Tinnitus and tinnitus disorder: Theoretical and operational definitions (an international multidisciplinary proposal)

De Ridder D 1 , Schlee W 2 , Vanneste S 3 , Londero A 4 , Weisz N 5 , Kleinjung T 6 Show all authors , Shekhawat GS 7 , Elgoyhen AB 8 , Song JJ 9 , Andersson G 10 , Adhia D 11 , de Azevedo AA 12 , Baguley DM 13 , Biesinger E 14 , Binetti AC 15 , Del Bo L 16 , Cederroth CR 17 , Cima R 18 , Eggermont JJ 19 , Figueiredo R 20 , Fuller TE 21 , Gallus S 22 , Gilles A 23 , Hall DA 24 , Van de Heyning P 25 , Hoare DJ 26 , Khedr EM 27 , Kikidis D 28 , Kleinstaeuber M 29 , Kreuzer PM 2 , Lai JT 30 , Lainez JM 31 , Landgrebe M 32 , Li LP 33 , Lim HH 34 , Liu TC 35 , Lopez-Escamez JA 36 , Mazurek B 37 , Moller AR 38 , Neff P 39 , Pantev C 40 , Park SN 41 , Piccirillo JF 42 , Poeppl TB 43 , Rauschecker JP 44 , Salvi R 45 , Sanchez TG 46 , Schecklmann M 2 , Schiller A 2 , Searchfield GD 47 , Tyler R 48 , Vielsmeier V 49 , Vlaeyen JWS 50 , Zhang J 51 , Zheng Y 52 , de Nora M 53 , Langguth B 2

Affiliations 

  • 1 Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. Electronic address: dirk.deridder@otago.ac.nz
  • 2 Department of Psychiatry and Psychotherapy, Bezirksklinikum, University of Regensburg, Regensburg, Germany
  • 3 Lab for Clinical and Integrative Neuroscience, Global Brain Health Institute, Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland
  • 4 Service ORL CCF, Hôpital Européen Georges Pompidou, Paris, France
  • 5 Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
  • 6 Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
  • 7 College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia; Ear Institute, University College London, London, United Kingdom; Tinnitus Research Initiative, Regensburg, Germany
  • 8 Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres" (INGEBI), Buenos Aires, AR, Argentina
  • 9 Department of Otorhinolaryngology, Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
  • 10 Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
  • 11 Department of Surgical Sciences, Section of Neurosurgery, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  • 12 OTOSUL, otorrinolaringologia Sul Fluminense, Volta Redonda, Brazil
  • 13 Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
  • 14 Centre of Otorhinolaryngology, Private Practice, Traunstein, Germany
  • 15 Buenos Aires British Hospital, Buenos Aires, Argentina
  • 16 Del Bo Tecnologia per l'ascolto srl, Milan, Italy
  • 17 National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Laboratory of Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
  • 18 Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands; Department of Health Psychology, Katholieke Universiteit Leuven, Leuven, Belgium; Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
  • 19 Department of Psychology, Department of Physiology and Pharmacology, University of Calgary, Calgary, AB, Canada
  • 20 Centro Universitário de Valença, Faculdade de Medicina, Valença, Brazil; OTOSUL, Clinical and Research Tinnitus Center, Volta Redonda, Brazil
  • 21 Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands; Spine and Biologics, Medtronic, Maastricht, Netherlands
  • 22 Laboratory of Lifestyle Epidemiology, Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
  • 23 Department of otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine, Antwerp University, Wilrijk, Belgium
  • 24 Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom; Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, United Kingdom; University of Nottingham Malaysia, Semenyih, Malaysia
  • 25 Univ Dept of Otorhinolaryngology and head and neck surgery, Antwerp University Hospital, Department of Translational Neurosciences, University of Antwerp. Antwerpen, Belgium
  • 26 NIHR Nottingham Biomedical Research Centre, Hearing Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
  • 27 Department of Neurology, Assiut University Hospital, Assiut, Egypt
  • 28 1st Department of Otolaryngology-Head and Neck Surgery, National and Kapodistrian University of Athens, Athens, Greece
  • 29 Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  • 30 Department of Otolaryngology, Kuang-Tien General Hospital, Taichung, Taiwan
  • 31 Department of Neurology, University Clinic Hospital, Catholic University of Valencia, Valencia, Spain
  • 32 kbo-Lech-Mangfall-Kliniken Agatharied, Hausham, Germany
  • 33 Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
  • 34 Department of Otolaryngology, Head and Neck Surgery, University of Minnesota Medical School, University of Minnesota, Minneapolis, MN, United States
  • 35 Department of Otolaryngology, National Taiwan University, Taipei, Taiwan
  • 36 Otology & Neurotology Group CTS 495, Department of Genomic Medicine, GENYO. Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, ES, Spain; Department of Otolaryngology, Instituto de Investigación Biosanitaria Ibs. Granada, Hospital Universitario Virgen de las Nieves, Granada, ES, Spain; Department of Surgery, Division of Otolaryngology, Universidad de Granada, Granada, ES, Spain
  • 37 Tinnitus Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
  • 38 School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, TX, United States
  • 39 University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
  • 40 Institute for Biomagnetism and Analysis of Biosignals, University of Muenster, Muenster, Germany
  • 41 Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
  • 42 Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, United States
  • 43 Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
  • 44 Department of Neuroscience, Georgetown University, Washington, DC, United States; Hans Fischer Senior Fellow and TUM Ambassador, Institute for Advanced Study and Klinikum Rechts der Isar, TUM, Munich, Germany
  • 45 SUNY Distinguished Professor, Center for Hearing and Deafness, 137 Cary Hall, University at Buffalo, Buffalo, NY, United States
  • 46 Department of Otolaryngology, University of São Paulo School of Medicine, São Paulo, Brazil; Instituto Ganz Sanchez, São Paulo, Brazil
  • 47 Section of Audiology, The University of Auckland, Auckland, New Zealand; Eisdell Moore Centre, The University of Auckland, Auckland, New Zealand; Centre for Brain Research, The University of Auckland, Auckland, New Zealand
  • 48 Department of Communication Sciences and Disorders, Department of Otolaryngology-Head and Neck Surgery, Iowa City, IA, USA
  • 49 Department of Otorhinolaryngology, University of Regensburg, Regensburg, Germany
  • 50 Department of Health Psychology, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands
  • 51 Department of Communication Sciences & Disorders, Department of Otolaryngology, Wayne State University, Detroit, MI, United States
  • 52 Department of Pharmacology and Toxicology, University of Otago, Dunedin, New Zealand
  • 53 Tinnitus Research Initiative, Regensburg, Germany
Prog Brain Res, 2021;260:1-25.
PMID: 33637213 DOI: 10.1016/bs.pbr.2020.12.002

Abstract

As for hypertension, chronic pain, epilepsy and other disorders with particular symptoms, a commonly accepted and unambiguous definition provides a common ground for researchers and clinicians to study and treat the problem. The WHO's ICD11 definition only mentions tinnitus as a nonspecific symptom of a hearing disorder, but not as a clinical entity in its own right, and the American Psychiatric Association's DSM-V doesn't mention tinnitus at all. Here we propose that the tinnitus without and with associated suffering should be differentiated by distinct terms: "Tinnitus" for the former and "Tinnitus Disorder" for the latter. The proposed definition then becomes "Tinnitus is the conscious awareness of a tonal or composite noise for which there is no identifiable corresponding external acoustic source, which becomes Tinnitus Disorder "when associated with emotional distress, cognitive dysfunction, and/or autonomic arousal, leading to behavioural changes and functional disability.". In other words "Tinnitus" describes the auditory or sensory component, whereas "Tinnitus Disorder" reflects the auditory component and the associated suffering. Whereas acute tinnitus may be a symptom secondary to a trauma or disease, chronic tinnitus may be considered a primary disorder in its own right. If adopted, this will advance the recognition of tinnitus disorder as a primary health condition in its own right. The capacity to measure the incidence, prevalence, and impact will help in identification of human, financial, and educational needs required to address acute tinnitus as a symptom but chronic tinnitus as a disorder.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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