The Relationships Among Tinnitus Intensity, Complexity, Sound Intolerance, and Psychiatric Symptoms

Objective: This study investigated the associations between tinnitus-related features, psychological symptoms, and everyday functioning. Material and Methods: In this study, 293 patients with primary subjective tinnitus participated. Participants received otorhinolaryngological and audiological evaluations and completed the Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI), and Generalised Anxiety Disorder-7 (GAD-7) questionnaires. Results: Significant positive correlations were observed between total THI scores and several tinnitus characteristics, including subjective loudness, pitch, complexity, and sound intolerance. Higher THI scores were also associated with higher depression and anxiety scores. Psychoacoustically matched tinnitus intensity was positively correlated with perceived tinnitus loudness; however, no significant association was found between overall THI scores and psychoacoustic tinnitus intensity. Longer tinnitus duration was positively correlated with both tinnitus loudness and participant age, while age was also positively associated with tinnitus loudness. Subjective tinnitus loudness, pitch, complexity, and sound intolerance were positively correlated with both BDI and GAD-7 scores. After applying the Bonferroni correction for multiple comparisons, the following correlations were no longer statistically significant: psychoacoustic tinnitus intensity with subjective tinnitus loudness and the THI Functional (F) subscale; tinnitus duration with subjective tinnitus loudness; subjective tinnitus loudness with BDI and GAD-7 scores; and age with subjective tinnitus loudness and tinnitus pitch. However, all remaining significant correlations were retained. In linear regression analyses, THI scores were independently associated with sound intolerance, tinnitus pitch, and BDI scores, while THI scores were also independently associated with BDI scores and sound intolerance in reciprocal models. Conclusions: In this single-centre, cross-sectional study of patients with tinnitus and without a control group, greater tinnitus handicap was associated with subjective tinnitus pitch, sound intolerance, and depressive symptoms. Subjective tinnitus loudness was positively associated with psychoacoustically matched tinnitus intensity before correction for multiple testing but was not retained after Bonferroni adjustment. Several subjective tinnitus characteristics remained associated with symptoms of depression and anxiety after adjustment for multiple comparisons. These findings describe associations within the studied population and should not be interpreted as evidence of causal relationships or generalised beyond similar clinical populations without further multicentre, longitudinal, controlled studies.