The Rapid Screening for Somatosensory Tinnitus Tool: a Data-Driven Decision Tree Based on Specific Diagnostic Criteria

Abstract

Background: Somatosensory or somatic tinnitus (ST) is a type of tinnitus where changes in somatosensory afference from the cervical spine or temporomandibular area alter the tinnitus perception. Very recently, the diagnostic value of a set of 16 diagnostic criteria for ST was determined. The next step in the development of easily applicable diagnostic criteria is to provide an uncomplicated model, based on the existing criteria, which can easily be used in clinical practice.Objectives: This study aims to construct an accurate decision tree, combining several diagnostic criteria, to optimize both sensitivity and specificity of ST diagnosis.Design: An online survey was launched on the online forum Tinnitus Talk, managed by Tinnitus Hub in a convenience sample of participants with tinnitus. The survey included 42 questions, both on the presence of diagnostic criteria for ST and on other potentially influencing factors. A decision tree was constructed to classify participants with and without ST using the rpart package in R. Tree depth was optimized during a five-fold cross-validation. Finally, model performance was evaluated on a subset containing 20% of the original dataset.Results: Data of 7981 participants were used to construct a decision tree for ST diagnosis. Four criteria were included in the final decision tree: 'Tinnitus and neck/jaw pain increase/decrease simultaneously', 'Tension in suboccipital muscles', 'Somatic modulation', and 'Bruxism'. The presented model has an accuracy of 82.2%, a sensitivity of 82.5%, and a specificity of 79%. Receiver operator characteristic curves demonstrated an area under the curve of 0.88. Conclusions:Based on a 42-item survey, a decision tree was created that was able to detect ST patients with high accuracy (82.2%) using only 4 questions. The RaSST is therefore expected to be easily implementable in clinical practice.

Somatosensory tinnitus and temporomandibular disorders: A common association

“…Indeed, a flow chart for somatosensory tinnitus has been primarily created as a tool for otorhinolaryngologists and audiologists who always have access to their patients' hearing thresholds, while it could be less useful in other clinical contests. 25 The neurophysiological pathway of somatosensory tinnitus explains the high prevalence of tinnitus in patients with TMD 8,11,12 in which the increased muscle tension in the masticatory muscles or pressure on myofascial trigger points, present in TMD, could evoke or modulate the tinnitus. 13 Interestingly, our study shows a high prevalence of TMJ noise in patients with somatosensory tinnitus while, on contrary, joint pain was more common in patients first evaluated at the stomatologic clinic.…”

“…Therefore, in our opinion, the great variability of association between tinnitus and TMD reported in the literature could be partly explained by selective admission of patients only to stomatologic or audiologic clinics, as well as the inclusion of distinct types of tinnitus in different studies. Indeed, a flow chart for somatosensory tinnitus has been primarily created as a tool for otorhinolaryngologists and audiologists who always have access to their patients' hearing thresholds, while it could be less useful in other clinical contests 25 …”

Pilot study on the role of somatic modulation in hyperacusis

“…Viceversa, not all patients diagnosed with somatic tinnitus are able to somatically modulate their tinnitus (54). Other diagnostic criteria appear to be more decisive in the diagnosis of somatic tinnitus, for example, simultaneous onset or increase/decrease of the tinnitus and neck or jaw complaints (55). Therefore, it might be of crucial importance to also take into account the other diagnostic criteria of somatic tinnitus when looking into the possibility of the existence of somatic hyperacusis.…”