Tinnitus & Hyperacusis Therapy Masterclass

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Specialist course for management of tinnitus and hyperacusis in children and adults


Trilogy of studies on the relationship between Adverse Childhood Experiences and tinnitus / hyperacusis-related distress  




Adverse childhood experiences are defined as exposures to different forms of abuse (physical, emotional and sexual) and family dysfunction (substance abuse, mental illness, mother treated violently, incarcerated household member and parental separation) (Felitti et al. 1998). There are many studies that suggest childhood adversities might lead to development of negative core beliefs about self, world, and the future (e.g., “I am unlovable”, “World is hostile”, “My future is too awful”) (Noone et al. 2015; Stowkowy et al. 2016). In the context of cognitive therapy, such perceptions are known as the cognitive triad and are believed to lead to distress and psychological disorders (Beckham et al. 1986).


Based on the clinical observations in over 2000 patients who underwent specialised cognitive behavioural therapy (CBT) for tinnitus and/or hyperacusis rehabilitation, Dr. Aazh’s team and their international collaborators postulated that there may be a relationship between adverse childhood experiences and being more vulnerable to develop tinnitus/hyperacusis-related distress, disability and suicidal or self-harm ideations across the life span. Consistent with this, there are several research studies suggesting that childhood adversities can have neurobiological and genetic influences on child development that may affect the way individuals respond to stress later in life (De Bellis & Zisk 2014; Anda et al. 2006).


Parental separation and parental poor mental health are important forms of adverse childhood experiences with prevalence of 23.3% and 19.4%, respectively (Anda et al. 2006).


In a trilogy of papers on the relationship betweenchildhood history of parental separation as well as parental mental illness and tinnitus/hyperacusis-related distress, disability and suicidal or self-harm ideations in adulthood (Aazh et al. 2018b; Aazh et al. 2018c; Aazh et al. 2018a), Dr. Aazh’s team reported that:

1-     There were no significant differences in Tinnitus Handicap Inventory (THI) and Hyperacusis Questionnaire (HQ) between patients with and without history of parental separation (Aazh et al. 2018c).

2-     The scores on THI and HQ were worse in the group that reported mental health disorders in their parents (p<0.01). Parental mental health illness did not significantly relate to THI, however, it was significantly related to the risk of hyperacusis (odds ratio, OR after adjusting for age and gender: 2.05, p = 0.026). The adjusted OR for a subgroup of patients with a diagnosis of hyperacusis was 6.7 (p = 0.011), indicating a stronger relationship for this subgroup.

3-     Parental mental illness significantly increased the risk of depression, with unadjusted ORs of 2.7 (95% CI: 1.08 to 6.7, p = 0.033) for the Patient Health Questionnaire (PHQ-9). This indicates that patients with tinnitus and/or hyperacusis are at higher risk of developing depression if they have a childhood history of parental mental illness than if they do not (Aazh et al. 2018a). Future studies should explore whether psychotherapeutic treatments that specifically address the impact of adverse childhood experiences, are useful for reducing the distress caused by tinnitus and hyperacusis.

4-     There is a significant relationship between suicidal and self-harm ideations and the history of parental mental illness after adjusting the model for (1) tinnitus disability as measured via THI, (2) hyperacusis as measured via HQ, (3) anxiety as measured via Generalised Anxiety Disorders (GAD-7), (4) depression as measured via PHQ-9, (5) age and gender. Adjusted OR was 2.5 (95% CI: 1.14, 5.6, p=.022) (Aazh et al. 2018b). Therefore, clinicians who offer tinnitus and hyperacusis rehabilitation should screen for suicidal and self-harm ideations among patients with symptoms of depression and a childhood history of parental mental illness. Patients with suicidal and self-harm ideations should be referred to mental health services for further diagnosis and treatment.   








Aazh, H., Danesh, A., & Moore, B. C. J. (2018a). Parental mental health in childhood as a risk factor for anxiety and depression among people seeking help for tinnitus and hyperacusis Journal of American Academy of Audiology, [in press]

Aazh, H., Landgrebe, M., & Danesh, A. A. (2018b). Parental mental illness in childhood as a risk factor for suicidal and self-harm ideations in adults seeking help for tinnitus and/or hyperacusis. American Journal of Audiolgy, [in press]

Aazh, H., Langguth, B., & Danesh, A. A. (2018c). Parental separation and parental mental health in childhood and tinnitus and hyperacusis handicap in adulthood. International Journal of Audiology [Epub ahead of print], 1-16.

Anda, R. F., Felitti, V. J., Bremner, J. D., et al. (2006). The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatry Clin Neurosci, 256, 174-86.

Beckham, E. E., Leber, W. R., Watkins, J. T., et al. (1986). Development of an instrument to measure Beck's cognitive triad: the Cognitive Triad Inventory. J Consult Clin Psychol, 54, 566-567.

De Bellis, M. D., & Zisk, A. (2014). The biological effects of childhood trauma. Child Adolesc Psychiatr Clin N Am, 23, 185-222, vii.

Felitti, V. J., Anda, R. F., Nordenberg, D., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American College of Preventive Medicine, 14, 245-58.

Noone, D., Ames, C., Hassanali, N., et al. (2015). A preliminary investigation of schematic beliefs and unusual experiences in children. Eur Psychiatry, 30, 569-75.

Stowkowy, J., Liu, L., Cadenhead, K. S., et al. (2016). Core Schemas in Youth at Clinical High Risk for Psychosis. Behav Cogn Psychother, 44, 203-13.