, Volume 67, Supplement 2, pp 46–50 | Cite as

ICD-10 Symptom Rating questionnaire for assessment of psychological comorbidities in patients with chronic tinnitus

  • P. Brueggemann
  • C. Seydel
  • C. Schaefer
  • A. J. Szczepek
  • N. Amarjargal
  • B. Boecking
  • M. Rose
  • B. MazurekEmail author
Original articles



Tinnitus frequently occurs alongside psychological comorbidities whose assessment is important for treatment planning and -success. The selection of suitable questionnaires is thus crucial. The present study aims to investigate the ICD-10 Symptom Rating (ISR) to this regard.


The current study investigated tinnitus burden and psychological comorbidities in a sample of N = 311 patients with chronic tinnitus. All participants completed an intensive 7‑day multimodal tinnitus-specific therapy. Tinnitus burden was measured using the German version of the Tinnitus Questionnaire (TQ). Psychological comorbidities were measured using the ISR (total score, depressive disorder, anxiety disorder, obsessive–compulsive disorder, somatoform disorder, and eating disorder), the Perceived Stress Questionnaire (PSQ; total score, tension, worries, joy, and demands), and the General Depression Scale (Allgemeine Depressionsskala, ADS).


Sixty-five percent of participants suffered from psychological comorbidities. Treatment response comprised improvements in the TQ, ISQ, PSQ and ADS. At baseline, tinnitus-burden correlated with the ISR-total, ISR-obsessive-compulsive disorder and PSQ-tension scores. Post treatment, the—now reduced—tinnitus burden was additionally predicted by ISR-depressive and eating disorder scores.


The ISR is a useful tool for measuring psychological comorbidities in patients with chronic tinnitus as well as short-term treatment response. Therapeutic approaches for chronic tinnitus should address stress-related tension, depressive symptomatology and coping strategies such as maladaptive eating behaviours.


Chronis tinnitus Depressive disorders Psychological comorbidities Anxiety disorders Obsessive-compulsive disorder 

ICD-10-Symptom-Rating-Fragebogen zur Beurteilung psychischer Komorbiditäten bei Patienten mit chronischem Tinnitus


Compliance with ethical guidelines

Conflict of interest

P. Brueggemann, C. Seydel, C. Schaefer, A.J. Szczepek, N. Amarjargal, B. Boecking, M. Rose, and B. Mazurek declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All patients agreed in writing that their data could be used anonymously for teaching and research purposes.

The supplement containing this article is not sponsored by industry.


  1. 1.
    Hesse G (2008) Neurootologic and psychosomatic habituation therapy. Treatment approaches in chronic tinnitus. HNO 56(7):686–693CrossRefGoogle Scholar
  2. 2.
    Langguth B et al (2013) Tinnitus: causes and clinical management. Lancet Neurol 12(9):920–930CrossRefGoogle Scholar
  3. 3.
    Zirke N et al (2013) Analysis of mental disorders in tinnitus patients performed with Composite International Diagnostic Interview. Qual Life Res 22(8):2095–2104CrossRefGoogle Scholar
  4. 4.
    Salviati M et al (2014) Tinnitus: clinical experience of the psychosomatic connection. Neuropsychiatr Dis Treat 10:267–275PubMedPubMedCentralGoogle Scholar
  5. 5.
    Malakouti S et al (2011) Comorbidity of chronic tinnitus and mental disorders. Int Tinnitus J 16(2):118–122PubMedGoogle Scholar
  6. 6.
    Sahlsten H et al (2018) Psychiatric (Axis I) and personality (Axis II) disorders and subjective psychiatric symptoms in chronic tinnitus. Int J Audiol 57(4):302–312CrossRefGoogle Scholar
  7. 7.
    Folmer RL, Griest SE, Martin WH (2008) Obsessive-compulsiveness in a population of tinnitus patients. Int Tinnitus J 14(2):127–130PubMedGoogle Scholar
  8. 8.
    Leaver AM, Seydell-Greenwald A, Rauschecker JP (2016) Auditory-limbic interactions in chronic tinnitus: challenges for neuroimaging research. Hear Res 334:49–57CrossRefGoogle Scholar
  9. 9.
    Zirke N et al (2013) Psychological comorbidity in patients with chronic tinnitus: analysis and comparison with chronic pain, asthma or atopic dermatitis patients. Qual Life Res 22(2):263–272CrossRefGoogle Scholar
  10. 10.
    Tritt K et al (2008) Development of the “ICD-10-Symptom-Rating”(ISR) questionnaire. Z Psychosom Med Psychother 54(4):409–418PubMedGoogle Scholar
  11. 11.
    Dilling H, Dittmann V (1990) Psychiatric diagnosis following the 10th revision of the International Classification of Diseases (ICD-10). Nervenarzt 61(5):259–270PubMedGoogle Scholar
  12. 12.
    Seydel C et al (2013) Gender and chronic tinnitus: differences in tinnitus-related distress depend on age and duration of tinnitus. Ear Hear 34(5):661–672CrossRefGoogle Scholar
  13. 13.
    Seydel C et al (2015) Three years later: report on the state of well-being of patients with chronic tinnitus who underwent modified tinnitus retraining therapy. Audiol Neurootol 20(1):26–38CrossRefGoogle Scholar
  14. 14.
    Goebel G, Hiller W (1994) The tinnitus questionnaire. A standard instrument for grading the degree of tinnitus. Results of a multicenter study with the tinnitus questionnaire. HNO 42(3):166–172PubMedGoogle Scholar
  15. 15.
    Fischer HF et al (2010) Factor structure and psychometric properties of the ICD-10-symptom-rating (ISR) in samples of psychosomatic patients. Psychother Psychosom Med Psychol 60(8):307–315CrossRefGoogle Scholar
  16. 16.
    Fischer HF et al (2011) Retest-reliability and Sertsitivity to change of the ICD-10-symptom-rating (ISR) in different samples. Psychother Psychosom Med Psychol 61(3–4):162–169CrossRefGoogle Scholar
  17. 17.
    Fischer HF et al (2011) How to compare scores from different depression scales: equating the patient health questionnaire (PHQ) and the ICD-10-symptom rating (ISR) using item response theory. Int J Methods Psychiatr Res 20(4):203–214CrossRefGoogle Scholar
  18. 18.
    Levenstein S et al (1993) Development of the Perceived Stress Questionnaire: a new tool for psychosomatic research. J Psychosom Res 37(1):19–32CrossRefGoogle Scholar
  19. 19.
    Fliege H et al (2005) The Perceived Stress Questionnaire (PSQ) reconsidered: validation and reference values from different clinical and healthy adult samples. Psychosom Med 67(1):78–88CrossRefGoogle Scholar
  20. 20.
    Hautzinger M (2008) Psychotherapy of depression. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 51(4):422–429CrossRefGoogle Scholar
  21. 21.
    Goebel G (2015) Tinnitus and psychiatric comorbidities. HNO 63(4):272–282CrossRefGoogle Scholar
  22. 22.
    Kratzsch V, Goebel G (2018) Current aspects of tinnitus and depression. HNO 66(3):188–197CrossRefGoogle Scholar
  23. 23.
    Langguth B (2011) A review of tinnitus symptoms beyond ‘ringing in the ears’: a call to action. Curr Med Res Opin 27(8):1635–1643CrossRefGoogle Scholar
  24. 24.
    Langguth B (2015) Treatment of tinnitus. Curr Opin Otolaryngol Head Neck Surg 23(5):361–368CrossRefGoogle Scholar
  25. 25.
    Mazurek B et al (2010) The significance of stress: its role in the auditory system and the pathogenesis of tinnitus. HNO 58(2):162–172CrossRefGoogle Scholar
  26. 26.
    Mazurek B, Szczepek AJ, Hebert S (2015) Stress and tinnitus. HNO 63(4):258–265CrossRefGoogle Scholar
  27. 27.
    Bruggemann P et al (2016) Impact of multiple factors on the degree of Tinnitus distress. Front Hum Neurosci 10:341CrossRefGoogle Scholar
  28. 28.
    Cima RF et al (2014) Cognitive-behavioral treatments for tinnitus: a review of the literature. J Am Acad Audiol 25(1):29–61CrossRefGoogle Scholar
  29. 29.
    Biesinger E et al (1998) Strategies in ambulatory treatment of tinnitus. HNO 46(2):157–169CrossRefGoogle Scholar
  30. 30.
    Bruggemann P et al (2018) Long-term changes in multimodal intensive tinnitus therapy : a 5year follow-up. HNO 66(Suppl 1):34–38CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • P. Brueggemann
    • 1
  • C. Seydel
    • 1
  • C. Schaefer
    • 1
  • A. J. Szczepek
    • 2
  • N. Amarjargal
    • 1
  • B. Boecking
    • 1
  • M. Rose
    • 3
  • B. Mazurek
    • 1
    Email author
  1. 1.Tinnitus CenterCharité—Universitätsmedizin BerlinBerlinGermany
  2. 2.Department of ORLCharité—Universitätsmedizin BerlinBerlinGermany
  3. 3.Department of Internal Medicine and PsychosomaticsCharité—Universitätsmedizin BerlinBerlinGermany

Personalised recommendations