Umashankar Abishek, Gander Phillip, Alter Kai, Sedley William
Newcastle University, UK.
University of Iowa, USA.
Hear Res. 2025 Jul;463:109299. doi: 10.1016/j.heares.2025.109299. Epub 2025 May 7.
Chronic tinnitus is a common consequence of hearing loss, which commonly coexists with a degree of increased subjective sensitivity to sound intensity, and sometimes overt hyperacusis. Central gain is thought to be an underlying mechanism for hyperacusis, whilst its relationship with tinnitus is debated. The natural history of chronic tinnitus from its acute stages has been subject to very limited formal study, and only from within the sub-population attending specialist clinics. We studied community-based samples of individuals with Acute Tinnitus (AT: <6 weeks from onset, N = 51), who were followed up longitudinally 6 months post-onset (N = 26), those with Chronic Tinnitus (CT: >6 months from onset, N = 51), and Non-Tinnitus controls (NT: N = 35) age/sex/hearing matched to the Acute Tinnitus group. We measured tinnitus symptoms with loudness matching, numerical rating scales (NRS), and the Tinnitus Handicap Inventory (THI) and Tinnitus Functional Index (TFI) questionnaires, and subjective auditory sensitivity with categorical loudness scaling (CLS) and the Hyperacusis Questionnaire (HQ) and Inventory of Hyperacusis Symptoms (IHS). Results revealed that measures of tinnitus (psychoacoustically matched loudness, THI, TFI) were maximal around the time of onset and reduced significantly over initial months, in line with previous reports of specialist clinic-based cohorts without high levels of initial distress, but with the additional novel demonstration of a reduction in psychoacoustically matched tinnitus loudness. Conversely, measures of auditory sensitivity (HQ, IHS, CLS slope at 1 kHz and at tinnitus frequency) did not change longitudinally or differ between AT and NT groups. We interpret these changes as indicating spontaneous habituation to the tinnitus over time, but also that subjective auditory sensitivity is not necessarily directly linked to tinnitus symptoms.
慢性耳鸣是听力损失的常见后果，通常与对声音强度的主观敏感度增加并存，有时还伴有明显的听觉过敏。中枢增益被认为是听觉过敏的潜在机制，但其与耳鸣的关系仍存在争议。慢性耳鸣从急性期开始的自然病程一直受到非常有限的正式研究，且仅在就诊于专科诊所的亚人群中进行。我们研究了基于社区的急性耳鸣患者样本（AT：发病后<6周，N = 51），这些患者在发病后6个月进行了纵向随访（N = 26），还有慢性耳鸣患者（CT：发病后>6个月，N = 51）以及年龄/性别/听力与急性耳鸣组匹配的非耳鸣对照组（NT：N = 35）。我们用响度匹配、数字评定量表（NRS）、耳鸣障碍量表（THI）和耳鸣功能指数（TFI）问卷来测量耳鸣症状，并用分类响度标度（CLS）、听觉过敏问卷（HQ）和听觉过敏症状量表（IHS）来测量主观听觉敏感度。结果显示，耳鸣测量指标（心理声学匹配响度、THI、TFI）在发病时最高，并在最初几个月显著降低，这与之前关于专科诊所队列的报道一致，这些队列初始痛苦程度不高，但额外新颖地证明了心理声学匹配的耳鸣响度降低。相反，听觉敏感度测量指标（HQ、IHS、1 kHz和耳鸣频率处的CLS斜率）在纵向没有变化，且在AT组和NT组之间没有差异。我们将这些变化解释为表明随着时间推移对耳鸣的自发习惯化，但也表明主观听觉敏感度不一定与耳鸣症状直接相关。
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