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Epidemiology of Tinnitus in Adults


Abstract and Figures

1. Many studies have addressed the prevalence of tinnitus, but the definition of tinnitus has varied. 2. Some studies have reported that as many as 80% of the adult population experience tinnitus at some point. 3. Six large population studies in different countries reported prevalence of prolonged tinnitus, varying between 4.4 and 15.1% for adults and between 7.6 and 20.1% for individuals below the age of 50 years. One of the studies reported that 2.4% of the population responded “yes” to the description of tinnitus as “tinnitus plagues me all day.” 4. A study in four cities in England found that tinnitus, on average, occurred in 17.5% of the participants in the age group of 40–60 years and 22.2% in participants above the age of 60 years. 5. Since tinnitus has many forms and its prevalence varies with age and, to some extent, gender, the prevalence of tinnitus cannot be described by a single number. 6. The prevalence of tinnitus increases monotonically up to the age of approximately 70 years, above which the prevalence either becomes constant or decreases slightly with age. 7. The prevalence of tinnitus is lower in women up to 75 years, above which the gender difference becomes small. 8. There is some evidence that noise exposure increases the risk of tinnitus. 9. The odds of having tinnitus increases with the degree of hearing loss when measured at 4 kHz. 10. While reported “trouble hearing” increases monotonically with age, “bothersome tinnitus” increases with age only up to the age group of 65–74, after which it becomes independent of age or decreases slightly with age.
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1. Many studies have addressed the prevalence of
tinnitus, but the definition of tinnitus has varied.
2. Some studies have reported that as many as 80%
of the adult population experience tinnitus at some
3. Six large population studies in different countries
reported prevalence of prolonged tinnitus, varying
between 4.4 and 15.1% for adults and between 7.6
and 20.1% for individuals below the age of 50
years. One of the studies reported that 2.4% of the
population responded “yes” to the description of
tinnitus as “tinnitus plagues me all day.
4. A study in four cities in England found that tinnitus,
on average, occurred in 17.5% of the participants in
the age group of 40–60 years and 22.2% in partici-
pants above the age of 60 years.
5. Since tinnitus has many forms and its prevalence
varies with age and, to some extent, gender, the
prevalence of tinnitus cannot be described by a
single number.
6. The prevalence of tinnitus increases monotoni-
cally up to the age of approximately 70 years,
above which the prevalence either becomes con-
stant or decreases slightly with age.
7. The prevalence of tinnitus is lower in women up
to 75 years, above which the gender difference
becomes small.
8. There is some evidence that noise exposure increases
the risk of tinnitus.
9. The odds of having tinnitus increases with the
degree of hearing loss when measured at 4 kHz.
10. While reported “trouble hearing” increases mono-
tonically with age, “bothersome tinnitus” increases
with age only up to the age group of 65–74, after
which it becomes independent of age or decreases
slightly with age.
Keywords Tinnitus Epidemiology Prevalence
• Adults • Hearing loss • Noise exposure
Understanding the incidence and prevalence of a
disease in a defined population is important for
improvement of health and prevention of diseases.
Accurate determination of the prevalence of a condi-
tion, such as tinnitus, which does not have objective
signs, depends on the ability to define the disease to
the members of the population that is studied.
Tinnitus affects different groups of people differ-
ently, such as different age groups, and the prevalence
of tinnitus in women and men is also different. This
means that a single number cannot describe the preva-
lence of tinnitus. It is therefore important to define the
part of the population that is studied.
Tinnitus is often accompanied by hyperacusis
(lowered tolerance for sound, see Chaps. 3 and 57),
misophonia (dislike of certain sounds), and phonophobia
(fear of certain sounds); see Chaps. 4 and 57. While the
prevalence of tinnitus, in general, is poorly known,
the prevalence of these symptoms is even less known. The
effect of tinnitus on a person’s quality of life depends
more on the distress it causes and less on how a person
perceives his or her tinnitus. However, the prevalence
of distress from tinnitus is poorly known.
Chapter 5
Epidemiology of Tinnitus in Adults
Aage R. Møller
A.R. Møller (*)
The University of Texas at Dallas, School of Behavioral
and Brain Sciences, GR 41, 800 W Campbell Rd,
Richardson, TX 75080, USA
A.R. Møller et al. (eds.), Textbook of Tinnitus,
DOI 10.1007/978-1-60761-145-5_5, © Springer Science+Business Media, LLC 2011
30 A.R. Møller
When discussing the prevalence of tinnitus, it is the
troubled tinnitus that is of the greatest interest because
that is the form of tinnitus that affects the quality of life
and which may have severe consequences for the per-
son who has tinnitus. Troubled tinnitus may result in
the inability to work and may have such a severe effect
on a person that it causes suicide.
This chapter discusses population studies of the
prevalence of tinnitus. Few studies have addressed the
incidence of tinnitus which will not be discussed, and
the natural history of tinnitus is not understood (see
Chaps. 63 and 64) [1].
For studies of the prevalence of tinnitus, the great-
est challenge lies in defining the tinnitus. As has been
discussed in many of the chapters in this book, tinnitus
has many forms (see especially Chaps. 2–4 and 17).
Tinnitus varies widely among individuals not only in
strength but also in character, and many investigators
have proposed different classification schemes for tin-
nitus (for a review see Heller 2003) [2]. An individu-
al’s tinnitus can vary widely from time to time. Many
forms of tinnitus change from day to day and even
change over the course of one day.
In that way, tinnitus has many similarities with pain.
When the task is to obtain accurate information regard-
ing its prevalence of tinnitus and pain, there are many
aspects of these two symptoms that must be taken into
account as has been discussed in Chaps. 14 and 94.
Tinnitus can noticeably decrease the quality of life
or it can just be a small annoyance. In fact, most people
who have tinnitus do not regard it as anything impor-
tant. One study reported that 0.5–1% of individuals
with tinnitus indicated that the condition severely
affected their ability to live a normal life [3]. Other
studies have reported different estimates of prevalence
of such forms of tinnitus.
The degree of distress tinnitus can cause is not
related to the character or the perceived strength of the
disorder as it is described by the persons who have
tinnitus. The perceived severity of tinnitus depends on
many different factors; one being a person’s personal-
ity (see Chaps. 27, 63 and 64). The perception of
tinnitus is also influenced by external circumstances.
These factors all make it difficult to obtain an accurate
estimate of the prevalence of tinnitus that affects a
person’s life. Different definitions of such forms of tin-
nitus have been used by individual investigators. This
is one of the reasons that the results reported by differ-
ent epidemiologic studies differ considerably, and
different studies report prevalence of tinnitus that
varies from study to study. The lack of objective signs
of tinnitus is another source of uncertainty in studies of
this disorder, and only self-reported evaluation of a
person’s tinnitus is available. Most epidemiologic
studies have not attempted to distinguish between the
different origins of the tinnitus, not even distinguish-
ing between objective and subjective tinnitus.
Another source of variation in the results of differ-
ent epidemiologic studies of tinnitus is shared with
other voluntary studies, namely, that not all persons
selected for a study respond. Normally, epidemiologic
studies will spend a considerable effort finding out if
the group of non-responders is different from the group
that responds.
Another reason for varying results in different
studies is that questions are formulated differently.
Some studies have used written questions distributed
to groups of people more or less representative of the
general population. Some studies have enrolled indi-
viduals seeking professional help for their tinnitus.
The participants in some studies must therefore be
regarded as being a selected group of individuals that
may not be representative of the general population.
Tinnitus depends on many factors, which makes it
important to obtain a multi-dimensional description of
its epidemiology. Thus, it is not meaningful to just
describe the prevalence with a single number.
Estimates of the Prevalence of Tinnitus
Data from the National Center for Health Statistics,
US Department of Health, Education, and Welfare
(1968), indicate that 30% of the general population
are affected by tinnitus, and that 6% of them (1.8% of
the general population) have incapacitating symptoms
[2]. Other studies have presented values of prevalence
that vary between 7.6 and 20.1% (see Table 5.1).
Prevalence of Tinnitus as a Function
of Age
One of the main variables in the prevalence of tinnitus is
age, and studies have therefore expressed the prevalence
of tinnitus as a function of age. Table 5.1 compares the
315 Epidemiology of Tinnitus in Adults
reported prevalence in several studies from the United
Kingdom, Sweden, Norway, and the US.
All published studies show values of prevalence of
tinnitus that are not the same for different age groups.
All published studies seem to agree that the risk of get-
ting tinnitus increases with age up to about 65 years,
after which age prevalence is either independent of or
decreases slightly with increasing age.
The design of the studies, the results of which are
shown in Table 5.1, all had differences, which make it
difficult to compare the results. The first study (United
Kingdom National Study of Hearing) used a postal
questionnaire sent to people in Cardiff, Glasgow,
Nottingham, and Southampton in age groups between
17 and more than 80 years. In the questionnaire, tin-
nitus was defined as “prolonged spontaneous tinnitus”
that lasts for more than 5 min and occurs not exclu-
sively after loud sounds [5].
In the study from Gothenburg, Sweden, question-
naires were mailed and had blinded response (no follow-
up of non-responders). Tinnitus was defined as an ear
noise that occurs “often or alwaysand sounds like a
peep, chirping, roaring, wind blowing in the trees, etc.,
[6]. In the same study, 2.4% of the population suffered
from the worst severity degree defined as “tinnitus
plaques me all day.
The United States National Health Interview Survey
(US NHIS) is a household survey with personal inter-
views of non-institutionalized civilians from randomly
chosen areas constituting a nationally representative
sample. The participants in this study had tinnitus that
was defined as “having been bothered by ringing in the
ears or other funny noises in the head in the past
12 months” [7]. The 1994–1995 US NHIS Disability
Supplement study, Phase I, used an impairment and
disability-screening questionnaire. Chronic tinnitus
was defined in the interview as “now having a ringing,
roaring, or buzzing in the ears that has lasted for at
least 3 months” [8, 9].
The participants in the Beaver Dam, WI Hearing
Loss study had significant tinnitus that was defined as
“buzzing, ringing, or noise in the ears in the past year
of at least moderate severity and/or tinnitus that caused
difculty in falling asleep” (Nondahl 2002) [10].
The Nord Trondelag, Norway Hearing Loss study
used a self-administered questionnaire filled out in
study clinics prior to the hearing examination [11].
Tinnitus was defined as “bothered by ringing in the
ears.” The participants in this study were thus individ-
uals who had sought professional help for their tinni-
tus. The results may therefore not be representative of
the general population.
While there are large differences between the values
of prevalence arrived at by different studies, there is
agreement that the prevalence of tinnitus increases
with age. Less clear is the relationship to gender, but
studies show a tendency for tinnitus to occur more fre-
quently in men than in women. Epide miological stud-
ies of prevalence show a slightly larger prevalence of
tinnitus in men, but the results are not consistent.
Most studies show an increase in the prevalence of
tinnitus with age in the age groups up to 65–74 and
considerably lower prevalence in individuals above
75 years than in the age group of 65–74 years. Since
tinnitus of an individual rarely decreases the preva-
lence arrived at in epidemiologic studies, at least up to
Table 5.1 Prevalence of self-reported tinnitus in adults by decade of life from several population-based, epidemiologic studies
Age (year) I (%) II (%) III (%) IV (%) V (%) VI (%)
20–29 5.7 7.5 5.1 1.4 9.8
30–39 7.4 5.8 6.0 2.0 9.6
40–49 9.9 8.9 7.2 3.7 11.8
50–59 12.5 18.6 10.1 5.7 7.3 16.9
60–69 16.3 20.3 13.0 7.9 10.1 20.2
70–79 14.4 21.3 12.6 9.4 8.7 24.0
>80 13.6 14.1 8.3 5.5 22.9
<50 14.2 20.1 12.1 7.6 8.2 20.1
Adult 10.2 14.2 8.4 4.4 15.1
Participants 34,050 2,556 59,343 99,435 3,737 47,410
I: United Kingdom National Study of Hearing (1980–1986); II: Gothenburg, Sweden (1989); III: US NHIS Hearing Supplement
(1990); IV: Disability Supplement (1994–1995); V: Beaver Dam, WI Hearing Loss Study (1993–1995); VI: Nord Trondelag, Norway
Hearing Loss Study (1996–1998)
Data from Hoffmann and Reed [4]
32 A.R. Møller
the age of 70 can be regarded as being cumulative,
above which it does not seem to increase very much.
This pattern of age relations of prevalence of tinni-
tus is clearly seen in the graphic representation of the
results of another study (Fig. 5.1).
This graph shows that the prevalence of tinnitus for
both men and women increases with age and that it
levels out and even decreases above a certain age. The
prevalence of tinnitus is higher for men than for women
up to the age of 75, and the prevalence of tinnitus
reaches its highest value earlier in life for men than for
women. At the age of 75, the prevalence in women
catches up with that of men, and above the age of 75
the prevalence of tinnitus is about the same for men
and women. This pattern is thus similar to that of the
prevalence of cardiovascular disease.
That the prevalence is less in the group of 80 years
of age may have to do with tinnitus being associated
with diseases, which may have caused early death.
Therefore, those who die before the age of 80 may have
had a higher prevalence of tinnitus than those who live
beyond the age of 80 years. Again, it may suggest that
tinnitus has similar risk factors as diseases that can
cause early death, such as cardiovascular disorders.
Animal studies have shown that rats genetically
predisposed for high blood pressure also acquire more
hearing loss from noise exposure than animals not
genetically predisposed for hypertension (normotensive
rats) [12, 13]. There may also be (unknown) relations
between cardiovascular factors and tinnitus in humans.
Those individuals who survive the age of 80 may,
thus, have fewer risk factors that shorten lifespan and
which are the same risk factors for tinnitus. It may
therefore be more representative to compare the values
for the higher age groups, such as the 60–69 years,
where the prevalence arrived at in different studies
varies between 20.3 and 8.7%.
Other studies found similar trends of prevalence of
tinnitus increasing with age between 50 and 75 years,
above which the prevalence decreased in two different
studies: one from the US and one from Australia
(Table 5.2).
It has been pointed out that the influence on daily
life from tinnitus is different and that the ways in which
questions asked of participants in epidemiologic studies
Fig. 5.1 Age- and sex-specific prevalence (in percentage of total
study population) of chronic tinnitus (“ringing, roaring or buzzing
in the ears or head now that has lasted at least 3 months”), based
on 1994–1995 US National Health Interview Survey Disability
Supplement. The study had 99,435 participants. Reproduced from
Hoffman and Reed [4] with permission by BC Decker Inc.
Table 5.2 Tinnitus prevalence by age and gender (%),
standardized to the Australian population, using 1996 Australian
census data
Age (years) Women Men Participants
< 60 23.6 32.3 28.0
60–69 30.5 35.1 32.7
70–79 28.7 32.7 30.5
80+ 27.7 21.5 25.4
All ages 28.6 32.2 30.3
Data from Sindhusake et al. [14]
5 Epidemiology of Tinnitus in Adults
are formulated influence the results. This is one of the
reasons for the difference in results of epidemiologic
A study from four cities in the UK (Table 5.3) [15],
which reported that tinnitus occurred in an average of
17.5% of individuals, showed that annoyance was clas-
sified to be moderate or severe in 5.3% on average for
the cities studied. This study also showed a similar pat-
tern of age relationship (14.5% in persons younger
than 40 years, 17.5% in the group of 40–60 years, and
22.2% in individuals older than 60 years).
Although the reported prevalence of tinnitus varies
between different studies, twenty percent of people
who say they have tinnitus reported their condition
as “severe tinnitus. This means that about 80% of
patients with tinnitus suffer little and are not seeking
Hearing Loss and Tinnitus
A study shows that the risk of having tinnitus (expressed
as odds ratio1) increases with the degree of hearing loss
at 4 kHz [16] (Fig. 5.2)
Table 5.3 Percentages of adult population reporting tinnitus and its effects
Cardiff Glasgow Nottingham Southampton
Starting number (N) 1035 2,787 1,028 1,954
Usable replies (N) 730 (71%) 2,033 (75%) 726 (71%) 1,511 (77%)
Tinnitus (%) 17.9 18.6 18.1 15.5
Annoyance: moderate (%) 4.1 4.1 4.4 3.8
Severe (%) 0.7 2.8 0.4 0.7
Combined (%) 4.8 6.9 4.8 4.5
Sleep disturbance (%) 3.8 7.3 5.4 4.4
Severe effect on life (%) 0.4 0.5 0.4 0.5
Data from Coles [15]
1Odds ratio: A measure of the size of an effect describing the
strength of association between two binary data values. It is dif-
ferent from the relative risk because it treats the two variables to
be compared symmetrically.
Fig. 5.2 Bar graph showing how the odds of having tinnitus
increase as hearing threshold level (HTL) at 4 kHz increases in
the United Kingdom National Study of Hearing. Because the
prevalence of tinnitus in people with 4 kHz thresholds less than
10 dB (the reference group) was about 1%, the odds ratios in this
case are very close to the actual prevalence rates in percentage.
After Coles [16]. Reproduced from Dobie [1] with permission
from BC Decker Inc
1019 dB: < 10 dB
2029 dB: < 10 dB
3039 dB: < 10 dB
4049 dB: < 10 dB
5059 dB: < 10 dB
6069 dB: < 10 dB
7079 dB: < 10 dB
80+ dB: < 10 dB
611 16 21 26 31
Odds Ratio
HTL at 4 kHz in Better Ear
34 A.R. Møller
“Trouble Tinnitus” Compared
with “Trouble Hearing”
There is considerable difference between having
tinnitus and being troubled by tinnitus (having “trouble
tinnitus”). The same is the case for hearing; having
“trouble hearing” is a distinction from just having
hearing loss. In a study based on the US National
Health Interview Survey, participants were asked to
report whether they had a “lot of trouble hearing” or
“any trouble hearing,” and for tinnitus the participants
were asked if they had “bothersome tinnitus.” In this
study, the reported hearing trouble only increased
slightly after age of 65, when self-reported problems
were concerned (Fig. 5.3).
It is evident that while hearing loss increases mono-
tonically with age, the prevalence of bothersome
tinnitus levels off and even decreases after the age of
70 years, thus, in agreement with other studies reported
above. That bothersome tinnitus reaches a level of
about 14% in the 65- to 74-year age group should be
Can Hearing Loss Cause Tinnitus?
The prevalence of tinnitus increases with age, and it
has been discussed whether hearing loss can be a
contributing cause of this increase in the prevalence of
tinnitus with age. Audiometric data show that hearing
loss increases with age [17, 18] (see Chap. 36) The
results of studies discussed in this chapter show that
the prevalence of tinnitus increases with age, but it is
not known if it is age-related changes in the ear and the
nervous system that cause the tinnitus to increase with
age or if it is the age-related hearing loss that causes
the increase in prevalence of tinnitus. Population stud-
ies have shown that individuals with tinnitus, on aver-
age, have hearing loss affecting mostly high frequencies
[19] (Fig. 5.4).
Other studies (Table 5.4) have confirmed the differ-
ence in prevalence of tinnitus between men and women.
There is considerable evidence that deprivation
of input to the auditory nervous system can cause
tinnitus (see Chaps. 11–13 and 21). There is also evi-
dence that noise exposure can cause hearing loss (see
Chap. 37), but it is not known if it is the noise expo-
sure, as such, or the associated hearing loss that causes
the tinnitus.
The hearing loss shown in Fig. 5.4 is slightly greater
in males than in females, resembling what is found in
population studies of hearing and showing signs of a
4-kHz dip, indicating that some of the hearing loss is
likely to have been caused by noise exposure.
As an example of the diversity of tinnitus, it has
been shown that the type of hearing (shape of the
audiogram) is related to the character of the tinnitus
Fig. 5.3 Prevalence of
self-reported hearing loss (“lot
of trouble hearing” or “any
trouble hearing”) and bother-
some tinnitus. Reproduced from
Hoffmann and Reed [4] with
permission by BC Decker Inc.;
based on US National Health
Interview Survey, Hearing
Supplement 1990
5 Epidemiology of Tinnitus in Adults
(Fig. 5.5). Patients with low-pitched tinnitus
(<1,500 Hz) tend to have much more severe hearing
losses, especially in the low frequencies, than do
patients with higher pitched tinnitus.
Again, it must be emphasized that these data are
also from tinnitus clinics, thus, only including people
who have sought professional help. While tinnitus
does occur in individuals with normal hearing, people
with tinnitus usually have hearing loss, and deprivation
of sound activation of the nervous system can cause
tinnitus by activating neural plasticity, as discussed in
Chap. 12. However, the prevalence of troubled tinnitus
does not increase above the age of 65, while audiomet-
ric hearing loss does continue to increase with age
above 65.
The fact that tinnitus cannot be measured objec-
tively as can hearing loss means that comparing tinni-
tus with audiometrical hearing loss may be regarded to
be an invalid comparison. However, as seen in Fig. 5.3,
the subjective trouble with hearing also increases with
age while the prevalence of tinnitus is not changing
above the age of 65. This could be because the debut of
tinnitus above that age is rare or that some individuals
who had tinnitus before the age of 65 improve and that
counteracts an increase in the new cases of tinnitus.
This question cannot be answered because the natural
history of tinnitus is poorly known. Studies that have
concerned the natural history of tinnitus have only
reported on the presence of the dis order, not its sever-
ity [20, 21, 22] or how the individuals perceive their
tinnitus. There are two reasons why the prevalence of
tinnitus may be higher in a population of individuals
with hearing loss. One reason is that hearing loss
implies a certain degree of deprivation of input to the
auditory system (see Chap. 11), which is known to be
able to activate neural plasticity, and known to be
involved in many forms of tinnitus (see Chaps. 12 and
13). Another reason that there may be a relationship
between the prevalence of tinnitus and hearing loss is
that the same factors that cause hearing loss may cause
tinnitus. Such common factors may be age, cardiovas-
cular disorders, and noise exposure.
When the kind of tinnitus individuals with hearing
loss have is correlated with the shape of their audio-
grams, it follows that there are distinct correlations
between the pitch of an individual’s tinnitus and the
Fig. 5.4 Mean hearing thresholds in the right ear for female and
male patients with tinnitus. Data are from patients who attended
a tinnitus clinic. From Henry et al. [19]
Table 5.4 Prevalence in percentages for males and females
Age Male (%) Female (%)
18–24 4.3 5.2
25–24 5.8 6.2
45–64 10.6 9.5
65+ 12.3 13.9
Prevalence based on a self report of “bothersome tinnitus” as a
function of age, sex, and percentage of each characteristic in the
population; based on the 1990 Hearing Supplement to the
National Health Interview Survey. Data from Hoffmann and
Reed [4]
Fig. 5.5 Mean hearing threshold of the right ear for individuals
in each group of patients according to the pitch of their tinnitus.
Data are from patients who attended a tinnitus clinic. From
Henry et al. [19]
36 A.R. Møller
individual’s audiogram (Fig. 5.5). This is yet another
complexity of tinnitus that makes it difficult to estab-
lish clear data on its prevalence.
It was shown in a study of patients with tinnitus of
different pitch that patients with low-pitched tinnitus
(less than 1,500 Hz) tend to have much more severe
hearing losses, especially at the low frequencies, than
do patients with higher pitched tinnitus.
The studies reported in the two preceding graphs
concerned patients who had sought help for their tin-
nitus. This means that the participants do not represent
a random selection of people. There are many reasons
why people seek professional help and equally many
reasons why people do not seek professional help.
Other Risk Factors for Tinnitus
Noise exposure and noise that induced hearing loss is
another factor anecdotally reported to cause tinnitus in
Risk factors for tinnitus other than age are hearing
loss, diseases such as middle-ear disorders, Ménière’s
disease, cerebrovascular diseases, and, in particular,
hearing loss of various causes and environmental fac-
tors such as exposure to noise and administration of
certain medications such as ototoxic antibiotics and
Noise exposure increases the risk of tinnitus, and, at
the same time, it causes hearing loss. The question is,
therefore, if the tinnitus from noise exposure is caused
by the hearing loss associated with noise exposure. The
increased prevalence of tinnitus in males may have to
do with the increased noise exposure in males and sub-
sequent higher frequency of hearing loss in men [17].
Tinnitus and Suffering
Tinnitus is a sensation, and suffering may be related to
and possibly a consequence of having tinnitus. The
prevalence of tinnitus, counting all forms, is of little
interest from a health care perspective because most
individuals with tinnitus are not bothered to an extent
that it affects their daily life, and few will seek medical
attention except for those who want to be sure that
their tinnitus is not a sign of a serious disease. In that
way, tinnitus has similarities with pain. Most people
have experienced pain in one form or another, but only
a few have severe pain that causes suffering.
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... Tinnitus can be described as a squeaking, buzzing, humming, or clicking, either in the ears or in the head [8,10]. Epidemiology suggests the problem affects between 4% and 15% of the adult population and shows an increasing trend [10,11]. ...
Background: Tinnitus is a phantom auditory sensation in the absence of an external stimulus. It is accompanied by a broad range of negative emotional symptoms and a significantly lower quality of life. So far, there is no cure for tinnitus, although various treatment options have been tried. One of them is mobile technology employing dedicated apps based on sound therapy. The apps can be managed by the patient and tailored according to their needs. Objective: The study aims to assess the effect of a mobile app that generates background sounds on the severity of tinnitus. Methods: The study involved 68 adults who had chronic tinnitus. Participants were divided into a study group (44 patients) and a control group (24 patients). For 6 months those in the study group used a free mobile app that enriched the sound environment with a background sound. Participants were instructed to use the app for at least 30 minutes a day using their preferred sound. The participants in the control group did not use the app. Subjective changes in the day-to-day functioning of both groups were evaluated using the Tinnitus Handicap Inventory (THI) questionnaire, a visual analog scale, and a user survey. Results: After 3 months of using the app, the THI global score significantly decreased (P<.001) in the study group, decreasing again at 6 months (P<.001). The largest improvements were observed in the emotional and catastrophic reactions subscales. A clinically important change in the THI was reported by 39% of the study group (17/44). Almost 90% of the study participants (39/44) chose environmental sounds to listen to, the most popular being rain and ocean waves. In the control group, tinnitus severity did not change over 3 or 6 months. Conclusions: Although the participants still experienced limitations caused by tinnitus, the advantage of the app was that it led to lower negative emotions and thus reduced overall tinnitus severity. It is worth considering whether a mobile app might be incorporated into the management of tinnitus in a professional setting.
... Knowledge about the prevalence of a disease is important for the organization of healthcare and prevention of the condition (5). Moreover, in the conceptual analysis "Why is there no cure for tinnitus" published in 2019, several other consequences were related to the lack of more detailed knowledge about prevalence numbers such as the lack of improvement in pharmacological therapies (6). ...
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Introduction: Tinnitus prevalence numbers in the literature range between 5 and 43%, depending on the studied population and definition. It is unclear when tinnitus becomes pathologic. Objectives: To assess the tinnitus prevalence in the Dutch general population with different cutoffs for definition. Methods: In this cross-sectional study, a questionnaire was sent to a sample ( n = 2,251) of the Nivel (Netherlands Institute for Health Services Research) Dutch Health Care Consumer Panel. Three questions were asked to assess the presence of tinnitus, duration, and frequency of the complaint. We classified people as having pathologic tinnitus when participants experienced it for 5–60 min (daily or almost daily or weekly), or tinnitus for >60 min or continuously (daily or almost daily or weekly or monthly), so tinnitus impact on daily life was measured with the Tinnitus Functional Index (TFI) and a single-item question. Answers were stratified to mid-decade years of age. Prevalence numbers were weighted by gender and age to match the Dutch population. Results: Nine hundred thirty-two of 2,251 participants (41%) filled out the questionnaire. The median age was 67.0 ( IQR 17) years. Three hundred thirty-eight of 932 (36%) experienced tinnitus for an undefined amount of time during the last year. Two hundred sixteen of 932 (23%) met our definition of having pathologic tinnitus (21% when weighted for age and gender). The median TFI score for all pathologic tinnitus participants was 16.6 ( IQR 21.8). A percentage of 50.4% of the pathologic tinnitus participants had a TFI in the range 0–17, which can be interpreted as not a problem. Conclusion: Twenty-three percent (unweighted) or 21% (weighted) of our sample met our definition of pathologic tinnitus, which was based on a combination of duration and frequency over the last year. The TFI score of 47.7% of the pathologic tinnitus participants is ≥18. This indicates that they consider the tinnitus to be at least “a small problem” [11.1% (unweighted) or 8.9% (weighted) of the total study group]. This study illustrates the difficulties with defining pathologic tinnitus. In addition, it demonstrates that tinnitus prevalence numbers vary with different definitions and, consequently, stresses the importance of using a uniform definition of tinnitus.
... Heterogeneity in phenotypic (i.e. observable) characteristics of people with tinnitus can be assessed in many ways, such as in differences in demographic characteristics, presence of comorbidities, tinnitus perceptual characteristics and the impact of tinnitus on the affected individual (Møller 2011;Ward et al. 2015;Koops, Husain, and van Dijk 2019;Lugo et al. 2020). Often, studies aim to identify subgroups with similar phenotypic characteristics, that could be associated with different tinnitus subtypes in terms of underlying mechanisms van den Berge et al. 2017). ...
Objective To our knowledge, there is no published study investigating the characteristics of people experiencing tinnitus in Albania. Such a study would be important, providing the basis for further research in this region and contributing to a wider understanding of tinnitus heterogeneity across different geographic locations. The main objective of this study was to develop an Albanian translation of a standardised questionnaire for tinnitus research, namely the European School for Interdisciplinary Tinnitus Research-Screening Questionnaire (ESIT-SQ). A secondary objective was to assess its applicability and usefulness by conducting an exploratory survey on a small sample of the Albanian tinnitus population. Design and study sample Three translators were recruited to create the Albanian ESIT-SQ translation following good practice guidelines. Using this questionnaire, data from 107 patients attending otolaryngology clinics in Albania were collected. Results Participants reporting various degrees of tinnitus symptom severity had distinct phenotypic characteristics. Application of a random forest approach on this preliminary dataset showed that self-reported hearing difficulty, and tinnitus duration, pitch and temporal manifestation were important variables for predicting tinnitus symptom severity. Conclusions Our study provided an Albanian translation of the ESIT-SQ and demonstrated that it is a useful tool for tinnitus profiling and subgrouping.
... Eines der am weitesten verbreiteten Modelle der Tinnitusentstehung beschreibt das Ohr- Regelfall begleitend auftretenden Inhibitionsprozesse Tinnitus erzeugen (Møller, 2011b (Bartels, Staal & Albers, 2007). Mertin und Kröner-Herwig (1997) ...
br/>Subjektiver Tinnitus bezeichnet eine Geräuschwahrnehmung in Abwesenheit einer objek- tivierbaren Schallquelle. Etwa 5% der Bevölkerung sind von chronischem Tinnitus betroffen, von denen etwa 17% stark unter dem Ohrgeräusch leiden. Dieses Leiden hängt dabei nur schwach mit der Lautheit des Tinnitus zusammen. Unter anderem werden Aufmerksamkeitsfokus auf den Tinnitus und seine dysfunktionale Bewertung als Bedingungen für die Tinnitusbelastungsentstehung und -aufrechterhaltung gesehen. Verschiedene neurophysiologische Modelle betonen eine Rolle limbischer Regionen bei Tinntusbelastung. Daneben sollen frontale Regionen und der Precuneus eine Rolle spielen, wobei mehrere Studien besonders eine Beteiligung frontaler und limbischer Areale bei Tinnitusbelastung unterstützen. Ergänzend zu Resting-State Studien sollten neuronale Korrelate von Tinnitusbelastung erstmalig in einem aufgabengeleiteten (task-driven) Ansatz mittels funktioneller Magnetreso- nanztomographie untersucht werden. In zwei Studien wurden hoch und niedrig belastete Tinni- tusbetroffene sowie gesunde Kontrollprobanden untersucht Die Aktivierung von Hirnregionen, die mit Tinnitusbelastung assoziiert sind, sollte in Studie 1 über die Darbietung negativer tinni- tusbezogener Sätze angeregt werden. In Studie 2 wurde ein Emotional Stroop Task eingesetzt, um Prozesse selektiver Aufmerksamkeit auf tinnitusbezogene Wörter und deren emotionale Verarbeitung zu untersuchen. In Studie 1 zeigte die hoch belastete Gruppe stärkere Aktivierungen in frontalen und lim- bischen Arealen gegenüber gesunden Kontrollprobanden, sowie im Vergleich zu niedrig belaste- ten Tinnitusbetroffenen im linken mittleren frontalen Gyrus. Tinnitusbelastung korrelierte erwar- tungskonform mit der Stärke der Aktivität limbischer und frontaler Regionen. In Studie 2 zeigte sich auf Verhaltensebene kein Interferenzeffekt für tinnitusbezogene Wörter bei hoch belasteten Probanden. Neuronal zeigten hoch belastete Tinnitusbetroffene stärkere Aktivierungen in der rechten Insula und frontalen Arealen gegenüber der niedrig belasteten Gruppe. Es gab keine hypothesenkonformen Unterschiede im Vergleich zu gesunden Kontrollprobanden. Die Höhe der Tinnitusbelastung korrelierte allerdings erwartungskonform mit der Stärke der Aktivität in der rechten Insula und dem rechten inferioren frontalen Gyrus. Übereinstimmend fand sich in beiden Studien eine Beteiligung des linken mittleren und des rechten inferioren frontalen Gyrus sowie der zentralen Insula. Der linke mittlere frontale Gyrus könnte eine Funktion bei der Aufrechterhaltung negativer tinnitusbezogener Information im Arbeitsgedächtnis haben, während der rechte inferiore frontale Gyrus mit der Salienz von Reizen in Verbindung gebracht wird. Der zentrale Teil der Insula ist mit Interozeption assoziiert, die eng mit emotionaler Verarbeitung in Beziehung steht. Der linke mittlere und der rechte infer- iore frontale Gyrus könnten sich als Zielregionen für neuromodulatorische Ansätze eignen. Zu- künftige Studien sollten hochbelastete Tinnitusbetroffene vor und nach einer belastungsreduzie- renden kognitiven Verhaltenstherapie mittels funktioneller Magnetresonanztomographie untersuchen.
... Tinnitus is the perception of sound without an external stimulus, often experienced as a ringing or buzzing sound. 1 2 It is a common symptom with an approximate prevalence of 10%-30%, depending on the selected population, 3 increasing to 30% of adults over the age of 50 years. 4 Tinnitus can be chronic and disabling for those individuals affected by it. ...
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Introduction Tinnitus is the perception of sound without an external stimulus, often experienced as a ringing or buzzing sound. Subjective tinnitus is assumed to origin from changes in neural activity caused by reduced or lack of auditory input, for instance due to hearing loss. Since auditory deprivation is thought to be one of the causes of tinnitus, increasing the auditory input by cochlear implantation might be a possible treatment. In studies assessing cochlear implantation for patients with hearing loss, tinnitus relief was seen as a secondary outcome. Therefore, we will assess the effect of cochlear implantation in patients with primarily tinnitus complaints. Method and analysis In this randomised controlled trial starting in January 2021 at the ENT department of the UMC Utrecht (the Netherlands), patients with a primary complaint of tinnitus will be included. Fifty patients (Tinnitus Functional Index (TFI) > 32, Beck’s Depression Index <19, pure tone average at 0.5, 1, 2 and 4 kHz: bilateral threshold between 50 and ≤75 dB) will be randomised towards cochlear implantation or no intervention. Primary outcome of the study is tinnitus burden as measured by the TFI. Outcomes of interest are tinnitus severity, hearing performances (tinnitus pitch and loudness, speech perception), quality of life, depression and patient-related changes. Outcomes will be evaluated prior to implantation and at 3 and 6 months after the surgery. The control group will receive questionnaires at 3 and 6 months after randomisation. We expect a significant difference between the cochlear implant recipients and the control group for tinnitus burden. Ethics and dissemination This research protocol was approved by the Institutional Review Board of the University Medical Center (UMC) Utrecht (NL70319.041.19, V5.0, January 2021). The trial results will be made accessible to the public in a peer-review journal. Trial registration number Trial registration number NL8693; Pre-results.
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Background Currently, there are no objective markers to measure treatment efficacy in chronic (distressing) tinnitus. This study explores whether stress-related biomarkers cortisol and brain-derived neurotrophic factor (BDNF) measured in hair samples of chronic tinnitus patients change after compact multimodal tinnitus-specific cognitive behavioral therapy. Methods In this longitudinal study, hair-cortisol and hair-BDNF levels, self-reported tinnitus-related distress (Tinnitus Questionnaire; TQ), and perceived stress (Perceived Stress Questionnaire; PSQ-20) were assessed before and 3 months after 5 days of treatment in N = 80 chronic tinnitus patients. Linear mixed-effects models with backward elimination were used to assess treatment-induced changes, and a cross-lagged panel model (structural equation model) was used for additional exploratory analysis of the temporal associations between TQ and hair-BDNF. Results At follow-up, a reduction in TQ ( p < 0.001) and PSQ-20 scores ( p = 0.045) was observed, which was not influenced by baseline hair-cortisol or hair-BDNF levels. No changes in biomarker levels were observed after treatment. The exploratory analysis tentatively suggests that a directional effect of baseline TQ scores on hair-BDNF levels at follow-up (trend; p = 0.070) was more likely than the opposite directional effect of baseline hair-BDNF levels on TQ scores at follow-up (n.s.). Discussion While the treatment effectively reduced tinnitus-related distress and perceived stress in chronic tinnitus patients, this effect was not mirrored in biological changes. However, the lack of changes in hair-cortisol and hair-BDNF levels might have been influenced by the treatment duration, follow-up interval, or confounding medical factors, and therefore must be interpreted with caution. The relationship between tinnitus-related distress and hair-BDNF levels should be explored further to obtain a better understanding of stress-related effects in chronic tinnitus.
Background: Few studies have examined the associations of temporomandibular disorders (TMDs) and tinnitus with health-related quality of life on a national level. Objective: We aimed to investigate the associations of TMDs, tinnitus, and quality of life among the Korean population, aged 19 years or older. Methods: Data was obtained from the fifth Korea National Health and Nutrition Examination Survey (2012; N = 5,786). TMDs, tinnitus, and health-related quality of life were assessed using self-report data from EuroQol-5 Dimension. Participants were divided into four groups: no TMD and no tinnitus, TMD present but no tinnitus, no TMD but tinnitus present, and both TMD and tinnitus present. Results: Among the participants, 21.88% had TMD, 24.93% had tinnitus, and 7.74% had both. The prevalence of most TMD and all types of tinnitus was higher among females than among males. The group with both TMD and tinnitus reported the highest percentage of problems in the usual activity, pain/discomfort, and anxiety/depression dimentions. Moreover, the odds ratio (OR) for lower quality of life was significantly higher in the group with both TMD and tinnitus compared to the group without TMD and tinnitus: mobility (OR = 1.527, 95% Confidence Interval [CI]: 1.014-2.300), pain/discomfort (OR = 2.072, 95% CI: 1.570-2.735), anxiety/depression (OR = 1.692, 95% CI: 1.034-2.767), EQ-5D score (OR = 1.651, 95% CI: 1.121-2.431), and EQ-VAS (OR = 1.682, 95% CI: 1.246-2.269). Conclusion: The presence of both TMD and tinnitus has a considerable impact on HRQoL in the Korean population. In our study, the group with both TMD and tinnitus showed lower HRQoL than without TMD and tinnitus group. These results emphasize the need for a multilateral and comprehensive approach to address these disorders, and provide baseline data for developing appropriate interventions.
Objective Self-help (without specialist support) can play an important role in tinnitus therapy. The purpose of this study was to investigate what fraction of subjects with tinnitus use self-help, what techniques are most commonly used to reduce tinnitus severity, and what distinguishes patients that use self-help from others. Design retrospective, observational study Study sample Adult patients admitted to our hospital clinic (460 participants) aged 19–83 years and reporting chronic tinnitus. The survey concerned therapy attempts prior to the clinic visit as well as self-help techniques chosen freely by the patient to reduce tinnitus severity. Results Data showed that 40.9% of the respondents chose some action themselves to reduce their tinnitus severity. Among the reported self-help techniques, acoustic stimulation was the most popular. In addition, patients chose distraction attention, relaxation, meditation, yoga, and physical activity. The likelihood of undertaking self-help increases with better education and higher tinnitus severity. Conclusions Knowledge about patients’ preferences of forms of self-help may help the health practitioner suggest a more suitable form of therapy. Due to the great interest in using sound therapy in tinnitus, it would be worthwhile looking at new forms of this therapy, for example increasingly popular mobile applications.
Tinnitus represents one of the most common and distressing otologic problems, and it causes various somatic and psychological disorders that interfere with the quality of life. This study aimed to compare the outcome of music therapy, tinnitus maskers and pharmacotherapy on patients with chronic tinnitus, to observe and analyse the etiological factors of tinnitus and to find out whether music can be used as an active listening mode by which tinnitus perception can be decreased. This was a comparative longitudinal study involving 90 patients with chronic tinnitus who were randomly assigned to 3 groups of 30 each: Group A (Music therapy), Group B (Pharmacotherapy) and Group C (Tinnitus masker). After a detailed clinical history and examination, Tinnitus Handicap Inventory and Visual Analogue Scores were recorded both prior to and following therapy, and patient were followed up monthly up to 2 months. There is a significant difference in the mean THI score (p = 0.002) and mean VAS(p = 0.0006) at 2 months follow up in patients treated with Music therapy and patients had a satisfactory outcome after music therapy and did not require any further treatment. Patients in pharmacotherapy and hearing aid group had a good clinical improvement but mean THI and mean VAS score was not statically significant. It was also noticed that loud noise exposure and hypertension were main etiological factors in 37.77% and 26% of patients respectively. Music therapy appears to be an effective and cost-efficient mode of therapy for chronic tinnitus and could be suitable for widespread implementation for patients with tinnitus of varying severity. Pharmacotherapy and hearing aid application in the treatment of tinnitus has good outcome in our study but requires long term treatment and follow up.
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Tinnitus disability is a heterogeneous and complex condition, affecting more than 10% and compromising the quality of life of 2% of the population, with multiple contributors, often unknown, and enigmatic pathophysiology. The available treatment options are unsatisfactory, as they can, at best, reduce tinnitus severity, but not eliminate its perception. Given the spread of tinnitus and the lack of a standardized treatment, it is crucial to understand the economic burden of this condition. We conducted a systematic review of the literature on PubMed/MEDLINE, Embase, the Cochrane Database of Systematic Reviews (CDSR) and Google Scholar, in order to identify all the articles published on the economic burden of tinnitus before 1 April 2021 (PROSPERO—International prospective register of systematic reviews—No: CRD42020180438). Out of 273 articles identified through our search strategy, only five articles from studies conducted in the United States of America (USA), the Netherlands and the United Kingdom (UK) provided data on tinnitus’s economic costs. Three studies provided mean annual estimates per patient ranging between EUR 1544 and EUR 3429 for healthcare costs, between EUR 69 and EUR 115 for patient and family costs and between EUR 2565 and EUR 3702 for indirect costs, including productivity loss. The other two studies reported an annual mean cost of EUR 564 per patient for tinnitus-related clinical visits, and total costs of EUR 1388 and EUR 3725 for patients treated with a sound generator and Neuromonics Tinnitus Treatment, respectively. Our comprehensive review shows a gap in the knowledge about the economic burden of tinnitus on healthcare systems, patients and society. The few available studies show considerable expenses due to healthcare and indirect costs, while out-of-pocket costs appear to be less financially burdensome. Comprehensive health economic evaluations are needed to fill the gaps in current knowledge, using a unified method with reliable and standardized tools.
A representative subsample of a cohort of 70 year olds has been investigated at the age of 70, 75 and 79 years. The reports of tinnitus on the three occasions have been studied longitudinally on an individual level. The results indicated substantial longitudinal fluctuations in tinnitus with a high occurrence of spontaneous remission in elderly people. The high rate of remissions is remarkable and might have a profound effect on the services and advice given to tinnitus patients. The findings of longitudinal fluctuations in tinnitus may shed new light upon reported results from several tinnitus treatment studies, where both the placebo effect and such longitudinal fluctuations in tinnitus could account for part of the decrease in tinnitus.
Pure-tone audiometry was administered to the adult population in Nord-Trøndelag County, Norway, 1995–97. The 51975 participants also provided questionnaire information about occupational and leisure noise exposure, previous ear infections, and head injury. Values averaged over both ears were calculated for low (250 and 500 Hz), middle (1 and 2 kHz) and high frequencies (3, 4, 6 and 8 kHz). The aim was to estimate the magnitude of hearing loss associated with various types of exposure by age and sex. Noise, ear infections and head injury explained 1–6% of the variance in hearing loss (varying with age, sex, and frequency range), in addition to what could be explained by age alone (30–58%). Only moderate effects of noise could be detected among women. The upper tenth percentile regarding occupational noise among men older than 44 years had on average an 8–9-dB high-frequency loss, adjusted for other predictors. Exposure to impulse noise (hunting, sports shooting) caused a 7–8-dB high-frequency loss in the same group. No significant effects of freq uent use of personal stereo players or regular attendance at discotheques or rock concerts could be demonstrated. There were clear effects of recurrent ear infections and head injury. Se practicó audiometría de tonos puros a la población adulta del condado de Nord-Trøndelag en Noruega de 1995 a1997. Los 51,975 parti-cipantes también respondieron un cuestionario sobre exposición al ruido por razones laborales o de entretenimiento, sobre infecciones previas del oido y sobre lesiones cefálicas. Se calcularon los valores promediados en ambos oídos para las bajas (250 y 500 Hz), medias (1 y 2 kHz) y altas frecuencias (3, 4, 6 y 8 kHz). El objetivo del estudio fue estimar la magnitud de la pérdida auditiva asociada a varios tipos de exposición por cdad y sexo. El ruido, las infecciones del oido y las lesiones cefálicas explicaron 1–6% de la variancia en las pérdidas auditivas, (variando con la edad, sexo y rango de frecuencias) además de lo que podria explicarse únicamente por la edad (30–58%). Entre las mujeres solo se pudieron detectar efectos modcrados del ruido. El percentil decimal superior relacionado con ruido ocupacional entre hombres mayores de 44 años tuvo un promedio de 8–9 dB de pérdida en las frecuencias agudas en el mismo grupo. La exposición a ruido impulsivo (tiro y caza) causaron una pérdida de 7–8 dB en las frecuencias agudas, en el mismo grupo. No se demostraron efectos significativos por el uso frecuente de reproductores stereo personales o por la asistencia regular a discotecas o conciertos de rock. Si se encontraron efectos claros relacionados con las infecciones recurrentes de oidos y con las lesiones cefálicas.
There have been few recent estimates of the prevalence of tinnitus from large population-based samples of older persons. Our study aimed to assess the prevalence and characteristics of prolonged tinnitus in a representative sample of 2015 adults aged 55-99 years, residing in the Blue Mountains, west of Sydney, Australia, during 1997-99. All participants underwent a detailed hearing examination by an audiologist, including comprehensive questions about hearing. After age adjustment, subjects reporting tinnitus had significantly worse hearing at both lower and higher frequencies (p<0.001). This difference was more marked in younger than in older subjects (p<0.05). Overall, 602 Subjects (30.3%) reported having experienced tinnitus, with 48% reporting symptoms in both ears. Tinnitus had been present for at least 6 years in 50% of cases, and most (55%) reported a gradual onset. Despite tinnitus being described as mildly to extremely annoying by 67%, only 37% had Sought professional help, and only 6% had received any treatment.
Les données de huit auteurs différents ayant publié au sujet de la presbyacousie, ont été analysées. Ce faisant toutes les valeurs du seuil d'ouïe pour des groupes d'aˇge spéciaux, ont été réduites au seuil d'ouïe dans le groupe d'aˇge de 25 ans dans le měme examen. Les valeurs ainsi trouvées ont été réunies dans un graphique, pour chaque fréquence à part. Pour chaque fréquence les constantes dans l'équation: log (P.A. + c) = b log (aˇge) - a, sont déterminées à tel point que la courbe qui convient à cette équation, cadre le mieux avec les points donnés. On a démontré que les valeurs calculées de cette manière peuvent ětre considérées comme des valeurs médians du seuil d'ouïe pour les groupes d'aˇge de 5 ou de 10 ans. En outre il n'est pas nécessaire de prendre des valeurs différentes pour hommes et femmes dans le groupe d'aˇge de 25 ans. Enfin on a donné des tableaux pour des valeurs de presbyacousie, définies comme le nombre de dB de la perte de seuil, par rapport à la ligne zéro standard pour l'étalonnement des audiomètres pour hommes et femmes dans les groupes d'aˇge de 5 et de 10 ans.
From the gerontological and geriatric study of 70-year-olds in Göteborg, Sweden, 674 persons were selected to participate in an investigation of tinnitus in old age. The subjects belonged to two cohorts, one of which was followed longitudinally at ages 75 and 79. Some 8-15% of the participants had continuous tinnitus and 20-42% occasional tinnitus. The prevalence of tinnitus was about the same for men as for women. There were significant correlations between tinnitus and exposure to occupational noise. Men with continuous tinnitus had, on average, been exposed to noise for 20-30 years, in contrast to men without tinnitus who had noise exposure of 11-15 years, on average. Those with continuous tinnitus had poorer pure-tone thresholds than those without tinnitus or with occasional tinnitus. Noise-induced hearing loss is an important etiological factor, especially for old men, but other types of hearing losses such as presbyacusis, Ménière's disease, otosclerosis and chronic otitis media also contribute to tinnitus.
Davis A C (MRC Institute of Hearing Research, University of Nottingham, University Park, Nottingham NG7 2RD, UK). The prevalence of hearing impairment and reported hearing disability in adults in Great Britain. International Journal of Epidemiology 1989, 18: 911–917. Estimates for the prevalence of self-reported hearing disability and measured hearing impairment as a function of age in the adult population of Great Britain (GB) are reported from two 2-stage surveys. The main study was conducted in Cardiff, Glasgow, Nottingham and Southampton, with rigorous audiological assessment at the second stage. A supplementary study used a sample representative of GB with simplified domiciliary audiological assessments. In the main study, neither stage showed any gross bias arising from the particular cities chosen; the estimates from the first stage are free of bias arising from non-response. The estimates from the second stage are relatively free of bias arising from non-attendance. For the present purposes, defining a ‘significant’ level of hearing impairment as at least 25 dBHL averaged over the frequencies 0.5, 1, 2, 4 kHz, 16% of the adult population (17–80 years) have a bilateral, and about one in four a unilateral or bilateral, hearing impairment. About 10% of the adult population (aged 17+) report bilateral hearing difficulty in a quiet environment.