Department of Otorhinolaryngology, Jena University Hospital, Friedrich Schiller University, Jena, Germany.
Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Friedrich Schiller University, Jena, Germany.
J Psychosom Res. 2022 Jun;157:110794. doi: 10.1016/j.jpsychores.2022.110794. Epub 2022 Mar 22.
BACKGROUND AND OBJECTIVE: Despite the availability of successful treatment approaches for chronic tinnitus, it has proven difficult to predict who profits from treatment and it is still an open question if it is possible at all. We tried to overcome methodological shortcomings and to predict treatment outcome indicated by questionnaires measuring tinnitus distress. METHODS: This is an observational, prospective cohort study. Lasso and post-selection inference methods were used to predict treatment outcome in patients suffering from chronic tinnitus (N = 747). Patients were treated for five consecutive days in an interdisciplinary setting according to guidelines. RESULTS: Early change, i.e. a positive response after the screening day, as well as change due to treatment was predicted by several psychopathological variables, but also tinnitus-related factors. Female gender as an example was a predictor for change due to treatment. In general, therapy success both for early change and change due to treatment cannot be predicted satisfactorily as indicated by a high mean cross-validation error (for early change: 9.83, for change due to treatment: 14.40). Analyzing sub-groups separated by tinnitus severity to reduce heterogeneity did not improve the situation and for patients with high tinnitus severity no predictors at all could be reported (cross-validated error: 11.62 for the low quartile, 13.38 for the low-medium quartile, and 15.61 for the medium-high quartile). CONCLUSION: Several psychopathological and tinnitus-related variables predicted early and long-term change. Nevertheless, also overcoming methodological shortcomings to predict treatment success did not lead to satisfactory results, but rather emphasizes the high heterogeneity of chronic tinnitus.
背景与目的:尽管针对慢性耳鸣已有多种成功的治疗方法,但预测哪些患者能从中获益一直颇具挑战,甚至有人怀疑这是否可行。我们试图克服方法学上的不足,预测通过问卷评估耳鸣困扰程度所指示的治疗结果。
方法:这是一项观察性、前瞻性队列研究。使用套索和后选择推理方法来预测患有慢性耳鸣的患者(N=747)的治疗结果。根据指南,患者在一个跨学科环境中接受连续 5 天的治疗。
结果:早期变化,即筛选日后的积极反应,以及治疗引起的变化,可由多个心理病理变量预测,但也可由耳鸣相关因素预测。例如,女性性别是治疗引起变化的预测因素。一般来说,早期变化和治疗引起的变化的治疗效果都不能令人满意地预测,这表明平均交叉验证误差较高(早期变化:9.83;治疗引起的变化:14.40)。通过按耳鸣严重程度划分亚组来分析以减少异质性的情况并未改善,对于耳鸣严重程度较高的患者,根本无法报告任何预测因素(交叉验证误差:低四分位数为 11.62,低-中四分位数为 13.38,中-高四分位数为 15.61)。
结论:一些心理病理和耳鸣相关的变量预测了早期和长期的变化。尽管如此,克服方法学上的不足来预测治疗效果也未能取得令人满意的结果,这反而强调了慢性耳鸣的高度异质性。
Psychosoc Med. 2006-12-6
Curr Top Behav Neurosci. 2021
Laryngorhinootologie. 2004-1
Eur Arch Otorhinolaryngol. 2025-1-17