{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T11:58:21Z","timestamp":1764331101510,"version":"build-2065373602"},"reference-count":60,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2021,7,20]],"date-time":"2021-07-20T00:00:00Z","timestamp":1626739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Tinnitus is the perception of a sound without an external source, often associated with adverse psychological and emotional effects leading to impaired quality of life (QoL). The present study investigated QoL and psychological distress in tinnitus patients and analysed the effects of associated comorbidities. Tonal and speech audiometry, tinnitus assessment, and clinical interviews were obtained from 122 Portuguese individuals (aged from 55 to 75). Portuguese versions of the Brief Symptoms Inventory (BSI), the Medical Outcomes Study Short Form Health Survey (MOS SF-36) and Tinnitus Handicap Inventory (THI) were used to evaluate psychological distress, health-related QoL, social difficulties and tinnitus severity. The presence of tinnitus was significantly associated with hearing loss. The increases in tinnitus severity were associated with decreases in QoL, particularly regarding MOS SF-36 subscales \u201cperception of health\u201d, \u201csocial functioning\u201d, and \u201cmental health\u201d. Regarding BSI, patients with greater tinnitus severity had more severe psychopathology symptoms, measured with scales \u201cObsessive\u2013compulsive\u201d, \u201cDepression\u201d, \u201cAnxiety\u201d, \u201cHostility\u201d and \u201cPhobic Anxiety\u201d. Our study supports the notion of the negative impact of increased tinnitus severity on QoL and psychological distress in older adults. Presented data strengthen the importance of a multidisciplinary approach to tinnitus assessment and treatment.<\/jats:p>","DOI":"10.3390\/brainsci11070953","type":"journal-article","created":{"date-parts":[[2021,7,20]],"date-time":"2021-07-20T05:10:59Z","timestamp":1626757859000},"page":"953","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Quality of Life and Psychological Distress in Portuguese Older Individuals with Tinnitus"],"prefix":"10.3390","volume":"11","author":[{"given":"Ha\u00fala F.","family":"Haider","sequence":"first","affiliation":[{"name":"ENT Department, Hospital Cuf Tejo\u2014Nova Medical School, 1350-352 Lisbon, Portugal"},{"name":"CUF Academic and Research Medical Center, 1350-352 Lisbon, Portugal"},{"name":"Comprehensive Health Research Centre (CHRC), 1169-056 Lisbon, Portugal"}]},{"given":"Sara F.","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"ENT Department, Hospital Cuf Tejo\u2014Nova Medical School, 1350-352 Lisbon, Portugal"},{"name":"CUF Academic and Research Medical Center, 1350-352 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8768-1392","authenticated-orcid":false,"given":"Derek J.","family":"Hoare","sequence":"additional","affiliation":[{"name":"National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Hearing Sciences, Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG7 2QL, UK"}]},{"given":"Gra\u00e7a","family":"Fialho","sequence":"additional","affiliation":[{"name":"Faculty of Sciences, BioISI\u2014Biosystems & Integrative Sciences Institute, University of Lisboa, 1749-016 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3804-1452","authenticated-orcid":false,"given":"Deborah A.","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Psychology, School of Social Sciences, Heriot-Watt University Malaysia, Putrajaya 62200, Malaysia"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1257-2829","authenticated-orcid":false,"given":"Mar\u00edlia","family":"Antunes","sequence":"additional","affiliation":[{"name":"Centro de Estat\u00edstica e Aplica\u00e7\u00f5es, Departamento de Estat\u00edstica e Investiga\u00e7\u00e3o Operacional, Faculdade de Ci\u00eancias, Universidade de Lisboa, 1749-016 Lisboa, Portugal"}]},{"given":"Helena","family":"Caria","sequence":"additional","affiliation":[{"name":"Faculty of Sciences, BioISI\u2014Biosystems & Integrative Sciences Institute, University of Lisboa, 1749-016 Lisboa, Portugal"},{"name":"Polytechnic Institute of Setubal, School of Health -Biomedical Sciences Department, CIIAS, 2910-761 Setubal, Portugal"}]},{"given":"Jo\u00e3o","family":"Pa\u00e7o","sequence":"additional","affiliation":[{"name":"ENT Department, Hospital Cuf Tejo\u2014Nova Medical School, 1350-352 Lisbon, Portugal"},{"name":"CUF Academic and Research Medical Center, 1350-352 Lisbon, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.heares.2016.05.009","article-title":"A systematic review of the reporting of tinnitus prevalence and severity","volume":"337","author":"McCormack","year":"2016","journal-title":"Hear. Res."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Biswas, R., and Hall, D.A. (2020). Prevalence, incidence, and risk factors for tinnitus. Curr. Top. Behav. Neurosci.","DOI":"10.1007\/7854_2020_154"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.heares.2019.02.017","article-title":"Standardised profiling for tinnitus research: The European School for Interdisciplinary Tinnitus Research Screening Questionnaire (ESIT-SQ)","volume":"377","author":"Genitsaridi","year":"2019","journal-title":"Hear. Res."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Joo, Y.H., Han, K.D., and Park, K.H. (2015). Association of hearing loss and tinnitus with health-related quality of life: The Korea National Health and Nutrition Examination Survey. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0131247"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Pavaci, S., Tortorella, F., Fioretti, A.B., Angelone, A.M., Businco, L.D.R., and Lauriello, M. (2019). Analysis of the audiological characteristics and comorbidity in patients with chronic tinnitus. Audiol. Res., 9.","DOI":"10.4081\/audiores.2019.231"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"McKenna, L., Handscomb, L., Hoare, D.J., and Hall, D.A. (2004). A scientific cognitive-behavioral model of tinnitus: Novel conceptualizations of tinnitus distress. Front. Neurol., 5.","DOI":"10.3389\/fneur.2014.00196"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1186\/s12955-018-0888-9","article-title":"A narrative synthesis of research evidence for tinnitus-related complaints as reported by patients and their significant others","volume":"16","author":"Hall","year":"2018","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_8","unstructured":"World Health Organization (WHO) (1996). WHOQOL-BREF Introduction, Administration, Scoring and Generic Version of the Assessment, World Health Organization. Available online: https:\/\/www.who.int\/mental_health\/media\/en\/76.pdf."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"216","DOI":"10.3109\/14992020209078334","article-title":"The short form 36 (SF36) in a specialist tinnitus clinic","volume":"41","author":"Wilson","year":"2002","journal-title":"Int. J. Audiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"257","DOI":"10.3766\/jaaa.18.3.7","article-title":"The impact of tinnitus on quality of life in older adults","volume":"18","author":"Nondahl","year":"2007","journal-title":"J. Am. Acad. Audiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"65","DOI":"10.3389\/fpsyg.2018.00065","article-title":"Validation of the Italian Tinnitus Questionnaire Short Form (TQ 12-I) as a brief test for the assessment of tinnitus-related distress: Results of a cross-sectional multicenter-study","volume":"9","author":"Moschen","year":"2018","journal-title":"Front. Psychol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1080\/16513860410027349","article-title":"Quality of life and tinnitus","volume":"2","author":"Kennedy","year":"2009","journal-title":"Audiol. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"25","DOI":"10.3389\/fpsyt.2020.00025","article-title":"An effective treatment for tinnitus and hyperacusis based on Cognitive Behavioral Therapy in an inpatient setting: A 10-year retrospective outcome analysis","volume":"11","author":"Nolan","year":"2020","journal-title":"Front. Psychiatry"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s00106-019-0633-7","article-title":"A multidisciplinary European guideline for tinnitus: Diagnostics, assessment, and treatment","volume":"67","author":"Cima","year":"2019","journal-title":"Hno"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.heares.2012.08.016","article-title":"GRM7 variants associated with age-related hearing loss based on auditory perception","volume":"294","author":"Newman","year":"2012","journal-title":"Hear. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1001\/archotol.1996.01890140029007","article-title":"Development of the tinnitus handicap inventory","volume":"122","author":"Newman","year":"1996","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_17","first-page":"101","article-title":"Balan\u00e7o da utiliza\u00e7\u00e3o da vers\u00e3o portuguesa do Tinnitus Handicap Inventory (THI)","volume":"1","author":"Oliveira","year":"2008","journal-title":"Audiol. Rev."},{"key":"ref_18","first-page":"55","article-title":"Cria\u00e7\u00e3o da vers\u00e3o portuguesa do MOS SF-36. Parte I\u2013Adapta\u00e7\u00e3o cultural e lingu\u00edstica","volume":"13","author":"Ferreira","year":"2000","journal-title":"Acta Med. Port."},{"key":"ref_19","unstructured":"Canavarro, M.C.S. (1999). Invent\u00e1rio de Sintomas Psicopatol\u00f3gicos, BSI."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1017\/S0033291700048017","article-title":"The brief symptom inventory: An introductory report","volume":"13","author":"Derogatis","year":"1983","journal-title":"Psychol. Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Vielsmeier, V., Lehner, A., Strutz, J., Steffens, T., Kreuzer, P.M., Schecklmann, M., Landgrebe, M., Langguth, B., and Kleinjung, T. (2015). The relevance of the high frequency audiometry in tinnitus patients with normal hearing in conventional pure-tone audiometry. BioMed Res. Int.","DOI":"10.1155\/2015\/302515"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Genitsaridi, E., Hoare, D.J., Kypraios, T., and Hall, D.A. (2020). A Review and a Framework of Variables for Defining and Characterizing Tinnitus Subphenotypes. Brain Sci., 10.","DOI":"10.3390\/brainsci10120938"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1007\/s00405-010-1270-7","article-title":"Age-related hearing loss or presbycusis","volume":"267","author":"Huang","year":"2010","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1044\/2017_AJA-16-0083","article-title":"The influence of social support and coping on quality of life among elderly with age-related hearing loss","volume":"26","author":"Moser","year":"2017","journal-title":"Am. J. Audiol."},{"key":"ref_25","first-page":"221","article-title":"Impact of Hearing Loss on Quality of Life in Adults","volume":"10","author":"Jha","year":"2020","journal-title":"Int. J. Life Sci. Pharm. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1093\/geront\/40.3.320","article-title":"Negative consequences of hearing impairment in old age: A longitudinal analysis","volume":"40","author":"Strawbridge","year":"2000","journal-title":"Gerontologist"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Dawes, P., Emsley, R., Cruickshanks, K.J., Moore, D.R., Fortnum, H., Edmondson-Jones, M., McCormack, A., and Munro, K.J. (2015). Hearing loss and cognition: The role of hearing AIDS, social isolation and depression. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0119616"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1001\/jamainternmed.2013.1868","article-title":"Hearing Loss and Cognitive Decline in Older Adults","volume":"173","author":"Lin","year":"2013","journal-title":"JAMA Intern. Med."},{"key":"ref_29","first-page":"39","article-title":"Connections between vision, hearing, and cognitive function in old age","volume":"27","author":"Wahl","year":"2003","journal-title":"Generations"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"182","DOI":"10.7326\/0003-4819-153-3-201008030-00258","article-title":"Systematic review: Factors associated with risk for and possible prevention of cognitive decline in later life","volume":"153","author":"Plassman","year":"2010","journal-title":"Ann. Intern. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.2147\/CIA.S195824","article-title":"Depression in elderly patients with hearing loss: Current perspectives","volume":"14","author":"Cosh","year":"2019","journal-title":"Clin. Interv. Aging"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1097\/WNR.0b013e3282202c35","article-title":"Enriched acoustic environment rescales auditory sensitivity","volume":"18","year":"2007","journal-title":"Neuroreport"},{"key":"ref_33","unstructured":"World Health Organization (2001). The World Health Report 2001: Mental Health: New Understanding, New Hope, World Health Organization."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1097\/AUD.0b013e31821106dd","article-title":"Catastrophizing and fear of Tinnitus predict quality of life in patients with chronic Tinnitus","volume":"2","author":"Cima","year":"2011","journal-title":"Ear Hear."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/S0030-6665(02)00170-6","article-title":"Pathophysiology of Tinnitus","volume":"36","year":"2003","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/S0030-6665(02)00168-8","article-title":"Depression and Tinnitus","volume":"36","author":"Dobie","year":"2003","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1080\/14992020500190235","article-title":"Predictive factors for development of severe Tinnitus suffering-further characterisation: Factores predictivos para el desarrollo de tinitus severo que sufren una caracterizaci\u00f3n adicional","volume":"44","author":"Holgers","year":"2005","journal-title":"Int. J. Audiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1097\/AUD.0b013e31820dd411","article-title":"Tinnitus interferes with daily life activities: A psychometric examination of the Tinnitus Disability Index","volume":"32","author":"Cima","year":"2011","journal-title":"Ear Hear."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s11920-010-0163-1","article-title":"Tinnitus-related distress: A review of recent findings","volume":"13","author":"Malouff","year":"2011","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"46","DOI":"10.3389\/fnsys.2012.00046","article-title":"An adaptation level theory of tinnitus audibility","volume":"6","author":"Searchfield","year":"2012","journal-title":"Front. Syst. Neurosci."},{"key":"ref_41","unstructured":"Derogatis, L.R., and Spencer, P.M. (1982). Administration and Procedures: BSI Manual I, Clinical Psychometric Research."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e279","DOI":"10.1097\/AUD.0000000000000168","article-title":"The role of dysfunctional cognitions in patients with chronic Tinnitus","volume":"36","author":"Conrad","year":"2015","journal-title":"Ear Hear."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1097\/AUD.0000000000000365","article-title":"Positive and negative thinking in Tinnitus: Factor structure of the Tinnitus cognitions questionnaire","volume":"38","author":"Handscomb","year":"2017","journal-title":"Ear Hear."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1111\/j.1365-2273.2004.00879.x","article-title":"Tinnitus and psychological morbidity: A cross-sectional study to investigate psychological morbidity in Tinnitus patients and its relationship with severity of symptoms and illness perceptions","volume":"29","author":"Reynolds","year":"2004","journal-title":"Clin. Otolaryngol. Allied Sci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.genhosppsych.2004.08.008","article-title":"Psychosocial and personality predictors of tinnitus-related distress","volume":"27","author":"Langenbach","year":"2005","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"606","DOI":"10.3389\/fpsyt.2020.00606","article-title":"Tinnitus Among Patients With Anxiety Disorder: A Nationwide Longitudinal Study","volume":"11","author":"Hou","year":"2020","journal-title":"Front. Psychiatry"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/0022-3999(87)90040-7","article-title":"Chronic tinnitus: Association with psychiatric diagnoses","volume":"31","author":"Katon","year":"1987","journal-title":"J. Psychosom. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/0163-8343(88)90037-0","article-title":"Disabling tinnitus: Association with affective disorder","volume":"10","author":"Sullivan","year":"1988","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"489","DOI":"10.3109\/15622975.2011.575178","article-title":"Tinnitus and depression","volume":"12","author":"Langguth","year":"2011","journal-title":"World J. Biol. Psychiatry"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1080\/13651501.2020.1757117","article-title":"Anxiety sensitivities, anxiety and depression levels, and personality traits of patients with chronic subjective tinnitus: A case-control study","volume":"24","author":"Karaaslan","year":"2020","journal-title":"Int. J. Psychiatry Clin. Pract."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1159\/000335043","article-title":"Emotional exhaustion as a predictor of Tinnitus","volume":"81","author":"Hebert","year":"2012","journal-title":"Psychother. Psychosom."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1477-7525-12-7","article-title":"Which tinnitus-related aspects are relevant for quality of life and depression: Results from a large international multicentre sample","volume":"12","author":"Zeman","year":"2014","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1176\/appi.psy.47.4.282","article-title":"Relationship between tinnitus severity and psychiatric disorders","volume":"47","author":"Svedlund","year":"2006","journal-title":"Psychosomatics"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1212\/WNL.50.1.114","article-title":"The functional neuroanatomy of tinnitus: Evidence for limbic system links and neural plasticity","volume":"50","author":"Lockwood","year":"1998","journal-title":"Neurology"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Meyer, M., Langguth, B., Kleinjung, T., and M\u00f8ller, A.R. Plasticity of neural systems in tinnitus. 2014, 2014, 968029.","DOI":"10.1155\/2014\/968029"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/S0194-5998(96)70133-X","article-title":"Receptors for glucocorticoids in the human inner ear","volume":"115","author":"Rarey","year":"1996","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0378-5955(04)00021-8","article-title":"A physiological correlate for the intolerance to both internal and external sounds","volume":"190","author":"Hebert","year":"2004","journal-title":"Hear. Res."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/0006-3223(93)90252-9","article-title":"Glucocorticoid receptor number and cortisol excretion in mood, anxiety, and psychotic disorders","volume":"34","author":"Yehuda","year":"1993","journal-title":"Biol. Psychiatry"},{"key":"ref_59","first-page":"31","article-title":"Psychological aspects of tinnitus","volume":"3","author":"Hallam","year":"1984","journal-title":"Contrib. Med. Psychol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1097\/AUD.0b013e3181cdb2a2","article-title":"Incidence, persistence, and progression of tinnitus symptoms in older adults: The Blue Mountains Hearing Study","volume":"31","author":"Gopinath","year":"2010","journal-title":"Ear Hear."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/11\/7\/953\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:32:05Z","timestamp":1760164325000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/11\/7\/953"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,20]]},"references-count":60,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,7]]}},"alternative-id":["brainsci11070953"],"URL":"https:\/\/doi.org\/10.3390\/brainsci11070953","relation":{},"ISSN":["2076-3425"],"issn-type":[{"type":"electronic","value":"2076-3425"}],"subject":[],"published":{"date-parts":[[2021,7,20]]}}}