DISCRIMINATIVE VALIDITY OF DIAGNOSTIC CRITERIA FOR SOMATOSENSORY TINNITUS IN TINNITUS PATIENTS".
validation study, somatosensory tinnitus, quality of life
Introduction: Tinnitus is defined as the perception of sound generated in the auditory or para-auditory pathways. Known as somatosensory tinnitus (SST), it is influenced by the somatosensory system of the cervical spine or temporomandibular region. The diagnosis of SST is established using standardized criteria developed by an international consensus of experts in the field through the Delphi method. However, the measurement properties of these criteria have not been evaluated. Objective: To propose a detailed clinical checklist adapted from the Diagnostic Criteria for Somatosensory Tinnitus for the diagnosis of SST and to assess the discriminative validity between patients with and without SST. Methods: This was a methodological study of the known-group validity type, with a sample of 70 tinnitus patients, aged 18 years or older, recruited from a specialized outpatient clinic. The patients underwent a multiprofessional evaluation in which they were questioned about the intensity of discomfort caused by tinnitus using the Numeric Rating Scale (NRS) and its impact on quality of life through the Tinnitus Handicap Inventory (THI). The known-group validity of the Checklist of Diagnostic Criteria for Somatosensory Tinnitus (CD/SST) was assessed using the chi-square test and the Phi coefficient. THI scores were compared between groups using the unpaired t-test, with effect size measured by Cohen's d. Preliminary results: The SST Group reported higher tinnitus-related discomfort (p<0.001) and impact on quality of life in the functional domain and total THI score (p=0.02 for both) compared to the Non-SST Group. Regarding the CD/SST, associations were found for modulation by somatic maneuvers (SM) in all movements of the cervical spine (p<0.05) and in the mandibular region during maximum mouth opening and teeth clenching in the SST Group, with both regions showing a very strong association (0.45). Modulation of tinnitus by gaze-evoked was also significant (p=0.01) and had a very strong association (0.29) in the same group. Modulation by palpation of the temporomandibular joint (TMJ), presence of crepitus, and pain did not show statistical significance. Modulation by palpation of the cervical and masticatory muscles showed significance (p<0.05) for the majority of the evaluated muscles, with associations ranging from strong to very strong (0.25 to 0.40). Regarding the presence of pain during voluntary movements in the cervical and TMJ region, only cervical protrusion (p=0.04) and teeth clenching (p=0.04) were statistically significant, both showing a strong association (0.24). The presence of pain during muscle palpation showed greater differences in the SST Group only in the origin and insertion of the right masseter (p=0.01 and p=0.04) and suboccipital muscles (p=0.01), ranging from strong to very strong (0.23 to 0.29). For referred pain during muscle palpation, only the suboccipital muscles (p=0.01) and right upper trapezius (p=0.04) had statistically significant differences in the same group. Conclusion:Based on the presented partial results, it can be inferred that there is likely known-group validity for the proposed hypothesis for some of the items. The suggestion of an adapted checklist based on the diagnostic criteria for SST, along with the differences between the researched groups, will provide more valid and applicable data for the identification and diagnosis of this subtype of tinnitus by physiotherapists and other healthcare professionals in their clinical practice.