Abstract
BackgroundCurrently, there are no objective markers to measure treatment efficacy in chronic (distressing) tinnitus. This study explores whether stress-related biomarkers cortisol and brain-derived neurotrophic factor (BDNF) measured in hair samples of chronic tinnitus patients change after compact multimodal tinnitus-specific cognitive behavioral therapy.MethodsIn this longitudinal study, hair-cortisol and hair-BDNF levels, self-reported tinnitus-related distress (Tinnitus Questionnaire; TQ), and perceived stress (Perceived Stress Questionnaire; PSQ-20) were assessed before and 3 months after 5 days of treatment in N = 80 chronic tinnitus patients. Linear mixed-effects models with backward elimination were used to assess treatment-induced changes, and a cross-lagged panel model (structural equation model) was used for additional exploratory analysis of the temporal associations between TQ and hair-BDNF.ResultsAt follow-up, a reduction in TQ (p < 0.001) and PSQ-20 scores (p = 0.045) was observed, which was not influenced by baseline hair-cortisol or hair-BDNF levels. No changes in biomarker levels were observed after treatment. The exploratory analysis tentatively suggests that a directional effect of baseline TQ scores on hair-BDNF levels at follow-up (trend; p = 0.070) was more likely than the opposite directional effect of baseline hair-BDNF levels on TQ scores at follow-up (n.s.).DiscussionWhile the treatment effectively reduced tinnitus-related distress and perceived stress in chronic tinnitus patients, this effect was not mirrored in biological changes. However, the lack of changes in hair-cortisol and hair-BDNF levels might have been influenced by the treatment duration, follow-up interval, or confounding medical factors, and therefore must be interpreted with caution. The relationship between tinnitus-related distress and hair-BDNF levels should be explored further to obtain a better understanding of stress-related effects in chronic tinnitus.
Highlights
Tinnitus is the subjective perception of a sound in absence of an external source
We previously investigated cross-sectional relationships between tinnitus loudness and distress with hair-cortisol and hair-brain-derived neurotrophic factor (BDNF) in a sample of chronic tinnitus patients and observed a negative association between tinnitus-related distress and hair-BDNF [28], suggesting that hair-BDNF might be treatment-sensitive to psychological interventions in chronic tinnitus
Between December 2018 and March 2020, 94 chronic tinnitus inpatients volunteered to participate in this study, which consisted of three measurements: [1] before and [2] directly after 5 days of compact multimodal tinnitus-specific cognitive behavioral therapy, which is the current standard clinical treatment for chronic tinnitus offered at the Tinnitus Center of Charité – Universitätsmedizin Berlin, and [3] a 3-month follow-up measurement
Summary
Tinnitus is the subjective perception of a sound in absence of an external source. Chronic tinnitus is a frequent phenomenon with prevalence estimates in adults ranging up to 15% [1]. No existing treatment option can eliminate the tinnitus percept. The negative impact of tinnitus on the quality of life (QoL) in tinnitus patients can be reduced by cognitive behavioral therapy [5, 6]. In the clinical care of tinnitus patients, cognitive behavioral therapy is focused on addressing dysfunctional cognitions, behaviors, and emotions related to tinnitus (which negatively affect the QoL) through cognitive restructuring and behavioral modification [5, 8]. Because of the complex and multifactorial etiology and maintenance of chronic tinnitus, cognitive behavioral therapy-based multidisciplinary treatment approaches are recommended [9, 10]. There are no objective markers to measure treatment efficacy in chronic (distressing) tinnitus. This study explores whether stress-related biomarkers cortisol and brain-derived neurotrophic factor (BDNF) measured in hair samples of chronic tinnitus patients change after compact multimodal tinnitus-specific cognitive behavioral therapy
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