| Summary: | This thesis examined the relationship between tinnitus and stress. Chapter 1 provides an overview of tinnitus and stress in terms of definitions, terminologies, mechanism, classification, assessment, and management. Chapter 2 describes the similarities between tinnitus and stress. It is divided into three sections. In the first section, I explain how both tinnitus and stress are associated with changes in brain function and structure, are associated with several diseases, and affect cognition. The second section summarises the findings of a scoping review of research on tinnitus and stress. It revealed discrepancies in the findings and limitations in the methodologies of reviewed studies. Cortisol was commonly studied. Thus, the third section describes the methods and findings of studies that assessed cortisol in tinnitus. The findings in this chapter informed the empirical studies described in the remaining chapters.
Chapter 3 describes an observational study that assessed stress (as a stimulus, a response, and perceived stress) in tinnitus and non-tinnitus participants. The primary outcome measure was hair cortisol. I found no differences in stress levels between tinnitus and non-tinnitus participants. Impact of tinnitus on the sense of control and sleep was associated with cortisol level. Daily hassles and perceived stress were associated with tinnitus-related emotional distress. Changes in tinnitus levels were not associated with changes in stress levels. Recent life changes did not affect tinnitus, nor did stress have any effect on the psychoacoustic characteristics of tinnitus.
Chapter 4 explored how tinnitus patients define the word ‘stress’. I conducted a concept mapping study which had a mixed-method design. It revealed that people with tinnitus expressed the meaning of the word ‘stress’ in various ways. Almost half of the participants defined stress as ‘internal factors’, the other half defined it as ‘external factors’ and an ‘individualised experience’. The findings of this study highlighted the importance of using validated stress instruments or defining stress in research. So, it could clarify which aspect of stress is associated with the disorder being studied.
Chapter 5 describes a service evaluation study to define how stress is assessed and managed in tinnitus clinics. Health professionals defined stress differently to non-health professionals. They face challenges in assessing and managing stress in their clinics that result from the lack of understanding of stress and lack of proper advice on how to manage stressed patients.
Chapter 6 then provides the key findings of the studies which highlighted the importance of refining the methodologies to identify links between tinnitus and stress. Furthermore, it clarified the importance of using a proper definition to the word ‘stress’ and how stress is defined by people who have tinnitus and by their clinical carers. This new understanding could help in improving the management of stress in tinnitus clinics.
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