Editorial: A Perspective on Tinnitus

0 ne of the more baffling aspects of tinnitus has always been the lack of a clear relation between the patient's apparent distress and such perceived measures of tinnitus character and strength as pitch and loudness. Patients whose tinnitus pitch and loudness judgments are similar often differ widely in the extent to which the tinnitus bothers them in daily living . In this issue of JAAA, authors Craig Newman, Jeanne Wharton, and Gary Jacobson make an important contribution to our understanding of this curious phenomenon . They divided a sample of tinnitus sufferers into two groups based on tests of self-attention and somatic attention, that is, the extent to which the patients were inwardly focused on the tinnitus or outwardly focused on and less attentive to the tinnitus . Then they compared the two groups on a number of measures, including (1) perceived psychological distress, (2) depression, (3) selfreport of tinnitus handicap, and (4) judgments of tinnitus pitch and loudness . Results were quite clear. "High self-attenders" were more depressed, rated the tinnitus as more handicapping, and showed greater emotional distress than the "low self-attenders ." In contrast, there were no differences between the two groups on judgments of perceived pitch and loudness . This study highlights the importance of psychological mechanisms in understanding the plight of the tinnitus sufferer. On the one hand, it helps to explain why some patients are exceedingly distressed by their tinnitus in spite of relatively low levels of perceived loudness on matching and rating procedures. At the same time, it emphasizes that management strategies must take such mechanisms into consideration. While low self-attenders may be well served solely by instrumental intervention such as a hearing aid or a tinnitus masker, high self-attenders may need additional therapeutic interventions directed toward a reduction in depression and somatic awareness. To paraphrase the authors, we are reminded anew that individual differences in a patient's reaction to tinnitus are not a simple function of psychoacoustic attributes like pitch and loudness .