Exploring tinnitus heterogeneity
Open accessAbstract
Introduction Tinnitus experiences differ widely. A greater understanding of the core processes underlying these variations is needed. Moreover, meaningful definitions for different subgroups are required to better manage this heterogeneous population. The objective of the present research was to contribute toward the understanding of tinnitus heterogeneity by identifying factors that can predict tinnitus severity and to ascertain if distinct subgroups of tinnitus presentation can be identified.Methods This cross-sectional study consisted of 326 adults subdivided into subgroups of those with mild tinnitus (n=32; 10%), significant tinnitus (n=99; 30%) and severe tinnitus (n=195; 60%) according to their scores from the Tinnitus Functional Index. Multiple regression was used to identify factors associated with tinnitus severity. These factors included personal traits, tinnitus-related traits, treatment modalities and clinical comorbidities.Results Insomnia, hearing distress, and anxiety were the best predictors of tinnitus severity (explaining 53% of the variability). These comorbidities were stronger predictors than any demographical factors (that explained 11% of the variability). Distinct subgroups based on tinnitus severity (mild, significant, and severe) and anxiety levels were evident. Those with severe tinnitus had significantly more severe comorbidities compared with the mild and significant groups.Conclusions This study highlights that people with tinnitus could initially be grouped according to tinnitus severity to direct further management. Those with higher tinnitus severity should receive more immediate and intensive care. Due to the strong associations between tinnitus severity and tinnitus-related comorbidities (e.g., insomnia, hearing disability, and anxiety), tinnitus assessment and interventions should focus on these comorbidities.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The higher the severity of tinnitus, the greater the likelihood of comorbidity.
“The higher the severity of tinnitus, the greater the likelihood of comorbidity (Langguth et al., 2011; Beukes et al., 2021).”
From Research trends and hotspots of cognitive behavioral therapy for tinnitus: a bibliometric analysis (2025) · cites this paper as Beukes et al., 2021
It is still unclear why some people state that tinnitus does not interfere with everyday life whereas others find it extremely debilitating.
“While various factors including pathophysiological aspects may contribute to the experience, it is still unclear why some people state that tinnitus does not interfere with everyday life whereas others find it extremely debilitating [2,3,4].”
From Social Representations of “Tinnitus” and “Health” among Individuals with Tinnitus Seeking Online Psychological Interventions (2023) · cites this paper as [3]
Cites
The satisfaction with life scale
Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985) · Journal of Personality Assessment · doi:10.1207/s15327752jpa4901_13 · Cited by 31,768 · see citing works
A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.10.1092 · Cited by 31,765 · see citing works
Spitzer, R. L. (1999) · JAMA · doi:10.1001/jama.282.18.1737 · Cited by 9,802 · see citing works
Validation of the Insomnia Severity Index as an outcome measure for insomnia research
Bastien, C. (2001) · Sleep Medicine · doi:10.1016/s1389-9457(00)00065-4 · Cited by 8,067 · see citing works
Harrell (2015) · Springer Series in Statistics · doi:10.1007/978-3-319-19425-7 · Cited by 6,878 · see citing works
Löwe, B., Decker, O., Müller, S., Brähler, E., Schellberg, D., Herzog, W., & Herzberg, P. Y. (2008) · Medical Care · doi:10.1097/mlr.0b013e318160d093 · Cited by 4,527 · see citing works
The Cognitive Failures Questionnaire (CFQ) and its correlates.
Broadbent, D., Cooper, P. F., Fitzgerald, P. H., & Parkes, K. (1982) · British Journal of Clinical Psychology · doi:10.1111/j.2044-8260.1982.tb01421.x · Cited by 2,967 · see citing works
Development of the Tinnitus Handicap Inventory.
Newman, C., Jacobson, G., & Spitzer, J. (1996) · Archives of Otolaryngology - Head and Neck Surgery · doi:10.1001/archotol.1996.01890140029007 · Cited by 2,140 · see citing works
Baguley, D., McFerran, D., & Hall, D. (2013) · The Lancet · doi:10.1016/s0140-6736(13)60142-7 · Cited by 1,245 · see citing works
Self-citationThe Tinnitus Functional Index: Development of a New Clinical Measure for Chronic, Intrusive Tinnitus
Meikle, M. B., Henry, J. A., Griest, S. E., Stewart, B. J., Abrams, H. B., McArdle, R., Myers, P. J., Newman, C. W., Sandridge, S., Turk, D. C., et al. (2012) · Ear & Hearing · doi:10.1097/aud.0b013e31822f67c0 · Cited by 792 · see citing works
A systematic review of the reporting of tinnitus prevalence and severity
McCormack, A., Edmondson-Jones, M., Somerset, S., & Hall, D. (2016) · Hearing Research · doi:10.1016/j.heares.2016.05.009 · Cited by 715 · see citing works
Coles, R. (1987) · Medical Entomology and Zoology · Cited by 541 · see citing works
Psychometric Normalization of a Hyperacusis Questionnaire
Khalfa, S., Dubal, S., Veuillet, E., Perez-Diaz, F., Jouvent, R., & Collet, L. (2002) · ORL · doi:10.1159/000067570 · Cited by 488 · see citing works
Prevalence, Severity, Exposures, and Treatment Patterns of Tinnitus in the United States
Bhatt, J. M., Lin, H. W., & Bhattacharyya, N. (2016) · JAMA Otolaryngology–Head & Neck Surgery · doi:10.1001/jamaoto.2016.1700 · Cited by 460 · see citing works
(2012) · Ear and Hearing · doi:10.1097/aud.0b013e3182597b3e · Cited by 434 · see citing works
Relationships between tinnitus and the prevalence of anxiety and depression
Bhatt, J. M., Bhattacharyya, N., & Lin, H. W. (2016) · The Laryngoscope · doi:10.1002/lary.26107 · Cited by 391 · see citing works
Systematic review and meta-analyses of randomized controlled trials examining tinnitus management.
Hoare, D. J., Kowalkowski, V. L., Kang, S., & Hall, D. A. (2011) · The Laryngoscope · doi:10.1002/lary.21825 · Cited by 255 · see citing works
Relationship between tinnitus severity and psychiatric disorders
Zöger, S., Svedlund, J., & Holgers, K.-M. (2006) · Psychosomatics · doi:10.1176/appi.psy.47.4.282 · Cited by 230 · see citing works
Editorial: towards an understanding of tinnitus heterogeneity
Cederroth, C. R., Gallus, S., Hall, D. A., Kleinjung, T., Langguth, B., Maruotti, A., Meyer, M., Norena, A., Probst, T., Pryss, R., et al. (2019) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2019.00053 · Cited by 227 · see citing works
Factors influencing tinnitus loudness and annoyance
Hiller, W., & Goebel, G. (2006) · Archives of Otolaryngology–Head & Neck Surgery · doi:10.1001/archotol.132.12.1323 · Cited by 209 · see citing works
Why Is There No Cure for Tinnitus?
McFerran, D. J., Stockdale, D., Holme, R. H., Large, C. H., & Baguley, D. (2019) · Frontiers in Neuroscience · doi:10.3389/fnins.2019.00802 · Cited by 204 · see citing works
Self-citationCognitive-behavioral treatments for tinnitus: a review of the literature
Cima, R. F. F., Andersson, G., Schmidt, C. J., & Henry, J. A. (2014) · Journal of the American Academy of Audiology · doi:10.3766/jaaa.25.1.4 · Cited by 155 · see citing works
Self-citationTinnitus retraining therapy: A different view on tinnitus
Jastreboff, P. J., & Jastreboff, M. M. (2006) · ORL · doi:10.1159/000090487 · Cited by 154 · see citing works
Neural networks of tinnitus in humans: Elucidating severity and habituation
Husain, F. T. (2015) · Hearing Research · doi:10.1016/j.heares.2015.09.010 · Cited by 125 · see citing works
Identifying Tinnitus Subgroups With Cluster Analysis
Tyler, R. S., Coelho, C., Tao, P., Ji, H., Noble, W. G., Gehringer, A. K., & Gogel, S. A. (2008) · American Journal of Audiology · doi:10.1044/1059-0889(2008/07-0044 · Cited by 123 · see citing works
Fackrell, K., Hall, D. A., Barry, J. G., & Hoare, D. J. (2015) · Hearing Research · doi:10.1016/j.heares.2015.09.009 · Cited by 118 · see citing works
Insomnia in patients with chronic tinnitus: Cognitive and emotional distress as moderator variables
Crönlein, T., Langguth, B., Pregler, M., Kreuzer, P. M., Wetter, T. C., & Schecklmann, M. (2016) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2016.03.001 · Cited by 107 · see citing works
Beukes, E. W., Baguley, D., Allen, P. M., Manchaiah, V. K. C., & Andersson, G. (2017) · Ear and Hearing · doi:10.1097/aud.0000000000000505 · Cited by 106 · see citing works
Self-citationIncidence Rates of Clinically Significant Tinnitus
Martínez, C., Wallenhorst, C., McFerran, D. J., & Hall, D. A. (2014) · Ear and Hearing · doi:10.1097/aud.0000000000000121 · Cited by 104 · see citing works
Hébert, S., Canlon, B., Hasson, D., Hanson, L. M. M., Westerlund, H., & Theorell, T. (2012) · PLoS ONE · doi:10.1371/journal.pone.0037733 · Cited by 101 · see citing works
Impact of Multiple Factors on the Degree of Tinnitus Distress
Brüeggemann, P., Szczepek, A. J., Rose, M., McKenna, L., Olze, H., & Mazurek, B. (2016) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2016.00341 · Cited by 100 · see citing works
Michiels, S., Sánchez, T. G., Oron, Y., Gilles, A., Haider, H. F., Erlandsson, S., Bechter, K., Vielsmeier, V., Biesinger, E., Nam, E., et al. (2018) · Trends in Hearing · doi:10.1177/2331216518796403 · Cited by 94 · see citing works
Beukes, E. W., Andersson, G., Allen, P. M., Manchaiah, V. K. C., & Baguley, D. (2018) · JAMA Otolaryngology–Head & Neck Surgery · doi:10.1001/jamaoto.2018.2238 · Cited by 88 · see citing works
Self-citationWhy Is Tinnitus a Problem? A Qualitative Analysis of Problems Reported by Tinnitus Patients
Watts, E. J., Fackrell, K., Smith, S., Sheldrake, J. B., Haider, H. F., & Hoare, D. J. (2018) · Trends in Hearing · doi:10.1177/2331216518812250 · Cited by 82 · see citing works
Pathophysiology, Diagnosis and Treatment of Somatosensory Tinnitus: A Scoping Review
Haider, H. F., Hoare, D. J., Costa, R., Potgieter, I., Kikidis, D., Lapira, A., Nikitas, C., Caria, H., da Cunha, N. T., & Paço, J. C. (2017) · Frontiers in Neuroscience · doi:10.3389/fnins.2017.00207 · Cited by 80 · see citing works
Long-term reductions in tinnitus severity
Folmer, R. L. (2002) · BMC Ear Nose and Throat Disorders · doi:10.1186/1472-6815-2-3 · Cited by 72 · see citing works
McCormack, A., Edmondson‐Jones, M., Fortnum, H. M., Dawes, P., Middleton, H. C., Munro, K. J., & Moore, D. R. (2015) · International Journal of Audiology · doi:10.3109/14992027.2015.1014577 · Cited by 71 · see citing works
Tinnitus and its current treatment–Still an enigma in medicine
Swain, S. K., Nayak, S., Ravan, J. R., et al. (2015) · Journal of the Formosan Medical Association · doi:10.1016/j.jfma.2015.11.011 · Cited by 71 · see citing works
Cluster Analysis to Identify Possible Subgroups in Tinnitus Patients
van den Berge, M. J. C., Free, R., Arnold, R., de Kleine, E., Hofman, R., van Dijk, J. V., & van Dijk, P. (2017) · Frontiers in Neurology · doi:10.3389/fneur.2017.00115 · Cited by 59 · see citing works
Tinnitus services in the United Kingdom: a survey of patient experiences
McFerran, D., Hoare, D. J., Carr, S., Ray, J., & Stockdale, D. (2018) · BMC Health Services Research · doi:10.1186/s12913-018-2914-3 · Cited by 58 · see citing works
Situationally influenced tinnitus coping strategies: a mixed methods approach
Beukes, E. W., Manchaiah, V. K. C., Andersson, G., Allen, P. M., Terlizzi, P. M., & Baguley, D. (2017) · Disability and Rehabilitation · doi:10.1080/09638288.2017.1362708 · Cited by 49 · see citing works
Self-citationInternet-Based Intervention for Tinnitus: Outcome of a Single-Group Open Trial
Beukes, E. W., Allen, P. M., Manchaiah, V. K. C., Baguley, D., & Andersson, G. (2017) · Journal of the American Academy of Audiology · doi:10.3766/jaaa.16055 · Cited by 43 · see citing works
Self-citationFackrell, K., Smith, H. L., Colley, V., Thacker, B., Horobin, A. J., Haider, H. F., Londero, A., Mazurek, B., & Hall, D. A. (2017) · Trials · doi:10.1186/s13063-017-2123-0 · Cited by 35 · see citing works
Prevalence and characteristics of spontaneous tinnitus in 11-year-old children
Humphriss, R. L., Hall, A. J., & Baguley, D. (2016) · International Journal of Audiology · doi:10.3109/14992027.2015.1120890 · Cited by 33 · see citing works
Self-citationDauman, N., Erlandsson, S., Albarracín, D., & Dauman, R. (2017) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2017.00272 · Cited by 27 · see citing works
Physiology and phenomenology of tinnitus: Implications for treatment
Noble, W. G., & Tyler, R. S. (2007) · International Journal of Audiology · doi:10.1080/14992020701506296 · Cited by 24 · see citing works
Manning, C. A., Thielman, E. J., Grush, L. D., & Henry, J. A. (2019) · American Journal of Audiology · doi:10.1044/2018_aja-ttr17-18-0041 · Cited by 23 · see citing works
Ueberfuhr, M. A., Wiegrebe, L., Krause, E. T., et al. (2017) · Frontiers in Neurology · doi:10.3389/fneur.2016.00239 · Cited by 17 · see citing works
Prior Treatments in a Group of Tinnitus Sufferers Seeking Treatment
Andersson, G. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000289117 · Cited by 14 · see citing works
Self-citationLongitudinal follow-up of occupational status in tinnitus patients.
Andersson, G. (2000) · PubMed · Cited by 12 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Beukes, E. W., Andersson, G., Fagelson, M. A., & Manchaiah, V. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100402 · Cited by 37 · see citing works
“Further research is required to identify tinnitus subgroups and which intervention components are most useful for each subgroup (Beukes et al., 2020c).”
BackgroundMethodSelf-citationBeukes, E. W., Andersson, G., Fagelson, M., & Manchaiah, V. (2021) · American Journal of Audiology · doi:10.1044/2021_aja-20-00222 · Cited by 34 · see citing works
Self-citationRodrigo, H., Beukes, E. W., Andersson, G., & Manchaiah, V. (2021) · doi:10.2196/preprints.28999 · Cited by 33 · see citing works
Self-citationEffectiveness of telerehabilitation interventions for self-management of tinnitus: systematic review
Demoen, S., Chalimourdas, A., Timmermans, A., Van Rompaey, V., Vanderveken, O. M., Jacquemin, L., Schlee, W., Marneffe, W., Luyten, J., Gilles, A., et al. (2023) · Journal of Medical Internet Research · doi:10.2196/39076 · Cited by 24 · see citing works
Rodrigo, H., Beukes, E. W., Andersson, G., & Manchaiah, V. (2022) · American Journal of Audiology · doi:10.1044/2022_aja-21-00270 · Cited by 9 · see citing works
Self-citationManchaiah, V., Chundu, S., Ratinaud, P., Andersson, G., & Beukes, E. W. (2023) · Audiology Research · doi:10.3390/audiolres13020020 · Cited by 6 · see citing works
Self-citationResearch trends and hotspots of cognitive behavioral therapy for tinnitus: a bibliometric analysis
He, Y., Liu, J., Cheng, H., Ye, H., Li, C., Gao, Y., & Xu, X. (2025) · Frontiers in Neuroscience · doi:10.3389/fnins.2025.1536224 · Cited by 2 · see citing works
- Authors
- Beukes, E. W., Manchaiah, V. K. C., Allen, P. M., Andersson, G., & Baguley, D.
- Affiliations
- Lamar University (US)
- Manipal Academy of Higher Education (IN)
- Anglia Ruskin University (GB)
- Linköping University (SE)
- Nottingham University Hospitals NHS Trust (GB)
- Corresponding author
- Eldre Wiida Beukes
- Venue
- Progress in Brain Research
- Publisher
- Elsevier
- Published
- 2021
- Volume
- 260
- Pages
- 79-99
- ISSN
- 0079-6123 (ISSN-L)
- OpenAlex
- W3045337790
- Cited by
- 55
- References
- 50
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 13 · 2023: 13 · 2022: 6 · 2021: 8 · 2020: 2
- FWCI
- 15.01
- Type
- book chapter
- Language
- en
- Open access
- Licence
- Locations
- Progress in brain research (publishedVersion)
- PubMed (publishedVersion)
- Repository@Nottingham (University of Nottingham) (acceptedVersion)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
- Topics
- Life Sciences › Neuroscience › Sensory Systems › Hearing, Cochlea, Tinnitus, Genetics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Hearing Loss and Rehabilitation
- Health Sciences › Health Professions › Speech and Hearing › Noise Effects and Management
- Keywords
- tinnitus, tinnitus severity, Tinnitus Functional Index, insomnia, hearing handicap, anxiety, comorbidities, tinnitus management
- MeSH terms
- Adult, Anxiety, Cross-Sectional Studies, Humans, Tinnitus, Comorbidity
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
