Psychiatric Comorbidities in Patients with Chronic Tinnitus

Chronic tinnitus, characterized by the persistent perception of sound without an external source, affects approximately 14% of adults globally, with about 2% experiencing severe forms [1]. This condition is often associated with significant psychological distress, leading to a notable impact on patients' quality of life.

The relationship between tinnitus and psychiatric disorders is well-documented. A scoping review encompassing studies published between 2014 and 2025 found that most studies reported significant associations between tinnitus and psychiatric symptoms, particularly anxiety, depression, stress, insomnia, and, in some cases, psychosis [2]. Additionally, a study by Boecking et al. reported that the prevalence of depression, anxiety, and somatic symptom disorders was higher among participants with tinnitus compared to those without, with somatic symptom disorders showing the highest prevalence [3].

The pathophysiological mechanisms underlying this comorbidity are multifactorial. Chronic tinnitus may lead to maladaptive neural plasticity, resulting in heightened emotional responses and cognitive impairments [4]. Furthermore, tinnitus severity has been positively correlated with the severity of psychiatric symptoms, suggesting that more severe tinnitus may exacerbate psychological distress [5].

Despite the established association between tinnitus and psychiatric disorders, the specific prevalence rates and contributing factors in different populations remain under-researched. Recent studies highlight the importance of evaluating these comorbidities systematically to inform targeted interventions [6,7]. This study aims to investigate the prevalence of psychiatric comorbidities among patients with chronic tinnitus and identify potential predictors, thereby contributing to the development of effective clinical strategies.

Study Design and Setting: This cross-sectional observational study was conducted at the Department of Psychiatry and Otolaryngology in an Indian Medical College.All participants provided written informed consent prior to enrollment.

Study Population:Adult patients aged 18–65 years presenting with chronic tinnitus (duration ≥ 6 months) to the outpatient clinics were included. Patients with hearing loss due to acute infections, neurological disorders affecting auditory function, severe cognitive impairment, or pre-existing psychiatric disorders diagnosed prior to tinnitus onset were excluded.

Sample Size: The sample size was calculated using the formula for prevalence studies:

n=Z²×p×(1−p)d²

Assuming a prevalence of psychiatric comorbidity in tinnitus patients of 40%, 95% confidence interval (Z = 1.96), and a margin of error of 5%, the minimum sample size required was 369. Considering a 10% non-response rate, a total of 410 patients were invited to participate.

Sampling Technique: A consecutive sampling method was employed, wherein all eligible patients visiting the clinic during the study period were approached for enrollment until the desired sample size was achieved.

Data Collection

Data were collected using a structured proforma including:

1. Sociodemographic information: age, gender, educational status, occupation, residence.
2. Clinical characteristics: duration, laterality, and severity of tinnitus.
3. Tinnitus severity assessment: using the Tinnitus Handicap Inventory (THI), a validated 25-item questionnaire with scores ranging from 0–100, categorized as slight (0–16), mild (18–36), moderate (38–56), severe (58–76), and catastrophic (78–100).
4. Psychiatric evaluation: conducted by a qualified psychiatrist using the Mini International Neuropsychiatric Interview (MINI 7.0.2) to diagnose common psychiatric comorbidities, including anxiety disorders, depressive disorders, and somatoform disorders.

Statistical Analysis: Data were analyzed using SPSS version 26.0. Descriptive statistics were used for demographic and clinical variables: continuous variables were expressed as mean ± standard deviation (SD) and categorical variables as frequencies and percentages. The prevalence of psychiatric comorbidities was calculated. Bivariate analysis using Chi-square or Fisher’s exact test assessed associations between psychiatric comorbidity and sociodemographic/clinical variables. Variables with p < 0.10 in bivariate analysis were entered into a multivariate logistic regression model to identify independent predictors. Statistical significance was set at p < 0.05.

Table 1: Sociodemographic Characteristics of Study Participants (n = 410)

Table 2: Clinical Characteristics of Tinnitus (n = 410)

Table 3: Prevalence of Psychiatric Comorbidities (n = 410)

Table 4: Association of Psychiatric Comorbidity with Tinnitus Severity (n = 410)

*Statistically significant (Chi-square test)

Table 5: Multivariate Logistic Regression for Independent Predictors of Psychiatric Comorbidity

*Significant predictors

Our study underscores the significant prevalence of psychiatric comorbidities among patients with chronic tinnitus, with nearly half of the participants exhibiting conditions such as anxiety, depression, and somatoform disorders [7]. The bidirectional relationship between tinnitus and psychiatric disorders is well-documented. Depressive symptoms can exacerbate tinnitus-related distress, and conversely, tinnitus can intensify depressive symptoms, suggesting a cyclical interaction between the two conditions [8]. This interplay emphasizes the necessity for integrated treatment approaches addressing both auditory and psychological aspects.

The severity of tinnitus, as measured by the Tinnitus Handicap Inventory (THI), was a significant predictor of psychiatric comorbidity [9]. Higher tinnitus severity has been associated with increased risk of psychiatric disorders, particularly depression and anxiety [10]. Additionally, the duration of tinnitus symptoms emerged as another critical factor; patients with tinnitus lasting over three years had a higher likelihood of psychiatric comorbidity [11].

Gender differences also influence the manifestation of psychiatric comorbidities in tinnitus patients. Females with tinnitus exhibited higher levels of depressive symptoms compared to males, suggesting that gender may affect the psychological impact of tinnitus [12]. Other studies have also highlighted the importance of addressing these demographic and clinical factors when planning comprehensive management [13,14].

These findings highlight the multifaceted nature of chronic tinnitus and its association with psychiatric disorders. They underscore the importance of comprehensive assessment and management strategies that encompass both auditory and psychological domains to improve patient outcomes.

Psychiatric comorbidities are highly prevalent among patients with chronic tinnitus, affecting nearly half of the study population. The risk is significantly elevated in patients with severe or catastrophic tinnitus and those with a longer duration of symptoms. Early psychiatric screening and integrated management strategies, including counseling and appropriate treatment of anxiety and depression, are essential to improve overall quality of life and clinical outcomes in these patients.

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