Question
Please discuss normative data you have collected on Dr. Meikle's
''Tinnitus Severity Index'' (TSI) and how the TSI relates to severity of
tinnitus.
Answer
The present version of the TSI is composed of twelve questions listed in appendix one of my article ''Managing Chronic Tinnitus as Phantom Auditory Pain.'' The Audiology Online Article was posted at www.audiologyonline.com in December 2000, and is available in the AO:Article Archives.
Dr. Mary Meikle and her colleagues analyzed data from thousands of patients evaluated and treated at our Tinnitus Clinic. Statistical analysis identified twelve questions that are the most reliable indicators of tinnitus severity. The TSI is a measure of how much tinnitus negatively impacts a patient's life and how bothersome patients perceive their tinnitus to be.
Numerous studies in our clinic (and others around the world) have consistently shown that the matched pitch and loudness of tinnitus are not correlated with its severity. Some patients with relatively loud tinnitus (20 dB SL or more) might not perceive it as a significant problem; they are able to ignore their tinnitus most of the time. Consequently, these patients would have low TSI scores.
Other patients with relatively low level tinnitus (0-3 dB SL) who are extremely bothered by it -- and have great difficulty ignoring it -- could have high severity scores.
What contributes most to high or low TSI scores? Patient personality factors and general coping skills play large roles. Tinnitus severity is highly correlated with degree of anxiety, depression, or insomnia experienced by patients. Tinnitus is not always responsible for these associated problems. In many cases, patients experienced anxiety, depression and/or insomnia before their tinnitus started.
As I noted in the Audiology Online article (above), Rizzardo et al (1998) stated there appears to be a ''link between psychological distress and tinnitus in a potential somatopsychological and psychosomatic vicious circle (a psychological predisposition to react emotionally to events, tinnitus as a source of distress that reinforces the symptom, accentuating hypochondriac fears)''.
Dobie & Sullivan (1998) agree that some people are more predisposed to depression than others and that tinnitus is one of many internal and external triggers that can precipitate major depression in susceptible individuals. Perhaps the most logical conclusion was stated by Halford &
Anderson (1991): ''It is considered that the causal relationship between these psychological variables and tinnitus severity is likely to be bi-directional.'' This is illustrated by the ''vicious circle'' diagram in the
Audiology Online article.
In its present form, the range of possible scores on the Tinnitus Severity Index is 12-56. The average severity score for our clinic population is between 38-40 (depending on the sample size). Of course, these scores are representative of a population of patients who chose to go to a specialized tinnitus clinic for treatment. We expect our clinic population to have higher TSI scores than the majority of people who experience chronic tinnitus but aren't usually bothered by it.
The goal of our treatment program is to reduce tinnitus severity for each of our patients. Successful treatment of insomnia, anxiety and depression will reduce tinnitus severity for patients who experience these multiple symptoms. For the most severe cases, a series of psychotherapy/counseling sessions and sometimes medications are necessary to improve the patient's
condition. Hearing aids, in-the-ear sound generators and other forms of acoustic therapy are tools which can give patients some immediate relief from tinnitus. These devices also allow patients to exert some control over their tinnitus, an important step toward developing productive coping skills and strategies.
BIO:
Robert Folmer earned his Ph.D. in Speech and Hearing Science from the University of California, San Francisco. At U.C.S.F. he conducted numerous EEG and evoked potential studies for the Departments of Psychiatry, Neurology, Otolaryngology, and Neurosurgery. In 1997 he joined the staff of the Oregon Health Sciences University Tinnitus Clinic where he currently serves as Clinical Neurophysiologist and Assistant Professor of Otolaryngology. His primary duties include evaluation and treatment of patients in the Tinnitus Clinic, and research on the psychological and biochemical factors related to tinnitus severity.