Psychoacoustic classification of persistent tinnitus

Suzuki, Flavia Alencar de Barros; Suzuki, Fabio Akira; Onishi, Ektor Tsuneo; Penido, Norma Oliveira

doi:10.1016/j.bjorl.2017.07.005

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Original articles • Braz. j. otorhinolaryngol. 84 (5) • Sep-Oct 2018 • https://doi.org/10.1016/j.bjorl.2017.07.005 copy

Psychoacoustic classification of persistent tinnitus^☆ ☆ Please cite this article as: Suzuki FA, Suzuki FA, Onishi ET, Penido NO. Psychoacoustic classification of persistent tinnitus. Braz J Otorhinolaryngol. 2018;84:583-90.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Tinnitus is a difficult to treat symptom, with different responses in patients. It is classified in different ways, according to its origin and associated diseases.

Objective:

to propose a single and measurable classification of persistent tinnitus, through its perception as sounds of nature or of daily life and its comparison with pure tone or noise, of high or low pitch, presented to the patient by audiometer sound.

Methods:

A total of 110 adult patients, of both genders, treated at the Tinnitus Outpatient Clinic, were enrolled according to the inclusion and exclusion criteria. Otorhinolaryngologic and Audiological, Pitch Matching and Loudness, Visual Analog Scale, Tinnitus Handicap Inventory and Minimum Masking Level assessments were performed.

Results:

In these 110 patients, 181 tinnitus complaints were identified accordingly to type and ear, with 93 (51%) Pure Tone, and 88 (49%) Noise type; 19 at low and 162 at high frequency; with a mean in the Pure Tone of 5.4.07 in the Visual Analog Scale and 12.31 decibel in the Loudness and a mean in the Noise of 6.66 and 10.51 decibel. For Tinnitus Handicap Inventory and Minimum Masking Level, the 110 patients were separated into three groups with tinnitus, Pure Tone, Noise and multiple. Tinnitus Handicap Inventory higher in the group with multiple tinnitus, of 61.38. Masking noises such as White Noise and Narrow Band were used for the Minimum Masking Level at the frequencies of 500 and 6000 Hz. There was a similarity between the Pure Tone and Multiple groups. In the Noise group, different responses were found when Narrow Band was used at low frequency.

Conclusion:

Classifying persistent tinnitus as pure tone or noise, present in high or low frequency and establishing its different characteristics allow us to know its peculiarities and the effects of this symptom in patients' lives.

KEYWORDS
Tinnitus/classification; Audiometry; Psychoacoustic/characteristics

Subjective characteristics	Pitch	High frequency		Low frequency		Chi-square test (p)^a a Chi-square test. p < 0.001. Significance 0.05%.n, number of responses to tinnitus similar to Pure Tone (PT) or Noise.	Total
		n	%	n	%		n	%
Ship horn	250 Hz/500 Hz	0	0%	4	100%	p < 0.001	4	4.3%
Whistle/cicada/insect	2 kHz/3 kHz/4 kHz/6 kHz/8 kHz/10 kHz	89	100%	0	0%		89	95.7%
Car engine/wave/airplane/waterfall	250 Hz/500 Hz/1 kHz	0	0%	15	100%		15	17%
Bee/wheezing/pressure cooker/rain	2 kHz/3 kHz/4 kHz/6 kHz/8 kHz	73	100%	0	0%		73	83%
n		162	100%	19	100%		181	100%

VAS	Pure Tone	Noise	Mann-Whitney test (p)	Result
Mean (0-10)	5.4.07	6.66	p = 0.002^a a Mann-Whitney test. Significance: 0.05%. n, number of responses to tinnitus similar to Pure Tone (PT) or Noise.	PT < Noise
Standard-deviation	2.47	2.35
n	93	88		Significant

Loudness	Pure Tone	Noise	Mann-Whitney test (p)	Result
Mean (dBSL)	12.31	10.51	p = 0.016^a a Mann-Whitney test. Significance: 0.05%. n, number of responses to tinnitus similar to Pure Tone (PT) or Noise.	PT > Noise
Standard-deviation	5.34	5.14
n	93	88		Significant

	PTG	NG	PTNG	Kruskal-Wallis test (p)	Tukey's multiple comparisons (p)	Result
Mean (0-100)	37.42	46.04	61.38	p = 0.009^a a Kruskal-Wallis test and Tukey's multiple comparisons. Significance of 0.05%. n, number of patients with tinnitus in all three groups.	PTG × NG. p = 0.229
Standard-deviation	21.56	28.81	23.26		PTG × PTNG. p = 0.004^a a Kruskal-Wallis test and Tukey's multiple comparisons. Significance of 0.05%. n, number of patients with tinnitus in all three groups.	PTG = NG < PTNG
n	45	49	16		NG × PTNG, p = 0.093

	Mean (dBSL)	GPT	GN	GPTN	Kruskal-Wallis test (p)	Tukey multiple comparisons (p)	Result
MML WN	Mean	14.9	14.8	17.5			PTG = NG = PTNG
	Standard deviation	8.8	9.8	8.2	0.300
	n	45	49	16
MML LFNBL	Mean	30.4	23.8	31.6		PTG × NG. p = 0.022^a a Kruskal-Wallis test and Tukey's multiple comparisons. Significance of 0.05%. n, number of patients with tinnitus in all three groups.	PTG = PTNG > NG
	Standard deviation	12.7	11.2	12.2	0.004^a a Kruskal-Wallis test and Tukey's multiple comparisons. Significance of 0.05%. n, number of patients with tinnitus in all three groups.	PTG × PTNG. p = 0.945
						NG × PTNG. p = 0.066
	n	45	49	16
MML HFNB	Mean	14.2	16.6	19.1			PTG = NG = PTNG
	Standard deviation	8.6	13.7	10.2	0.255
	n	45	49	16

	Mean (dBSL)	MML WN	MML LFNB	MML HFNB	Friedman's test (p)	Tukey multiple comparisons (p)	Result
High-frequency PTG	Mean	15,24	31,07	14,64		WN × LFNB p < 0.001^a a Friedman's test and Tukey's multiple comparisons. Significance of 0.05%. n, number of patients with tinnitus in all three groups.
High-frequency PTG	Standard deviation	8,900	12,761	8,582	<0.001^a a Friedman's test and Tukey's multiple comparisons. Significance of 0.05%. n, number of patients with tinnitus in all three groups.	WN × HFNB p = 0.877	WN = HFNB < LFNB
						HFNB × LFNB p < 0.001^a a Friedman's test and Tukey's multiple comparisons. Significance of 0.05%. n, number of patients with tinnitus in all three groups.
	n	42	42	42
High-frequency NG	Mean	13,08	24,23	12,05		WN × LFNB p < 0.001^a a Friedman's test and Tukey's multiple comparisons. Significance of 0.05%. n, number of patients with tinnitus in all three groups.
	Standard deviation	7,832	10,671	8,006	<0,001^a a Friedman's test and Tukey's multiple comparisons. Significance of 0.05%. n, number of patients with tinnitus in all three groups.	WN × HFNB p = 0.485	WN = HFNB < LFNB
						HFNB × LFNB p < 0.001^a a Friedman's test and Tukey's multiple comparisons. Significance of 0.05%. n, number of patients with tinnitus in all three groups.
	N	39	39	39
High-frequency PTNG (pure tone and noise)	Mean	15,00	29,29	16,79		WN × LFNB p < 0.001^a a Friedman's test and Tukey's multiple comparisons. Significance of 0.05%. n, number of patients with tinnitus in all three groups.
	Standard deviation	4,804	11,242	8,684	<0,001^a a Friedman's test and Tukey's multiple comparisons. Significance of 0.05%. n, number of patients with tinnitus in all three groups.	WN × HFNB p = 0.718	WN = HFNB < LFNB
						HFNB × LFNB p < 0.001^a a Friedman's test and Tukey's multiple comparisons. Significance of 0.05%. n, number of patients with tinnitus in all three groups.
	N	14	14	14

	Mean (dBSL)	MML WN	MML LFNB	MML HFNB	Friedman's test (p)	Tukey's multiple comparisons (p)	Result
Low-frequency PTG	Mean	10.00	21.67	8.33	-	-	-
	Standard deviation	5.000	7.638	7.638	-	-	-
	n	3	3	3
Low-frequency NG	Mean	21.50	22.00	34.50		WN × LFNB. p = 0.984
	Standard deviation	13.754	13.581	16.907	0.005^a a Friedman's test and Tukey's multiple comparisons. Significance of 0.05%. n, number of patients with low frequency tinnitus in PTG and Noise and high frequency for PT and low frequency for Noise in the PTNG.	WN × HFNB. p < 0.001^a a Friedman's test and Tukey's multiple comparisons. Significance of 0.05%. n, number of patients with low frequency tinnitus in PTG and Noise and high frequency for PT and low frequency for Noise in the PTNG.	WNp = LFNB < HFNB
	Standard deviation	13.754	13.581	16.907		HFNB × LFNB. p = 0.001^a a Friedman's test and Tukey's multiple comparisons. Significance of 0.05%. n, number of patients with low frequency tinnitus in PTG and Noise and high frequency for PT and low frequency for Noise in the PTNG.
	n	10	10	10
Low-frequency (noise) + High-frequency (pure tone) PTNG	Mean	35.00	47.50	35.00	-	-	-
	Standard deviation	0.000	3.536	0.000	-	-	-
	n	2	2	2

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
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[1] * Corresponding author. E-mail:flavia_fabs@yahoo.com.br (F.A. Suzuki).

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Psychoacoustic classification of persistent tinnitus☆ ☆ Please cite this article as: Suzuki FA, Suzuki FA, Onishi ET, Penido NO. Psychoacoustic classification of persistent tinnitus. Braz J Otorhinolaryngol. 2018;84:583-90.

Abstract

Introduction:

Objective:

Methods:

Results:

Conclusion:

Psychoacoustic classification of persistent tinnitus^☆ ☆ Please cite this article as: Suzuki FA, Suzuki FA, Onishi ET, Penido NO. Psychoacoustic classification of persistent tinnitus. Braz J Otorhinolaryngol. 2018;84:583-90.