What are possible risk factors for developing tinnitus?

Updated: Feb 27, 2020
  • Author: Aaron G Benson, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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A study by Kim et al of 19,290 adults (from the Korea National Health and Nutrition Examination Survey) found a prevalence of tinnitus of 20.7% in this population and a greater adjusted odds ratio for the condition in persons with a history of the following [7] :

  • Smoking

  • Reduced sleep (≤ 6 h)

  • Stress

  • Hyperlipidemia

  • Osteoarthritis

  • Rheumatoid arthritis

  • Asthma

  • Depression

  • Thyroid disease

  • Tympanic membrane abnormality

  • Unilateral or bilateral hearing loss

  • Noise exposure from earphones

  • Noise exposure in or outside of the workplace

  • Brief noise exposure

Women, unemployed individuals, soldiers, and persons living in smaller households also had a greater prevalence of tinnitus. A literature review by Yang et al suggested that hypertension may be a risk factor for tinnitus, with the pooled odds ratio found to be 1.37. [8]

A report by Loiselle et al, consisting of a clinic-based, cross-sectional questionnaire study and a population-based, cross-sectional study, indicated that persons with glaucoma are more likely to also have tinnitus. The clinical study found an 85% greater likelihood of tinnitus in glaucoma patients, while according to the population-based study, the odds for the existence of tinnitus were 19% greater in the presence of glaucoma. The investigators suggested that a common mechanism, possibly “vascular dysregulation due to impairment of nitric oxide production,” could be involved in glaucoma and tinnitus. [9]

A study by Qian and Alyono, using the National Health and Nutrition Examination Survey (2011-2012), indicated that regular marijuana use may be linked to prevalent tinnitus. The investigators found the odds ratio for prevalent tinnitus among persons who had used marijuana at least once per month during the previous 12-month period to be 1.75, after covariables such as age, gender, audiometric hearing loss, noise exposure history, depression, anxiety, smoking, salicylate use, cardiovascular disease, hypertension, and diabetes had been taken into account. However, no association was found between tinnitus and alcohol, cocaine, methamphetamine, or heroin use. The report suggested that psychosocial factors modulate the marijuana/tinnitus relationship. [10]

Because tinnitus is associated with depression, seek signs of the condition. A careful assessment of the mental status of patients is an essential part of the initial history. The Minnesota Multiphasic Personality Index can be useful, but it is time consuming and requires professional interpretation. The common associated symptoms of early morning awakening and sleeplessness may be helpful. Other criteria can be used from the current Diagnostic and Statistical Manual of Mental Disorders (DSM). A useful adjunct to patient history is the Beck Depression Inventory. A score of 8 or more on the inventory indicates a need for further evaluation.

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