Tinnitus and Psychiatric Disorders (a Clinical Psychopathological Study of Patients without Otorhinolaryngological Pathology)

Abstract

   Background: tinnitus is the perception of acoustic, phantom sounds in the ear and/or head in the absence of an external source. The prevalence of tinnitus is 5–15 % in the population. The occurrence of subjective noise may have a number of possible causes, but the causal relationship between psychiatric disorders and tinnitus remains insufficiently proven, according to previous studies.   The aim was to study an acoustic phenomenon of the “ear/head noise” type, comparable with tinnitus symptomatology, in the absence of otorhinolaryngological, neurological, somatic pathologies.   Patients and methods: the sample consisted of 12 patients (11 men, 1 woman, mean age 38 ± 8.5 years) who underwent complex psychopathological, pathopsychological, psychometric, otorhinolaryngological, neurological, and instrumental examinations, statistical. The patients met the diagnostic criteria of subjective tinnitus according to ICD-10 classification (code H93.1).   Results: the psychopathological qualification of tinnitus in our observations corresponds to psychosensory disorders of the synesthesia type. In the most cases, the ear noise occurred against the background of already long-standing neurotic or overvalued hypochondria. Depending on clinical picture of ear noise, and features of the course of hypochondriacal disorder, the acoustic phenomenon of the “ear / head noises” type was revealed within four nosologies: hypochondriacal schizophrenia, schizotypal disorder, cluster B personality disorder with the phenomenon of hypochondriacal diathesis, paranoid personality disorder with the phenomenon of overvalued hypochondria.   Conclusion: the results of the present study, in spite of a limited number of observations, allow us (as a working hypothesis) to propose the following statement: the acoustic phenomenon of the “ear / head noise” type can manifest in psychiatric disorders (psychopathological phenomena of the hypochondriacal circle) duplicating the symptoms of tinnitus at clinical level which, are formed within otolaryngological, neurologicl and somatic pathology. Taking into account these clinical data, hypochondriacal formations appearing in the considered casuistic of the present study, having no base of otorhinolaryngology-related pathology, or internal organ pathology, can be qualified in accordance with the criteria presented in publication A. B. Smulevich et al. (2023) as a part of somatic paranoia. Further comprehensive study of this phenomenon is necessary for more accurate verification of the clinical criteria for differential diagnosis, increasing the efficiency of identifying the pathology under discussion, and determining rational methods of complex treatment, including psychopharmacotherapy and psychotherapeutic modalities.