Abstract
Chronic tinnitus is a complex, multi-factorial symptom that requires careful assessment and management. Evidence-based therapeutic approaches involve audiological and psychological treatment components. However, not everyone benefits from treatment. The identification and characterisation of patient subgroups (or “phenotypes”) may provide clinically relevant information. Due to the large number of assessment tools, data-driven methods appear to be promising. The acceptance of these empirical results can be further strengthened by a comprehensive visualisation. In this study, we used cluster analysis to identify distinct tinnitus phenotypes based on self-report questionnaire data and implemented a visualisation tool to explore phenotype idiosyncrasies. 1228 patients with chronic tinnitus from the Charité Tinnitus Center in Berlin were included. At baseline, each participant completed 14 questionnaires measuring tinnitus distress, -loudness, frequency and location, depressivity, perceived stress, quality of life, physical and mental health, pain perception, somatic symptom expression and coping attitudes. Four distinct patient phenotypes emerged from clustering: avoidant group (56.8%), psychosomatic group (14.1%), somatic group (15.2%), and distress group (13.9%). Radial bar- and line charts allowed for visual inspection and juxtaposition of major phenotype characteristics. The phenotypes differed in terms of clinical information including psychological symptoms, quality of life, coping attitudes, stress, tinnitus-related distress and pain, as well as socio-demographics. Our findings suggest that identifiable patient subgroups and their visualisation may allow for stratified treatment strategies and research designs.
Highlights
Chronic tinnitus is a complex, multi-factorial symptom that requires careful assessment and management
While some studies affirm the efficacy of cognitive behavioural therapy (CBT) in reducing tinnitus impairment and distress[8], others conclude that CBT is not superior to other treatments or no treatment in improving subjective tinnitus loudness and quality of life[9]
Previous studies found subgroups of tinnitus patients with cluster analysis based on a small number of audiometric features[13], a combination of features extracted from self-reports, audiometry and p sychoacoustics[14], a subset of socio-demographics, tinnitus characteristics, self-reports and audiological measurements[16] or neuroimaging data and socio-demographics[17]
Summary
Chronic tinnitus is a complex, multi-factorial symptom that requires careful assessment and management. Previous studies found subgroups of tinnitus patients with cluster analysis based on a small number of audiometric features[13], a combination of features extracted from self-reports, audiometry and p sychoacoustics[14], a subset of socio-demographics, tinnitus characteristics, self-reports and audiological measurements[16] or neuroimaging data and socio-demographics[17] Each of these studies provided insights in tinnitus subgroup patterns we believe that to increase acceptance amongst medical practitioners, clustering results need to be presented with intuitive visualisations that show individual subgroup patterns and enable the visual juxtaposition of multiple subgroups with respect to multi-variate data. The results of this study could be used for stratified research designs and treatment approaches
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