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Chronischer Tinnitus im Wechselspiel somatischer und psychischer Faktoren

Chronic tinnitus: An interplay between somatic and psychological factors

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Zusammenfassung

Chronischer Tinnitus ist ein häufiges, mitunter stark belastendes Phänomen, das durch ein Wechselspiel körperlicher und psychologischer Faktoren ausgelöst und aufrechterhalten werden kann. Moderne HNO-Heilkunde integriert mit der klinischen Psychologie und psychosomatischen Medizin als Partnern sowohl medizinische (z. B. Hörverlust) als auch psychologische Einflüsse. Letztere umfassen z. B. Wechselwirkungen zwischen biographischen Erfahrungen, Persönlichkeitseigenschaften, der subjektiven Bewertung intrapsychischer und zwischenmenschlicher Reize, Gefühlszuständen, und intrapsychischen oder zwischenmenschlichen Emotionsregulationsstrategien. Beide Variablengruppen können die Intensität und den Verlauf einer chronischen Tinnitussymptomatik direkt und indirekt beeinflussen – wobei die Qualität und relativen Ausprägungsgrade psychologischer und körperlicher Anteile am Selbsterleben einer Person fluktuieren können. Vor diesem Hintergrund unterscheidet der vorliegende Artikel zwischen chronischer Tinnitussymptomatik mit oder ohne Hörverlust – und plädiert nachdrücklich für ein integriertes Verständnis des chronischen Tinnitus innerhalb eines ganzheitlichen psychologischen Bezugsrahmens. Nach einer kurzen Einführung in die Prinzipien psychosomatischer Medizin und Psychotherapie erörtert der Artikel die psychotherapeutische Fallkonzeptualisierung am Beispiel eines Vulnerabilitäts-Stress-Coping(VSC)-Modells, skizziert klinische Aspekte und Diagnostik einer chronischen Tinnitussymptomatik und schließt mit der Konzeptualisierung chronischen Tinnitusdistresserlebens als Funktion personenzentrierter VSC-Wechselwirkungen.

Abstract

Chronic tinnitus is a common, sometimes highly distressing phenomenon that can be triggered and maintained by an interplay of physical and psychological factors. Partnering with clinical psychology and psychosomatic medicine, modern otolaryngology integrates both medical (e.g., hearing loss) and psychological influences (e.g., interactions between biographical experiences, personality traits, subjective evaluation of intrapsychic and interpersonal stimuli, emotional states, and intrapsychic or interpersonal emotion regulation strategies). Both groups of variables can influence the intensity and course of chronic tinnitus symptomatology both directly and indirectly, whereby the quality and relative degrees of psychological and physical components in a person’s self-experience can fluctuate. With this in mind, the present article distinguishes between chronic tinnitus symptomatology with or without hearing loss—and strongly advocates for an integrated understanding of the symptomatology within a holistic psychological frame of reference. After a brief introduction to the principles of psychosomatic medicine and psychotherapy, the article discusses psychological case conceptualization using a vulnerability–stress–coping (VSC) model as an example, outlines clinical aspects and diagnostics of chronic tinnitus symptomatology, and concludes with a conceptualization of chronic tinnitus-related distress as a function of person-centered VSC interactions.

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Notes

  1. Beispiel einer nomothetischen Fragestellung: Lassen sich interindividuelle Unterschiede in Tinnitusdistress durch interindividuelle Unterschiede in „Katastrophisierungsneigung“ erklären [24]?; Beispiel einer idiographischen Fragestellung: Welche katastrophisierenden Gedanken beschäftigen diese Person und – vor dem Hintergrund ihrer Biographie und Lebenssituation – weswegen?

  2. Natürlich gibt es auch biopsychosoziale Varianten dieses Modelltyps [49].

  3. Hierbei ist allerdings wichtig, psychiatrische Diagnosekategorien nicht als „Erkrankungseinheiten“ zu verstehen, sondern lediglich als vereinfachende Beschreibung komplexer psychologischer Wechselwirkungen, deren Ursprung und Bedeutung idiographisch exploriert werden müssen.

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Authors and Affiliations

  1. Tinnituszentrum, Charité – Universitätsmedizin Berlin, Luisenstraße 13, 10117, Berlin, Deutschland

    Benjamin Boecking,  Petra Brueggemann &  Birgit Mazurek

  2. Medizinische Klinik mit Schwerpunkt für Psychosomatik und Psychotherapie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    Matthias Rose

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  1. Benjamin Boecking
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Correspondence to Birgit Mazurek.

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B. Boecking, P. Brueggemann, M. Rose und B. Mazurek geben an, dass kein Interessenkonflikt besteht.

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Boecking, B., Brueggemann, P., Rose, M. et al. Chronischer Tinnitus im Wechselspiel somatischer und psychischer Faktoren. HNO 71, 719–730 (2023). https://doi.org/10.1007/s00106-023-01370-2

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