اثرات آموزش آرام سازی بر پارامترهای روان سنجی و ایمونولوژیک در افراد مبتلا به وزوز گوش

Objective: Tinnitus often entails severe psychological distress. Reversely, tinnitus may be considered as a chronic stressor. Based on this hypothesis, we investigated whether improving stress-managing capabilities would influence psychological and stress-related immunological parameters in chronic tinnitus sufferers. Methods: Tinnitus (TPs, n=26) and non-tinnitus participants (NTPs, n=13) took part in a standardised 10-week relaxation program. An additional group of tinnitus sufferers (n=18), randomly assigned to a waiting list, served as control (TC) subjects. Mood, perceived stress, global quality of life, and tinnitus disturbance were assessed before and after the intervention. The stress-sensitive immunological parameters TNF-α, IL-6, and IL-10 were measured before, during, and at the end of the intervention. Results: The program resulted in a significantly decreased perception of stress, anxious depression, anger, and tinnitus disturbance, paralleled by a reduction of TNF-α. No alterations were noted for IL-6 or IL-10. For the NTPs and TCs, no relevant psychological or immune changes could be observed. Conclusion: The data suggest that (1) the training offered improved stress-managing capabilities in chronic tinnitus sufferers, and (2) TNF-α may be conceived as a stress marker.

A link between tinnitus and psychological distress has been confirmed in many studies [1], [2], [3], [4], [5] and [6]. Given the association between tinnitus and psychological distress, tinnitus may also be regarded as a chronic stressor, creating a vicious circle of stress and an exacerbation of tinnitus [7]. Psychoneuroimmunological research has given substantial evidence for the fact that psychological distress is associated with dramatic changes in immune measures [8], [9] and [10]. Uncontrollability of the stressor has been identified as a major determinant of the immunological stress response [11] and [12], a characteristic that also applies to the condition of tinnitus. We therefore hypothesised that tinnitus, perceived as disturbing and uncontrollable, acts like a chronic stressor and thereby interferes with stress-related Th1/Th2 cytokines. TNF-α was selected as a marker of the Th1 cytokines, since it has been shown to react to acute stress in mice models [13] as well as to psychological stress in humans [14] and [15]. IL-6 and IL-10 represent Th2 cytokines. Increased IL-6 levels have been described in association with psychological stress and major depressive disorders [16] and [17]. IL-10 has also been demonstrated to increase with psychological stress [15], although stress-related alterations of this cytokine are still not fully elucidated.