Study Design, Preparation, and Participants:
A cross-sectional study was conducted among attendees of the Ear, Nose, and Throat Clinic at Damascus Al-Mujtahid Hospital to investigate tinnitus. Informed written consent was obtained from all participants, ensuring anonymity in the recorded responses. Participants were informed that revealing their identity was not mandatory, and responding to all questions was optional. Inclusion criteria encompassed individuals visiting medical clinics during the months of April and May 2023, aged 18 and above. The study objectives were communicated to participants in writing, accompanied by the survey.
Using the Tinnitus Detection Scale, the sample was categorized into three groups: the study involved 621 participants, including 418 experiencing tinnitus and 203 without tinnitus.
Ethics approval and consent to participate
This study was approved by the Institutional Review Board (IRB) at Syrian Private University. Written consent was obtained from all participants. Participation in the study was voluntary and participants were assured that there would be no victimization of anyone who did not want to participate or who decided to withdraw after giving consent.
Study Instruments:
A self-administered Arabic-language questionnaire, previously employed in similar studies, was distributed among attendees of medical clinics.
The questionnaire comprised two sections:
1. Demographic and Social Habits Information: It included questions about age, gender, residence, and social habits such as smoking.
2. Tinnitus Detection and Classification Scale: Specifically, designed questions aimed at classifying participants based on the duration and frequency of tinnitus, including:
Participants were initially asked if they had experienced ear ringing in the past year.
Subsequently, a question inquired about the duration of tinnitus (<5 minutes, 5-60 minutes, ≥ 60 minutes, or continuous). The third question pertained to the frequency of the perceived sound (daily or almost daily, weekly, monthly, less than once a year). The questionnaire defined individuals as suffering from pathological tinnitus if they experienced ringing for 5-60 minutes (daily, almost daily, or weekly), or for ≥ 60 minutes or continuously (daily, almost daily, weekly, or monthly).
4. Tinnitus Functional Distress Scale (TFI):
The impact of tinnitus on daily life was assessed using the Tinnitus Functional Distress Scale (TFI). This questionnaire comprises 25 questions, each answered on an 11-point Likert scale. The final score ranges from 0 to 100, with interpretations as follows: 0-17 indicates no problem, 18-31 suggests a minor problem, 32-53 denotes a moderate problem, 54-72 indicates a significant problem, and 73-100 reflects a very significant problem. The 25 questions of the TFI cover various aspects of daily life, divided into eight subcategories: intrusiveness, control, cognition, sleep, hearing, relaxation, quality of life, and emotions, with each subcategory addressed by 3-4 questions. The TFI is a globally recognized scale in English, translated into Arabic and validated (Cronbach's alpha 0.91).
5. Hospital Anxiety and Depression Scale (HADS):
Symptoms of anxiety and depression in individuals with a history of tinnitus were measured using the Hospital Anxiety and Depression Scale (HADS). This questionnaire consists of 14 items assessing anxiety (seven items) and depression (seven items) on a four-point scale. A score of 8 or higher indicates the likelihood of anxiety or depression in participants. The questionnaire was administered in Arabic and demonstrated reliability (Cronbach's alpha 0.78).
6. Hearing Health Questions:
Several questions regarding hearing health were posed to the entire sample. These questions covered various aspects, including a history of chronic diseases or specific medications, the use of earplugs, exposure to potentially harmful sound levels, the use of hearing protection devices, and other relevant factors.
Statistical Analysis:
The data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 26.0. Descriptive statistics, including frequencies and percentages (for categorical variables), as well as means and standard deviations (SD) (for continuous variables), were computed. The Tinnitus Functional Distress Scale (TFI) scores were calculated, with each response on the 11-point Likert scale contributing points ranging from 0 to 10. The total score was then calculated and classified as a percentage to align with the following percentile interpretation: 0-17 indicating no problem, 18-31 a minor problem, 32-53 a moderate problem, 54-72 a significant problem, and 73-100 a very significant problem.
Similarly, the Anxiety and Depression Scale, comprising 14 questions, was computed, with each question offering four response options carrying scores from 0 to 3 points. The total points were then calculated, and a score of 8 or higher indicated the likelihood of anxiety or depression in participants.
The relationship between tinnitus and demographic factors, such as gender, age categories, smoking status, and the association between tinnitus and hearing health questions, was examined using the Chi-Square test of independence. The relationship between tinnitus and age as a continuous variable was assessed using the T-test. A p-value < 0.05 was considered statistically significant.