Tinnitus Heterogeneity, Different Types of Tinnitus, and Gender Aspects

Tinnitus is a highly heterogeneous condition with respect to its perceptual characteristics, its etiology, its comorbidities, and its burden. Different forms of tinnitus also differ in their pathophysiology and presumably in their response to specific treatments. Thus, tinnitus heterogeneity is a major challenge in the identification of efficient tinnitus treatments. Several strategies have been applied to identify more homogeneous tinnitus subtypes. In particular, it has been tried to identify subtypes from large databases. These approaches suggest that the majority of tinnitus patients cannot be categorized in clearly delineated (i.e. distinct) subtypes. Instead, the heterogeneity is better explained by patient characteristics falling along various continua. This has important implications for both clinical management and research. In order to optimize treatment for the individual patient, a personalized treatment plan should be developed, considering the tinnitus profile, the comorbidities, the psychological distress, the gender, and the previous treatment experiences of the patient. Moreover, it is essential to consider tinnitus heterogeneity in research designs.