Study: Insomnia takes toll on tinnitus patients

For the more than 36 million people plagued by tinnitus, insomnia can have a negative effect on the condition, worsening the functional and emotional toll of chronic ringing, buzzing, hissing or clicking in the head and ears, according to a new study from Henry Ford Hospital in Detroit.

The study shows a significant association between insomnia and the severity of perceived tinnitus symptoms, with patients with insomnia reporting greater emotional distress from tinnitus.

“Tinnitus involves cognitive, emotional, and psycho-physiological processes, which can result in an increase in a patient’s distress,” says study co-author Kathleen L. Yaremchuk, M.D., Chair, Department of Otolaryngology-Head & Neck Surgery at Henry Ford. “Sleep complaints, including insomnia, in these patients may result in a decrease in their tolerance to tinnitus.”

The study will be presented this week at the Combined Otolaryngological Spring Meetings in San Diego.

While the exact physiological cause of tinnitus is not known, there are several conditions that have been shown to trigger or worsen tinnitus: Exposure to loud noises, wax build-up in the ear, ear or sinus infections, head and neck trauma, and certain disorders, such as hypo- or hyperthyroidism, Lyme disease, fibromyalgia, and thoracic outlet syndrome.

Previous medical studies also have shown a strong association between tinnitus and various psychological disturbances.

For the Henry Ford study, Dr. Yaremchuk, Dr. George Miguel and their research team conducted a retrospective study of 117 patients treated between 2009 and 2011 at Henry Ford.

Tinnitus is the medical term for ringing in the ears. Symptoms can range from a slight annoying ring to a constant hum or even a loud buzz. Individuals who suffer with this condition know just how irritating it is to live with on a daily basis.

Pulsatile and nonpulsatile are the two main forms of tinnitus. Blood flow, heart rate or muscle movement can often be heard within the ear as a pulsating noise. This pulsating noise can be found to be in relation to vascular problems in the neck. The nonpulsatile form is thought to be caused by the nerves within the ear that are not operating properly. This condition can affect one ear or both of the ears. Patients often report the sound is coming from “inside” their heads.

Some Tinnitus Causes

Tinnitus is a bothersome and irritating condition that can be triggered by any one of multiple reasons. Just some of the most common causes are excessive earwax, antibiotics or aspirin, drinking too much caffeinated beverages or alcohol, dental problems, injury to the fragile components of the inner ear and excessive weight loss or malnutrition. There are so many possible reasons for a patient to develop ringing in the ears that it is sometimes hard for doctors to actually pin down the exact cause of the discomfort.

To add even more possible causes to the list it is necessary to include a rapid drop or change in environmental pressure, a prolonged hyperextended position of the neck muscles, as is often seen with those individuals who are avid bicyclists, vascular or blood flow problems and neurological disorders such as migraine headaches and multiple sclerosis. With all these possible causes is it no wonder that physicians and patients alike are often frustrated when both medicine and personal life changes of the patient offer no relief.

Information was gathered from patients through telephone and written interviews using the Tinnitus Reaction Questionnaire (or, TRQ, which determines the emotional effects tinnitus has had on a person’s lifestyle and general well-being) and the Insomnia Severity Index (or, ISI, a brief screening measure of insomnia) scales.

Severity of TRQ was shown to be a good predictor of sleep disturbance and in predicting group association, especially the “emotional” subscore component (sensitivity 96.9 percent and specificity 55.3 percent for identifying tinnitus patients with insomnia).

The greater the insomnia disability, the more severe the patient’s complaints were regarding the tinnitus, the study finds.

“Treating patients with tinnitus is challenging,” notes Dr. Yaremchuk. “A chronic tinnitus patient presents a challenging clinical picture that may include anxiety, depression, annoyance, or self-reported emotional distress. And one of most frequent self-reported complaint of tinnitus patients is ‘getting to sleep.’”

Because of its subjective and personal nature, tinnitus is a challenge to good health which itself can be challenged by sufferers. With determination and a positive outlook, it is possible to intervene successfully in the course of events when tinnitus strikes and discover ways of getting the better of what at first can seem like a noisy monster invading the head. Some simple therapies under the direction of skilled people and, just as valuably, a few basic pieces of advice can lighten the burden.
The new sufferer will be regaled with scores of highly dubious ‘remedies’ deserving of the title quack medicine. Practitioners of some of the more boastful branches of alternative medicine, who claim with scant evidence that they have the key to healthier living, have latterly added tinnitus to their lists. At the same time, there are treatments – on the fringe of conventional medicine – with credible testimonials from people with tinnitus.
Certainly it is not easy to make much progress in the partial defeat of tinnitus without accepting the psychological element in it. As it is a perceived noise, which others cannot hear, the processes of thought and sensations are heavily involved. It is therefore wrong to think of tinnitus as an ear-based affliction only, although the temptation to do so is great, as sounds and the hearing of them are fundamental to the car.

The study also offers further proof that evaluation and treatment of insomnia patients with tinnitus may result in a reduction in tinnitus symptom severity.

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Study funding: Henry Ford Hospital.

Along with Drs. Yaremchuk and Miguel, Henry Ford co-authors are Christopher Drake, Ph.D.; Thomas Roth, Ph.D.; and Ed Peterson, Ph.D.

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Krista Hopson
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313-874-7207
Henry Ford Health System

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