{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T11:41:53Z","timestamp":1790595713773,"version":"4.1.0"},"reference-count":46,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2020,8,26]],"date-time":"2020-08-26T00:00:00Z","timestamp":1598400000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010665","name":"H2020 Marie Sk\u0142odowska-Curie Actions","doi-asserted-by":"publisher","award":["722046"],"award-info":[{"award-number":["722046"]}],"id":[{"id":"10.13039\/100010665","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010661","name":"Horizon 2020 Framework Programme","doi-asserted-by":"publisher","award":["848261"],"award-info":[{"award-number":["848261"]}],"id":[{"id":"10.13039\/100010661","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Tinnitus, the perception of sound in the absence of a corresponding sound, and the distress caused by it, is rarely a static phenomenon. It rather fluctuates over time depending on endogenous and exogenous factors. The COVID-19 pandemic is a potential environmental stressor that might influence the individually perceived tinnitus distress. Since not all people are affected by the pandemic in the same way, the situation allows one to identify environmental factors and personality traits that impact tinnitus distress differently. In our study, 122 tinnitus patients were included at two time points: in the year 2018 and during the German lockdown in April 2020. We assessed tinnitus-related distress, depressive symptoms, personality characteristics and the individual perception of the pandemic situation. On average, there was only a small increase of tinnitus distress with heterogeneous changes during the lockdown. People perceiving the situation as generally stressful with increased grief, frustration, stress and nervousness reported the worsening of tinnitus distress. People with high values in neuroticism also reported the worsening of tinnitus distress, while the personality traits extraversion, conscientiousness and openness seemed to be a protection factor. The study identifies factors that influence tinnitus distress change during a pandemic and spots those patients that need specific help in the pandemic situation.<\/jats:p>","DOI":"10.3390\/jcm9092756","type":"journal-article","created":{"date-parts":[[2020,8,26]],"date-time":"2020-08-26T09:05:37Z","timestamp":1598432737000},"page":"2756","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["The Effect of Environmental Stressors on Tinnitus: A Prospective Longitudinal Study on the Impact of the COVID-19 Pandemic"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7942-1788","authenticated-orcid":false,"given":"Winfried","family":"Schlee","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Bezirksklinikum, University of Regensburg, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7067-2695","authenticated-orcid":false,"given":"Sondre","family":"H\u00f8lleland","sequence":"additional","affiliation":[{"name":"Department of Mathematics, University of Bergen, 5020 Bergen, Norway"},{"name":"Institute of Marine Research, 5817 Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Bulla","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Bezirksklinikum, University of Regensburg, 93053 Regensburg, Germany"},{"name":"Department of Mathematics, University of Bergen, 5020 Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Simoes","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Bezirksklinikum, University of Regensburg, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Neff","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Bezirksklinikum, University of Regensburg, 93053 Regensburg, Germany"},{"name":"URPP \u201cDynamics of Healthy Ageing\u201d, University of Z\u00fcrich, 8006 Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3633-999X","authenticated-orcid":false,"given":"Stefan","family":"Schoisswohl","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Bezirksklinikum, University of Regensburg, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella","family":"Woelflick","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Bezirksklinikum, University of Regensburg, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Schecklmann","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Bezirksklinikum, University of Regensburg, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Schiller","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Bezirksklinikum, University of Regensburg, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Staudinger","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Bezirksklinikum, University of Regensburg, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6113-2133","authenticated-orcid":false,"given":"Thomas","family":"Probst","sequence":"additional","affiliation":[{"name":"Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berthold","family":"Langguth","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Bezirksklinikum, University of Regensburg, 93053 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1016\/S0140-6736(13)60142-7","article-title":"Tinnitus","volume":"382","author":"Baguley","year":"2013","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1056\/NEJMcp1506631","article-title":"Tinnitus","volume":"378","author":"Bauer","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1016\/S1474-4422(13)70160-1","article-title":"Tinnitus: Causes and clinical management","volume":"12","author":"Langguth","year":"2013","journal-title":"Lancet Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"8075","DOI":"10.1073\/pnas.1018466108","article-title":"Phantom percepts: Tinnitus and pain as persisting aversive memory networks","volume":"108","author":"Elgoyhen","year":"2011","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1038\/nrn4003","article-title":"Tinnitus: Perspectives from human neuroimaging","volume":"16","author":"Elgoyhen","year":"2015","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"879","DOI":"10.3389\/fnins.2019.00879","article-title":"Impact of Temporomandibular Joint Complaints on Tinnitus-Related Distress","volume":"13","author":"Edvall","year":"2019","journal-title":"Front. Neurosci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1177\/0194599811413376","article-title":"Tinnitus with Temporomandibular Joint Disorders: A Specific Entity of Tinnitus Patients?","volume":"145","author":"Vielsmeier","year":"2011","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.heares.2015.10.001","article-title":"The consequences of tinnitus and tinnitus severity on cognition: A review of the behavioural evidence","volume":"332","author":"Mohamad","year":"2016","journal-title":"Hear. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1080\/14992027.2016.1185168","article-title":"The impact of tinnitus upon cognition in adults: A systematic review","volume":"55","author":"Bennett","year":"2016","journal-title":"Int. J. Audiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1177\/0194599819835178","article-title":"Depression in Patients with Tinnitus: A Systematic Review","volume":"161","author":"Salazar","year":"2019","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1007\/s00106-014-2973-7","article-title":"Stress und Tinnitus","volume":"63","author":"Mazurek","year":"2015","journal-title":"HNO"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1159\/000478267","article-title":"Mindfulness-Based Cognitive Therapy as a Treatment for Chronic Tinnitus: A Randomized Controlled Trial","volume":"86","author":"McKenna","year":"2017","journal-title":"Psychother. Psychosom."},{"key":"ref_13","first-page":"278","article-title":"Chronic Tinnitus: An Interdisciplinary Challenge","volume":"110","author":"Kreuzer","year":"2013","journal-title":"Dtsch. \u00c4rzteblatt Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1159\/000335043","article-title":"Emotional Exhaustion as a Predictor of Tinnitus","volume":"81","author":"Canlon","year":"2012","journal-title":"Psychother. Psychosom."},{"key":"ref_15","first-page":"1","article-title":"Emotional states as mediators between tinnitus loudness and tinnitus distress in daily life: Results from the \u201cTrackYourTinnitus\u201d application","volume":"6","author":"Probst","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_16","first-page":"1","article-title":"Emotion dynamics and tinnitus: Daily life data from the \u201cTrackYourTinnitus\u201d application","volume":"6","author":"Probst","year":"2016","journal-title":"Nat. Public Group"},{"key":"ref_17","first-page":"162","article-title":"Cognitive behavioural therapy for tinnitus","volume":"38","author":"Fuller","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/S0079-6123(07)66020-8","article-title":"Tinnitus severity, depression, and the big five personality traits. In Tinnitus: Pathophysiology and Treatment","volume":"166","author":"Langguth","year":"2007","journal-title":"Prog. Brain Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/j.genhosppsych.2013.02.008","article-title":"The influence of psychological factors on tinnitus severity","volume":"35","author":"Anders","year":"2013","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_20","first-page":"1","article-title":"Big Five Personality Traits are Associated with Tinnitus Improvement over Time","volume":"9","author":"Schlee","year":"2019","journal-title":"Nat. Publ. Group"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Mazza, C., Ricci, E., Biondi, S., Colasanti, M., Ferracuti, S., Napoli, C., and Roma, P. (2020). A Nationwide Survey of Psychological Distress among Italian People during the COVID-19 Pandemic: Immediate Psychological Responses and Associated Factors. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17093165"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/S0140-6736(20)30460-8","article-title":"The psychological impact of quarantine and how to reduce it: Rapid review of the evidence","volume":"395","author":"Brooks","year":"2020","journal-title":"Lancet"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.3201\/eid1007.030703","article-title":"SARS Control and Psychological Effects of Quarantine, Toronto, Canada","volume":"10","author":"Hawryluck","year":"2004","journal-title":"Emerg. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e2016048","DOI":"10.4178\/epih.e2016048","article-title":"Mental health status of people isolated due to Middle East Respiratory Syndrome","volume":"38","author":"Jeong","year":"2016","journal-title":"Epidemiol. Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e100213","DOI":"10.1136\/gpsych-2020-100213","article-title":"A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: Implications and policy recommendations","volume":"33","author":"Qiu","year":"2020","journal-title":"Gen. Psychiatry"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Wang, H., Xia, Q., Xiong, Z., Li, Z., Xiang, W., Yuan, Y., Liu, Y., and Li, Z. (2020). The psychological distress and coping styles in the early stages of the 2019 coronavirus disease (COVID-19) epidemic in the general mainland Chinese population: A web-based survey. PLoS ONE, 15.","DOI":"10.1101\/2020.03.27.20045807"},{"key":"ref_27","unstructured":"Vu, V., and Meyer, J. (2020, July 12). Corona-Pandemie: Die Gutgelaunten, ZEIT. Available online: https:\/\/www.zeit.de\/gesellschaft\/2020-05\/corona-pandemie-umfrage-wohlbefinden-homeoffice-entschleunigung?wt_zmc=sm.ext.zonaudev.mail.ref.zeitde.share.link.x."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.otohns.2006.12.007","article-title":"Which tinnitus patients benefit from transcranial magnetic stimulation?","volume":"137","author":"Kleinjung","year":"2007","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_29","first-page":"166","article-title":"The tinnitus questionnaire. A standard instrument for grading the degree of tinnitus. Results of a multicenter study with the tinnitus questionnaire","volume":"42","author":"Goebel","year":"1994","journal-title":"HNO"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/S0165-0327(00)00309-8","article-title":"The sensitivity and specificity of the Major Depression Inventory, using the Present State Examination as the index of diagnostic validity","volume":"66","author":"Bech","year":"2001","journal-title":"J. Affect. Disord."},{"key":"ref_31","unstructured":"Danner, D., Rammstedt, B., Bluemke, M., and Treiber, L. (2016). Die Deutsche Version des Big Five Inventory 2 (bfi-2), Horgrefe Verlag."},{"key":"ref_32","unstructured":"R Core Team (2019). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing."},{"key":"ref_33","unstructured":"Torchiano, M. (2020, August 24). Effsize: Efficient Effect Size Computation (R Package Version 0.7.1). Available online: https:\/\/CRAN.R-project.org\/package=effsize."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"271","DOI":"10.3102\/10769986018003271","article-title":"Estimation of Effect Size from a Series of Experiments Involving Paired Comparisons","volume":"18","author":"Gibbons","year":"2016","journal-title":"J. Educ. Stat."},{"key":"ref_35","unstructured":"Borenstein, M., Hedges, L.V., Higgins, J.P.T., and Rothstein, H.R. (2011). Introduction to Meta-Analysis, John Wiley & Sons."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1214\/aos\/1013699998","article-title":"The control of the false discovery rate in multiple testing under dependency","volume":"29","author":"Benjamini","year":"2001","journal-title":"Ann. Stat."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Anzivino, R., Sciancalepore, P.I., Petrone, P., D\u2019Elia, A., Petrone, D., and Quaranta, N. (2020). Tinnitus revival during COVID-19 lockdown: How to deal with it?. Eur. Arch. Otorhinolaryngol., 1\u20132.","DOI":"10.1007\/s00405-020-06147-9"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1001\/jamaoto.2018.2238","article-title":"Effectiveness of Guided Internet-Based Cognitive Behavioral Therapy vs Face-to-Face Clinical Care for Treatment of Tinnitus","volume":"144","author":"Beukes","year":"2018","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_39","first-page":"2331216519851749","article-title":"Internet-Based Interventions for Adults with Hearing Loss, Tinnitus, and Vestibular Disorders: A Systematic Review and Meta-Analysis","volume":"23","author":"Beukes","year":"2019","journal-title":"Trends Hear."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"74","DOI":"10.3389\/fpsyg.2020.00483","article-title":"I Wasn\u2019t at War With the Noise: How Mindfulness Based Cognitive Therapy Changes Patients\u2019 Experiences of Tinnitus","volume":"11","author":"Marks","year":"2020","journal-title":"Front. Psychol."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Li, S., Wang, Y., Xue, J., and Zhao, N. (2020). The impact of COVID-19 epidemic declaration on psychological consequences: A study on active Weibo users. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17062032"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1007\/978-1-60761-145-5_46","article-title":"Algorithm for the Diagnostic and Therapeutic Management of Tinnitus","volume":"Volume 166","author":"Langguth","year":"2011","journal-title":"Textbook of Tinnitus"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1590\/2237-6089-2020-0029","article-title":"Personality differences and COVID-19: Are extroversion and conscientiousness personality traits associated with engagement with containment measures?","volume":"42","author":"Carvalho","year":"2020","journal-title":"Trends Psychiatry Psychother."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"294","DOI":"10.3389\/fnagi.2016.00294","article-title":"Measuring the Moment-to-Moment Variability of Tinnitus: The TrackYourTinnitus Smart Phone App","volume":"8","author":"Schlee","year":"2016","journal-title":"Front. Aging Neurosci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"252","DOI":"10.3389\/fpubh.2020.00252","article-title":"Clinical Implications of Chloroquine and Hydroxychloroquine Ototoxicity for COVID-19 Treatment: A Mini-Review","volume":"8","author":"Prayuenyong","year":"2020","journal-title":"Front. Public Health"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1080\/14992027.2020.1776406","article-title":"Does coronavirus affect the audio-vestibular system? A rapid systematic review","volume":"59","author":"Almufarrij","year":"2020","journal-title":"Int. J. Audiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/9\/2756\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:06:41Z","timestamp":1760177201000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/9\/2756"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,26]]},"references-count":46,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020,9]]}},"alternative-id":["jcm9092756"],"URL":"https:\/\/doi.org\/10.3390\/jcm9092756","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,26]]}}}