMed]
  88. Seydel, C.; Haupt, H.; Olze, H.; Szczepek, A.J.; Mazurek, B. Gender and Chronic Tinnitus: Differences in Tinnitus-Related Distress Depend on Age and Duration of Tinnitus. Ear Hear. 2013, 34, 661–672. [Google Scholar] [CrossRef] [PubMed]
  89. Milerová, J.; Anders, M.; Dvořák, T.; Sand, P.G.; Königer, S.; Langguth, B. The Influence of Psychological Factors on Tinnitus Severity. Gen. Hosp. Psychiatr. 2013, 35, 412–416. [Google Scholar] [CrossRef]
  90. Ahmed, B.; Ahmed, A.; Aqeel, M.; Akhtar, T.; Salim, S. Impact of Tinnitus Perception on Psychological Distress in Male and Female Tinnitus Patients. Found. Uni. J. Psychol. 2017, 1, 56–77. [Google Scholar]
  91. Vanneste, S.; Joos, K.; De Ridder, D. Prefrontal Cortex Based Sex Differences in Tinnitus Perception: Same Tinnitus Intensity, Same Tinnitus Distress, Different Mood. PLoS ONE 2012, 7, e31182. [Google Scholar] [CrossRef]
  92. Remes, O.; Brayne, C.; Van Der Linde, R.; Lafortune, L. A Systematic Review of Reviews on the Prevalence of Anxiety Disorders in Adult Populations. Brain Behav. 2016, 6, e00497. [Google Scholar] [CrossRef]
  93. Riecher-Rössler, A. Sex and Gender Differences in Mental Disorders. Lancet Psychiatr. 2017, 4, 8–9. [Google Scholar] [CrossRef]
  94. Christiansen, D.M. Examining Sex and Gender Differences in Anxiety Disorders. In A Fresh Look at Anxiety Disorders; InTech: London, UK, 2015. [Google Scholar]
  95. Bobo, W.V.; Yawn, B.P.; Sauver, J.L.; Grossardt, B.R.; Boyd, C.M.; Rocca, W.A. Prevalence of Combined Somatic and Mental Health Multimorbidity: Patterns by Age, Sex, and Race/Ethnicity. J. Gerontol. Ser. Biomed. Sci. Med. Sci. 2016, 71, 1483–1491. [Google Scholar] [CrossRef] [Green Version]
  96. Piccinelli, M.; Wilkinson, G. Gender Differences in Depression: Critical Review. Br. J. Psychiatr. 2000, 177, 486–492. [Google Scholar] [CrossRef] [Green Version]
  97. Parker, G.; Brotchie, H. Gender Differences in Depression. Int. Rev. Psychiatr. 2010, 22, 429–436. [Google Scholar] [CrossRef]
  98. Kuehner, C. Why Is Depression More Common among Women than among Men? Lancet Psychiatr. 2017, 4, 146–158. [Google Scholar] [CrossRef]
  99. Seidler, Z.E.; Dawes, A.J.; Rice, S.M.; Oliffe, J.L.; Dhillon, H.M. The Role of Masculinity in Men’s Help-Seeking for Depression: A Systematic Review. Clin. Psychol. Rev. 2016, 49, 106–118. [Google Scholar] [CrossRef]
  100. Yousaf, O.; Grunfeld, E.A.; Hunter, M.S. A Systematic Review of the Factors Associated with Delays in Medical and Psychological Help-Seeking among Men. Health Psychol. Rev. 2015, 9, 264–276. [Google Scholar] [CrossRef] [Green Version]
  101. Möller-Leimkühler, A.M. Barriers to Help-Seeking by Men: A Review of Sociocultural and Clinical Literature with Particular Reference to Depression. J. Affect. Disord. 2002, 71, 1–9. [Google Scholar] [CrossRef]
  102. Krumm, S.; Checchia, C.; Koesters, M.; Kilian, R.; Becker, T. Men’s Views on Depression: A Systematic Review and Metasynthesis of Qualitative Research. Psychopathology 2017, 50, 107–124. [Google Scholar] [CrossRef]
  103. Whittle, E.L.; Fogarty, A.S.; Tugendrajch, S.; Player, M.J.; Christensen, H.; Wilhelm, K.; Hadzi-Pavlovic, D.; Proudfoot, J. Men, Depression, and Coping: Are We on the Right Path? Psychol. Men Masc. 2015, 16, 426. [Google Scholar] [CrossRef]
  104. Oliffe, J.L.; Kelly, M.T.; Bottorff, J.L.; Johnson, J.L.; Wong, S.T. “He’s More Typically Female Because He’s Not Afraid to Cry”: Connecting Heterosexual Gender Relations and Men’s Depression ∗. In The Psychology of Gender and Health; Elsevier: Amsterdam, The Netherlands, 2017; pp. 177–197. [Google Scholar]
  105. Koops, E.A.; Husain, F.T.; van Dijk, P. Profiling Intermittent Tinnitus: A Retrospective Review. Int. J. Audiol. 2019, 58, 434–440. [Google Scholar] [CrossRef]
  106. Burkart, M.; Brueggemann, P.; Szczepek, A.J.; Frank, D.; Mazurek, B. Intermittent Tinnitus—An Empirical Description. Hno 2019, 67, 51–58. [Google Scholar] [CrossRef] [PubMed]
  107. Hu, J.; Xu, J.; Streelman, M.; Xu, H.; Guthrie, O. The Correlation of the Tinnitus Handicap Inventory with Depression and Anxiety in Veterans with Tinnitus. Int. J. Otolaryngol. 2015, 2015, 689375. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  108. Bishop, S.J.; Duncan, J.; Lawrence, A.D. State Anxiety Modulation of the Amygdala Response to Unattended Threat-Related Stimuli. J. Neurosci. 2004, 24, 10364–10368. [Google Scholar] [CrossRef] [Green Version]
  109. Andersson, G.; Jüris, L.; Classon, E.; Fredrikson, M.; Furmark, T. Consequences of Suppressing Thoughts about Tinnitus and the Effects of Cognitive Distraction on Brain Activity in Tinnitus Patients. Audiol. Neurotol. 2006, 11, 301–309. [Google Scholar] [CrossRef] [PubMed]
  110. Van der Wal, A.; Michiels, S.; De Pauw, J.; Jacxsens, L.; Chalimourdas, A.; Gilles, A.; Braem, M.; van Rompaey, V.; Van de Heyning, P.; De Hertogh, W. ICF Domains Covered by the Tinnitus Questionnaire and Tinnitus Functional Index. Disabil. Rehabil. 2021. ahead of print. [Google Scholar]
  111. Boecking, B.; Brueggemann, P.; Kleinjung, T.; Mazurek, B. All for One and One for All?–Examining Convergent Validity and Responsiveness of the German Versions of the Tinnitus Questionnaire (TQ), Tinnitus Handicap Inventory (THI), and Tinnitus Functional Index (TFI). Front. Psychol. 2021, 12, 630. [Google Scholar] [CrossRef] [PubMed]
  112. Searchfield, G.D. Hearing Aids for Tinnitus. Tinnitus Clin. Res. Perspect. San Diego CA Plur. Publ. 2015, 197–212. [Google Scholar]
  113. Trotter, M.I.; Donaldson, I. Hearing Aids and Tinnitus Therapy: A 25-Year Experience. J. Laryngol. Otol. 2008, 122, 1052. [Google Scholar] [CrossRef]
  114. Shekhawat, G.S.; Searchfield, G.D.; Stinear, C.M. Role of Hearing Aids in Tinnitus Intervention: A Scoping Review. J. Am. Acad. Audiol. 2013, 24, 747–762. [Google Scholar] [CrossRef] [PubMed]
  115. Hoare, D.J.; Edmondson-Jones, M.; Sereda, M.; Akeroyd, M.A.; Hall, D. Amplification with Hearing Aids for Patients with Tinnitus and Co-Existing Hearing Loss. Cochrane Database Syst. Rev. 2014. [Google Scholar] [CrossRef]
  116. Mohlman, J. Cognitive Self-Consciousness–a Predictor of Increased Anxiety Following First-Time Diagnosis of Age-Related Hearing Loss. Aging Ment. Health 2009, 13, 246–254. [Google Scholar] [CrossRef]
  117. Fava, G.A.; Mangelli, L.; Ruini, C. Assessment of Psychological Distress in the Setting of Medical Disease. Psychother. Psychosom. 2001, 70, 171–175. [Google Scholar] [CrossRef]
  118. Heine, C.; Browning, C.J. Communication and Psychosocial Consequences of Sensory Loss in Older Adults: Overview and Rehabilitation Directions. Disabil. Rehabil. 2002, 24, 763–773. [Google Scholar] [CrossRef] [PubMed]
  119. Gazzillo, F.; Dimaggio, G.; Curtis, J.T. Case Formulation and Treatment Planning: How to Take Care of Relationship and Symptoms Together. J. Psychother. Integr. 2021, 31, 115–128. [Google Scholar] [CrossRef] [Green Version]
  120. Johnstone, L.; Dallos, R. Formulation in Psychology and Psychotherapy: Making Sense of People’s Problems; Routledge: Oxford, UK, 2013. [Google Scholar]
  121. Johnstone, L. Psychological Formulation as an Alternative to Psychiatric Diagnosis. J. Humanist. Psychol. 2018, 58, 30–46. [Google Scholar] [CrossRef]
Table 1. Sample descriptors and univariate comparisons for general audiological (a), tinnitus-related (b), and other distress-related indices (c). PTA = pure tone audiometry; SC = speech comprehension; TRD = tinnitus-related distress; TQ = Tinnitus Questionnaire; THI = Tinnitus Handicap Inventory; TFI = Tinnitus Functional Index; PSQ = Perceived Stress Questionnaire; HADS_a = Hospital Anxiety and Depression Scale_anxiety subscale; HADS_d = depression subscale; ISR = ICD-10 symptom rating. Italicised numbers denote significantly differing contrasts. * p < 0.05; ** p < 0.01; *** p < 0.001.
Table 1. Sample descriptors and univariate comparisons for general audiological (a), tinnitus-related (b), and other distress-related indices (c). PTA = pure tone audiometry; SC = speech comprehension; TRD = tinnitus-related distress; TQ = Tinnitus Questionnaire; THI = Tinnitus Handicap Inventory; TFI = Tinnitus Functional Index; PSQ = Perceived Stress Questionnaire; HADS_a = Hospital Anxiety and Depression Scale_anxiety subscale; HADS_d = depression subscale; ISR = ICD-10 symptom rating. Italicised numbers denote significantly differing contrasts. * p < 0.05; ** p < 0.01; *** p < 0.001.
General Audiological Indices Hearing Ability [PTA]SC_0 dBSC_55 dBSC_65 dB
Previous psychotherapy
no12470.1 73.7513.16(1171) = 3.96 *
yes5329.9 69.3414.08
Previous hearing aid use
no12369.535.827.36(1170) = 4.89 *98.552.62(1174) = 13.57 ***
yes5329.940.116.41 95.8812.72
Tinnitus type
pure-tone12168.4 98.632.59(1167) = 5.97 *
narrow-band5229.4 95.6112.94
Tinnitus location
Tinnitus pitch
very high--
Perceived tinnitus pitch
very high3720.9 66.7111.17(3169) = 3.11 *18.1613.58(3169) = 2.72 *
high10458.8 74.2814.35 27.5520.02
middle3218.1 72.7612.14 21.7217.33
low31.7 77.503.54 22.503.54
Perceived tinnitus onset
gradual9252.037.926.79(1163) = 4.78 *
Perceived tinnitus duration
<1/2 year52.8
1/2–1 year95.1
1–2 years2313.0
2–5 years2413.6
>5 years10760.5
Perceived sound intermittence
Perceived loudness fluctuation
Tinnitus-related distress indicesTQ THI TFI
male 36.9019.73(1171) = 4.03 *
female 43.3522.01
Previous psychotherapy
no28.9714.33(1171) = 7.97 **27.4019.41(1171) = 15.43 ***38.0819.59(1171) = 4.96 *
yes36.3018.62 41.3225.61 45.7823.80
Previous hearing aid use
Tinnitus type
Tinnitus location
Tinnitus pitch
Perceived tinnitus pitch
very high37.8917.15(3171) = 3.76 *42.8123.76(3.171) = 5.64 **50.8524.34(3171) = 5.62 **
high30.3215.94 30.2521.69 39.2320.04
middle26.0012.48 22.9017.41 31.3015.20
low20.0012.73 12.0014.14 26.868.57
Perceived tinnitus onset
gradual 28.0920.67(1.160) = 5.41 *
sudden 36.4524.93
Perceived tinnitus duration
Perceived sound intermittence
intermittent 30.2518.37(1172) = 5.67 *
permanent 41.8521.23
Perceived loudness fluctuation
Other psychological distress-related indicesPSQ HADS_a HADS_d ISR
male25.3315.37(1171) = 6.53 *5.503.81(1171) = 4.63 * 0.520.45(1171) = 4.50 *
female32.7721.64 6.844.27 0.690.57
Previous hearing aid use
Previous psychotherapy
no23.6714.03(1171) = 42.89 ***5.123.33(1171) = 35.09 ***4.484.13(1171) = 25.42 ***0.480.38(1171) = 29.19 ***
yes42.4323.29 8.814.59 8.154.93 0.910.67
Tinnitus type
Tinnitus location
Tinnitus pitch
Perceived tinnitus pitch
very high 7.924.83(3170) = 3.57 *7.785.52(3170) = 4.30 **0.870.61(3171) = 4.89 **
high 5.993.92 5.284.45 0.570.51
middle 4.973.20 3.973.63 0.420.35
low 3.500.71 4.001.41 0.430.15
Perceived tinnitus onset
gradual26.6416.56(1160) = 4.50 *
Perceived tinnitus duration
Perceived sound intermittence
Perceived loudness fluctuation
constant25.1416.67(1170) = 5.52 *5.263.89(1170) = 6.58 *
variable32.1420.64 6.884.17
Table 2. Significant correlation coefficients between HA use time (t1 − t2) and general audiological as well as distress-related indices at pre- and post-treatment. Patients’ hearing ability was measured at a preceding screening timepoint. PTA = pure tone audiometry; SC = speech comprehension; TQ = Tinnitus Questionnaire; THI = Tinnitus Handicap Inventory; TFI = Tinnitus Functional Index; PSQ = Perceived Stress Questionnaire: HADS_a = Hospital Anxiety and Depression Scale, anxiety; HADS_d = depression; ISR = ICD-10 Symptom Rating; * p < 0.05; ** p < 0.01; *** p < 0.001.
Table 2. Significant correlation coefficients between HA use time (t1 − t2) and general audiological as well as distress-related indices at pre- and post-treatment. Patients’ hearing ability was measured at a preceding screening timepoint. PTA = pure tone audiometry; SC = speech comprehension; TQ = Tinnitus Questionnaire; THI = Tinnitus Handicap Inventory; TFI = Tinnitus Functional Index; PSQ = Perceived Stress Questionnaire: HADS_a = Hospital Anxiety and Depression Scale, anxiety; HADS_d = depression; ISR = ICD-10 Symptom Rating; * p < 0.05; ** p < 0.01; *** p < 0.001.
n = 155
HA use Time
[t1 − t2]
n = 150
HA use Time
[t2 − t3]
Hearing ability [PTA]
SC_0 dB
SC_55 dB−0.17 *
SC_65 dB
TQ−0.30 *** −0.32 ***
THI−0.26 *** −0.29 ***
TFI−0.29 *** −0.42 ***
PSQ−0.19 * −0.20 *
HADS_a−0.17 * −0.23 **
HADS_d−0.23 ** −0.19 *
ISR−0.20 * −0.27 **
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Boecking, B.; Psatha, S.; Nyamaa, A.; Dettling-Papargyris, J.; Funk, C.; Oppel, K.; Brueggemann, P.; Rose, M.; Mazurek, B. Hearing Aid Use Time Is Causally Influenced by Psychological Parameters in Mildly Distressed Patients with Chronic Tinnitus and Mild-to-Moderate Hearing Loss. J. Clin. Med. 2022, 11, 5869.

AMA Style

Boecking B, Psatha S, Nyamaa A, Dettling-Papargyris J, Funk C, Oppel K, Brueggemann P, Rose M, Mazurek B. Hearing Aid Use Time Is Causally Influenced by Psychological Parameters in Mildly Distressed Patients with Chronic Tinnitus and Mild-to-Moderate Hearing Loss. Journal of Clinical Medicine. 2022; 11(19):5869.

Chicago/Turabian Style

Boecking, Benjamin, Stamatina Psatha, Amarjargal Nyamaa, Juliane Dettling-Papargyris, Christine Funk, Kevin Oppel, Petra Brueggemann, Matthias Rose, and Birgit Mazurek. 2022. "Hearing Aid Use Time Is Causally Influenced by Psychological Parameters in Mildly Distressed Patients with Chronic Tinnitus and Mild-to-Moderate Hearing Loss" Journal of Clinical Medicine 11, no. 19: 5869.

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