Age-Associated Psychological Distress in Tinnitus Patients With Middle Ear Stiffness Disorders: An Audiological and Clinical Evaluation

Age-Associated Psychological Distress in Tinnitus Patients With Middle Ear Stiffness Disorders: An Audiological and Clinical Evaluation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Age-Associated Psychological Distress in Tinnitus Patients With Middle Ear Stiffness Disorders: An Audiological and Clinical Evaluation Mayank Mehra¹, Vivek Kumar Jha² This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9588534/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Conductive hearing loss due to middle ear stiffness disorders (otosclerosis, cholesteatoma, tympanosclerosis) is often accompanied by tinnitus. These can interfere with sound transmission and cause hearing impairment and psychological distress. Objective To assess the audiometric and psychometric status in tinnitus patients with stiffness-induced conductive hearing loss, focusing on age-related effects. Methods Fifty patients (aged 18–60 years) with tinnitus and conductive hearing loss from stiffness-related middle ear disorders were enrolled in this cross-sectional study. Pure tone audiometry (PTA) and impedance audiometry was used to assess hearing. The Tinnitus Handicap Inventory (THI), Tinnitus Functional Index (TFI) and Hospital Anxiety and Depression Scale (HADS) were used to quantify tinnitus and level of distress respectively. Data were analysed using SPSS version 25, with p < 0.05 considered significant. Results The prevalence of mild, moderate and moderately severe hearing loss was 50%, 30% and 20%, respectively. Distress was found in 75% of participants. The highest prevalence of distress was in those aged > 45 years (85%). TFI and THI scores showed a moderate-to-severe tinnitus severity. A statistically significant correlation was found between age and psychological distress (p = 0.028). Moreover, there was a high positive correlation between tinnitus severity and psychological distress (r = 0.62, p = 0.001). Conclusion Tinnitus has a negative impact on psychological function, especially in the elderly. Our results show the need for multifaceted audiological and psychological treatment strategies Tinnitus Conductive hearing loss Psychological distress THI TFI HADS Figures Figure 1 Figure 2 Introduction Tinnitus is the experience of hearing a sound when there is no external source of stimulation, often described as a ringing, buzzing or hissing sound. It may be caused by hearing loss and can lower quality of life. Stiffness of the middle ear, such as otosclerosis, cholesteatoma and tympanosclerosis, play a role in conductive hearing loss by restricting the movement of the ossicular chain and its ability to conduct sound. Such auditory deprivation can affect central auditory function and result in tinnitus. Tinnitus is also strongly associated with psychological distress, such as anxiety, depression, and social isolation. The level of distress can be influenced by age, tinnitus duration and coping strategies. The purpose of this study is to assess the audiological features and the psychological impact in tinnitus patients with middle ear stiffness disorders and to investigate the impact of age on the level of distress. Materials and Methods Study Design Cross-sectional study Participants - 50 patients (18-60 years old) with tinnitus and conductive hearing loss due to stiffness. Inclusion Criteria - Stiffness-related conductive hearing loss - Presence of tinnitus Exclusion Criteria - Sensori-neural hearing loss Neurological and psychiatric history Assessment Tools - Pure Tone Audiometry (PTA) Impedance Audiometry Tinnitus Handicap Inventory (THI) Tinnitus Functional Index (TFI) Hospital Anxiety and Depression Scale (HADS) Statistical Analysis SPSS version 25 was used to analyse the data. A p-value < 0.05 was considered statistically significant. Results Table 1: Distribution of Hearing Loss Degree of Hearing Loss Number (n) Percentage (%) Mild 25 50 Moderate 15 30 Moderately Severe 10 20 The most common hearing loss severity was mild loss. Table 2: Age-wise Distribution of Psychological Distress Age Group (Years) Total (n) Distress (n) Percentage (%) 18–30 12 7 58 31–45 18 13 72 45–60 20 17 85 Psychological distress was found to increase with age. Tinnitus Severity (THI and TFI)- Participants showed moderate to severe tinnitus severity. THI scores showed considerable emotional and functional distress, and TFI scores showed considerable interference with everyday activities and quality of life. Psychological Status (HADS)- Around 75% of people had clinically relevant levels of anxiety and depression. Older participants tended to have greater levels of distress. Statistical Findings Chi-square statistical test: p = 0.028 (significant) Association between tinnitus severity and psychological distress: r = 0.62, p = 0.001 Discussion This study shows a significant relationship between tinnitus and psychological distress for patients with stiffness-related conductive hearing loss. Many patients reported anxiety and depression symptoms, suggesting that tinnitus not only affects hearing but also has a profound psychological impact. Distress was more prevalent in older patients, likely due to the longer duration of symptoms and diminished ability to cope, as well as greater communication difficulties. These results are consistent with previous studies highlighting the multimodal effects of tinnitus. The application of validated instruments like THI, TFI and HADS provides more accurate results and highlights the need for holistic assessment in the management of tinnitus. Conclusion Psychological well-being is greatly affected by middle ear stiffness-related tinnitus, especially in the elderly. Early detection and a multifaceted approach is key. Multidisciplinary assessment and treatment by audiologists, otolaryngologists and psychologists is suggested to optimise clinical outcomes and quality of life. Declarations Conflicts of Interest The authors have no conflicts of interest. Ethics Statement Human Ethics Institutional Ethics Committee of Shree Guru Gobind Singh Tricentenary University approved this study. Consent All participants gave written consent for inclusion. Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Author Contribution Mayank Mehra: Conceptualisation, data collection, audiological evaluation, data analysis, writing manuscript •Vivek Kumar Jha: Methodology, supervision, manuscript review and editing Acknowledgement The authors thank all the participants for their co-operation. They also thank the Department of Audiology & Speech-Language Pathology, Shree Guru Gobind Singh Tricentenary University, Gurugram, for support. Data Availability Ethics StatementHuman EthicsInstitutional Ethics Committee of Shree Guru Gobind Singh Tricentenary University approved this study.ConsentAll participants gave written consent for inclusion. References Baguley D, McFerran D, Hall D. Tinnitus. Lancet . 2013;382(9904):1600–1607. Langguth B. Treatment of tinnitus. Curr Opin Otolaryngol Head Neck Surg . 2015;23(5):361–368. Henry JA, Dennis KC, Schechter MA. General review of tinnitus: prevalence, mechanisms, effects, and management. J Speech Lang Hear Res . 2005;48(5):1204–1235. McKenna L, Handscomb L, Hoare DJ, Hall DA. A scientific cognitive-behavioral model of tinnitus: novel conceptualizations of tinnitus distress. Trends Cogn Sci . 2014;18(8):433–442. Jastreboff PJ. Phantom auditory perception (tinnitus): mechanisms of generation and perception. Neurosci Res . 1990;8(4):221–254. Newman CW, Jacobson GP, Spitzer JB. Development of the Tinnitus Handicap Inventory. Arch Otolaryngol Head Neck Surg . 1996;122(2):143–148. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav . 1983;24(4):385–396. Møller AR. Pathophysiology of tinnitus. Ann Otol Rhinol Laryngol . 1984;93(1 Pt 1):39–44. Eggermont JJ, Roberts LE. The neuroscience of tinnitus. Trends Neurosci . 2004;27(11):676–682. Axelsson A, Ringdahl A. Tinnitus—a study of its prevalence and characteristics. Br J Audiol . 1989;23(1):53–62. Lockwood AH, Salvi RJ, Burkard RF. Tinnitus. N Engl J Med . 2002;347(12):904–910. Shargorodsky J, Curhan GC, Farwell WR. Prevalence and characteristics of tinnitus among US adults. Am J Med . 2010;123(8):711–718. Dobie RA. Depression and tinnitus. Otolaryngol Clin North Am . 1999;32(2):393–400. Hesser H, Weise C, Westin VZ, Andersson G. A systematic review and meta-analysis of randomized controlled trials of cognitive behavioral therapy for tinnitus distress. Psychol Psychother . 2011;84(2):187–201. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9588534","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":634166517,"identity":"402cb1df-e8b3-4909-bd13-90ea6bd2fbc2","order_by":0,"name":"Mayank Mehra¹","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFUlEQVRIiWNgGAWjYNCCAwwMBkDK+EeFhByY/4BYLcUMZ2yMwfwEYrV8ZmxJS2wACeDTott+xvBzwZltcubShx9uLmw4nD4/7PBDoC12croN2LWYnckxlp5x47axZV+asfHMHYdzN95OMwBqSTY2O4BDy4EcA2meD7cTN5xhMDPgPQPUMjsBpOVA4jZcWs6/Mf4N1FK/4Qz79x+8bYfTDWenf8Cv5UaOmTTPjdsJBmd4DIx529IS5KVzCNhy41mZNc+Z24YbzvAUGM44Y2O4QTqn4ECCAR6/nE/efJvn2G15gzPsGww+VEjIy89O3/zhQ4WdHC4tDAwcBqh8A7BKAywq4YD9ASpfvgGf6lEwCkbBKBiJAADx3m5PSBTuhQAAAABJRU5ErkJggg==","orcid":"","institution":"Shree Guru Gobind Singh Tricentenary University","correspondingAuthor":true,"prefix":"","firstName":"Mayank","middleName":"","lastName":"Mehra¹","suffix":""},{"id":634166518,"identity":"934265ed-5187-4a64-8a01-8499a306258c","order_by":1,"name":"Vivek Kumar Jha²","email":"","orcid":"","institution":"Shree Guru Gobind Singh Tricentenary University","correspondingAuthor":false,"prefix":"","firstName":"Vivek","middleName":"Kumar","lastName":"Jha²","suffix":""}],"badges":[],"createdAt":"2026-05-01 18:25:57","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9588534/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9588534/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108840737,"identity":"8dffd1c7-4ed3-447e-8e5b-3d458a00b366","added_by":"auto","created_at":"2026-05-09 00:55:40","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":81417,"visible":true,"origin":"","legend":"\u003cp\u003e\u0026nbsp;See image above for figure legend.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9588534/v1/231f9a9bcbb05cc0b36897d7.png"},{"id":108840739,"identity":"554f68b1-008f-41de-b4b9-3a87d0a76db0","added_by":"auto","created_at":"2026-05-09 00:55:42","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":85681,"visible":true,"origin":"","legend":"\u003cp\u003e\u0026nbsp;See image above for figure legend.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9588534/v1/0e4b377b752ae745476497e9.png"},{"id":108977424,"identity":"7aadb73b-db7d-4018-83ce-7bb0d0ccf29f","added_by":"auto","created_at":"2026-05-11 11:31:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":294537,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9588534/v1/cfe05770-370b-46b3-8b70-655a6b7b1d70.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Age-Associated Psychological Distress in Tinnitus Patients With Middle Ear Stiffness Disorders: An Audiological and Clinical Evaluation","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTinnitus is the experience of hearing a sound when there is no external source of stimulation, often described as a ringing, buzzing or hissing sound. It may be caused by hearing loss and can lower quality of life. Stiffness of the middle ear, such as otosclerosis, cholesteatoma and tympanosclerosis, play a role in conductive hearing loss by restricting the movement of the ossicular chain and its ability to conduct sound. Such auditory deprivation can affect central auditory function and result in tinnitus. Tinnitus is also strongly associated with psychological distress, such as anxiety, depression, and social isolation. The level of distress can be influenced by age, tinnitus duration and coping strategies. The purpose of this study is to assess the audiological features and the psychological impact in tinnitus patients with middle ear stiffness disorders and to investigate the impact of age on the level of distress.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCross-sectional study \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants -\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e50 patients (18-60 years old) with tinnitus and conductive hearing loss due to stiffness.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria -\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eStiffness-related conductive hearing loss -\u003c/li\u003e\n \u003cli\u003ePresence of tinnitus \u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria -\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eSensori-neural hearing loss\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eNeurological and psychiatric history \u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eAssessment Tools -\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003ePure Tone Audiometry (PTA)\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eImpedance Audiometry\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTinnitus Handicap Inventory (THI)\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTinnitus Functional Index (TFI)\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHospital Anxiety and Depression Scale (HADS) \u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSPSS version 25 was used to analyse the data. A p-value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003ch3\u003e\u003cstrong\u003eTable 1: Distribution of Hearing Loss\u003c/strong\u003e\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\" width=\"480\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDegree of Hearing Loss\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eModerately Severe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eThe most common hearing loss severity was mild loss.\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eTable 2: Age-wise Distribution of Psychological Distress\u003c/strong\u003e\u003c/h3\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\" width=\"474\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAge Group (Years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDistress (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e18\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e31\u0026ndash;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e45\u0026ndash;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003ePsychological distress was found to increase with age.\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eTinnitus Severity (THI and TFI)-\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eParticipants showed moderate to severe tinnitus severity. THI scores showed considerable emotional and functional distress, and TFI scores showed considerable interference with everyday activities and quality of life.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003ePsychological Status (HADS)-\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eAround 75% of people had clinically relevant levels of anxiety and depression. Older participants tended to have greater levels of distress.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eStatistical Findings\u003c/strong\u003e\u003c/h3\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eChi-square statistical test: p = 0.028 (significant)\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAssociation between tinnitus severity and psychological distress: r = 0.62, p = \u003cstrong\u003e0.001\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study shows a significant relationship between tinnitus and psychological distress for patients with stiffness-related conductive hearing loss. Many patients reported anxiety and depression symptoms, suggesting that tinnitus not only affects hearing but also has a profound psychological impact. Distress was more prevalent in older patients, likely due to the longer duration of symptoms and diminished ability to cope, as well as greater communication difficulties. These results are consistent with previous studies highlighting the multimodal effects of tinnitus. The application of validated instruments like THI, TFI and HADS provides more accurate results and highlights the need for holistic assessment in the management of tinnitus.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePsychological well-being is greatly affected by middle ear stiffness-related tinnitus, especially in the elderly. Early detection and a multifaceted approach is key. Multidisciplinary assessment and treatment by audiologists, otolaryngologists and psychologists is suggested to optimise clinical outcomes and quality of life.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflicts of Interest\u003c/h2\u003e\n\u003cp\u003eThe authors have no conflicts of interest.\u003c/p\u003e\n\u003ch2\u003eEthics Statement\u003c/h2\u003e\n\u003cp\u003eHuman Ethics\u003c/p\u003e\n\u003cp\u003eInstitutional Ethics Committee of Shree Guru Gobind Singh Tricentenary University approved this study.\u003c/p\u003e\n\u003ch2\u003eConsent\u003c/h2\u003e\n\u003cp\u003eAll participants gave written consent for inclusion.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eMayank Mehra: Conceptualisation, data collection, audiological evaluation, data analysis, writing manuscript \u0026bull;Vivek Kumar Jha: Methodology, supervision, manuscript review and editing\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eThe authors thank all the participants for their co-operation. They also thank the Department of Audiology \u0026amp; Speech-Language Pathology, Shree Guru Gobind Singh Tricentenary University, Gurugram, for support.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eEthics StatementHuman EthicsInstitutional Ethics Committee of Shree Guru Gobind Singh Tricentenary University approved this study.ConsentAll participants gave written consent for inclusion.\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eBaguley D, McFerran D, Hall D. Tinnitus. \u003cem\u003eLancet\u003c/em\u003e. 2013;382(9904):1600\u0026ndash;1607.\u003c/li\u003e\n \u003cli\u003eLangguth B. Treatment of tinnitus. \u003cem\u003eCurr Opin Otolaryngol Head Neck Surg\u003c/em\u003e. 2015;23(5):361\u0026ndash;368.\u003c/li\u003e\n \u003cli\u003eHenry JA, Dennis KC, Schechter MA. General review of tinnitus: prevalence, mechanisms, effects, and management. \u003cem\u003eJ Speech Lang Hear Res\u003c/em\u003e. 2005;48(5):1204\u0026ndash;1235.\u003c/li\u003e\n \u003cli\u003eMcKenna L, Handscomb L, Hoare DJ, Hall DA. A scientific cognitive-behavioral model of tinnitus: novel conceptualizations of tinnitus distress. \u003cem\u003eTrends Cogn Sci\u003c/em\u003e. 2014;18(8):433\u0026ndash;442.\u003c/li\u003e\n \u003cli\u003eJastreboff PJ. Phantom auditory perception (tinnitus): mechanisms of generation and perception. \u003cem\u003eNeurosci Res\u003c/em\u003e. 1990;8(4):221\u0026ndash;254.\u003c/li\u003e\n \u003cli\u003eNewman CW, Jacobson GP, Spitzer JB. Development of the Tinnitus Handicap Inventory. \u003cem\u003eArch Otolaryngol Head Neck Surg\u003c/em\u003e. 1996;122(2):143\u0026ndash;148.\u003c/li\u003e\n \u003cli\u003eCohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. \u003cem\u003eJ Health Soc Behav\u003c/em\u003e. 1983;24(4):385\u0026ndash;396.\u003c/li\u003e\n \u003cli\u003eM\u0026oslash;ller AR. Pathophysiology of tinnitus. \u003cem\u003eAnn Otol Rhinol Laryngol\u003c/em\u003e. 1984;93(1 Pt 1):39\u0026ndash;44.\u003c/li\u003e\n \u003cli\u003eEggermont JJ, Roberts LE. The neuroscience of tinnitus. \u003cem\u003eTrends Neurosci\u003c/em\u003e. 2004;27(11):676\u0026ndash;682.\u003c/li\u003e\n \u003cli\u003eAxelsson A, Ringdahl A. Tinnitus\u0026mdash;a study of its prevalence and characteristics. \u003cem\u003eBr J Audiol\u003c/em\u003e. 1989;23(1):53\u0026ndash;62.\u003c/li\u003e\n \u003cli\u003eLockwood AH, Salvi RJ, Burkard RF. Tinnitus. \u003cem\u003eN Engl J Med\u003c/em\u003e. 2002;347(12):904\u0026ndash;910.\u003c/li\u003e\n \u003cli\u003eShargorodsky J, Curhan GC, Farwell WR. Prevalence and characteristics of tinnitus among US adults. \u003cem\u003eAm J Med\u003c/em\u003e. 2010;123(8):711\u0026ndash;718.\u003c/li\u003e\n \u003cli\u003eDobie RA. Depression and tinnitus. \u003cem\u003eOtolaryngol Clin North Am\u003c/em\u003e. 1999;32(2):393\u0026ndash;400.\u003c/li\u003e\n \u003cli\u003eHesser H, Weise C, Westin VZ, Andersson G. A systematic review and meta-analysis of randomized controlled trials of cognitive behavioral therapy for tinnitus distress. \u003cem\u003ePsychol Psychother\u003c/em\u003e. 2011;84(2):187\u0026ndash;201.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Tinnitus, Conductive hearing loss, Psychological distress, THI, TFI, HADS","lastPublishedDoi":"10.21203/rs.3.rs-9588534/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9588534/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConductive hearing loss due to middle ear stiffness disorders (otosclerosis, cholesteatoma, tympanosclerosis) is often accompanied by tinnitus. These can interfere with sound transmission and cause hearing impairment and psychological distress.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo assess the audiometric and psychometric status in tinnitus patients with stiffness-induced conductive hearing loss, focusing on age-related effects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFifty patients (aged 18–60 years) with tinnitus and conductive hearing loss from stiffness-related middle ear disorders were enrolled in this cross-sectional study. Pure tone audiometry (PTA) and impedance audiometry was used to assess hearing. The Tinnitus Handicap Inventory (THI), Tinnitus Functional Index (TFI) and Hospital Anxiety and Depression Scale (HADS) were used to quantify tinnitus and level of distress respectively. Data were analysed using SPSS version 25, with p \u0026lt; 0.05 considered significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of mild, moderate and moderately severe hearing loss was 50%, 30% and 20%, respectively. Distress was found in 75% of participants. The highest prevalence of distress was in those aged \u0026gt; 45 years (85%). TFI and THI scores showed a moderate-to-severe tinnitus severity. A statistically significant correlation was found between age and psychological distress (p = 0.028). Moreover, there was a high positive correlation between tinnitus severity and psychological distress (r = 0.62, p = 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTinnitus has a negative impact on psychological function, especially in the elderly. Our results show the need for multifaceted audiological and psychological treatment strategies\u003c/p\u003e","manuscriptTitle":"Age-Associated Psychological Distress in Tinnitus Patients With Middle Ear Stiffness Disorders: An Audiological and Clinical Evaluation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-09 00:55:34","doi":"10.21203/rs.3.rs-9588534/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"18f08e2d-aa40-485f-a1c5-03119e0224c6","owner":[],"postedDate":"May 9th, 2026","published":true,"recentEditorialEvents":[{"type":"editorAssigned","content":"","date":"2026-05-05T03:21:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-05-05T03:20:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"The Egyptian Journal of Otolaryngology","date":"2026-05-01T18:11:05+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-09T00:55:34+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-09 00:55:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9588534","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9588534","identity":"rs-9588534","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}