Fig 1.
Flowchart of the major procedures in this study.
*numbers in parentheses are those of cases that were lost to the study. THI: tinnitus handicap inventory, SAS: Zung’s Self-Rating Anxiety Sale, ST: sound therapy, HA: hearing aid, EC: educational counseling.
Table 1.
Comparison of initial clinical characteristics of patients between 2020 and 2019.
Fig 2.
Comparisons of initial SAS, THI scores and TL between years and subjects with and without anxiety.
A: SAS showing a significant difference between years and between the subgroups within the two years. B and D: The differences in THI and TL as the result of the two main factors—year and anxiety. C and E: Post-hoc comparison on THI and TL showing the difference within the factors of year and anxiety respectively. Within 2020, subjects with anxiety appeared to have a significantly higher THI and TL; no difference was seen in THI between anxiety and non-anxiety subgroups within 2019, while a higher TL was seen in non-anxiety subgroup within 2019. THI: tinnitus handicap inventory, SAS: Zung’s Self-Rating Anxiety Sale, TL: tinnitus loudness.
Table 2.
Between-year match in the demographic and selected clinic features in tinnitus patients treated with STEC.
Table 3.
Between-year match in the demographic and selected clinic features in tinnitus patients treated with EC alone.
Fig 3.
The SAS difference before and after the treatment of STEC (upper panels) and EC alone (the lower panels). A and C: The pre- and post-SAS. B and D: the pre-post difference of SAS score. STEC treatment reduced SAS in both years (A). However, EC alone did not improve SAS in 2020, instead the SAS was increased significantly in the 2nd assessment (C). Correspondingly, STEC produced a slightly better improvement in SAS in 2019 than in 2020, but improvement by EC alone was much better in 2019 than in 2020, in which SAS was deteriorated. The number of symbols (*, $ or #) represents the level of significance, with 1, 2 or 3 symbols for ρ < 0.05, 0.01, or 0.001 respectively. STEC: sound therapy + educational counseling, EC: educational counseling.
Table 4.
Changes of cases with anxiety after the treatments of STEC and EC alone.
Fig 4.
Correlations between the initial SAS score and the improvement in SAS score.
A: The correlation of STEC by year. B: The correlation of EC alone by year. Significant, moderate correlations were seen in STEC group and EC alone groups in 2020 in which the average initial SAS scores were much higher. SAS: Zung’s Self-rating Anxiety Scale, ST: sound therapy, EC: educational counseling.
Table 5.
Self-reported improvement of tinnitus loudness in the follow-ups of treatment groups between years.
Fig 5.
The difference in THI before and after the treatment of STEC (upper panels) and EC alone (the lower panels). A and C: The pre- and post-THI scores. B and D: the pre-post difference of THI score. STEC resulted in a significant THI reduction in both years (A), but there was no significant difference in the amount of reduction between years and between subjects with and without anxiety (B). EC alone reduced THI in 2019, but opposite in 2020 (C and D). The THI got deteriorated in 2020 and worse than 2019 in both subgroups with and without anxiety (D). Therefore, within subjects with or without anxiety, the treatment resulted in a better THI in year 2019. STEC: sound therapy + educational counseling, EC: educational counseling.
Fig 6.
Correlations between the improvements of emotional section in THI and SAS in 2020 and 2019.
A: The correlation in ST-EC group. B: The correlation in EC alone group. Significant, moderate correlations were seen in ST with EC group in both years and EC alone groups in 2019. SAS: Zung’s Self-rating Anxiety Scale, ST: sound therapy, EC: educational counseling.
Fig 7.
The changes in TL between the two assessments before and after the treatment of STEC (upper panels) and EC alone (the lower panels). A and C: The pre- and post-TL. B and D: the pre-post difference of TL. The TL got deteriorated in 2020 and worse than 2019 in the subgroup with anxiety (D). Significance: ** ρ < 0.01, *** ρ < 0.001 in ANOVA. STEC: sound therapy + educational counseling, EC: educational counseling, TL: tinnitus loudness.
Table 6.
Correlation between SAS improvements and those in THI and MML.