Biomarkers of tinnitusrelated distress in chronic tinnitus patients

Biomarkers of tinnitus-related distress in chronic tinnitus patients Laura Basso (laura. basso@charite. de)

Tinnitus • Study 3 „Telomere“ • Study 4 „Stress-pathway“ • Study 5 „Inflammation“ Biological marker Hair Blood • Study 2 „Epidemiology“ Multimodal treatment • Study 3 „Telomere“ • Study 4 „Stress-pathway“ • Study 5 „Inflammation“ • Study 1 „Patient-rated change“ • Study 6 „Experimental study“ Distress Behavioural marker Psychometric data

Patient-rated change following multimodal treatment for chronic tinnitus 1) Treatment response? Psychometric instruments 4) 3) Baseline severity T 0 Short-term multimodal treatment 2. a) Patient-rated global change during treatment? T 1 T 2 2. b) Patient-rated global change since treatment? Subjective impression

Methods - N = 250 - Treatment: 06/17 -07/18; Inclusion criteria: Pre and Post data - Follow up: ∼ 9 months later Tinnitus Questionnaire Perceived Stress Questionnaire ICD-10 Symptom Rating T 0 Tinnitus Questionnaire Perceived Stress Questionnaire ICD-10 Symptom Rating Short-term multimodal treatment T 1 T 2 „How much did your symptoms change during treatment? “ „How much have your symptoms changed since treatment? “

Treatment response Tinnitus Questionnaire 50 PRE POST ** 40 30 ** 20 ** ** 10 0 ** Total score Emotional burden (E) Cognitive burden Psychological (C) burden (E+C) n. s. * n. s. Intrusiveness of Auditory Sleep difficulties Somatic sound (I) difficulties (A) (SI) complaints (SO)

Treatment response Perceived Stress Questionnaire 70 60 PRE ** ** * 50 40 30 20 10 0 Total score Worry Tension Joy Demands POST

Treatment response ICD-10 Symptom rating 2. 00 PRE POST ** n. s. 1. 50 ** n. s. 1. 00 ** 0. 50 0. 00 Total score Depressive disorder Anxiety disorder Obsessive-compulsive Somatoform disorder Eating disorder

Retrospective patient-rated global change Since treatment During treatment 44. 4% subjective improvement 36% subjective improvement 140 47. 2% (n=118) 120 100 25. 6% (n=64) 80 80 60 40 20 0 5. 2% (n=13) much worse 60 11. 6% (n=29) 10. 4% (n=26) 40 20 slightly worse 32% (n=80) no change slightly better much better 0 8. 8% (n=22) much worse 25. 2% (n=63) 14. 8% (n=37) slightly worse no change slightly better 19. 2% (n=48) much better

Treatment response and retrospective patient-rated global change Δ Change during treatment Tinnitus Questionnaire cognitive burden psychological burden intrusiveness of sound -. 14* -. 18** Perceived Stress Questionnaire worry -. 16* ICD-10 Symptom Rating anxiety disorder somatoform disorder Change since treatment -. 15* -. 13* -. 15*

Summary Baseline severity affects treatment response and change-ratings T 0 1) Treatment response? Effective Short-term multimodal treatment T 1 2. a) Patient-rated global change during treatment? Influenced by change in intrusiveness of tinnitus, cognitive burden, and worry T 2 2. b) Patient-rated global change since treatment? Variability Delayed treatment effects Influenced by change in anxiety and somatoform symptoms Conclusion: Psychological variables predict the subjective sense of global improvement Biomarker studies need to include psychological measures and use follow-up time point(s) to capture delayed psychological treatment effects