COVID-19 associated anxiety enhances tinnitus

  1. Li Xia
  2. Gang He
  3. Yong Feng
  4. Xiaoxu Yu
  5. Xiaolong Zhao
  6. Shankai Yin
  7. Zhengnong Chen
  8. Jian Wang
  9. Jiangang Fan
  10. Chuan Dong

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Abstract

To investigate if the anxiety associated with coronavirus disease 2019 (COVID-19) is a promoting factor to tinnitus. A retrospective research design collected from 188 tinnitus patients, was used to compare the clinical characteristics of tinnitus between the patients in 2020 under pandemic pressure and those from the matching period in 2019. While anxiety was quantified using the Zung’s Self-rating Anxiety Scale (SAS), tinnitus severity was evaluated using the Tinnitus Handicap Inventory (THI) questionnaire and the test of tinnitus loudness (TL). The assessments were repeated after the sound therapy plus educational counselling (STEC) for 38 patients in 2020 and 58 patients in 2019 and compared with EC alone therapy for 42 patients in 2020 and 17 patients in 2019. A large increase in anxiety was evident in 2020 in both case rate and SAS. The treatment of both methods was less effective in 2020. SAS, THI and TL were all deteriorated after the EC alone treatment in 2020, while an improvement was seen in 2019. This suggests that EC alone could not counteract the stress by COVID-19 at all, and the stress, if not managed well, can significantly increase the severity of tinnitus and associated anxiety. By using the EC subgroup in virtual control, we conclude that anxiety can serve as a promoting factor to tinnitus. We believe that this is the first study report that confirm the causative/promotive role of anxiety on tinnitus during COVID-19 pandemic.

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  1. Version published to 10.1371/journal.pone.0246328
  2. Version published to 10.1101/2020.07.02.20145532v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2020.07.02.20145532: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Although no procedure was experimental, we sought and received approval for the study from the Ethics Review Board of the Sichuan Provincial People’s Hospital and Sichuan Academy of Medical Sciences (permit number: 2020–355).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were performed using the SPSS 19.0.0 software at a significance level of 0.05.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: There were several limitations to our study. Firstly, this was a retrospective study in which only the SAS was used to evaluate anxiety. This makes it difficult to compare our study with previous ones. Secondly, STEC was compared with EC alone without the use of wait-list control, making it difficult to fully evaluate the impact of anxiety on tinnitus. Thirdly, more patients in 2020 selected EC alone treatment probably due to the financial constraints, which may have produced some bias in comparison with 2019 subgroup. Last but not least, the overall sample size in the present study was small as the data were collected only from one hospital within a limited period. Although the data and conclusion are solid in the present study, further investigation would be helpful to verify the conclusion with a larger sample. Currently, the link between anxiety and tinnitus was more evaluated in the direction of how tinnitus, as a stressor, can interact with (pre-existing) psychological disorders and change the subjects responses to them (Kroner-Herwig et al., 2006), but was not emphasized on the direction whether other stressors would enhance tinnitus. This has been reflected in evaluation tools. For example, the THI questions for the emotional subscale (e.g., Question 22: Does your tinnitus make you feel anxious) obviously ask the impact of tinnitus on emotion, but there is no question asking whether a stressor changes the severity of tinnitus (Newman et al., 2008). This b...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2020.07.02.20145532v1 on medRxiv